Dyspareunia Scores Research Articles

Sexual Dysfunction in Males and Females with Type 2 Diabetes Referring to Healthcare Centers of Zarand, Kerman: A Cross-Sectional Study

Background: Sexual dysfunction is a common complication of type 2 diabetes in males and females. Although sexual function is important, it is often neglected as a component of type 2 diabetes care. Objectives: This study aimed at investigating the association between sexual function and marital dissatisfaction in males and females with type 2 diabetes living in southern Iran. Methods: This study was a case-control research, which was carried out on 120 non-pregnant females and 120 males with type 2 diabetes. In addition, available samples of healthy individuals (120 females and 120 males), who referred to central cares located in Zarand, Kerman during year 2015, were used as the control group. The female sexual function data was obtained based on a questionnaire compromised of Rosen female sexual function indices (FSFI, 2000). The international index of erectile function (IIEF) questionnaire was used to obtain male sexual dysfunction data. Results: Forty-one diabetic individuals (17.08%) of total diabetic participants had impaired sexual function, 29 of which (70.73%) were male (with higher rates in males than females, P < 0.05). In addition, 12 diabetic patients (5%) had decreased sexual desire and 66.6% were diabetic males. There was no significant difference in sexual desire between healthy and diabetic groups. Sexual arousal was significantly (P < 0.001) lower in the diabetic group compared with healthy individuals. In addition, sexual lubrication (P = 0.008), orgasm (P = 0.003), satisfaction (P = 0.05), and dyspareunia (P = 0.05) scores were significantly higher in the healthy group in comparison to the diabetic group. Severe erectile dysfunction was significantly (P < 0.001) greater between diabetic than the healthy group. Sexual dissatisfaction was significantly (P < 0.001) higher in diabetic males compared to healthy individuals; the amount of libido average and marital life satisfaction were significantly lower in diabetic males (P = 0.01). Conclusions: Based on the findings of this study, counseling, and prevention of diseases, such as diabetes is suggested along with a focus on marital and sexual relations at the age of fertility.

Vaginal diazepam plus transcutaneous electrical nerve stimulation to treat vestibulodynia: A randomized controlled trial

ObjectiveTo assess the effectiveness of vaginal diazepam in addition to transcutaneous electrical nerve stimulation (TENS) in the treatment of vestibulodynia (VBD). Study DesignThis study was a randomized, double-blind, placebo-controlled trial. Forty-two patients with VBD were randomized, 21 underwent diazepam and TENS (diazepam group) and 21 received placebo and TENS (placebo group). Vulvar pain was assessed on a on a 10-cm visual analogue scale (VAS) and dyspareunia according to the Marinoff dyspareunia scale. Vaginal surface electromyography (EMG) and vestibular current perception threshold (CPT) testing were performed at baseline and 60 days after treatment. The primary endpoints included the change in pain and dyspareunia from baseline to 60 days of pain and dyspareunia. The secondary endpoints was the variation in objectivity of pelvic floor muscle (PFM) function and vestibular nerve fiber current perception threshold (CPT). ResultsThe VAS scores for pain from basal values of 7.5 and 7.2 for the diazepam and placebo, respectively, showed significant (p 0.01) decreases from 4.7 to 4.3, but this difference was not statistically significant. The Marinoff dyspareunia scores in the diazepam group showed a significant difference (p 0.05) from values measured in the placebo group. The ability to relax the PFM after contraction (difference between maximal contraction and rest tone) was significantly greater for the diazepam group versus the placebo group (3.8 μv and 2.4 μv, respectively, p 0.01). The CPT values for all of the nerve fibers increased after the treatment, but this increase was significant in the diazepam group only for the values at a 5-Hz stimulation (C fibers) with a change of 47.8% vs 26.9% (p < 0.05). Only two patients reported a mild drowsiness in the diazepam group. ConclusionsThe present study provided indications that vaginal diazepam plus TENS is useful to improve pain and PFM instability in women with VBD.

Progesterone receptor modulators for endometriosis.

Progesterone receptor modulators for endometriosis.

