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Background: Painful bladder syndrome (PBS) is characterized by persistent pelvic discomfort and urinary symptoms. Cystoscopy is frequently utilized to investigate bladder abnormalities in patients with PBS, particularly those presenting with persistent hematuria, refractory symptoms, or suspected bladder pathology. Objective: We aimed to evaluate the relationship between cystoscopy findings and symptom severity in patients with PBS. Materials and Methods: The study included 22 patients who underwent cystoscopy for PBS. Indications for the procedure included persistent hematuria, unrelenting symptoms, and suspected bladder pathology. Based on visual assessment, the cystoscopic findings were classified into three categories: normal, mild, and severe. Symptom severity was evaluated using a standardized symptom score questionnaire administered before treatment. Results: Of the 22 patients, 6 had normal cystoscopy findings, 14 exhibited mild changes, and 2 demonstrated severe changes. Symptom severity scores varied across the group, with no clear correlation between the severity of symptoms and cystoscopic findings. Notably, patients with severe symptoms often had normal or only mild changes on cystoscopy. Conclusion: No significant correlation was found between symptom severity and cystoscopy findings in PBS patients. This discrepancy may stem from the subjective nature of symptom scoring, the multifactorial origins of PBS symptoms, and the potential influence of functional disorders. Further research is warranted to identify additional factors influencing symptom severity in PBS.

Abstract Anogenital distance (AGD) is regarded as a potential biomarker for endometriosis, and a measurement on MRI images has been found to be promising. This study aimed to evaluate the measurement of AGD on MRI to predict the surgical diagnosis of endometriosis. We included 127 patients who received an MRI for endometriosis between October 2018 and February 2023. AGD was measured on MRI by two readers (MRI-AGD-AC: clitoris to anus; MRI-AGD-AF: posterior fourchette to anus). The feasibility and interobserver reliability of AGD measurements were evaluated. Differences in AGD between patient groups were analyzed. The intraclass correlation coefficient estimates indicated a good to excellent reliability of MRI-AGD-AC (0.92; 95% CI: 0.83–0.95) and a poor to good reliability of MRI-AGD-AF (0.68; 95% CI: 0.27–0.83). No statistically significant differences in the mean MRI-AGD-AC and MRI-AGD-AF in patients with and without surgical diagnosis of DIE (p = 0.413; p = 0.110), peritoneal endometriosis with and without DIE (p = 0.641; p = 0.323), and ovarian endometriosis (p = 0.155; p = 0.150) were found. The AUC ranged from 0.475 (95% CI: 0.365–0.584) to 0.586 (95% CI: 0.454–0.718). Thus, AGD does not constitute a valuable biomarker for patients with clinically suspected endometriosis.

Abstract Background Primary dysmenorrhea (PD) is one of the most common pains experienced by women. Stress Inoculation Training (SIT) is a cognitive-behavioral technique that immunizes them against future periods of stress. The purpose of this research is to investigate the effectiveness of a computer-based stress inoculation approach on pelvic pain, depression, and anxiety symptoms in students with PD. Methods The present study is a clinical trial conducted on 100 students with PD. The SIT intervention consisted of eight consecutive sessions. The content of the sessions was created as multimedia on a computer platform of a site. In each session, several interactive questions were asked about the topics of that session, and participants answered them, with responses recorded in the system. Then, each individual session, lasting about 50 min, was sent as a link (offline) to a participant. Data collection tools included the demographics Checklist, McGill Pain Questionnaire (MPQ), Moos Menstrual Distress Questionnaire (MMDQ), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), and Perceived Stress Scale (PSS-14), which were completed on the second menstrual day of the cycle before the study and for three consecutive cycles after the intervention by each student. The data were analyzed using chi-square, generalized linear mixed models (GLMM), and multiple linear regression tests. The significance level was set at P

BACKGROUND AND OBJECTIVES: Primary dysmenorrhea (PD) is defined as lower abdominal pain occurring before or during menstruation, unrelated to other diseases. Existing studies investigating potential risk factors for PD development and its incidence in various groups have been fragmented, controversial, or overly broad, posing challenges for analysis. Therefore, this study aims to identify potential risk factors for PD development through a literature-based case-control study. METHODS: Following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), this one-year case-control study aimed to establish relationships between PD variables and pain categories (light, moderate, and severe) among 252 Brazilian women. RESULTS: The regularity of the menstrual cycle, intensity of menstrual flow, seeking medical assistance, and use of pain drugs demonstrated statistical significance (p=0.00) across different pain categories. Conversely, factors such as smoking, alcohol consumption, daily diet, physical activity, regular menstrual cycle, previous pregnancy, active sex life, family history of PD, pain site, and the time of onset of PD after the first menstrual cycle were not statistically significant within the pain categories. Although no statistical significance was observed, certain observations can still be drawn by comparing this study with similar ones. CONCLUSION: This study offers valuable insights into the risk factors, pain intensity, menstrual flow patterns, and treatment-seeking behavior associated with PD. By addressing these factors and improving our understanding of PD, we can enhance the well-being and quality of life of women affected by this common gynecological condition.

Endometriosis is a benign, estrogen-dependent, persistent chronic inflammatory heterogeneous condition that features fibrotic adhesions caused by periodic bleeding. The characteristic ectopic lesions are marked by a widely spread dense fibrotic interstitium comprising of fibroblasts, myofibroblasts, collagen fibers, extracellular proteins, inflammatory cells, and active angiogenesis. Fibrosis is now recognized as a critical component of endometriosis because of which current treatments, such as hormonal therapy and surgical excision of lesions are largely ineffective with severe side effects, high recurrence rates, and significant morbidity. The symptoms include dysmenorrhea (cyclic or noncyclic), dyspareunia, abdominal discomfort, and infertility. The significant lack of knowledge regarding the underlying root causes, etiology, and complex pathogenesis of this debilitating condition, hinders early diagnosis and implement effective therapeutic approaches with minimal side effects presenting substantial hurdles in endometriosis management. Emerging research offer a close relationship between endometriosis and fibrosis, which is believed to be tightly linked to pain, a primary contributor to the deterioration of the patient’s quality of life. However, the underlying pathophysiological cellular and molecular signaling pathways behind endometriosis-associated fibrosis are poorly addressed. The available experimental disease models have tremendous challenges in reproducing the human characteristics of the disease limiting the treatment effectiveness. Future translational research on the topic has been hindered by the lack of an adequate fibrotic model of endometriosis emphasizing the necessity of etiological exploration. This review article focuses on recent developments in the field and highlight the necessity for novel fibrotic models for early diagnosis, a better understanding the disease’s etiology and develop effective anti-fibrotic treatments. By addressing these knowledge gaps, we want to open fresh avenues for a thorough investigation and extended research in the field of endometriosis.

