Pelvic Pain In Women Research Articles

Laparoscopic treatment of isolated superficial peritoneal endometriosis for managing chronic pelvic pain in women: study protocol for a randomised controlled feasibility trial (ESPriT1)

BackgroundEndometriosis (where endometrial-like tissue is found outside the uterus) affects ~ 176 million women worldwide and can lead to debilitating pelvic pain. Three subtypes of endometriosis exist, with ~ 80% of women having superficial peritoneal endometriosis (SPE). Endometriosis is diagnosed by laparoscopy and, if SPE is found, gynaecologists usually remove it surgically. However, many women get limited pain relief from surgical removal of SPE. We plan to undertake a future large trial where women who have only SPE found at initial laparoscopy are randomly allocated to have surgical removal (excision or ablation) of SPE, or not. Ultimately, we want to determine whether surgical removal improves overall symptoms and quality of life, or whether surgery is of no benefit, exacerbates symptoms, or even causes harm. The primary objective of this feasibility study is to determine what proportion of women with suspected SPE undergoing diagnostic laparoscopy will agree to randomisation. The secondary objectives are to determine if there are differences in key prognostic parameters between eligible women that agree to be randomised and those that decline; how many women having laparoscopy for investigation of chronic pelvic pain are eligible for the trial; the range of treatment effects and variability in outcomes and the most acceptable methods of recruitment, randomisation and assessment tools.MethodsWe will recruit up to 90 women with suspected SPE undergoing diagnostic laparoscopy over a 9-month recruitment period in four Scottish hospitals and randomise them 1:1 to either diagnostic laparoscopy alone (with a sham port to achieve blinding of the allocation) or surgical removal of endometriosis. Baseline characteristics, e.g. age, index of social deprivation, ethnicity, and intensity/duration of pain will be collected. Participants will be followed up by online questionnaires assessing pain, physical and emotional function at baseline, 3 months, 6 months and 12 months.DiscussionRecruitment to a randomised controlled trial to assess the effectiveness of surgery for endometriosis may be challenging because of preconceived ideas about treatment success amongst patients and clinicians. We have designed this study to assess feasibility of recruitment and to inform the design of our future definitive trial.Trial registrationClincicalTrials.gov, NCT04081532StatusRecruiting

Womb Chair Speaks

Feminist Studies 47, no. 3. © 2021 by Feminist Studies, Inc. 627 Kirin Joya Makker Womb Chair Speaks The human womb is extraordinary, an active biological marvel that moves through 450+ menstrual cycles during a lifetime.1 Comprising a unique and curious set of organs, the womb provides an optimal environment for conception and gestation. Yet over time the reproductive system’s cycles and tissues also makes the womb an active site of aberrant cell growth and scarring. Thickening and thinning hundreds of times over decades, this anatomy often ends up acquiring a host of irregular formations—spongey cysts, fibrous tumors, mushroomy polyps, soft adhesions, and other fragments of endometrial flotsam.2 Anyone with a womb experiences this biological operation and manages its manifestations and effects throughout their life. 1. This project considers the term “womb” to be first, a biological characteristic of a population of humans, primarily composed of women. The term “womb” is used because it comprises not only the uterus, but the entire reproductive system as well as a deep pelvic region of the body. However, the project emphasizes that the term “womb” works metaphorically to describe human sexuality, femininity, and care work, and thus the womb as a cultural phenomenon affects and constrains womxn, femmes, and trans and nonbinary people, whether they have physical wombs or not. The title “Womb Chair Speaks” was the idea of May Farnsworth, whom I thank sincerely. 2. Natalie Angier, Woman: An Intimate Geography (Boston: Houghton Mifflin Harcourt, 1999), 124–25. 628 Kirin Joya Makker Despite the womb’s dynamic, textured, and resilient biology, it has not received tribute and attention in line with its complex qualities.3 Medically, socially, and aesthetically, our conceptual understanding of the womb has been tightly framed by its role in reproduction. Gynecology and obstetrics—the fields devoted to the biology and health of the female genital tract—are centered on this procreative function. There remains no medical specialty devoted to the womb’s unique cellular biology, tissues, or menstruation, despite detailed knowledge of diseased pelvic anatomy from the first century CE.4 When the womb has been given sustained theorization and study in the sciences, it has included spurious diagnoses of “hysteria” for women who are now believed to have been struggling with chronic pelvic pain.5 The emphasis in medicine on the procreative purpose of the womb has encouraged widespread ignorance in the healthcare industry and its patients about the genital system’s everyday existence and functioning , from its biology to its short- and long-term cycles, to understanding 3. Susan D. Mathias, Miriam Kupperman, Rebecca F. Liberman, Ruth C. Lipschitz , and John F. Steege, “Chronic Pelvic Pain: Prevalence, Health-Related Quality of Life, and Economic Correlates,” Obstetrics and Gynecology 87, no. 3 (1996): 3, 321–27, https://doi.org/10.1016/0029-7844(95)00458-0321. This article reports that worldwide, between fourteen and thirty-two percent of women of childbearing age report chronic pelvic pain. See also Abimbola A. Ayorinde, Gary J. Macfarlane, Lucky Saraswat, and Siladitya Bhattacharya , “Chronic Pelvic Pain in Women: An Epidemiological Perspective,” Women’s Health 11, no. 6 (November 2015): 851–64, https://doi.org/10.2217 /whe.15.30. This article reports that most studies about chronic pelvic pain are conducted among women of reproductive age. Older women, who are perceived as less susceptible to pelvic pain, have been traditionally excluded from prevalence studies. In 1994, a cross-sectional analysis of a primary care database in the United Kingdom found higher rates of chronic pelvic pain in women aged 61 to 73 compared with women in younger age groups. More recent population studies in the United Kingdom and the United States have also confirmed significant reporting of chronic pelvic pain among older women. While the highest rate reported in one of the studies was in women aged 18 to 25 years (17 percent), women older than 75 years had a rate of 13 percent (855). 4. Greek Physician Soranus of Ephesus, first/second century CE, wrote a fourpart treatise on gynecological diseases and is believed to have been the first Western physician to describe the symptoms of pelvic disease at length. 5. Camran Nezhat, Farr Nezhat, and Ceana...