Comparison of combined hormonal vaginal ring and low dose combined oral hormonal pill for the treatment of idiopathic chronic pelvic pain: a randomised trial

ObjectiveTo compare the efficacy and acceptability of combined hormonal vaginal ring with combined oral hormonal pill in women with idiopathic chronic pelvic pain. Study designRandomised prospective interventional trial conducted in 60 women with idiopathic chronic pelvic pain. Women were randomised into two groups of 30 each. In each group, treatment was given for 84 days using either combined vaginal ring or combined oral hormonal pill. Hormonal vaginal ring releases 15mcg of ethinyl estradiol and 120mcg of the etonogestrel per day while the hormonal pill contained 30mcg of ethinyl estradiol and 150mcg of levonorgestrel. There was no ring or pill free week. After every 28 days, pain relief was measured using visual analogue scale (VAS), and verbal rating score (VRS) calculated by summing dysmenorrhea, non-cyclic pelvic pain (NCCP) and deep dyspareunia scores. Side effects, compliance, satisfaction, and user acceptability were also measured. Data was analyzed using various parametric and non-parametric tests. ResultsReduction in mean VAS score at end of treatment in ring group was 6.23 (95% confidence interval [CI], 5.45–7.01; p<0.001) as compared to 5.53 in pill group (95% CI, 4.83–6.23; p<0.001). Reduction in mean VRS score was 5.63 in ring users (95% CI, 4.84–6.42; p<0.001) versus 4.36 in pill users (95% CI, 3.63–5.10; p<0.001). A significantly higher persistent relief in NCPP score was observed in vaginal ring group as compared to oral pill group at end of one month after stopping treatment. Compliance, satisfaction, and user acceptability were higher in ring users (80%) than pill users (70%) and a higher incidence of nausea was seen in pill group. ConclusionPresent study demonstrates for first time that both vaginal and oral hormonal therapy are effective in treatment of idiopathic chronic pelvic pain and vaginal ring may be a better choice with higher satisfaction rate and fewer side effects.

Scrapping therapy combined with Qingxin Zishen Decoction for perimenopausal syndrome with pattern of fire excess from yin deficiency

To observe the efficacy difference between scrapping therapy combined with Qingxin Zishen Decoction and the single application of Qingxin Zishen Decoction for perimenopausal syndrome (PMS) with pattern of fire excess from yin deficiency. Eighty patients were assinged into an observation group and a control group, 40 cases in each one. Patients in the control group were treated with oral administration of Qingxin Zishen Decoction to clear heart heat and nourish kidney. One dose of the decoction was taken by two times within one day. Based on the treatment of the control group, patients in the observation group were additionally treated with scrapping therapy along the urinary bladder meridian of foot-taiyang, heart meridian of hand-shaoyin and kidney meridian of foot-shaoyin; the scrapping therapy was performed at Back-shu points, Shenmen (HT 7), Yongquan (KI 1), Taixi (KI 3), Zhaohai (KI 6), Sanyinjiao (SP 6), Zusanli (ST 36), etc.; the treatment was given once every week. Four weeks of treatment were taken as one course in two groups, and totally 2 courses were given. The modified Kupperman score, menopausal quality of life (MENQOL), level of serum estrogen (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH) before and after treatment as well as the clinical efficacy were valuated between the two groups. After treatment, each item score and total score of modified Kupperman were reduced apparently in the two groups (P<0.01,P<0.05) except dyspareunia score in the control group. The score of hot flash and sweating, paresthesia, depression, fatigue, arthralgia, palpitation, formication, urinary symptoms and total score in the observation group were superior to those in the control group (P<0.01, P<0.05). After treatment, the total score and each dimension score of MENQOL were obviously decreased in the two groups (all P<0.01), and the scores of vasomotor symptoms, psychosocial condition and physical condition in the observation group were significantly lower than those in the control group (P<0.01, P<0.05). There were no significant differences of serum hormone levels before and after treatment between the two groups (all P>0.05), however, after treatment, the serum E2 level had the tendency to raise and serum LH, FSH levels had the tendency to decrease in the observation group. The total effective rate was 97.4% (37/38) in the observation group, which was higher apparently than 81.1% (30/37) in the control group (P<0.01). The scrapping therapy combined with Qingxin Zishen Decoction or the simple application of Qingxin Zishen Decoction can both improve PMS symptoms and the quality of life, delay the ovary recession; the combination of scrapping therapy and Qingxin Zishen Decoction achieve superior efficacy on PMS syndrome to the simple application of Qingxin Zishen Decoction.