Background. The annual number of new cases of chronic pelvic pain syndrome in women of reproductive age is increasing worldwide. The high prevalence of this condition among the able-bodied female population leads to higher state expenditures on the treatment of this category of patients. New methods of diagnosis and early prophylaxis contribute to reducing economic burden associated with chronic pelvic pain syndrome in women and improving health of the female population as a fundamental demographic factor.Objectives. To determine somatic, obstetric-gynecological, anatomical, and psycho-emotional predictors of chronic pelvic pain syndrome.Methods. An observational cohort clinical and ultrasound study involved 60 patients of reproductive age. The study was conducted on the basis of the clinic for women, Voronezh City Outpatient Clinic No. 1 — clinical base of the Department of Obstetrics and Gynecology No. 2, Voronezh State Medical University named after N. N. Burdenko, Russia. According to clinical and laboratory data, the participants were divided into 2 groups. Group 1 (n = 30) included women of reproductive age without clinical manifestations of chronic pelvic pain syndrome; Group 2 (n = 30) enrolled women of reproductive age clinically diagnosed with chronic pelvic pain.Results. The mean age of the study participants in the main group comprised 27.4 ± 6.30 and 26.3 ± 7.25 years in the control group, p > 0.05. Diseases of gastrointestinal tract, endocrine, cardiovascular, musculoskeletal and urinary systems, as well as neurocirculatory and vegetative disorders prevailed in the structure of somatic pathology in the main group, p < 0.001. Analysis of obstetric and gynecologic anamnesis revealed no statistically significant differences in the incidence of gynecologic pathology in the study groups. However, according to the detailed analysis of the delivery history of the participants, 23 patients of the main group (76 %) and 3 patients (6.6 %) of the control group underwent episiotomy during labor, p < 0.001. The evaluation of the comparison groups in terms of pain component in myofascial syndrome involved the pain rating index, number of selected descriptors, sensory index of the selected descriptors, emotional index of the selected descriptors, and pain intensity. Statistically significant differences were revealed for all of the above indicators, thereby confirming a reliable picture of pathopsychological changes in the compared groups of women. The analysis of the ultrasound parameters of topographic and anatomical relationships demonstrated the relevant change in the following parameters: urethral length, diameter of the external urethral sphincter, angle between the external urethra and the body of the bladder, direct and transverse dimensions of the levator hiatus in the studied groups under the muscle tension.Conclusion. An issue of early diagnosis and prophylaxis of chronic pelvic pain syndrome in women of reproductive age remains urgent and requires interdisciplinary participation of medical specialists. The development of new approaches to ultrasound evaluation of pelvic floor will increase the effectiveness of therapeutic and prophylactic measures and reduce the economic burden of this nosology in the morbidity structure of the able-bodied female population.

We evaluated the management of a ruptured non-communicated rudimentary horn pregnancy at the 15th gestational week. A 22-year-old multigravida who was detected to have a 15-week pregnancy according to her last menstrual period was admitted to our clinic with abdominal pain. As the uterine cavity was imaged in 30 mm on transvaginal ultrasonography and front of the uterus 15-week-old fetus without cardiac activity, emergency laparotomy was performed with the possible diagnosis of uterine rupture. Diagnosis of rudimentary uterine horn pregnancy is challenging; thus, it can be encountered with the clinical picture of uterine rupture in later weeks of pregnancy. The most appropriate treatment in such patients is excision of the uterine horn.

BACKGROUND AND OBJECTIVES: Chronic pelvic pain (CPP) is a common condition in women and there are often associated comorbidities. The objective of this study was to evaluate the prevalence of comorbidities in patients with CPP and to seek associations between comorbidities and the manifestations of chronic pain. METHODS: Observational case-control study with sociodemographic, behavioral and clinical information, including comorbidities, in 246 women, 123 with CPP and 123 without CPP (control group). RESULTS: Anxiety, depression, migraine and endometriosis were the most frequent comorbidities in women with CPP. The comorbidities assessed in the CPP group were not associated with pain intensity score, history of abortion, physical violence or sexual violence (p>0.05). In the group of women with CPP and endometriosis, the median anxiety and depression score was significantly lower than in the group without endometriosis (14.5; 95% CI: 11.0-14.9) versus (17.0; 95% CI: 14.6-16.7), p=0.012 and (13.0; 95%CI: 11.1-15.9) versus (16.5; 95% CI: 14.5-17.6), p= 0.045, respectively. In patients with migraine, the median depression score was higher in the group of women with CPP compared to the group without CPP (15.0; 95% CI: 14.1-17.8) versus (10.0; 95% CI: 8.5-12.4), p=0.048. CONCLUSION: The most prevalent comorbidities in women with CPP were mental disorders, migraine and endometriosis. Comorbidities were not related to pain intensity, physical violence or sexual violence. Having a diagnosis of endometriosis is associated with lower anxiety and depression scores in patients with CPP. Overlapping migraine and CPP were associated with a worse depression score.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and non-lethal urological condition with painful symptoms. The complexity of CP/CPPS’s pathogenesis and lack of efficient etiological diagnosis results in incomplete treatment and recurrent episodes, causing long-term mental and psychological suffering in patients. Recent findings indicate that the autonomic nervous system involves in CP/CPPS, including sensory, sympathetic, parasympathetic, and central nervous systems. Neuro-inflammation and sensitization of sensory nerves lead to persistent inflammation and pain. Sympathetic and parasympathetic alterations affect the cardiovascular and reproductive systems and the development of prostatitis. Central sensitization lowers pain thresholds and increases pelvic pain perception in chronic prostatitis. Therefore, this review summarized the detailed processes and mechanisms of the critical role of the autonomic nervous system in developing CP/CPPS. Furthermore, it describes the neurologically relevant substances and channels or receptors involved in this process, which provides new perspectives for new therapeutic approaches to CP/CPPS.

Objectives: Pelvic floor disorders (PFDs) such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can be managed through conservative treatments, such as conservative management involving biofeedback (BF) and electrostimulation. This study aimed to investigate the therapeutic effects of conservative treatments on PFDs. Materials and Methods: A retrospective cohort study was conducted. Women with PFD who underwent 1–3 months of BF and electrostimulation between January 1, 2020, and January 31, 2021, were included in the study. BF treatment was administered using three sensors to monitor pelvic floor muscle activity, providing patients with immediate feedback and guidance on muscle exercises. One session lasted for 5–10 min. Electrostimulation treatment utilized a specially made pelvic belt with electrode sheets to stimulate and contract pelvic floor muscles passively. One session lasted for 15 min. Six therapies in 1 month were prescribed. Pre- and post-treatment Pelvic Floor Distress Inventory (PFDI-20) scores, including POP distress inventory 6 (POPDI-6), colorectal-anal distress inventory (CRAD-8), and urinary distress inventory 6 (UDI-6) scores, were compared. Subgroup analysis by age, menopause, body mass index (BMI), and child delivery mode was performed. Results: The study included 51 women with PFDs (SUI, POP, frequency or urgency or nocturia, and pain) treated with BF and electrostimulation, with a mean age of 49.94 ± 13.63 years. Sixteen patients (37.1%) were menopausal, with a mean menopause age of 50 ± 5.20 years. Twenty-six patients (68.4%) had a history of normal vaginal delivery. The mean PFDI-20 scores before and after treatment were 32.67 (standard deviation [SD] 10.05) and 25.99 (SD 9.61), respectively (P < 0.001). This decrease in scores reflected an improvement in subjective perceptions of symptoms and quality of life. The POPDI-6, CRAD-8, and UDI-6 scores significantly decreased after treatment. Subgroup analysis of scores change regarding age, menopause, BMI, and child delivery mode was not statistically significant. Conclusion: The study demonstrated the effectiveness of BF and electrostimulation for treating women with PFDs. The findings contributed to the understanding of treatment duration, patient characteristics, and the potential benefits of a multimodal approach. Moreover, the study’s diverse participant population and the use of validated outcome measures enhance the generalizability and scientific rigor of the findings.