Infiltrating endometriosis: Diagnostic keys in abdominal ultrasonography

ObjectiveEndometriosis is the presence of endometrial tissue outside the uterus. Endometriosis of the bowel and urinary tract are types of extragenital endometriosis that manifest with nonspecific symptoms, but their detection involves specific therapeutic strategies. Although the characteristics of the disease on transvaginal ultrasonography and on magnetic resonance imaging have been described in many publications, few references describe its characteristics on abdominal ultrasonography.This paper illustrates the findings for infiltrating endometriosis involving the bowel and urinary tract on abdominal ultrasonography and shows the usefulness of this technique for identifying signs of the disease that have been described with other techniques. Knowledge of infiltrating endometriosis and its ultrasonographic features will enable radiologists to suggest its diagnosis and to include it in the differential diagnosis of pelvic pain in women of child-bearing age. ConclusionAbdominal ultrasonography is a useful tool in the diagnosis of extragenital endometriosis. Familiarity with the ultrasonographic appearance of this entity facilitates the diagnostic orientation and management of patients with pelvic pain.

Isolated Fallopian Tubal Torsion Complicated by a Large Hydrosalpinx in a Perimenopausal Woman

Adnexal torsion frequently causes acute pelvic pain in women. Ovarian tumour torsion is common; twisting and torsion of a fallopian tube are rare. This report presents a rare case of fallopian tubal torsion requiring the management of a large hydrosalpinx with laparoscopic surgery. A 48-year-old woman reported with acute abdominal pain and lower abdomen tenderness. Transvaginal ultrasonography and Magnetic Resonance Imaging (MRI) showed a cystic mass on the anterior uterine surface. Emergency surgery was performed for a suspected torsion of the left ovarian cyst. In the abdominal cavity, the left fallopian tube was enlarged (neonatal head size), dark purple coloured, and exhibited a 180° torsion; the left ovary was normal. Laparoscopic left salpingectomy was performed and the postoperative course was uneventful. Surgical pathology revealed hydrosalpinx with torsion. As diagnosing isolated fallopian tube torsion before surgery is difficult, laparoscopic surgery is useful in diagnosing and treating isolated tubal torsion.