Is cervix removal associated with patient-centered outcomes of pain, dyspareunia, well-being and satisfaction after laparoscopic hysterectomy?

To determine the effect of cervix removal at hysterectomy on patient-centered outcomes including post-operative pain, dyspareunia, well-being, and overall satisfaction during the 3-month post-operative period. This is a prospective cohort study of 228 women who underwent elective abdominal, laparoscopic and robotic hysterectomy without concomitant urogynecological or cancer-related procedures, at the Henry Ford Hospital (Detroit, MI). Participants completed a baseline survey evaluating quality of life measures including pain, well-being, sexual and daily function and repeated this survey at serial intervals through 12 weeks post-operatively. Medical record review was performed to confirm demographic and obtain surgical data. Hierarchical generalized linear models were used to model the trajectory of pain, well-being and satisfaction over the course of the post-surgical period. Subanalysis including only laparoscopic cases was performed. There was no difference in satisfaction (p = 0.48, OR 0.80 [CI 95% 0.43, 1.48]), well-being (p = 0.55, OR 1.12 [CI 95% 0.84, 1.79]), or dyspareunia (p = 0.57, OR 0.75 [CI 95% 0.27, 2.04]) scores between laparoscopic/robotic supracervical and total hysterectomy groups. This was unchanged when all hysterectomy approaches were included in analysis. Cervix removal was associated with higher pain scores with all surgical approaches although this did not reach statistical significance. Patient-centered outcomes suggest overall equivalent tolerance of supracervical and total hysterectomy procedures with a trend towards short-term pain improvement with cervical retention.

Endovascular intervention for pelvic congestion syndrome is justified for chronic pelvic pain relief and patient satisfaction.

Pelvic congestion syndrome (PCS) is difficult to diagnose, poorly understood, and often confused with other causes of chronic pelvic pain. Thus, gonadal vein reflux, its relation to lower extremity venous insufficiency (LEVI), and treatment remains controversial to physicians and payors. We present our experience with endovascular PCS treatment and hypothesize that properly selected patients can realize significant improvement. A retrospective study of patients treated for PCS at our institution from 2008 to 2012 was performed. Diagnosis was made clinically by the presence of pelvic pain, dyspareunia, and/or perineal varicosities. Clinical parameters, procedural details, and follow-up were reviewed. A questionnaire including a visual analog scale was sent to patients. Diagnosis was made in 15 women (mean age, 36years; mean parity, two). All had pelvic pain, 6 had dyspareunia, 14 had perineal varicosities, and 10 had concomitant LEVI. Fourteen had gonadal vein reflux (mean diameter, 7.4mm) and pelvic varicosities at angiography and had coiling (n= 12) and/or Amplatzer plug (St. Jude Medical, Inc, St. Paul, Minn) (n= 4). One patient had stenting ofastenotic left common iliac vein. All patients with concomitant LEVI had successful appropriate treatment. Eightpatients completed the questionnaire at a mean follow-up of 4years. The mean pelvic pain score went from 9.375 to 1.875post-procedure (P< .0001; Student t-test). Mean dyspareunia score went from 8.875 to 1.5 (P< .0001). Mean perineal varicosity pain score went from 9.285 to 1.285 (P< .0001). Two patients had recurrence with a mean pelvic pain score of 4.5 at a mean 21months. On a five-point Likert scale, all patients were satisfied (one) or extremely satisfied (seven) with treatment. Endovascular PCS treatment offers excellent pelvic pain relief and patient satisfaction. Women with pelvic pain, dyspareunia, or perineal varicosities with gonadal vein reflux and pelvic varicosities or iliac vein stenosis should not be denied treatment. A significant number may have concomitant LEVI and should be screened accordingly.

Are mood and anxiety disorders and alexithymia associated with endometriosis? A preliminary study.

