Objective: Chronic pelvic pain without a clear etiology remains a diagnostic challenge in gynecology. In many women, standard investigations are normal, yet symptoms persist. A substantial proportion of these cases may involve neuromuscular mechanisms, particularly obturator and pudendal neuralgias. The objective of this work is to propose a structured clinical framework to support diagnostic evaluation and management. Materials and Methods: This article presents a narrative clinical framework derived from routine perineological practice. It describes a stepwise approach based on clinical history, pelvic nerve examination, assessment of sacroiliac stability, and evaluation of generalized hypersensitivity. Targeted treatment strategies are outlined using dextrose injections: low concentration (5%, perineural injection therapy) for neural involvement and higher concentrations (15-25%, prolotherapy) for ligamentous instability. The identification of psycho-traumatic factors is based on structured clinical history, and autonomic modulation strategies may be considered in selected patients. Results: This framework allows patients to be classified into clinically coherent profiles, including isolated neuralgia, generalized hypersensitivity associated with psycho-traumatic history, and sacroiliac instability. In clinical practice, dextrose injections may be associated with symptom improvement and functional recovery, although responses vary and should be interpreted within an observational context. Evidence from other peripheral neuropathies provides indirect support for the proposed mechanisms. Conclusion: This integrative clinical framework may help structure the evaluation and management of chronic pelvic pain by linking clinical findings to targeted therapeutic strategies. It should be considered hypothesis-generating rather than confirmatory, and further controlled studies are required to assess clinical effectiveness.