Cannabis as Treatment for Chronic Pelvic Pain in Women: An Opportunity for the Cannabis Wellness Industry

In a healthcare landscape that routinely ignores women’s pain, many women turn to cannabis to manage their otherwise debilitating chronic pelvic pain caused by conditions such as endometriosis and polycystic ovary syndrome. This paper explores how the Controlled Substances Act wrongly characterized cannabis as having “no medicinal value” and the effects this federal illegality still has on women seeking alternative pain management therapies for chronic pelvic pain. Additionally, this paper explains why and how cannabis helps relieve such pain through discussing the effects of cannabinoids like THC and CBD on the body’s inflammatory response and the body’s endocannabinoid system. Women, as the leading consumers in our society, have expressed a need and a desire for products that provide relief from chronic pelvic pain and increase sexual pleasure. The 2018 Farm Bill opened the doors to CBD businesses looking to break into the women’s sexual and reproductive wellness market. The market for women-centric CBD pain relief and sexual enjoyment is far from saturated, and this paper encourages those in the CBD industry (or those looking to enter the industry) to take note.

Machine Learning Revealed New Correlates of Chronic Pelvic Pain in Women

Chronic pelvic pain affects one in seven women worldwide, and there is an urgent need to reduce its associated significant costs and to improve women's health. There are many correlated factors associated with chronic pelvic pain (CPP), and analyzing them simultaneously can be complex and involves many challenges. A newly developed interaction ensemble, referred to as INTENSE, was implemented to investigate this research gap. When applied, INTENSE aggregates three machine learning (ML) methods, which are unsupervised, as follows: interaction principal component analysis (IPCA), hierarchical cluster analysis (HCA), and centroid-based clustering (CBC). For our proposed research, we used INTENSE to uncover novel knowledge, which revealed new interactions in a sample of 656 patients among 25 factors: age, parity, ethnicity, body mass index, endometriosis, irritable bowel syndrome, painful bladder syndrome, pelvic floor tenderness, abdominal wall pain, depression score, anxiety score, Pain Catastrophizing Scale, family history of chronic pain, new or re-referral, age when first experienced pain, pain duration, surgery helpful for pain, infertility, smoking, alcohol use, trauma, dysmenorrhea, deep dyspareunia, CPP, and the Endometriosis Health Profile for functional quality of life. INTENSE indicates that CPP and the Endometriosis Health Profile are correlated with depression score, anxiety score, and the Pain Catastrophizing Scale. Other insights derived from these ML methods include the finding that higher body mass index was clustered with smoking and a history of life trauma. As well, sexual pain (deep dyspareunia) was found to be associated with musculoskeletal pain contributors (abdominal wall pain and pelvic floor tenderness). Therefore, INTENSE provided expert-like reasoning without training any model or prior knowledge of CPP. ML has the potential to identify novel relationships in the etiology of CPP, and thus can drive innovative future research.

Endometriosis infiltrante: claves diagnósticas en la ecografía abdominal

ObjectiveEndometriosis is the presence of endometrial tissue outside the uterus. Endometriosis of the bowel and urinary tract are types of extragenital endometriosis that manifest with nonspecific symptoms, but their detection involves specific therapeutic strategies. Although the characteristics of the disease on transvaginal ultrasonography and on magnetic resonance imaging have been described in many publications, few references describe its characteristics on abdominal ultrasonography.This paper illustrates the findings for infiltrating endometriosis involving the bowel and urinary tract on abdominal ultrasonography and shows the usefulness of this technique for identifying signs of the disease that have been described with other techniques. Knowledge of infiltrating endometriosis and its ultrasonographic features will enable radiologists to suggest its diagnosis and to include it in the differential diagnosis of pelvic pain in women of child-bearing age. ConclusionAbdominal ultrasonography is a useful tool in the diagnosis of extragenital endometriosis. Familiarity with the ultrasonographic appearance of this entity facilitates the diagnostic orientation and management of patients with pelvic pain.

MASSIVE HAEMOPERITONIUM FROM A RUPTURED CORPUS LUTEAL CYST

A ruptured functional ovarian cyst can be a frequent cause of acute pelvic pain in women of reproductive age. The disease course varies from no symptoms or signs to severe peritoneal irritations and even life-threatening shock (1). Women of reproductive age are at risk of ruptured corpus luteum with hemoperitoneum. Prompt recognition and treatment is required for this condition because late diagnosis can be life threating for the patient. This case we are going to discuss , a 26 years married women, Para- 2 Live- 2,presented to the emergency room with acute pelvic pain. Right adnexal mass massive haemoperitonium was found on USG and CT abdomen. Emergency laparotomy was performed and proceeded with right salphingo -oophorectomy.Histopathological examination revealed right ruptured haemorrhagic corpus luteal cyst (functional cyst) to be the cause for massive haemoperitonium. Ruptured corpus luteal cyst can be a differential diagnosis for acute abdominal pain in women of reproductive age group.