Objective. The aim of this preliminary study was to determine whether psychiatric disorders, psychopathological symptoms, and alexithymia are associated with endometriosis in an Italian population. Study Design. A preliminary study comprising 37 Italian patients with surgically confirmed endometriosis and 43 controls, without clinical and ultrasound signs of endometriosis, was carried out. Both patients and controls were evaluated for the presence/absence of psychiatric disorders, psychopathological symptoms, alexithymia, and pain symptoms (nonmenstrual pelvic pain, dysmenorrhea, and dyspareunia). Results. Statistically significant differences were found between cases and controls for prevalence of mood and anxiety disorders, malfunctioning on obsessive-compulsive subscale (P < 0.01) and depression subscale (P < 0.05) of the Symptom Checklist-90-Revisited (SCL-90-R), and higher alexithymia levels (P < 0.01). Patients with endometriosis-associated pain showed greater prevalence of psychiatric disorders compared to pain-free patients but that difference was not significant. Significant correlation was found between malfunctioning in some SCL-90-R dimensions and pelvic pain, dysmenorrhea, and dyspareunia scores at the visual analog score (VAS). Conclusion. Some psychopathological aspects, such as psychoemotional distress and alexithymia, are more frequent in women with endometriosis and might amplify pain symptoms in these patients.

Elagolix, an Oral GnRH Antagonist for Endometriosis-Associated Pain: A Randomized Controlled Study.

ObjectiveThe aim of this study was to estimate the efficacy of elagolix, an oral gonadotropin-releasing hormone (GnRH) antagonist, for the treatment of endometriosis-associated pelvic pain.MethodsThis was a phase II, randomized, placebo-controlled parallel group study conducted at 37 US centers, consisting of an 8-week double-blind period followed by a 16-week open-label period. Patients were 137 women aged 18 to 49, with laparoscopically confirmed endometriosis and moderate to severe nonmenstrual pelvic pain and dysmenorrhea, who were administered elagolix 150 mg daily or placebo. The primary outcomes of the study were the daily assessment of dysmenorrhea, nonmenstrual pelvic pain and dyspareunia using a modified Biberoglu-Behrman scale.ResultsDuring the double-blind period, there were significantly greater mean reductions from baseline to week 8 in dysmenorrhea (-1.13 ± 0.11 vs. −0.37 ± 0.11, p<0.0001), nonmenstrual pelvic pain (-0.47 ± 0.07 vs. −0.19 ± 0.07, p = 0.0066), and dyspareunia scores (-0.61 ± 0.10 vs. −0.23 ± 0.10, p = 0.0070) in the elagolix group compared with placebo. Continued improvements were observed during the open-label treatment regardless of initial treatment allocation. Elagolix treatment was also associated with significant improvements in quality-of-life measures during the double-blind and open-label periods. The most common adverse events occurring with elagolix were nausea, headache and hot flush, each in 9.9% of patients.ConclusionElagolix effectively reduced endometriosis-associated pelvic pain over a 24-week period and was well-tolerated.

The role of immunoenzymatic therapy in the management of vestibulodynia associated with painful bladder syndrome

Background: Vestibulodynia (VBD) and painful bladder syndrome (PBS) are two common and often concomitant conditions. Objective: To assess the effectiveness of an enzymatic combination of papain, bromelain, trypsin, chymotrypsin and quercetin in the supportive treatment of VBD/PBS, patients underwent TENS + amitriptyline and pregabalin therapy as a multimodal treatment strategy. Method: 40 patients were randomly assigned to receive a systemic therapy: amitriptyline + pregabalin (Group A) versus amitriptyline + Pregabalin plus a systemic enzyme preparation (Group B). All patients received a transcutaneous electric nerve stimulation (TENS) therapy in a self-administered domiciliary protocol. Results: The VAS and the dyspareunia score after the treatment showed a significant difference in the two groups (VAS: Group A difference of 4.3, Group B difference of 3.1, p = 0.005; dyspareunia: Group A and Group B 1.8 vs. 0.8, p = 0.005). Conclusion: The positive results of our study prove the utility effectiveness of an enzyme combination to decrease and normalize the biomarkers of inflammation in VBD and PBS patients in a multimodal approach.

