Pelvic Pain Research Articles

To contract or not to contract: should we use pelvic floor muscle exercises in the treatment of dyspareunia

Pelvic floor physiotherapy incorporates pelvic floor muscle (PFM) exercises (PFMEs), i.e. various tasks involving contraction and relaxation. These are widely used as an integral part of conservative treatment for different pelvic health conditions (e.g. urinary incontinence). Currently, there is a debate about the adoption of PFMEs for pelvic pain conditions, specifically dyspareunia. The prevailing belief within both the physiotherapy community and wider social media platforms is that PFMEs for dyspareunia are not appropriate and may even be harmful. The aim of this study was to investigate the role of PFMEs in the treatment of dyspareunia, including an exploration of potential mechanisms through which these exercises may alter its symptoms. Specifically, the authors addressed the following questions: What is the rationale for PFMEs in dyspareunia? What are the documented side effects, if any? What are the outcomes following PFMEs? A list of relevant studies was compiled from extensive searches conducted for the purpose of other reviews performed by the authors, and additional, complementary searches utilizing a combination of keywords associated with dyspareunia, physiotherapy and PFMEs. The inclusion criteria were any studies discussing and investigating the use of PFMEs, such as (but not limited to) repeated contractions or hold contractions as a sole intervention or as part of multimodal treatment. Data were extracted and narratively synthesized to identify arguments advocating for and against PFMEs in the treatment of dyspareunia. Part of the narrative analysis included 10 studies involving women with different types of dyspareunia, such as vulvodynia, postpartum dyspareunia, dyspareunia related to menopause and dyspareunia in cancer survivors. Pelvic floor muscle exercises were implemented as a main intervention or as a part of multimodal physiotherapy. All of the studies reported positive results favouring interventions involving PFMEs across various outcomes, such as pain intensity, sexual function, symptom severity and inconvenience, and PFM morphometry and function. None of the studies reported any side effects following interventions incorporating PFMEs. These exercises may have multiple applications in the treatment of dyspareunia. It appears essential to consider PFMEs as a multifaceted intervention that can be adapted in various forms for diverse objectives that extend beyond simple strengthening. Contrary to prevailing beliefs, PFMEs have been widely incorporated in research studies that have reported positive outcomes and demonstrated the safety of the interventions implemented.

Evaluation of efficacy and safety of low-intensity pulsed ultrasound in patients with concurrent erectile dysfunction and chronic prostatitis/chronic pelvic pain syndrome: a prospective, randomized controlled study

ObjectiveThe primary objective of this clinical trial is to investigate the effect of low-intensity pulsed ultrasound (LIPUS) on patients suffering from comorbid erectile dysfunction (ED) and chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS).MethodsThe clinical trial was conducted in the andrology outpatient treatment room of the Department of Urology, Xiangya Hospital, Central South University from August to November 2022 A total of 60 patients who met the research criteria for comorbid ED combined with CP/CPPS were recruited and randomly assigned to three treatment groups. They were treated with LIPUS (Group A), drug therapy(Group B), and LIPUS combined with drug therapy (Group C), respectively. Each group comprised 20 patients. Statistical analysis was performed on the five-item version of International Index of Erectile Function (IIEF-5), Erection Hardness Score (EHS), National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), the nine-item Patient Health Questionnaire (PHQ-9), the seven-item Generalized Anxiety Disorder Scale (GAD-7), and the incidence of adverse events to comprehensively evaluate the efficacy and safety of LIPUS.ResultsThe positive response rate of ED and CP/CPPS treatment in Group A is 40%(8/20) and 45%(9/20), while those in Group B is 55%(11/20) and 60%(12/20), and those in Group C is 85%(17/20) and 85%(17/20). A notable increase in IIEF-5 scores was observed across the three groups post-treatment (10.45 ± 2.50 vs. 13.65 ± 3.03, P = 0.008; 11.80 ± 3.21 vs. 16.40 ± 3.20, P = 0.011; 12.90 ± 3.92 vs. 19.40 ± 2.35, P = 0.042) with a concomitant significant decrease in NIH-CPSI scores (16.75 ± 4.53 vs. 14.65 ± 4.51, P = 0.016; 16.35 ± 4.32 vs. 12.20 ± 4.74, P = 0.007; 16.00 ± 4.40 vs. 8.15 ± 4.28, P = 0.021). Notably, the most pronounced changes were seen in the group receiving LIPUS combined with tadalafil and doxazosin. Additionally, all groups exhibited marked improvements in anxiety and depression symptoms post-treatment. No adverse events were observed during treatment.ConclusionLIPUS can improve erectile function and CP/CPPS symptoms with good safety, and LIPUS combined with tadalafil and doxazosin is more effective during the treatment. However, its long-term efficacy remains to be seen.Trial RegistrationChinese Clinical Trial Registry; approval number: ChiCTR2200063038 (https://www.chictr.org.cn/) on August 29, 2022.