Abstract Background Intrauterine devices are a widely used method of contraception worldwide. These devices are reliable, cost-effective, long-acting, and reversible. Their placement in the uterus is usually simple and safe. Forgotten IUDs carry some complications and can adversely affect the health of women. Therefore, appropriate counseling during insertion and timely removal are crucial. Case summary We present the case of retained Lippes loop IUD for 40 years in a 75-year-old postmenopausal patient from Western Ethiopia. The patient presented to the hospital with postmenopausal pelvic pain. The loop was removed with spongy forceps. The patient was discharged with analgesia and doxycycline twice a day for 3 days. Conclusion Different works of the literature showed that retained Lippes loop IUD carries some complications. Our case was also presented with postmenopausal pelvic pain. Therefore, we recommend the removal of IUDs at their expiry date or menopause.

Background: While the majority of reproductive-aged females will experience pelvic pain during their lives, biological mechanisms underlying pelvic pain are not well understood. We investigated associations between pelvic pain symptoms and oxidative stress among people with and without surgically-confirmed endometriosis. Methods: Using an enzyme-linked immunosorbent assay, we measured 8-Hydroxy-2’-deoxyguanosine (8-OHdG) in urine samples and corrected for creatinine levels in 434 surgically-confirmed endometriosis participants compared to 605 participants never diagnosed with endometriosis. At enrollment, participants reported details of their pelvic pain symptoms. Linear regression was used to compute geometric mean (GM) creatinine-corrected 8-OHdG levels with 95% confidence intervals (CI) among all participants and those with and without endometriosis separately, adjusting for potential confounders. Interactions by surgically-confirmed endometriosis status were tested by Wald statistics. Results: No trends in 8-OHdG were observed among those with or without endometriosis for severity or frequency of dysmenorrhea, acyclic pelvic pain, dyspareunia or pain with bowel movements. Among endometriosis participants, lower 8-OHdG levels were observed for participants with any white, blue/black, or brown lesions (GM=76.7 versus 82.9 ng/mg; p=0.10), which was primarily driven by lower levels of 8-OHdG for any blue/black lesions (GM=72.8 versus 81.6 ng/mg; p=0.05). Conclusion: While no associations were observed between 8-OHdG and pelvic pain symptoms, future research is needed to assess how other pathways of oxidative damage, e.g. through proteins or lipids, may affect endometriosis-associated symptoms. Additionally, further research is needed to understand differences in oxidative stress among endometriosis lesion sub-phenotypes.

Background Limited data are available to establish evidence-based management protocols for vestibulodynia (VBD), a chronic vulvar pain condition that affects approximately 14 million women in the U.S. For the purposes of the study, our group subdivided VBD subtypes that may benefit from different types of treatment: 1) VBD peripheral (VBD-p), characterized by pain localized to the vulvar vestibule and 2) VBD central (VBD-c), characterized by VBD alongside one or more other chronic overlapping pain conditions (e.g. irritable bowel syndrome, temporomandibular disorder, and fibromyalgia syndrome) that affect remote body regions. Here, we describe the rationale and design of an NIH-funded multicenter clinical trial comparing the effectiveness of topical and/or systemic medication for alleviating pain and normalizing pain- relevant biomarkers among women with VBD-p and VBD-c.Methods Participants will be randomly assigned to one of four parallel arms: peripheral treatment with 5% lidocaine + 0.5 mg/ml 0.02% oestradiol compound cream + oral placebo pill, 2) central treatment with the tricyclic antidepressant nortriptyline + placebo cream, 3) combined peripheral cream and central pill treatments, or 4) placebo cream and placebo pill. The treatment phase will last 16 weeks, with outcome measures and biomarkers assessed at 4 time points (0, 8, 16, and 24 weeks). First, we will compare the efficacy of treatments in alleviating pain using standardized tampon insertion with a numeric rating scale and self-reported pain on the short form McGill Pain Questionnaire. Next, we will compare the efficacy of treatments in improving perceived physical, mental, and sexual health using standardized questionnaires. Finally, we will measure cytokines and microRNAs in local vaginal and circulating blood samples using multiplex assays and RNA sequencing, and determine the ability of these biomarkers to predict treatment response.Conclusion This is the first multicenter randomized controlled trial to evaluate the efficacy of peripherally and centrally acting medications currently used in clinical practice for treating unique VBD subtypes based on distinct clinical and biological signatures. Administrative information Vestibulodynia UPDATe is a multi-centre, two-by-two factorial designed randomized, double-blind, placebo-controlled trial registered at clinical trials.gov (NCT03844412). This work is supported by the R01 HD096331 awarded to Drs. Nackley, Rapkin, Geller and Carey by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).Key messagesPeripheral lidocaine and oestradiol and centrally-targeted nortriptyline medications are used for the treatment of pain in women with VBD, but there is a lack of data from well-powered RCTs.This two-by-two factorial RCT will test the efficacy of these medications in VBD subtypes characterized by distinct clinical characteristics and biomarker profiles.We hope that results will provide clinicians with scientific evidence of therapeutic efficacy in distinct VBD subtypes in an effort to direct and optimize treatment approaches.