Surgical versus medical treatment for endometriosis-associated severe deep dyspareunia: I. Effect on pain during intercourse and patient satisfaction

Does surgical or medical treatment for endometriosis-associated severe deep dyspareunia achieve better results in terms of patients' satisfaction (main study outcome), variation of coital pain and frequency of intercourse? Surgery and progestin therapy were equally effective in the treatment of deep dyspareunia in women with rectovaginal endometriosis, whereas medical therapy performed significantly better than excisional treatment in those without deeply infiltrating lesions. Conservative surgery and hormonal therapies have been used independently for endometriosis-associated deep dyspareunia with inconsistent results. This study reports a direct comparison between the two treatment options in women with severe pain during intercourse. Patient preference, parallel cohort study with a 12-month follow-up. The effect of conservative surgery at laparoscopy was compared with treatment with a low-dose of norethisterone acetate per os (2.5 mg/day) in women with persistent/recurrent severe deep dyspareunia after first-line surgery. A total of 51 patients chose repeat surgery and 103 progestin treatment. Patient satisfaction was graded according to a five-category scale. Variations in pain during intercourse were measured by means of a 100-mm visual analogue scale. In the surgery group, a marked and rapid short-term dyspareunia score reduction was observed, followed by partial recurrence of pain. The pain relief effect of the progestin was more gradual, but progressive throughout the study period. At a 12-month follow-up, the frequency of intercourse per month (mean ± SD) was 4.6 ± 1.8 in the surgery group and 5.3 ± 1.5 in the norethisterone acetate group (P = 0.02). A total of 22/51 (43%) women were satisfied in the surgery group compared with 61/103 (59%) in the progestin group [adjusted odds ratios (OR), 0.36; 95% confidence interval (CI), 0.16-0.82; P = 0.015]. Corresponding figures in women with and without rectovaginal endometriotic lesions were, respectively, 13/24 (54%) versus 18/35 (51%; adjusted OR, 0.77; 95% CI, 0.22-2.67; P = 0.68), and 9/27 (33%) versus 43/68 (63%; adjusted OR, 0.23; 95% CI, 0.07-0.76, P = 0.02). BIAS, CONFOUNDING, AND OTHER REASONS FOR CAUTION: Treatments were not randomly assigned, and distribution of participants as well as of dropouts between study arms was unbalanced. However, the possibility of choosing the treatment allowed assessment of the maximum potential effect size of the interventions. Caucasian patients able to choose their treatment. This study was supported by a research grant from the University of Milan School of Medicine (PUR number 2009-ATE-0570). None of the authors have a conflict of interest.

A new oral contraceptive regimen for endometriosis management: preliminary experience with 24/4-day drospirenone/ethinilestradiol 3 mg/20 mcg

We report our preliminary experience with the use of a low-dose oral contraceptive containing Drospirenone/Ethinylestradiol 3 mg/20 mcg, both in cyclic and continuous regimen for endometriosis management. A total of 93 women were retrospectively included: 52 were treated by medical therapy (exclusive combined oral contraceptives (COC)-users), while 41 were submitted to surgery followed by postoperative therapy (postoperative COC-users). A clinical examination was performed at baseline and at 6-months follow-up. Presence and intensity of endometriosis-related symptoms were assessed by a visual analogue scale. Presence and dimension of endometriotic lesions were evaluated by transvaginal ultrasonography. Adverse effects and tolerability were analysed. In exclusive COC-users, significant reductions in dysmenorrhoea and dyspareunia scores and in endometrioma mean diameter were observed at follow-up. In postoperative COC-users, anatomical and symptom recurrence rates at follow-up were 4.9% and 17%, respectively. The most frequent adverse effects were spotting and headache. No difference between cyclic and continuous regimen in terms of symptom relief, lesion progression and tolerability was observed. From our preliminary experience, Drospirenone/Ethinylestradiol 3 mg/20 mcg seems to be promising in endometriosis management.