Transcutaneous Tibial Nerve Stimulation for Quality-of-Life Improvement and Sleep Deficiency in Women with Primary Dysmenorrhea: A Randomized Clinical Trial.

Background: Primary dysmenorrhea is a leading cause of chronic cyclic pelvic pain, contributing to a reduced quality of life and sleep disturbances in women. The objective of this study was to assess the effectiveness of transcutaneous tibial nerve stimulation (TTNS) in improving the quality of life, sleep, and overall health perceptions of participants compared to a control group of women with dysmenorrhea over short-term, medium-term, and long-term periods. Methods: A single-blind, controlled clinical trial was conducted, with participants randomly assigned to an experimental group (receiving TTNS) or a control group (receiving sham TTNS). Both groups underwent 12, weekly 30 min sessions using the NeuroTrac™ PelviTone electrostimulation device. Outcomes related to quality of life, sleep deficiency, and overall improvement were evaluated at three time points: short-term (post-treatment), medium-term (1-3 months), and long-term (6 months). Results: Of the 61 participants initially randomized (31 in the experimental group and 30 in the control group), 55 completed the study and were included in the final analysis. A statistically significant improvement was observed in the experimental group in both physical and mental health components, as measured by the SF-36v2® questionnaire, following 12 weeks of intervention, compared to the control group, persisting 6 months after the intervention. Additionally, statistically significant differences in overall improvement were noted between the two groups, as measured by the PGIC questionnaire at the end of treatment (p = 0.0103) and 6 months post-treatment (p = 0.0432). Conclusions: TTNS appears to be a safe and effective strategy for enhancing quality of life and overall health in women with PD, potentially reducing the reliance on pharmacological treatments or more invasive methods.

Prevalence and Clinical Correlates of Endometriosis in Patients With IC/BPS.

Interstitial cystitis/bladder pain syndrome (IC/BPS) presents as a complex heterogeneous disorder that poses a significant clinical challenge both for diagnosis and treatment. The identification of patient subgroups with significant overlap in their nonurological associated symptoms, including endometriosis, may enable a more targeted therapeutic approach. This study investigated the prevalence, clinical correlates, and clinical sequelae associated with concurrent endometriosis in patients with IC/BPS. Demographic, clinical, surgical, and questionnaire data from female patients (n = 533) with a diagnosis of IC/BPS were evaluated in this retrospective cohort study. Surgical history was obtained from patient electronic medical records, using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Data from participants with and without concurrent endometriosis were compared using univariate analysis, followed by binary logistic regression to identify associated variables. Of 533 participants, 108 (20.3%) reported a history of endometriosis. Those with concurrent endometriosis were younger, had a larger bladder capacity, and had a higher number of nonurological associated symptoms. Patients with concurrent endometriosis were less likely to have a history of cystectomy (the surgical removal of the bladder) and report allergies but more prone to report comorbidities such as chronic pelvic pain, chronic fatigue, fibromyalgia, migraines, and pelvic floor dysfunction. Binary logistic regression identified a positive association between endometriosis and chronic pelvic pain, and a negative association between allergies and low bladder capacity for those with concurrent endometriosis. Endometriosis is common in younger female patients with IC/BPS and is associated with a non-bladder-centric (ie, systemic pain disorder) phenotype.

Younger Age Is Associated With Pelvic Floor Muscle Dysfunction in Women With Urinary Symptoms.