Current medical treatments for endometriosis-associated pain (EAP) have limitations, including symptom recurrence and hormonal side effects. For this reason, it is important to elucidate any alternative or complementary treatments available, while Chinese herbal medicine (CHM) shows potential to be this treatment. This study aims to provide evidence for the efficacy and safety of CHM for EAP. Randomized control trials comparing CHM to other treatments for EAP in women with endometriosis were considered eligible, and they were searched for in Medline, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, as well as in the Chinese databases Sino-Med and CNKI, from inception to October 2021. Numerous outcomes were put through meta-analysis using a weighted mean difference and a 95% CI, and the results of dichotomous data were presented as a pooled RR with a 95% CI. A total of 34 eligible studies with 3389 participants were included. Compared with no treatment, there was a statistically significant pooled benefit of CHM on dysmenorrhea at the end of 3-month treatment, and these effects continued for 3 months, but not 9 months, after treatment. Compared with conventional therapy, a significant difference was found in the levels of pelvic pain with a lower rate of hot flush and irregular vaginal bleeding at the end of treatment for 3 months, but not after treatment. Comparing combined treatment with CHM and conventional therapy with conventional therapy alone, significant decreases were found in dysmenorrhea, dyspareunia, and pelvic pain after a 3-month treatment cycle, and in dysmenorrhea after a 4-month treatment cycle with a lower hot flash rate. In conclusion, CHM, used alone or in combination with conventional therapies, appears to have benefits in relieving EAP with fewer side effects than traditional treatment. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain affects between 6% and 25% of women. It is a complex condition that has multifactorial etiologies, including but not limited to conditions arising from the gynecologic, urologic, gastrointestinal, musculoskeletal, neurologic, and psychologic systems. In this literature review, we examine and summarize evidence for interventional treatments compared to conservative treatments for women with musculoskeletal or myofascial pelvic pain. Searches were performed in PubMed and Embase databases. Studies were included if they were randomized controlled trials with a treatment arm of physical therapy, dry needling, trigger point injection (TPI), or injection with botulinum toxin. A total of 106 studies were returned with our search terms, and six articles were included in this review. These studies suggest that pelvic floor physical therapy, dry needling of abdominal wall trigger points, and TPI to abdominal wall and pelvic floor trigger points have some evidence as being effective for treatment of pelvic pain. The evidence for treatment with botulinum toxin was not as robust and also had higher rates of adverse events when compared to other interventions. Most of these studies are limited by small sample sizes and varied baseline demographics, which makes generalization of these findings to different patient populations difficult. In general, treatments for myofascial pelvic pain are low-risk and are effective in reducing myofascial pelvic pain.

bjectives: Significant delays occur in referring cases for care of endometriosis, despite women suffering for years. This study was conducted to assess whether there is a specific symptom profile characteristic of endometriosis to alert physicians for earlier referrals. Methods: In this retrospective observational cohort study, patient data of the women who attended Sultan Qaboos University Hospital from January 2011 to December 2019 with a diagnosis of endometriosis was collected from the hospital’s electronic data archive and analyzed. Results: Cases of N = 262 endometriosis patients were studied. The diagnosis was surgical in 198 (75.6%) of patients and the remaining 64 (24.4%) were diagnosed by clinical assessment and imaging. The mean age at diagnosis was 30.7±6.8 years (range = 15–51). The presence of ovarian endometrioma on ultrasound served as an alert for earlier referral. The mean age at diagnosis for those who had an endometrioma was 30.3±6.7 years and 32.4±7.1 years for those without an endometrioma without a significant difference. The mean age at diagnosis for those who did not have pain was 31.2 years and those with pain was 30.0 years (p =0.894; CI: -2.58–2.91). Among the 163 married women in the sample, 88 (54.0%) had primary infertility, and 31 (19.0%) had secondary infertility. There was no significant difference between the groups in the mean age at diagnosis (analysis of variance test; p =0.056). Over the nine-year period, diagnosis was made at progressively younger ages (p =0.047). Conclusions: Based on this study, no specific symptom profile appears to predict an early diagnosis of endometriosis. However, over the years the diagnosis of endometriosis is made earlier likely due to increasing awareness of women and their physicians about the disease.

Background: In this scoping review, we sought to identify published studies evaluating the drugs currently used in the treatment of endometriosis-related pelvic pain, with reflection on their chemical properties, pharmacokinetics, safety profile, and clinical efficacy. Methods: A literature search was conducted with the use of the PubMed and EMBASE electronic databases, focusing on identifying articles published in English between January 1990 and 2023. Results: Based on the included studies, current therapy options for the treatment of endometriosis-related pain identified and reviewed in this article were: (1) non-steroidal anti-inflammatory drugs; (2) combined oral contraceptive (COCs); (3) progestins; (4) gonadotropin-releasing hormone agonists and antagonists; (5) aromatase inhibitors (AIs); (6) selective estrogen and progesterone receptor modulators; and (7) levonorgestrel-intrauterine device. Conclusions: Based on the published evidence, clinicians should consider NSAIDs, COCs, and progestins as the first-line medical therapies. Compared with second-line options, such as GnRH agonists/antagonists or AIs, the abovementioned first-line options are well tolerated, efficacious, and exhibit lower overall price. Future research priorities should be to identify novel target therapies and to evaluate the effects of available drugs through different routes of administration.

Pelvic congestion syndrome is a relatively recent, but actual and separate nosological form. Pelvic varicocele is a form of varicose disease, which is increasingly regarded as the main cause of chronic pelvic pain in women with various clinical manifestations. A woman with chronic pelvic pain is a difficult patient with combative behavior, who contacts with physicians in various specialties. There are many causes of chronic pelvic pain, but pelvic congestion syndrome has a special place. In recent years, in addition to widespread use of diagnostic radiology, the relevance of this pathology is beyond any doubt. The aim of the study was to summarize and present literature data on the etiology, pathogenesis, clinical manifestations, diagnosis and treatment of pelvic congestion syndrome by analyzing the literature data. Materials and methods. A non-systematic review was conducted using PubMed, Web of Science, Google and Google Scholar databases. The review included free full-text articles published between 1974 and 2021 using key words: pelvic congestion syndrome, pelvic varices, pelvic venous disorders, pelvic varicocele, pelvic venous stasis, chronic pelvic pain, gonadal veins, ovarian veins, vena ovarica, Nutcracker syndrome, May–Thurner syndrome. Conclusions. Pelvic congestion syndrome is still a rarely diagnosed pathology in patients with chronic pelvic pain. Detailed medical history, physical examination as well as maintaining diagnostic algorithm would allow the disease to be diagnosed correctly and timely. The choice of method for surgical intervention is a key point in the treatment of patients with pelvic congestion syndrome, but today there are no criteria for the choice of one, so the problem is far from being resolved and requires further study and research.

Objective: To describe the presenting signs and symptoms, clinic-pathological findings of ovarian masses and to establish diagnostic value of clinical examination, ultrasonography and its correlation with histopathological diagnosis. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Rawalpindi Jun 2017 May 2018. Methodology: Women who underwent surgery for ovarian masses were included. Data was collected from hospital records including; age, presenting symptoms, duration of symptoms, changes in menstrual cycle, and the results of the physical examination. The preliminary diagnoses as well as the final diagnosis were noted. Results: A total of 83 patients with ovarian masses, who underwent surgery over the period of a year, were included. The most common symptom was abdominal pain in 56 (67.5%) followed by abdominal distention 9 (10.8%), dysmenorrhea 8(9.6%). When both clinical and sonological diagnosis were combined, the overall sensitivity, specificity, positive and negative predictive value for diagnosis and discriminating benign and malignant ovarian neoplasms were 87.5%, 96.7%, 70%, and 98.88%, respectively. Conclusion: In this study most, common symptom was abdominal pain both in benign and malignant ovarian masses. Whereas, abdominal distention was more common in malignant masses. Preoperative diagnostic approach should always include careful history taking, physical examination, imaging and evaluation of tumor markers. Early detection, thorough treatment and regular follow-up are the need of time to reduce the morbidity and mortality.