Laparoscopic Colorectal Resection for Bowel Endometriosis

To evaluate the short- and long-term outcomes of laparoscopic colorectal resection for endometriosis. This study included 357 consecutive patients who underwent colorectal resection. We evaluated intraoperative and postoperative complications, symptom outcomes, and long-term follow-up. Three hundred forty-three patients (96.1%) underwent laparoscopic colorectal resection, and radical endometriosis ablation was in 334 patients (93.6%). Fourteen (3.9%) required laparoconversion. Median operating time was 300 (range, 85-720) minutes, with a median estimated blood loss of 250 (range, 50-550) mL. Radical endometriosis ablation was achieved in 334 patients (93.6%). Median ileus was 4 (range, 1-8) days, with a median postoperative hospitalization of 8 (range, 3-36) days. Early and late complications were observed in 44 patients (12.3%) and, in 35 of these (79.5%), surgical management was necessary. Median follow-up after colorectal resection was 19.6 (range, 6-48) months. The median preoperative and postoperative dyspareunia scores were 8 (range, 4-10) and 3 (range, 0-10), respectively (P < .04), and the median preoperative and postoperative gastrointestinal tract symptom scores were 7 (range, 2-10) and 2 (range, 0-10), respectively (P < .05). During follow-up, 24 of 286 recurrences (8.4%) were registered. Patients who previously underwent surgery for endometriosis showed a higher risk of recurrence compared with patients undergoing primary surgery (13.2% vs 3.4%; P < .048). Laparoscopic colorectal resection for severe endometriosis is feasible and markedly improved endometriosis-related symptoms. Despite the risk of major postoperative complications, the procedure shows good results in terms of recurrence rate and could be adopted as the primary approach for patients with symptomatic colorectal infiltrating endometriosis.

Symptom resolution and sexual function after anterior vaginal wall repair with or without polypropylene mesh

To evaluate whether symptom resolution and sexual function is better after reinforcement with polypropylene mesh than with traditional anterior repair. Ninety-seven patients were randomized to anterior colporrhaphy and 105 to an operation with mesh. Participants were evaluated up to 24 months by physical examination, standard questions, and questionnaire. The overall symptom rate did not differ between the groups, but a sensation of vaginal bulge was reported less frequently in the mesh group, the figures being 17 versus 5 (p = 0.003). The recurrence rate for the no-mesh group was 41% and for the mesh group 11% (p < 0.001). The dyspareunia score was statistically significantly lower in the mesh group (p = 0.015). The mesh exposure rate was 8%. Sensation of vaginal bulge was relieved more efficiently by the mesh technique without causing dyspareunia.

Hormonal suppression treatment or dietary therapy versus placebo in the control of painful symptoms after conservative surgery for endometriosis stage III–IV. A randomized comparative trial

To evaluate the effectiveness for the outcomes of endometriosis-related pain and quality of life of conservative surgery plus placebo compared with conservative surgery plus hormonal suppression treatment or dietary therapy. Randomized comparative trial. University hospital. Two hundred twenty-two consecutive women who underwent conservative pelvic surgery for symptomatic endometriosis stage III-IV (r-AFS). Six months of placebo (n = 110) versus GnRH-a (tryptorelin or leuprorelin, 3.75 mg every 28 days) (n = 39) or continuous estroprogestin (ethynilestradiol, 0.03 mg plus gestoden, 0.75 mg) (n = 38) versus dietary therapy (vitamins, minerals salts, lactic ferments, fish oil) (n = 35). Painful symptoms (visual analogue scale score) and quality-of-life endometriosis-related symptoms (SF-36 score) at 12 months' follow-up. Patients treated with postoperative hormonal suppression therapy showed less visual analogue scale scores for dysmenorrhoea than patients of the other groups. Hormonal suppression therapy and dietary supplementation were equally effective in reducing nonmenstrual pelvic pain. Surgery plus placebo showed significative decrease in dyspareunia scores. Postoperative medical and dietary therapy allowed a better quality of life than placebo. Postoperative hormonal suppression treatment or dietary therapy are more effective than surgery plus placebo to obtain relief of pain associated with endometriosis stage III-IV and improvement of quality of life.