Recent articles have highlighted the existence of pelvic floor myofascial dysfunction in women presenting with pelvic floor disorders. The aim of the study was to evaluate whether younger age is associated with pelvic floor muscle dysfunction in women with lower urinary tract symptoms, including urinary urgency, frequency, nocturia, and urinary incontinence. This retrospective cohort study included women seeking an initial outpatient urogynecology evaluation for urinary symptoms from 8/2018 to 2/2022. The primary outcome was the presence of pelvic floor muscle dysfunction, defined as a diagnosis of levator myalgia/spasm. Multivariable logistic regression was used to evaluate the association. Four hundred twenty-one women with lower urinary tract symptoms were included, and 115 (27.3%) were diagnosed with pelvic floor muscle dysfunction. Women with pelvic floor dysfunction were 13 years younger, less likely to report any incontinence (60% vs 71.9%, P = 0.026) and urgency incontinence (8.7% vs 17.3%, P = 0.04). There was no difference in reported urgency, frequency, or nocturia. Women with pelvic floor dysfunction were more likely to report dysuria (19.1% vs 9.5%, P = 0.012), dyspareunia (39% vs 7.5%, P < 0.001), vulvodynia (11.3% vs 2.3%, P < 0.001), and pelvic pain (25.2% vs 7.2%, P < 0.001). The odds of pelvic floor muscle dysfunction in women <40 years old was 2.34 times greater than women ≥40 years old, after adjusting for other factors (adjusted odds ratio 2.341, 95% confidence interval [1.102, 4.972]). Younger women with lower urinary tract symptoms were significantly more likely to have pelvic floor muscle dysfunction compared to older women with similar symptoms, even after controlling for other associated characteristics.

Brain predicted age in chronic pelvic pain: a study by the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network.

The effect of chronic pain on brain-predicted age is unclear. We performed secondary analyses of a large cross-sectional and 3-year longitudinal data set from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network to test the hypothesis that chronic pelvic pain accelerates brain aging and brain aging rate. Brain-predicted ages of 492 chronic pelvic pain patients and 72 controls were determined from T1-weighted MRI scans and used to calculate the brain-predicted age gap estimation (brainAGE; brain-predicted - chronological age). Separate regression models determined whether the presence of chronic pelvic pain could explain brainAGE and brain aging rate when accounting for covariates. We performed secondary analyses to understand whether brainAGE was associated with factors that subtype chronic pelvic pain patients (inflammation, widespread pain, and psychological comorbidities). We found a significant association between chronic pelvic pain and brainAGE that differed by sex. Women with chronic pelvic pain had higher brainAGE than female controls, whereas men with chronic pelvic pain exhibited lower brainAGE than male controls on average-however, the effect was not statistically significant in men or women when considered independently. Secondary analyses demonstrated preliminary evidence of an association between inflammatory load and brainAGE. Further studies of brainAGE and inflammatory load are warranted.

Long-term follow up for the treatment of symptomatic pelvic venous insufficiency secondary to combined iliac vein stenosis and ovarian vein reflux treated with iliac vein stenting alone