Resumen: Introducción: La endometriosis de infiltración profunda (EIP) es una enfermedad crónica de difícil diagnóstico, que frecuentemente es confundida con otras patologías pelvianas. Objetivo: Presentar dos casos de endometriosis de infiltración profunda, donde la resonancia magnética (RM) de pelvis, fue importante para el diagnóstico y planificación del tratamiento quirúrgico. Caso Clínico: Se describe el caso de dos pacientes. La primera de 24 años afectada por un nódulo de EIP retrocervical con extensión intestinal sintomática y la segunda, una paciente de 37 años con una recidiva sintomática de EIP en la cúpula vaginal después de una histerectomía total. Resultados: La RM de pelvis describe en ambos casos la extensión de las lesiones endometriósicas y presenta una excelente correlación con los hallazgos intra operatorios en la laparoscopía quirúrgica. Conclusiones: La RM de pelvis es un excelente recurso en el estudio diagnóstico de las pacientes con dolor pélvico crónico, tanto en el caso de EIP retrocervical con extensión intestinal y también en la recidiva de EIP en la cúpula vaginal después de una histerectomía total. Summary: Introduction: Deep infiltration endometriosis (DIE) is a chronic disease of difficult diagnosis, which is frequently confused with other pelvic pathologies. Objective: To present two cases of deep infiltrating endometriosis, where the pelvic magnetic resonance imaging (MRI) was important in the diagnosis and surgical treatment planning. Clinical Cases: Two cases, one 24 years-old patient suffering from retrocervical DIE nodule with symptomatic bowel involvement, and a 37 years-old patient, with a symptomatic DIE at the vaginal cuff after total hysterectomy. Results: Pelvic MRI describes in both cases the extension of the endometriotic lesions and presents an excellent correlation with the intra operatory findings during surgical laparoscopy. Conclusions: Pelvic MRI is an excellent diagnostic tool for patients with pelvic pain, in case of retrocervical DIE with bowel involvement, and also in recurrence of DIE at the vaginal cuff after total hysterectomy.

Introduction: Atypical infections are often considered as a potential etiology for men with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). We aimed to describe the prevalence of atypical infections in this patient population to inform clinical management for male patients complaining of pelvic pain. Methods: We retrospectively reviewed patients at a single center from January 2016 to January 2019. We included patients with CP/CPPS Type III diagnosed with pelvic or genital pain in the absence of bacterial infection. All patients underwent an atypical infection panel. The primary outcome measure was the presence of any atypical infection. Results: In total, 345 patients met the inclusion criteria. Of those, 9/345 (2.6%) had an atypical infection (5 mycoplasma and 4 ureaplasma). The mean age of patients with positive atypical infections was 34 compared to the overall study population (44 years, P=0.01). Two patients with atypical infections were also followed for infertility. Urinalysis was available for 6 of the 9 patients with positive atypical infection: 50% (3 out of 6) were normal and 50% (3 out of 6) had >5 WBC/hpf. Symptoms resolved in 66% (2 out of 3) of the patients with positive atypical infection with available follow-up data. Conclusion: Atypical infectious agents were uncommon causes of CP/CPPS. Screening for atypical microbes such as chlamydia, ureaplasma, or mycoplasma may not be necessary for male patients complaining of pelvic or genital pain.

Background Endometriosis is a common disorder in women of childbearing age. Standard medical and surgical treatments are not always satisfactory. Shockwave therapy has been suggested as a possible novel treatment. There are no clinical data however to support this approach. This article describes the research protocol for a pilot interventional trial aiming to evaluate transvaginal low intensity shockwave therapy in women with endometriosis. Methods Adult women (anticipated N = 64) suffering from endometriosis will be recruited in a general gynaecology clinic and randomly allocated in a 1:1 ratio to an intervention group and a control group (parallel group design). The intervention group will receive 4 weekly sessions of transvaginal low intensity radial shockwave therapy. The control group will receive 4 sham procedures. The group allocation will be blinded to the patients but not to caregivers or data analysts (single blinded). Assessment will be carried at 1, 3 and 6 months. The primary endpoint is the visual analogue score for pelvic pain (dysmenorrhea, chronic pelvic pain, dysuria, dyschezia) and the deep dyspareunia score. Conclusion This prospective monocentric single blinded randomised controlled pilot trial will assess transvaginal low intensity shockwave therapy as a novel treatment for endometriosis.

Menstrual disorders are common in puberty, but they are of great concern to patients when presented with primary amenorrhea. This paper reports the case of a 17-year-old single female with secondary sexual characteristics and a suspicious mass in pelvic floor. She also complained from chronic pelvic pain. In laboratory tests, the hormone levels were normal and ultrasound scan showed a 50 to 89 mm hypoechoic adnexal mass. Computerized Tomography scan and Magnetic resonance imaging also confirmed the ultrasound findings. Due to the suspicious nature of the mass and chronic pain, the patient was subject to laparotomy, but was unwilling to undergo surgery, so, she was treated with oral estrogen and progesterone for 21 days. After discontinuation of medication, the first menstrual bleeding occurred. After the bleeding period (nine days), ultrasound scan was performed and no lump or lesion were reported. In cases where the patient has primary amenorrhea, despite the presence of pelvic mass, in case of normal laboratory tests and physical examination, a short term period with contraceptive pills is recommended.

Interstitial cystitis or bladder pain syndrome (IC/BPS) is a chronic pelvic pain syndrome related to the urinary bladder. The ideal treatment should match as much as possible with the pathophysiologic causes of the IC/BPS, but the scarcely available evidence limits this approach, with the majority of available treatments that are primarily targeted to the control of symptoms. The treatment strategies have traditionally focused on the bladder, which is considered the primary end-organ and source of pain. Nevertheless, the growing body of evidence suggests a multifaceted nature of the disease with systemic components. In general, guidelines recommend the personalized and progressive approach, that starts from the more conservative options and then advances toward more invasive and combined treatments. The behavioral changes represent the first and most conservative steps. They can be combined with oral medications or progressively with intravesical instillation of drugs, up to more invasive techniques in a combined way. Despite the multiple available options, the optimal treatment is not easy to be found. Only further investigation on the etiopathogenetic mechanisms, taking into account the differences among subgroups, and the interaction between central and peripherical factors may allow providing a real improvement in the treatment and management of these patients.