Chronic Pelvic Pain in Women with a History of Essure Placement: A Systematic Review of Differential Diagnosis and Management Options

Study Objective The purpose of this article is to provide an evidence based review of management options for patients with pelvic pain and an in situ Essure device. Design Literature review and qualitative analysis. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results The Essure device was voluntarily withdrawn from the market in 2018 by the manufacturer due in part to concerns about post placement adverse events and an FDA black box warning about uterine and fallopian tube perforation, suspected allergic or hypersensitivity reaction, and need for surgical removal for adverse events which were mostly related to pain. We performed a PubMed keyword literature search, as well as directed searches of Obstetrics & Gynecology, American Journal of Obstetrics and Gynecology, and Journal of Minimally Invasive Gynecology. A total of 43 publications were included, and consisted of 7 prospective studies, 15 retrospective studies, 18 case series, 2 review articles, and one summary article by the FDA. Conclusion A brief summary of recommendations and conclusions from this review: - Initial work up of pain in a patient with Essure devices should begin with placement confirmation via either transvaginal ultrasound or hysterosalpingogram/Xray. - In the event Essure microinserts are malpositioned, device removal is recommended. - In patients with a history and physical exam suggestive of possible endometriosis or adenomyosis, consider an attempt at hormonal management prior to surgical excision of the Essure device. - We recommend a laparoscopic resection of the fallopian tubes with or without partial coronuectomy for the management of pelvic pain of and no other identifiable source, even if Essure device is positioned appropriately. - We recommend an imaging modality be available in the OR during device removal to confirm an intact device and/or complete resection. - If hysterectomy is planned for in patients with the Essure device for indications other than pelvic pain, we recommend en block resection of the fallopian tubes and cornua.

Responsiveness and thresholds for clinically meaningful changes in worst pain numerical rating scale for dysmenorrhea and nonmenstrual pelvic pain in women with moderate to severe endometriosis

To evaluate the utility, responsiveness, and thresholds for clinically meaningful change of a numerical rating scale for worst pain associated with dysmenorrhea (NRS-DYS) and nonmenstrual pelvic pain (NRS-NMPP) in women with moderate to severe endometriosis-associated pain. Analysis of data from two phase III randomized clinical trials (EM-I [NCT01620528] and EM-II [NCT01931670]). Not applicable. Premenopausal women ages 18-49 years with moderate to severe endometriosis-associated pain. Participants in both trials were randomized 3:2:2 to receive placebo, elagolix 150 mg once daily, or elagolix 200 mg twice daily for 6 months. NRS-DYS and NRS-NMPP. EM-I enrolled 871 women and EM-II enrolled 815 women. For patients with a global impression of improvement at month 3, the least-squares mean change between baseline and month 3 was -3.6 (EM-I and EM-II) for NRS-DYS and -1.9 (EM-I) and -2.0 (EM-II) for NRS-NMPP. Standard errors of measurement were 2.99 (EM-I) and 2.86 (EM-II) for NRS-DYS and 1.74 (EM-I) and 1.71 (EM-II) for NRS-NMPP. Baseline half standard deviations were 0.78 (EM-I) and 0.85 (EM-II) for NRS-DYS and 0.92 (EM-I) and 0.96 (EM-II) for NRS-NMPP. Based on these results, clinically meaningful changes were defined as a reduction of 4 points for NRS-DYS and 2 points for NRS-NMPP. This study demonstrated the utility and responsiveness of separate numerical rating scales to assess worst pain for dysmenorrhea and NMPP in women with moderate to severe endometriosis-associated pain and identified initial thresholds for clinically meaningful change.

Chronic pelvic pain in women

Chronic pelvic pain resulting from varicose veins of the small pelvis is a multidisciplinary problem. A key cause of pelvic congestion is congenital or acquired gonadal valve failure. Ultrasound and Doppler examination for chronic pelvic pain allows in most cases to diagnose pelvic varicose veins. Multispiral computed tomography or magnetic resonance imaging details the nature and extent of the pathology. Selective phlebography is considered the gold standard for diagnosing varicose veins of the small pelvis. Conservative treatment with phlebotropic drugs is prescribed for limited pelvic varicose veins. Surgical treatments include open resection and retroperitoneal and transperitoneal laparoscopic gonadal vein excision or clipping. The most effective is minimally invasive endovascular occlusion of reflux veins using spiral technologies and sclerosants. The left ovarian vein is reduced more often. The decision on bilateral embolization of blood vessels depends on the severity of changes in veins and the intensity of blood reflux. A decrease in the intensity or disappearance of pain in the pelvic area is achieved in 80–100% of cases after the procedure. Diagnosis of this condition is difficult due to the fact that the appearance of pelvic varicose veins is nonspecific and includes symptoms of surgical, urological, gynecological and other diseases of the pelvic organs.