We previously reported that in women with symptomatic pelvic venous insufficiency (PVI) secondary to combined iliac vein stenosis (IVS) and ovarian vein reflux (OVR), treated with iliac vein stenting alone that 78% reported complete symptom resolution up to six months. The purpose of this investigation is to determine the long-term effectiveness of this treatment strategy, the post-stent re-intervention rate and the incidence of post-stent ovarian vein embolization (OVE) for residual symptoms. A retrospective review of prospectively collected data at the Center for Vascular Medicine was performed. We investigated women with pelvic pain or dyspareunia secondary to combined IVS and OVR who were treated with stenting alone. Patients whose primary complaint was dysmenorrhea and/or leg symptoms were excluded from the analysis. Assessments and interventions consisted of an evaluation for other causes of PeVD by a gynecologist, documentation of pre, three, six, 12, 24 and 36 month visual analog pain scores (VAS), trans-abdominal duplex ultrasound, stent type, diameter, length, vein territory covered and reintervention rates. All patients underwent diagnostic venography of their pelvic, left ovarian veins, pelvic reservoirs and intra-vascular ultrasonography of their iliac veins. From February 2018 to January 2023, 141 women with a pelvic venous disorder (PeVD) secondary to IVS and OVR were identified. Average age was 44.7±10.5 years with 3.18±1.82 pregnancies. Average follow-up time for the entire cohort was 12±12.1 months (Median: 10.65 months). Types of stents were the following: Venovo 48 (34%), Wallstent 14 (10%) Abre 79 (56%). Most common diameter and stent lengths utilized were 14 and 16mm and 140 and 150mm respectively. Most common vein territories covered were the inferior vena cava (IVC) to the left external iliac vein in 83% and IVC to right external iliac vein in 13%. Pelvic and dyspareunia VAS scores pre-intervention, 3,6, 12, 24 and 36 months post intervention were as follows: 6.4±73 (n=141), 2.6± 3.3(n=98), 1.71±2.83 (n=77), 2.04±3.5 (n=76), 2.4±3.7 (n=30) and 1.15±3 (n=13) (p≤0.001). Of the entire cohort no patients required OVE and pelvic reservoir embolization. Pelvic reservoirs were present in 113/141 (83%) patients. Stent reinterventions were required in 19/141 (13%) patients. The majority of women with pelvic pain secondary to combined IVS and OVR achieved near complete symptom resolution with iliac vein stenting alone despite the presence of a pelvic reservoir in 83% of patients. Although most women complained of some minimal residual pelvic pain or dyspareunia, the majority were satisfied with their outcomes and did not require further intervention. In this patient population, iliac vein stenting should be considered the primary treatment modality. OVE should be reserved for patients with persistent or recurrent pelvic pain unresolved with stenting.

Multitargeted docking approach reveals droxidopa against DNA replication and repair-related protein of cervical cancer

Cervical cancer begins in the cells lining the cervix and is caused by persistent infection with certain types of human papillomavirus (HPV). Initially, it has no symptoms, and later it causes pelvic pain, abnormal vaginal bleeding, and pain during intercourse. It is the fourth-ranked cancer among women, and many women die from cervical cancer every year, particularly in low-income countries and the majority could be prevented with early detection and treatment. In this study, we have taken Cervical Cancer DNA Replication and Repair-Related Protein with the PDBID- 3H15, 5VBN, and 6NT9 and performed the multitargeted molecular docking with the FDA-approved drug library using HTVS, SP and XP docking. Then, the poses were filtered with MM\\GBSA for proper computations of free energy, identified a multitargeted inhibitor Droxidopa with docking and MM\\GBSA scores ranging from − 5.559 to − 6.835 Kcal/mol and − 26.04 to − 37.33 Kcal/mol, respectively. We also performed interaction fingerprints revealing 2VAL, 2LYS, 1ALA, 1ARG, 1ASN, 1CYS, 1GLN, 1GLU, 1ILE, 1MET, 1PHE, 1PRO, 1SER, and 1THR were most interacted residues and computed the ADMET properties with QikProp and DFT with Jaguar, which supported the study and compounds’ suitability. Moreover, we performed the 100ns MD simulation in water, showing the controlled deviation and fluctuations of the residues with many interactions, and MM\\GBSA was performed with the same trajectories, showing a better understanding of each frame’s total complex and binding-free energy. The whole study favours droxidopa as an inhibitor of cervical cancer DNA Replication and Repair-Related Proteins—however, experimental studies are needed before use.

Evaluating Language Processing Artificial Intelligence Answers to Patient-Generated Queries on Chronic Pelvic Pain.

Evaluating Language Processing Artificial Intelligence Answers to Patient-Generated Queries on Chronic Pelvic Pain.

Efficacy and safety of bioregulatory peptides in the treatment of prostate diseases: a review

The article describes the risk factors, pathogenetic mechanisms of development of various prostate diseases and highlights the problems in their treatment. Information on regulatory peptides and their mechanism of action is presented. Clinical studies proving the high effectiveness of bioregulatory peptides in the treatment of chronic prostatitis, chronic pelvic pain syndrome and benign prostatic hyperplasia are presented. The analysis was carried out and evidence of the effectiveness of domestic drugs Prostatex and Prostateks Plus in the treatment of prostate diseases was presented.