Vascular malformations of uterus are extremely rare, benign lesions. A survey of the literature identified fewer than 50 cases of hemangioma of the uterus. Here, we describe a rare case of a cavernous hemangiomatous polyp in 36 years old non pregnant wowan with endometrial polypectomy. A vascular lesions localized to a portion of the uterus may be clinically silent during pregnancy and throughout delivery thus making it difficult to detect. Though rare, it may be an important differential in any female patient who presents with non-responsive uterine bleeding and/or unremitting pelvic pain.

Background: Pregnancy leads to some physiological changes and anatomical changes within maternal and developmental fetus. Posterior pelvic pain usually arises in 20% of the pregnant ladies which may become a cause of adductor tightness during third trimester. Objective: The objective of the study was to find out the impact of pelvic pain on hip adductors in pregnant females during third trimester. Study type, settings & duration: A cross sectional study was conducted at Arif Memorial Teaching Hospital, General Hospital Lahore and Dr. Sadia Khan Clinic, Lahore from March to October 2019. Methodology: Total 206 pregnant women were enrolled. A non-probability convenient sampling method was used. Keeping the margin of error 0.05% and level of significance equal to 5%. Pain was measured by pelvic girdle questionnaire and hip adduction was measured by hip adduction test using goniometer. The standard normal range of hip adduction was 25. Results: Pelvic Pain during pregnancy was reported by 66 % of multigravida patients which was 135 out of 206. Data collector and data analyzer were blinded and main methodological problems were avoided by careful study planning to avoid biasness. Hip adduction tightness was up to 16 degree and found in the pregnant ladies; whereas normal range of hip adduction is 20 to 30 degree. Hip adductors tightness mostly found in multigravida patient with the mean age of 29 years. Conclusion: Study concluded that pregnant ladies who suffered from posterior pelvic pain during third trimester can also have hip adductor tightness.

Pain syndromes affecting women have a significant global impact. There is increasing evidence that chronic pain affects a higher proportion of women than men around the world; unfortunately, women are less likely to receive treatment. Moreover, women generally experience more recurrent pain, more severe pain and longer-lasting pain than men. Pain conditions are more prevalent in women such as fibromyalgia, chronic pelvic pain and lumbopelvic pain during pregnancy and postpartum. Gender differences in pain sensitivity, pharmacological therapy, and nonpharmacological pain interventions have also been reported. It is becoming evident that gender differences in pain and its relief arise from an interaction of genetic, anatomical, physiological, neuronal, hormonal, psychological and social factors that modulate pain differently.

Introduction and and purpose of paper: The aim of this paper was to present modern methods of treatment for endometriosis. Endometriosis is a chronic inflammatory condition of women that is characterized by the implementation of endometrial tissue outside the uterus. It affects 7 to 15% of menstruating women, and 35 to 50% of women treated for infertility. State of knowledge: Diagnosis of endometriosis is made on the basis of well-collected gynecological history, clinical examinations and imaging techniques. The golden standard for diagnostics is laparoscopy with subsequent histological examination of the material collected during the procedure. Among the methods of treatment in women with endometriosis, pharmacological and surgical treatment is applied. The pharmacological agents most commonly used in endometriosis are: combined hormonal contraceptives, progestins and anti-progestins, GnRH agonists and antagonists, aromatase inhibitors, Danazol and non-steroidal anti-inflammatory drugs (NSAIDs). Pharmacological treatment is only symptomatic, not cytoreductive, therefore, to remove endometriosis lesions, surgery should be performed. There are two ways to perform surgery: laparotomy and laparoscopy. Surgical treatment of endometriosis may be associated with local excision of lesions and sometimes even removal of the entire organ. Treatment should be conducted in consultation with the patient and her wishes. Conservative treatment is most commonly used among women of reproductive age. Summary: The pharmaceutical or surgical treatment require an individual approach and deliberated informed consent of patient. Pharmacological treatment is only symptomatic, not cytoreductive, therefore, to remove endometriosis lesions, surgery should be performed.

Pelvic pain is one of the common causes for visiting a doctor, which can be the main symptom of gynecological diseases and an independent pathological condition. Acute pelvic pain is most often caused by an infection that affects the organs of a woman’s reproductive system. Non-infectious causes of pain are also associated with inflammation, and estrogens support pain and inflammation in women, which increases the risk of chronic pelvic pain (CPP). The urgency of the pelvic pain problem is considered not only in connection with an adequate diagnosis of its causes, but also from the perspective of managing the pain symptoms themselves. The anaesthesia strategy significantly improves the quality of life and prevents the development of chronic inflammatory diseases and CPP syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in pain therapy, and their effect consists in reducing the synthesis of prostaglandins and is pathogenetically substantiated both in the complex treatment of acute pelvic infections and in the treatment of idiopathic menstrual pain. The article presents clinical observations of the use of NSAIDs with the specified purpose.

ABSTRACT: Introduction: While two-thirds of women will experience dyspareunia and vaginal dilators are often used to treat dyspareunia, outside of a single case report, no study has investigated the potential of low-dose, high frequency movement-based dilator therapy for dyspareunia in premenopausal female patients. Aim: To determine the utility of low-dose, high frequency movement-based dilator use for dyspareunia in premenopausal female patients. Methods: Retrospective study of women presenting to outpatient hospital-based pelvic floor physical therapy office in a tertiary care center. All adult premenopausal female patients who were referred to pelvic floor physical therapy for dyspareunia and completed movement-based dilator therapy (MBDT) and met study criteria (n = 26) were included for analysis. Main Outcome Measure: Patient change in pain level status using Numeric Pain Rating Scale with intercourse was compared between initial evaluation and time of discharge from pelvic floor physical therapy. Results: Among the 26 women who met criteria for this study, the average pain score decreased from 8.3 (SD 2.2) before treatment to 1.3 (SD 2.0) after treatment and was statistically significant (P< .001). Complete resolution of dyspareunia was reported in 58% of patients. Patients completed between 2 and 6 total pelvic floor physical therapy visits (average 3.7, SD1.5), over 0–44 weeks (mean 9.6 weeks, SD 8.3). Conclusion: Low-dose, high frequency, movement-based dilator therapy significantly reduced or resolved the experience of pain with penetrative vaginal intercourse with dyspareunia. Future prospective studies with larger samples and the inclusion of sexual functional status should be considered to explore the full potential of this modality in treatment of premenopausal patients with dyspareunia. Miles K, Miles S. Low Dose, High Frequency Movement Based Dilator Treatment for Dyspareunia: Retrospective Analysis of 26 Cases. Sex Med 2021;9:100344.