Primary Dysmenorrhea: Diagnosis and Therapy.

Primary dysmenorrhea is defined as pain during the menstrual cycle in the absence of an identifiable cause. It is one of the most common causes of pelvic pain in women. Dysmenorrhea can negatively affect a woman's quality of life and interfere with daily activities. The pathophysiology of primary dysmenorrhea is likely a result of the cyclooxygenase pathway producing increased prostanoids, particularly prostaglandins (PGs). The increased PGs cause uterine contractions that restrict blood flow and lead to the production of anaerobic metabolites that stimulate pain receptors. Women with a history typical for primary dysmenorrhea can initiate empiric treatment without additional testing. Shared decision making is key to effective management of dysmenorrhea to maximize patient compliance and satisfaction. After a discussion of their risks and benefits, extremely effective empiric therapies are nonsteroidal antiinflammatory drugs and contraceptive hormonal therapy. Other treatments for primary dysmenorrhea can be employed solely or in combination with other modalities, but the literature supporting their use is not as convincing. The physician should initiate an evaluation for secondary dysmenorrhea if the patient does not report improved symptomatology after being compliant with their medical regimen.

The Relationship between Serum Levels of Oxidative Stress Biomarkers and Dysmenorrhea, Dyspareunia and Pelvic Pain in Women with Endometriosis

The Relationship between Serum Levels of Oxidative Stress Biomarkers and Dysmenorrhea, Dyspareunia and Pelvic Pain in Women with Endometriosis

Gabapentin for chronic pelvic pain in women (GaPP2): a multicentre, randomised, double-blind, placebo-controlled trial

SummaryBackgroundChronic pelvic pain affects 2–24% of women worldwide and evidence for medical treatments is scarce. Gabapentin is effective in treating some chronic pain conditions. We aimed to measure the efficacy and safety of gabapentin in women with chronic pelvic pain and no obvious pelvic pathology.MethodsWe performed a multicentre, randomised, double-blind, placebo-controlled randomised trial in 39 UK hospital centres. Eligible participants were women with chronic pelvic pain (with or without dysmenorrhoea or dyspareunia) of at least 3 months duration. Inclusion criteria were 18–50 years of age, use or willingness to use contraception to avoid pregnancy, and no obvious pelvic pathology at laparoscopy, which must have taken place at least 2 weeks before consent but less than 36 months previously. Participants were randomly assigned in a 1:1 ratio to receive gabapentin (titrated to a maximum dose of 2700 mg daily) or matching placebo for 16 weeks. The online randomisation system minimised allocations by presence or absence of dysmenorrhoea, psychological distress, current use of hormonal contraceptives, and hospital centre. The appearance, route, and administration of the assigned intervention were identical in both groups. Patients, clinicians, and research staff were unaware of the trial group assignments throughout the trial. Participants were unmasked once they had provided all outcome data at week 16–17, or sooner if a serious adverse event requiring knowledge of the study drug occurred. The dual primary outcome measures were worst and average pain scores assessed separately on a numerical rating scale in weeks 13–16 after randomisation, in the intention-to-treat population. Self-reported adverse events were assessed according to intention-to-treat principles. This trial is registered with the ISRCTN registry, ISCRTN77451762.FindingsParticipants were screened between Nov 30, 2015, and March 6, 2019, and 306 were randomly assigned (153 to gabapentin and 153 to placebo). There were no significant between-group differences in both worst and average numerical rating scale (NRS) pain scores at 13–16 weeks after randomisation. The mean worst NRS pain score was 7·1 (standard deviation [SD] 2·6) in the gabapentin group and 7·4 (SD 2·2) in the placebo group. Mean change from baseline was −1·4 (SD 2·3) in the gabapentin group and −1·2 (SD 2·1) in the placebo group (adjusted mean difference −0·20 [97·5% CI −0·81 to 0·42]; p=0·47). The mean average NRS pain score was 4·3 (SD 2·3) in the gabapentin group and 4·5 (SD 2·2) in the placebo group. Mean change from baseline was −1·1 (SD 2·0) in the gabapentin group and −0·9 (SD 1·8) in the placebo group (adjusted mean difference −0·18 [97·5% CI −0·71 to 0·35]; p=0·45). More women had a serious adverse event in the gabapentin group than in the placebo group (10 [7%] of 153 in the gabapentin group compared with 3 [2%] of 153 in the placebo group; p=0·04). Dizziness, drowsiness, and visual disturbances were more common in the gabapentin group.InterpretationThis study was adequately powered, but treatment with gabapentin did not result in significantly lower pain scores in women with chronic pelvic pain, and was associated with higher rates of side-effects than placebo. Given the increasing reports of abuse and evidence of potential harms associated with gabapentin use, it is important that clinicians consider alternative treatment options to off-label gabapentin for the management of chronic pelvic pain and no obvious pelvic pathology.FundingNational Institute for Health Research.