Rare Seminal Vesicle Cystadenoma: Case Report and Literature Review

Abstract Introduction/Objective Primary neoplasms of seminal vesicles (SV) are rare, with the majority being metastatic tumors, often from prostatic carcinoma. SV cystadenoma is an exceedingly rare benign epithelial tumor that arises from the remnants of the Mullerian duct. The tumor formed of cysts of variable sizes lined by bland cuboidal epithelium. Herein we present a case of SV cystadenoma in a 38-year-old male, underscoring its rarity and risk of progression to higher grades, as outlined in literature review. Methods/Case Report A 38-year-old male with a history of left atrophic kidney and intermittent pelvic pain due to recurrent obstruction of the SV. Pelvic Magnetic Resonance Imaging revealed a 5.3 cm benign unilocular cyst within the SV, along the posterior aspect of the urinary bladder. The patient underwent successful laparoscopic excision of the left SV. Gross examination of the excised SV demonstrated a 3.5X 2.7X 1.5 cm cyst within the SV. Microscopic examination displayed a benign cyst lined by single to multiple layers of cuboidal epithelium, surrounded by unremarkable SV stroma. The epithelial lining cells exhibited round nuclei with inconspicuous nucleoli, lacking dysplasia. Immunohistochemistry revealed positive staining for cytokeratin 7 and PAX 8 in the epithelial cells, whereas prostatic specific antigen staining was negative. Results (if a Case Study enter NA) NA Conclusion Cystadenoma and mixed epithelial stromal tumors of the SV (MEST) are rare entities, with approximately 30 reported cases. This case demonstrates classic histologic features consistent with low-grade MEST, as per recently proposed grading criteria. Notably, a recent case report has suggested a potential for malignant transformation to high-grade dysplasia and adenocarcinoma in SV cystadenoma, as evidenced by focal epithelial dysplasia.

Effect of different electric stimulation modalities on pain and functionality of patients with pelvic pain: Systematic review with META-analysis.

Pelvic pain is located in the anterior abdominal wall, below the umbilical scar. Its treatment includes pharmacological therapy, which can cause adverse effects and is not always sufficient to control symptoms. Thus, the use of adjunct therapies such as electric stimulation has been suggested. Therefore, this review intends to appraise the literature on the effectiveness of electrostimulation in the treatment of pelvic pain. The search for studies was conducted until April 2024 in PubMed, Cochrane Library, ScienceDirect, SciELO, PEDro, CINAHL, BVS, Web of Science, Scopus, and Google Scholar databases using a combination of Mesh terms "Electric Stimulation" and "Pelvic Pain." Risk of bias assessment and meta-analysis were performed with The Cochrane Collaboration tool (RevMan 5.4). Quality of the evidence was assessed with GRADE tool. From the 3247 studies found, 19 were included. In the qualitative analysis, seven studies showed TENS, electroacupuncture, PTNS, and tDCS reduced pain intensity, one study on PTNS showed increased quality of life, and one on tDCS showed improved functional performance. However, in the meta-analysis, only TENS showed efficacy for the reduction of acute pelvic pain and primary dysmenorrhea. Our results indicate that there is moderate-quality evidence for TENS to reduce pain intensity in primary dysmenorrhea and low-quality evidence for the same outcome in acute pelvic pain. Randomized controlled clinical trials with larger sample size and with better methodological quality are needed to establish the effectiveness of other forms of electrical stimulation in pelvic pain.

Urogynecological symptoms and pelvic floor muscle tender points in women with and without fibromyalgia

Aims: To compare the urinary, sexual and vaginal symptoms frequency, pelvic floor muscles (PFM) tender points and pain severity in women with and without fibromyalgia. Methods: Cross-sectional study composed by women with fibromyalgia (FMG) and without it (control group, CG) assessed by: (a) sexual (Female Sexual Function Index - FSFI); (b) vaginal (International Consultation on Incontinence Questionnaire ICIQ-Vaginal Symptoms); (c) urinary (ICIQ: Urinary Incontinence Short Form ICIQ-UI SF and ICIQ-Overactive Bladder ICIQ-OAB); (d) quality of life (King’s Health Questionnaire - KHQ), as well as digital palpation assessment of: tone (normal, increased or decreased); tender points (position by clock-face); and pain severity (numeric rating scale - NRS). Statistical analysis included Student’s t-test, Wilcoxon-Mann-Whitney’s, logistic Regression and Spearman’s Correlation (significance level: 5%). Results: Of the 84 women enrolled, 39 FMG and 39 CG completed the study. No differences in urinary or vaginal symptoms were found. FMG presented lower FSFI (FMG: 7.2; CG: 21.6; p&lt;0.001), more PFM tender points (FMG: 10 (25.6%); CG: 1 (2.6%); p=0.03), greater quality of life impairment (FMG: 5, CG: 4; p=0.01) and sleep/energy (FMG: 5, CG: 2, p&lt;0.01) both KHQ domains. The pain severity was FMG: 4 (1-6); CG: 7(7); p=0.05. Conclusion: More PFM tender points, greater impairment in sexual function, as well as in quality of life were all more frequent in women with fibromyalgia when compared to healthy controls. However, the correlation between sexual function and PFM pain was low.