Background: Chronic pelvic pain affects 2–24% of women worldwide, and evidence for medical treatments is limited. Gabapentin is effective in treating some chronic pain conditions, but its effect on central pain processing is unknown. Objectives: To test the hypothesis that gabapentin can reduce pain and improve physical and emotional functioning in women with chronic pelvic pain. We investigated the mechanism of action of gabapentin in a subset of women. Design: A randomised, double-blind, placebo-controlled, multicentre trial with a brain imaging substudy. Setting: This trial took place in 39 UK hospitals. Participants: A target of 300 women with a history of chronic pelvic pain in whom a laparoscopy revealed no obvious pelvic pathology. Intervention: Women were randomised to receive 300 mg of gabapentin (which was escalated to a maximum of 2700 mg daily) or a matched placebo over a 4-week dose-escalation period, followed by 12 weeks on optimal dose. A mechanistic substudy was also undertaken, in which a subset of participants had a functional magnetic resonance imaging scan of their brain before and following 16 weeks of treatment. Main outcome measures: The dual primary measure of the worst and average pelvic pain scores was assessed weekly by a numerical rating scale (0–10) in weeks 13–16 post randomisation. The secondary outcomes were patient-reported questionnaires, assessed physical functioning, fatigue, psychological health, sexual activity, work and productivity, and pain catastrophising. Health-care resource use, analgesic use and adverse events were also collected. The main outcome measure for the mechanistic study was brain activity at rest and in response to noxious stimuli. Results: In the main trial, 306 participants were randomised. The mean worst pain score was 7.1 (standard deviation 2.6) in the gabapentin group and 7.4 (standard deviation 2.2) in the placebo group (adjusted mean difference –0.20, 97.5% confidence interval –0.81 to 0.42; p = 0.47). The mean average pain score was 4.3 (standard deviation 2.3) in the gabapentin group and 4.5 (standard deviation 2.2) in the placebo group (adjusted mean difference –0.18, 97.5% confidence interval –0.71 to 0.35; p = 0.45). No significant between-group differences were observed for any secondary outcome. A higher proportion of women experienced a serious adverse event in the gabapentin group than in the placebo group (10/153 vs. 3/153; p = 0.04). Dizziness, drowsiness and visual disturbances were more common in the gabapentin group than in the placebo group. In the mechanistic study, 45 participants had a baseline functional magnetic resonance imaging scan of their brain, with 25 participants returning for a scan at the end of treatment. Gabapentin significantly decreased evoked activity in the anterior cingulate cortex and cuneus. Change in anterior cingulate cortex activity after treatment related to improvement on the pain interference scale, and baseline activation of this region predicted response to treatment. Conclusions: Gabapentin did not reduce pain and did not improve other outcomes compared with placebo over 16 weeks. Serious adverse effects were significantly higher in the gabapentin group than in the placebo group. Gabapentin reduces evoked activity in the anterior cingulate cortex, with changes of activity in this region tracking reported pain, and baseline activity predicting response to treatment. Limitations: Primary outcome data were unavailable in 62 and 60 women for the average and worst numerical rating scale pain scores, respectively. A sensitivity analysis using imputation methods did not change the result. Future work: Clinical trials to investigate other pharmacological interventions (monotherapy vs. combination therapy), physiotherapy and cognitive–behavioural therapy to treat women with chronic pelvic pain are needed. Trial registration: Current Controlled Trials ISRCTN77451762 and EudraCT 2014-005035-13. Funding: This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 7, No. 7. See the NIHR Journals Library website for further project information.

ABSTRACT Foetal bone retention is a rare cause of infertility. They act as barriers within the endometrial cavity like an intrauterine device. Nonspecific clinical symptoms such as abnormal uterine bleeding, pelvic pain, vaginal discharge and dysmenorrhea may be present in some patients. Here, the present author reports a case of a 31-year-old female who presented with secondary infertility and a history of recurrent brownish vaginal discharge following voluntary termination of pregnancy 16 years earlier. Ultrasonography was suggestive of bone retention and further evaluation with hysteroscopy confirmed the diagnosis. She had successful removal of bone fragments and she was pregnant 6 months post-removal of bone fragments.

Benign cystic mesothelioma is a rare tumor originated from mesenchymal cells of the abdominal and pelvic peritoneum. This rare tumor should be considered in the differential diagnosis of young women presenting with abdominal pain and a multicystic abdominal mass. Keywords: Benign cystic mesothelioma; pelvic pain; dispareunia

The article presents the pathogenesis aspects of dysmenorrhea based on the role of prostaglandin hyperproduction in the development of the disease. The presence of severe painful cramps in dysmenorrhea resulting in a temporary decline in labour productivity contributes to not only on a significant decrease in the patients’ quality of life, but also to economic costs. In this regard, seeking a solution to the dysmenorrhea therapy problem acquires not only medical, but also social significance. The use of nonsteroidal anti-inflammatory drugs (nimesulide) as a pathogenetically validated therapy for dysmenorrhea proves their efficiency and is a feasible option for therapy.

Postpartum Pubic Symphysis Diastasis (PPSD) refers to an abnormally wide gap between the two pubic bones following delivery. Being an uncommon condition, it presents with pain in pubic area and groin causing inability to stand, sit and walk. We report a case of pelvic diastasis in a 30-year-old G2P1L1 following normal vaginal delivery whose definitive diagnosis was made through frontal radiograph of the pelvis. We aim to stress upon timely suspicion of this under-diagnosed condition as it helps immensely in successful recovery of these patients failing which they end in chronic pain with gait abnormality which significantly hampers the quality of life and may require corrective surgery.

BACKGROUND AND OBJECTIVE: Pelvic pain is one of the most important symptoms of endometriosis. There is evidence that high blood flow to endometrioma is associated with more pelvic pain, but this has not been completely proven. Therefore, the present study was conducted to evaluate the relationship between uterine endometrial neovascularization and pelvic pain intensity. METHODS: In this cross-sectional study, 76 patients with ovarian endometrioma (based on the final diagnostic pathology) were divided into two groups of mild/moderate pelvic pain (VAS lower than 66) and severe pelvic pain (VAS 66 to 100) in terms of pelvic pain intensity (using the visual analog scale). Patients underwent transvaginal doppler ultrasound prior to surgery, and endometrial neovascularization, as well as resistive index (RI) and pulsatility index (PI) in the artery of the endometrioma cyst wall were measured and were compared between two groups of mild/moderate pelvic pain and severe pelvic pain. FINDINGS: Moderate and severe neovascularization (50%) in patients with severe pelvic pain was significantly higher than patients with mild/moderate pelvic pain (13%) (p=0.005). The mean RI in the group with severe pelvic pain (0.59±0.05) was lower than the mild/moderate group (0.66±0.06) (p

Chronic scrotal content pain remains one of the more challenging urological problems to manage. This is a frustrating disorder to diagnose and effectively treat for both the patient and clinician, as no universally accepted treatment guidelines exist. Many patients with this condition end up seeing physicians across many disciplines, further frustrating them. The pathogenesis is not clearly understood, and the treatment ultimately depends on the etiology of the problem. This article reviews the current understanding of chronic scrotal content pain, focusing on the diagnostic work-up and treatment options.