Chronic pelvic pain in women, stages and methods of diagnosis (Literature review)

Usually, women suffering from chronic pelvic pain experience it for some time and do not seek treatment until the pain becomes so severe that it adversely affects a woman’s normal daily functioning, preventing her from maintaining a normal lifestyle and leading to development of chronic pain syndrome. Chronic pelvic pain syndrome is often accompanied by behavioral disorders, cognitive, psychoemotional and sexual disorders, as well as symptoms of dysfunction of the lower urinary and digestive systems, pelvic organs, gynecological dysfunction, which are the result of neurobiological, physiological and sometimes anatomical changes in the body and central nervous system.Often a gynecologist automatically focuses exclusively on gynecological organs, assuming that they are the cause of the problem, but most often the cause of chronic pelvic pain is a group of factors. Disorders of the gastrointestinal, urological, and musculoskeletal systems are at least as common as disorders of the reproductive system in women with chronic pelvic pain. Therefore, diagnostic measures should be aimed at identifying all the causes which requires doctors to take a multidisciplinary approach to the diagnosis and management of chronic pelvic pain. The causes of the problem in most cases can be identified by a thorough history taking and physical examination, which should be more detailed than usual. As a diagnostic tool, it can minimize the need for expensive laboratory testing and imaging or risky surgery. The use of specialized assessment forms and questionnaires for chronic pelvic pain can be important and useful to ensure coverage of all critical points.When planning a diagnostic plan for women with chronic pelvic pain, it is important to consider the key role of the nervous system in the perception of pain. Experiencing pain for a long period of time can change how the brain perceives and processes pain signals, leading to an amplification of pain and cross-organ sensitization.Complicated differential diagnosis often causes the absence of a definitive diagnosis in most patients who complain of chronic pelvic pain. Therefore, during the first visit of the patient, it is sometimes impossible to immediately determine the cause of pain. Because the causes of many disorders associated with chronic pelvic pain have not been identified, most clinicians treat them empirically. Therefore, in the presence of several etio-pathogenetic factors, treatment of only some of them will lead to incomplete relief.The definition of «chronic pelvic pain» can hide many diseases, the detection of which requires the involvement of a multidisciplinary team of gynecologists, urologists, gastroenterologists, nephrologists, vascular surgeons, orthopedists, psychiatrists, psychologists and doctors of other specialties. However, it is mostly gynecologists who are the first to come into contact with this pathology because, in most cases, women who suffer from chronic pelvic pain first turn to them for help. That is why they should be the main members of the multidisciplinary team and take responsibility for its creation. Unfortunately, physicians often lack an interdisciplinary approach to the management of chronic pelvic pain, which complicates comprehensive assessment, diagnosis, and treatment and leads to frustration among women who go from one specialist to another without an adequate solution to their problem.