Partnership and relationship happiness in endometriosis related chronic pelvic pain: a multicenter case-control study.

Partnership is an important resource in dealing with endometriosis related chronic pain. Hence, our objective was to assess partnership in the context of endometriosis and its symptoms, considering the perspectives of both individuals involved. The study was designed as a multi-center matched case-control study in Switzerland, Germany and Austria. Altogether 381 women with surgically/histologically confirmed endometriosis and 381 control women, 250 male partners of endometriosis-affected women and 229 of control women were evaluated. Partnership quality, partnership happiness, separation thoughts, and areas of conflict were evaluated through the Partnership Questionnaire and a validated list of conflict areas. Quality of partnership was rated as high by 60.1% of the women with endometriosis and 66.7% of the control women, as well as by 45.8 and 50.2% of their respective partners. Women with endometriosis mentioned separation thoughts, mostly related to sexual satisfaction, more often (34.9%/28.3%) and experienced more partnership-related conflicts than control women. Chronic pain, dyspareunia, dissatisfaction with sexuality, fatigue, and infertility were significantly associated with partnership conflicts. Fatigue and infertility but not pain experiences were related to lower partnership quality. Male partners in both groups reported separation thoughts equally often. In men, a high intensity of pain experienced by their partner was associated with reduced partnership happiness. Given the significance of partnership in dealing with chronic diseases and the connection between symptoms of endometriosis and a decrease in partnership quality, it is essential to incorporate strategies that alleviate the negative impacts on relationships for both partners into medical support. identifier NCT02511626.

CT and MRI radiographic characteristics of seminal vesicle cysts

PurposeSeminal vesicle cysts are relatively uncommon benign lesions. Early and accurate diagnosis is crucial for guiding appropriate management strategies. The purpose of this study was to investigate the radiographic characteristics of seminal vesicle cysts in order to enhance the diagnostic proficiency of radiologists. MethodsWe conduct a comprehensive descriptive analysis of the CT and MRI findings pertaining to 15 patients with seminal vesicle cyst, complemented by a brief literature review. ResultThe mean age of 15 patients with seminal vesicle cyst was 57.53 ± 17.0 years. Among these patients, 53.33% (8/15) were incidentally detected, while 40% (6/15) presented with symptoms of abdominal or pelvic pain. One patient exhibited hematospermia. In 86.67% (13/15) of cases, the cysts were unilateral, while the remaining 13.33% (2/15) were bilateral. Radiological assessment comprised CT scans for 7 patients, MRI scans for 12 patients, and a combination of both modalities for 4 patients. Imaging characteristics revealed 11 cases of unilocular cysts and 4 cases of multilocular cysts, with the largest measuring approximately 16.0 × 9.8 cm. CT imaging distinctly demonstrated punctate or nodular calcification along the cyst wall in 3 cases. MRI, on the other hand, facilitated the visualization of cystic contents, including mucinous protein in 9 cases and hemorrhagic components in 2 cases. ConclusionThe radiographic manifestations of seminal vesicle cysts exhibit distinct characteristics, CT and MRI imaging modalities are instrumental in facilitating their accurate diagnosis.