Combined Laparoscopic Uterosacral and Round Ligament Procedures for Treatment of Symptomatic Uterine Retroversion and Mild Uterine Decensus

Study Objective To evaluate the efficacy of a new modified technique to treat a symptomatic retrodisplaced uterus. Design Prospective clinical study (Canadian Task Force classification II-2). Setting Tertiary care university hospital. Patients Thirty-one women with symptomatic uterine retrodisplacement but without significant pelvic pathology. Intervention Laparoscopic shortening and plication of uterosacral ligaments with modified Gilliam suspension. Measurements and Main Results In average follow-up of 3.3 ±1.0 years, all patients had an anteverted, anteflexed uterus. Mean ± SD operating time was 24.1 ± 4.7 minutes. There were no complications during or after surgery. Dyspareunia scores before and after surgery were 5.4 ± 1.4 and 0.5 ± 0.7, respectively (p <0.001). Chronic pelvic pain was satisfactorily relieved in seven of nine women. Vagina lengths before and after surgery were 5.9 ± 0.7 and 7.0 ± 0.3 cm, respectively (p <0.001). Conclusion Our technique achieved long-lasting good results in suspending uteri in anteverted, anteflexed position and relieved symptoms caused by retrodisplacement.

Diagnosing interstitial cystitis in women with chronic pelvic pain

OBJECTIVE:To evaluate the Interstitial Cystitis Symptom Index and Problem Index as a screening tool for interstitial cystitis, and to estimate the prevalence and risk factors for interstitial cystitis in women with chronic pelvic pain.METHODS:Forty-five women scheduled to undergo laparoscopy for chronic pelvic pain were recruited. Women were questioned about lower urinary tract symptoms, administered the Interstitial Cystitis Symptom Index and Problem Index, and rated pain symptoms on a 0–10 visual analogue scale. Cystoscopy with hydrodistension and bladder biopsy was performed at the time of laparoscopy. Interstitial cystitis was diagnosed if women had a combination of: 1) urgency, 2) frequency or nocturia, and 3) positive cystoscopic findings.RESULTS:Seventeen women (38%) were diagnosed with interstitial cystitis. A score of 5 or more on the Symptom Index had 94% sensitivity (95% confidence interval [CI] 71%, 99.8%) and 93% negative predictive value (95% CI 68%, 99.8%) in diagnosing interstitial cystitis. On multivariable analysis, an elevated Symptom Index score of 5 or more (odds ratio [OR] 9.4; 95% CI 1.01, 88.1) and an elevated dyspareunia score of 7 or more (OR 5.5; 95% CI 1.10, 27.1) were risk factors for interstitial cystitis.CONCLUSION:In our sample of women with chronic pelvic pain, the prevalence of interstitial cystitis was 38%. The Interstitial Cystitis Symptom Index was a useful screening tool. Independent risk factors for the diagnosis of interstitial cystitis were an elevated Symptom Index score and an elevated dyspareunia pain score. For women with chronic pelvic pain, screening for interstitial cystitis should be performed.

Diagnosing interstitial cystitis in women with chronic pelvic pain

Objective: To determine the prevalence of interstitial cystitis (IC) and to evaluate the Interstitial Cystitis Symptom and Problem Index as a screening tool for IC in women with chronic pelvic pain. Methods: Forty-five women scheduled to undergo laparoscopy for chronic pelvic pain were recruited. The women were questioned about lower urinary tract symptoms; the Interstitial Cystitis Symptom and Problem Index was administered to them, and they rated pain symptoms on a 0–10 visual analogue scale. Cystoscopy with hydrodistention and biopsy were performed at the time of laparoscopy. Interstitial cystitis was diagnosed if women had a combination of 1) urgency, 2) frequency or nocturia, and 3) positive cystoscopic findings. Results: Seventeen women (38%) were diagnosed with IC. A score of 5 or more on the Symptom Index had a sensitivity of 94%, specificity of 50%, positive predictive value of 53%, and a negative predictive value of 93% for the diagnosis of IC. On univariate analysis, significant risk factors were a Symptom Index score of 5 or more, a dyspareunia score of 7 or more, and a history of more than one urinary tract infection per year. On multivariate analysis, the Symptom Index score (odds ratio = 9.44, 95% CI = 1.01–88.1) and the dyspareunia score (odds ratio = 5.47, 95% CI = 1.10–27.1) remained risk factors for IC. Conclusion: In our study of women with chronic pelvic pain, the prevalence of IC is 38%, and the Symptom Index is a useful screening tool for IC. In these women, when the Symptom Index score is 5 or more, IC should be suspected, and cystoscopy with hydrodistention should be considered.