Role of multi-detector CT venography in evaluation of pelvic congestion syndrome

BackgroundPelvic congestion syndrome (PCS) is a problematic cause of chronic pelvic pain in women. It is thought to result from venous insufficiency of either ovarian or pelvic veins. Patients also present a variety of symptoms including dysuria and dyspareunia as well as vulva and buttock varicosities. The aim of this study is to evaluate the efficacy of multi-detector CT (MDCT) in diagnosis of PCS. Two hundred patients were included in our study and underwent CT venography of the abdomen and pelvis.ResultsWe performed a prospective comparative study conducted on 200 patients. Thirty patients (15%) were diagnosed as PCS. There were congestion of the ovarian venous plexus and uterine venous engorgement in all patients. Filling of the veins across the midline was noted in 10 patients and filling of the vulval and thigh varicosities was noted in 3 patients. Ten patients had right ovarian vein dilatation; 12 patients had left ovarian vein dilatation; while 8 patients had bilateral ovarian vein dilatation. The right ovarian vein mean diameter (± SD) = 7.1 ± 0.8 mm; while the left ovarian vein mean diameter (± SD) = 7.6 ± 1 mm. Left ovarian venous reflux was found in 6 cases while no pathological reflux depicted on right side.ConclusionsCT venography is considered as one of the initial investigations for the diagnosis of PCS in female patients with chronic pelvic pain making the further assessment by ovarian venography is for interventional management of diagnosed cases.

Роль мышечно-фасциального синдрома и дисфункции в развитии синдрома хронической тазовой боли у женщин (Обзор литературы)

According to the classification of chronic pain syndromes proposed by the International Association for the Study of Pain (IASP) and due to the high clinical significance, chronic pelvic pain (CPP) represents an independent nosological structure and is defined as pain in the pelvic region (in the lower abdomen and the lower back), mainly between the navel and the pubic symphysis, which lasts for at least six months and disrupts the normal functioning of the body. Myofascial pelvic pain syndrome (MPPS) in English literature is included in the subgroup of etiology of CPP. Myofascial pelvic pain syndrome itself is not a direct threat to life and health and does not require urgent help. But today it is almost not diagnosed and is not considered as a source of chronic pain and dysfunction in the pelvic region. Such patients, unfortunately, are left without appropriate treatment and cannot get rid of the oppressive pain. They often receive unnecessary treatment, including surgical interventions. This problem causes neurosis, depression, sexual dysfunction and, as a result, leads to the deterioration in the quality of life. CPP can often have multiple causes and should be evaluated in terms of the pathology of various physiological systems, including reproductive, urogenital, gastrointestinal, musculoskeletal and nervous system. Based on a full picture of the multifactorial nature of CPP, the treatment of this category of patients requires an integrated approach involving specialists in various fields. Particular attention in the differential diagnosis of chronic pelvic pain in women should be paid to abdominal myofascial pain syndrome, the role of which is currently underestimated. Therefore, doctors should be aware of the main directions of diagnosis and treatment of CPP due to myofascial pain syndrome. Keywords: chronic pelvic pain, myofascial syndrome, nidling, post-isometric relaxation of muscles, relising.

Myofascial chronic pelvic pain in women : Aretrospective evaluation of the effects of specific diagnostics and therapy

The prevalence of chronic pelvic pain of 11.8% in the general population underlines the importance of this disease. However, the specific diagnostics and therapy of the muscles of this region are not yet part of the standard examination. The following study examines the effects of specific diagnostics and therapy on myofascial chronic pelvic pain. The effectiveness of targeted diagnostics and multimodal therapy in the context of chronic pelvic pain and the need for acomplementary drug adjustment. This study retrospectively evaluated the data of 59patients, who were referred to apain center for treatment-resistant chronic pelvic pain in the period from January 2012 to April 2017. The pain needed to be clearly identified as myofascial. Aprevious minimum duration of pain as well as previous operations or other treatment procedures did not constitute exclusion criteria. Previous traumatization was areason for exclusion. Therapy components included manual therapeutic treatment, training in self-stretching exercises, medication with the active ingredients flupirtine or methocarbamol, as well as relaxation procedures. Therapy was evaluated on the basis of the German Pain Questionnaire. After the treatment interval, the following statistically significant improvements were recorded: The average pain intensity decreased by 29.95 points (standard deviation [SD] = 20.61). General quality of life (Marburg questionnaire on habitual well-being, MFHW) increased by 1.1points (SD = 0.73). The depression and anxiety assessment decreased by 2.56 (SD = 3.99) and 2.63 points (SD = 5.21) respectively. Amultimodal therapy concept with amanual therapeutic treatment focus can lead to an improvement in pain symptoms and quality of life in patients with myofascial chronic pelvic pain after atreatment period of 120 days. Myofascial syndromes of urogenital muscles must be considered in the assessment of the cause of chronic pelvic pain.