The Benefits of an Integral HAMMAM Experience Combining Hydrotherapy and Swedish Massage on Pain, Subjective Well-Being and Quality of Life in Women with Endometriosis-Related Chronic Pelvic Pain: A Randomized Controlled Trial

Background and Objectives: To evaluate the effectiveness of an integral HAMMAM experience, a 4-week therapeutic program that combined hydrotherapy and Swedish massage, applied in a multisensorial immersive environment, on pain, well-being and quality of life (QoL) in women with endometriosis-related chronic pelvic pain that is unresponsive to conventional treatment. Materials and Methods: This randomized controlled trial included 44 women with endometriosis. They were randomly allocated to either the ‘HAMMAM’ group (n = 21) or to a control group (n = 23). The primary outcome, pain intensity, was evaluated using numeric rating scales (NRSs). The secondary outcomes were pain interference, pain-related catastrophic thoughts, pressure pain thresholds (PPTs), subjective well-being, functional capacity and QoL, which were evaluated using the brief pain inventory (BPI), the pain catastrophizing scale (PCS), algometry, the subjective well-being scale-20 (EBS-20), the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) and the Endometriosis Health Profile-30 Questionnaire (EHP-30), respectively. The primary and secondary outcomes were measured at the baseline and after the intervention. The statistical (between-group analyses of covariance) and clinical effects were analyzed by the intention to treat. Results: The adherence rate was 100.0% and the mean (± standard deviation) satisfaction was 9.71 ± 0.46 out of 10. No remarkable health problems were reported during the trial. The ‘HAMMAM’ intervention improved dysmenorrhea and dyspareunia after the intervention with large and moderate effect sizes, respectively. Improvements in pain interference during sleep and PPTs in the pelvic region were also observed in women allocated to the ‘HAMMAM’ group. No effects were observed in catastrophizing thoughts, well-being nor QoL, except for the sleep subscale. Conclusions: A 4-week program of an integral ‘HAMMAM’ experience combining hydrotherapy and massage in a multisensorial immersive environment is a feasible and effective intervention to alleviate pain during menstruation and sexual intercourse as well as pain interference with sleep in women with endometriosis.

Screening and identification of key biomarkers associated with endometriosis using bioinformatics and next-generation sequencing data analysis

BackgroundEndometriosis is a common cause of endometrial-type mucosa outside the uterine cavity with symptoms such as painful periods, chronic pelvic pain, pain with intercourse and infertility. However, the early diagnosis of endometriosis is still restricted. The purpose of this investigation is to identify and validate the key biomarkers of endometriosis.MethodsNext-generation sequencing dataset GSE243039 was obtained from the Gene Expression Omnibus database, and differentially expressed genes (DEGs) between endometriosis and normal control samples were identified. After screening of DEGs, gene ontology (GO) and REACTOME pathway enrichment analyses were performed. Furthermore, a protein–protein interaction (PPI) network was constructed and modules were analyzed using the Human Integrated Protein–Protein Interaction rEference database and Cytoscape software, and hub genes were identified. Subsequently, a network between miRNAs and hub genes, and network between TFs and hub genes were constructed using the miRNet and NetworkAnalyst tool, and possible key miRNAs and TFs were predicted. Finally, receiver operating characteristic curve analysis was used to validate the hub genes.ResultsA total of 958 DEGs, including 479 upregulated genes and 479 downregulated genes, were screened between endometriosis and normal control samples. GO and REACTOME pathway enrichment analyses of the 958 DEGs showed that they were mainly involved in multicellular organismal process, developmental process, signaling by GPCR and muscle contraction. Further analysis of the PPI network and modules identified 10 hub genes, including vcam1, snca, prkcb, adrb2, foxq1, mdfi, actbl2, prkd1, dapk1 and actc1. Possible target miRNAs, including hsa-mir-3143 and hsa-mir-2110, and target TFs, including tcf3 (transcription factor 3) and clock (clock circadian regulator), were predicted by constructing a miRNA-hub gene regulatory network and TF-hub gene regulatory network.ConclusionsThis investigation used bioinformatics techniques to explore the potential and novel biomarkers. These biomarkers might provide new ideas and methods for the early diagnosis, treatment and monitoring of endometriosis.

Benign Cystic Mesothelioma of the Uterus: Myth or Reality?