Purpose: We aim to evaluate the efficacy of pollen extract in association with vitamins in patients affected by chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and to evaluate the level of the pro-inflammatory mediators interleukin (IL)-6, IL-8, and IL-10. Materials and Methods: Patients diagnosed with CP/CPPS between January and December 2015 were enrolled in this study. Participants were randomly assigned to receive oral capsules of pollen extract and vitamins (group A) or bromelain (group B) for 3 months. At the enrolment time and 3 months after enrolment, all patients completed questionnaires (the National Institutes of Health Chronic Prostatitis Symptom Index [NIH-CPSI] and the Short Form-36 and underwent urological examinations and microbiological evaluation. Levels of IL-6, IL-8, and IL-10 were evaluated in seminal plasma. Results: Sixty-five male patients (mean age of 32.7±4.7 years) were analysed (group A, n=32; group B, n=33). At the follow-up examination, 24 of the 32 patients in group A showed a significant reduction in the NIH-CPSI total score compared with 8 of the 33 patients in the bromelain group (p＜0.001). Moreover, the mean level of IL-8 was significantly lower in the pollen extract and vitamins group when compared with the bromelain group (298 pg/mL vs. 736 pg/mL, respectively; p＜ 0.001). In group A we found a statistically significant reduction in the levels of IL-8 between enrolment and the follow-up visit (878 pg/mL vs. 298 pg/mL, respectively; p＜0.001). Conclusions: Treatment with pollen extract and vitamins improved the quality of life in CP/CPPS patients by reducing the levels of pro-inflammatory IL-8.

Abstract Objective Chronic scrotal pain (CSP) is a common and well recognized symptom of young males presenting to primary care units. Historically, CSP is defined as a testicular pain lasting for over 3 months. However, its etiology and outcome are poorly understood and its management is largely empirical. This study was conducted to examine the frequency, spectrum of pathology and outcome of CSP among young adults. Results The medical records of 382,036 young males were reviewed for anamnestic information, physical findings, primary care physician decisions, and final outcome. CSP, defined as scrotal pain longer than 14 days, was recorded in 3084 patients (0.8%). The total number of primary physician’s visits due to this complaint was 16,222, with a mean of 5.3 visits per patient (range 1–37). Varicocele was the most common physical finding (54.1%). Other common findings were inguinal hernia (4.5%), genital infection (4.3%), hydrocele (4.2%) and referred pain (3.3%). 252 patients (8.2%) underwent surgical treatment but orchiectomy was not necessary in any patient. In 34.4% no specific etiology could be found. Neither malignant tumors nor testicular torsion were diagnosed in any patient. The prevalence of the diagnoses was similar between the different time groups—15–29 days, 30–59 days and more than 60 days. Considering the similar etiologies CSP over a wide spectrum of time we suggest defining CSP as testicular pain lasting longer than 14 days.

Herlyn-Werner-Wunderlich (HWW) syndrome is part of a spectrum of Müllerian duct anomalies that occur during embryonic development. The syndrome is characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. Only few cases of this disease were reported worldwide. We present a 23-year-old female patient with chronic pelvic pain for years. The patient was diagnosed with HWW syndrome with a history of hematocolpos and vaginoplasty at the age of 12. Five months later, she sought urgent medical care due to intense pain, and a clinical picture suggestive of peritoneal irritation. Clinical condition deteriorated and the patient underwent an exploratory laparotomy, which failed to identify anything to justify the abdominal pain. Uroculture and blood culture were negative. A magnetic resonance imaging showed a tube-shaped formations extending from the right retrovesical region to the mesogastrium corresponding to the persistence of the mesonephric duct, related to ipsilateral renal agenesis. The patient underwent laparoscopic procedure, identifying a right ureteric remnant blind ending, with distal and proximal obliteration, filled with purulent secretion, which was totally resected. This case differs from the other reported cases due to pelvic pain secondary to infection and abscess in ureteric remnant. We did not find any case with similar clinical presentation.

Background Common prenatal ailments negatively impact performance of activities of daily living and it has been proposed that the use of dynamic elastomeric fabric orthoses, more commonly referred to as compression garments, during pregnancy might aid in the reduction of pain from these ailments, allowing for improved functional capacity. However, the effectiveness of such garments in this context has not been established. This study aims to determine whether compression shorts are effective and thermally safe in the prevention and management of prenatal pelvic and low back pain (LBP). Method A prospective quasi-experimental controlled study using parallel groups without random allocation was conducted, involving 55 childbearing women (gestational weeks 16–31) recruited from hospital and community-based maternity care providers. The compression shorts group (SG) wore SRC Pregnancy Shorts in addition to receiving usual care. The comparison group (CG) received usual care alone. Primary outcome measures—Numeric Pain Rating Scale (NPRS) and Roland Morris Disability Questionnaire (RMDQ) and secondary measures Pelvic Floor Impact Questionnaire - 7 (PFIQ-7) and SF-36 Short Form Health Survey—were assessed fortnightly over 6-weeks for both groups. The compression SG self-assessed daily their body temperatures to monitor thermal impact. Data analysis involved descriptive analyses of the primary and secondary outcome measures scores by group and time-point, and multivariable linear regressions to assess between-group differences in change scores at 6-weeks from baseline while controlling for baseline factors. Results After controlling for baseline scores, gestational weeks and parity, statistically significant differences in NPRS and RMDQ change scores between groups were in favour of the compression SG. At 6-weeks, mean (SD) NPRS change scores in the compression SG and CG were significantly different, at −0.38 (2.21) and 2.82 (2.68), respectively, p = 0.003. Mean (SD) RMDQ change scores in the compression SG and CG were also significantly different, at 0.46 (3.05) and 3.64 (3.32), respectively, p = 0.009. A total of 883 (99.7%) of the reported daily self-assessed body temperatures ranged between 35.4 and 38.0 °C when wearing the compression shorts. At 6-weeks, mean (SD) PFIQ-7 and SF-36 change scores in the compression SG and CG were not significantly different. Conclusion Compression shorts are effective and thermally safe for prenatal management of pelvic and LBP. Registration Trial registration was not required (Australian Government Department of Health Therapeutic Goods Administration (TGA), 2018).

Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ with ischemia. It can affect females of all ages. Ovarian torsion occurs in around 2%–15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment.

The inflammatory chronic abacterial prostatis/chronic pelvic pain syndrome accounts for 60-65% of all cases of chronic prostatitis. The etiology of the chronic abacterial prostatis/chronic pelvic pain syndrome remains unstudied to the full. The major objective of clinical study is to rule out possible organic urologic diseases. The inflammatory chronic abacterial prostatis/ chronic pelvic pain syndrome is characterized by the inflammatory reaction in the prostate secretion in absence of bacteria in the diagnostics titer in the urine and the prostate secretion. Cyclogenase-2 inhibitors reduce the content of prostaglandins in the sperm and urine, pain sensation and edema of the prostate gland. Use of nimesulide in patients of this category allows removing pelvic pains, increasing blood flow in the prostate gland at low percentage of adverse events.