Botulinum toxin A injection in the treatment of chronic pelvic pain with hypertonic pelvic floor in women: Treatment techniques and results.

Chronic pelvic pain (CPP) is an extremely bothersome condition which leads to major effects in women's everyday life. In addition to visceral sources of pain, pelvic floor dysfunction including myofascial pain and spasm on the pelvic floor muscles causing hypertonicity are causes often overlooked. Injecting botulinum toxin type A (BoNT-A) into hypertonic pelvic floor muscles may aid the relaxation of pelvic floor musculature. The muscles that are injected in CPP treatment include the obturator internus, levator ani (pubococcygeus, iliococcygeus, and puborectalis), and coccygeus. Generally, injections can be performed tolerably with safety under conscious sedation combined with local anesthesia. Most practitioners perform BoNT-A injection of pelvic floor muscles using anatomical landmarks identified by manual palpation only. For the precise location of injection sites, some needle guidance techniques were proposed, including electromyography, electrical stimulation, ultrasound, fluoroscopy, and/or computed tomography. Side effects of BoNT-A injection in CPP are rare and self-limiting. Because of the reversible nature of BoNT-A, reinjection appears to be necessary. Increasing proof points out that BoNT-A is a promising treatment option for CPP in women. We conducted a review of published literature in Pubmed, using chronic pelvic pain in women, hypertonic pelvic floor, and botulinum toxin as the keywords. This article aims to summarize the treatment techniques and results of BoNT-A injection for hypertonic pelvic floor in women with chronic pelvic pain.

Effectiveness Of SNPE On Disability, Range Of Motion, Muscular Strength, And Pelvic Pain In Women With Chronic Low Back Pain

PURPOSE: The SNPE (Self Natural Posture Exercise), developed and practiced widely in Korea uses unique tools and body correction belts to make tension release and to correct unbalanced posture. This study examined the effectiveness of SNPE on disability, range of motion (ROM), muscular strength, and pelvic pain in young women with chronic low back pain. METHODS: Twenty five women (27.6±6.5 yrs, 23.8±3.8 kg/m2) who had back pain for more than 3 months and scored 5-14 of the Korean Oswestry Disability Index (KODI) were divided into three groups; SNPE group (SNPEG, n=9), stretching group (SG, n=8), and non-exercise group (NG, n=8). SNPEG and SG participated in a respective 60 min exercise program twice a week for 12 weeks, while NG did not. KODI, Remodified Schober Test, Finger-to-Floor Distance Test, back strength, and VAS were measured at pre and post of 12 weeks. Statistical analysis was performed by paired t-test and ANCOVA. RESULTS: The lumbar disorder index was significantly decreased in SNPEG (pre: 7.6±2.7 vs. post: 3.1±2.7, p<0.001), and the decrease was the biggest in SNPEG than other two groups (p<0.001). Flexion of lumbar increased from 22.4±2.7 to 26.8 ± 2.9 cm (p<0.05) while extension decreased from 12.2±1.0 to 10.9±1.0 cm (p<0.05). Lateral flexion to left side was decreased from 46.8±3.9 to 42.5±2.7 cm in SNPEG and from 46.6±3.2 to 44.7±3.4 in SG (p<0.01), and lateral flexion to right side showed similar changes (p<0.01). No changes in lateral flexion to both side in NG was found. The changes in flexion, extension, and lateral flexion to left and right were the largest in SNPEG (p<0.05). Back strength increased in SNPEG from 57.5±13.4 to 72.6±12.5 kg (p<0.001), while other groups did not increase. Pelvic pain in SNPEG decreased in all 10 sites from 4.6±1.1, 3.0±1.5, 6.5±1.4, 5.8±1.6, 4.7±2.2, 5.7±1.9, 5.2±2.5, 6.3±2.1, 6.3±2.2, and 6.4±2.4 to 0.7±0.9, 1.2±1.3, 2.3±1.5, 2.2±1.6, 1.6±1.9, 2.1±1.6, 2.5±2.2, 3.1±2.4, 1.8±0.8, and 1.7±0.8 in Sacrum left and right (L-R), Iliopsoas L-R, Lateral Iliac Crest L-R, Adductor L-R, and Gluteus maximus L-R, respectively (p<0.05). Pelvic pain in SG also decreased in all sites (p<0.05) while not in NG. CONCLUSION: The results suggest that the SNPE can be an effective exercise program for improving disability, ROM, muscular strength, and pelvic pain release in young women with low back pain.