Mesothelioma is a very rare tumor of mesodermal origin that covers the surface of body organs such as the peritoneum, pleura and pericardium. This tumour in the majority of cases presents in its malignant form where it represents some characteristics: increased cellularity, cytological atypia, papillary formations, even invasion. We report the case of Mrs AB, 37 years old, blood group A positive with no particular pathological history, nulli gesture nulli pare, consulted for pelvic pain and abdominal bloating. The clinical examination showed a distended bloated abdomen with a 20 centimetre pelvic mass with regular contours and painlessness. Abdominal and pelvic ultrasound showed a globular uterus increased in size by 200 millimetres with a multilocular cystic image intra myometrial (corporal anterior and fundial) of 188*79 millimetres. Intraoperatively, a globular uterus was found to be enlarged with a 15 centimetre parovascular cystic mass, dependent on the anterior aspect of the uterus, with a rock water fluid content, without any other associated abnormalities The postoperative course was simple. To conclude, Benign cystic mesothelioma of the uterus is a tumour of diagnostic value. This tumour is spleen. The preoperative evaluation allows the diagnosis to be suspected, especially by pelvic magnetic resonance imaging.

Use of Continuous Oral Drospirenone for Menstrual Suppression in Adolescents

PurposeTo describe experiences of adolescents taking continuous drospirenone (DRSP-C) oral contraceptives, without placebo, for menstrual suppression, including breakthrough bleeding and other side-effects. MethodsThis was a retrospective chart review of adolescents prescribed DRSP-C for menstrual suppression. Demographics and indications for DRSP-C were collected on the visit where DRSP-C was prescribed. Data through the final follow-up visit during the study period included documented effects and side-effects of DRSP-C and continuation of therapy. Statistical analyses were primarily descriptive. ResultsPatients prescribed DRSP-C were included (n = 136). Dysmenorrhea was the most common indication for DRSP-C (58.8%, n = 80/136) followed by endometriosis (44.8%, n = 61/136). The median time on DRSP-C for the 116 patients who were able to initiate treatment was 12.3 months (interquartile range [IQR] 6.8, 17.4). Patients trialed, on average, 2 other forms of menstrual management before starting DRSP-C (IQR 1, 3). Pelvic pain or dysmenorrhea resolution or improvement was reported in 84.6% (44/52) of dysmenorrhea patients, and 77.8% (28/36) of pelvic pain patients. Almost half of patients reported breakthrough bleeding on DRSP-C (41.3%, n = 48/116); however, only 11 patients (42%, 11/26) discontinued DRSP-C because of it. Within the study period, 22.4% (n = 26/116) of patients discontinued DRSP-C, with a median treatment duration of 101 days (IQR 71, 157). Among patients who discontinued DRSP-C, the most common reason was breakthrough bleeding (42%, n = 11/26). DiscussionDRSP-C for menstrual suppression was well tolerated in adolescents, with most patients reporting resolution or improvement of their indication for taking DRSP-C. Findings demonstrate DRSP-C is a viable option for menstrual suppression in adolescents.

Validity and reliability of the Polish version of the Pregnancy Mobility Index (PMI-PL).

Mobility, defined as active, controlled, multi-joint flexibility used in movement, is limited in pregnant women due to problems with low back pain (LBP) and pelvic girdle pain (PGP). The Pregnancy Mobility Index (PMI) is a tool for assessing mobility in relation to LBP/PGP. The lack of a Polish version of the PMI test prompted a transcultural adaptation to the Polish conditions. The aim of the study was to evaluate the measurement properties of the Polish adaptation of the Pregnancy Mobility Index. The study involved 121 pregnant women aged 18-44. The translation process was in accordance with the transcultural adaptation design. Reliability was assessed by intraclass correlation coefficient (ICC). Construct validity between the Polish version of the PMI (PMI-PL) and the Physical Activity Pregnancy Questionnaire (PPAQ-PL) was assessed by Spearman's rank correlation coefficient. The transcultural adaptation of the PMI test into Polish was satisfactory, with high internal consistency (Cronbach's alpha = 0.97-0.98, ICC = 0.989). Statistically significant inverse proportional correlations were found for total PA, total PA (light and above), light PA, moderate PA, and vigorous PA in the construct validity analysis between PMI-PL and PPAQ-PL. The Polish version of the PMI is a reliable instrument. The introduction of a questionnaire with a classification system will make it easier for health professionals to monitor the health status of pregnant women and encourage them to engage in physical activity appropriate for their current level of mobility.