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Background: Persistent pelvic pain (PPP) is a complex and often debilitating condition. While widely accepted to be multifactorial in nature, the precise aetiology of PPP remains elusive. In many cases, women who undergo laparoscopy for PPP will have no visible pathology identified (a 'negative' laparoscopy). Currently, there are no consensus guidelines which outline the recommended management following a negative laparoscopy, and the woman's experiences and outcomes are not widely known. Aims: This review aims to identify and summarise the literature surrounding the experiences of women with PPP who have a negative laparoscopy; specifically, their outcomes of pain, quality of life (QoL), satisfaction with care, and their overall management. Materials and Methods: A systematic search of the electronic databases Ovid Medline, PubMed and Embase was performed. Studies in English exploring the outcomes of women with PPP following a negative laparoscopy were included. Results: Four studies consisting of a total of 200 women were included. Results were inconsistent. Three studies concluded that the majority of women with PPP had persistent pain following a negative laparoscopy. A single study found that pain significantly improved after negative laparoscopy. QoL outcomes varied, with two studies reporting a positive impact and two studies reporting a deleterious impact on QoL following a negative laparoscopy. Conclusions: The impact on pain outcomes and QoL following a laparoscopy that does not diagnose pathology remains unknown, and the available evidence is insufficient to guide evidence‐based practice. This review highlights a significant gap in our understanding of surgical management for PPP. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the anti-inflammatory and antioxidative effects of extracorporeal shockwave therapy (ESWT) on prostatitis and explore the mechanism of alleviating pain. Materials and Methods: For in vitro testing, RWPE-1 cells were randomly divided into 5 groups: (1) RWPE-1 group (normal control), (2) LPS group (lipopolysaccharide inducing inflammation), (3) 0.1ESWT group (treated by 0.1 mJ/mm energy level), (4) 0.2ESWT group (treated by 0.2 mJ/mm energy level), and (5) 0.3ESWT group (treated by 0.3 mJ/mm energy level). After ESWT was administered, cells and supernatant were collected for ELISA and western blot. For in vivo testing, SpragueDawley male rats were randomly divided into 3 groups: (1) normal group, (2) prostatitis group, and (3) ESWT group (n=12 for each). Prostatitis was induced by 17 beta-estradiol and dihydrotestosterone (DHT) administration. Four weeks after ESWT, the pain index was assessed for all groups and prostate tissues were collected for immunohistochemistry, immunofluorescence, apoptosis analysis and, western blot. Results: Our in vitro studies showed that the optimal energy flux density of ESWT was 0.2 mJ/mm . In vivo, ESWT ameliorated discomfort in rats with prostatitis and inflammation symptoms were improved. Compared to normal rats, overexpressed NLRP3 inflammasomes triggered apoptosis in rats with prostatitis and this was improved by ESWT. TLR4-NFκB pathway was overactive after experimental prostatitis, compared to normal and ESWT groups, and prostatitis induced alterations in BAX/ BAK pathway were inhibited by ESWT. Conclusions: ESWT improved CP/CPPS by reducing NLRP3 inflammasome and ameliorated apoptosis via inhibiting BAX/ BAK pathway in a rat model. TLR4 may play a key role in bonding NLRP3 inflammasome and BAX/BAK pathways. ESWT might be a promising approach for the treatment of CP/CPPS. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain in the female patient is often debilitating and can arise from a variety of sources, often with multiple etiologies. Difficulties managing these disorders parallel the difficulties in establishing a specific diagnosis for them. A focused and detailed history and a physical examination are often most helpful, categorizing pain signs and symptoms and suggesting an organ system that is not in homeostasis. Diagnostic laboratory testing and imaging are often of limited value. Initial treatment focuses on identification of the specific causes or sources of this pelvic pain. Oral analgesics, physical and psychologic treatments, interventional procedures, and injections have the potential to be both diagnostic and therapeutic for patients. Surgical management is often maintained as a last-line treatment option and may not necessarily enhance diagnostic evaluation or add pain relief. (J GYNECOL SURG 39:257) [ABSTRACT FROM AUTHOR]

Pelvic venous disorder (PeVD) is a term that encompasses all the interrelated causes of chronic pelvic pain (CPP) and perineal/lower extremity varicose veins of pelvic venous origin historically known as nutcracker syndrome, pelvic congestion syndrome, and May-Thurner syndrome, resulting in a more precise diagnosis that accounts for the underlying pathophysiology and anatomy. PeVD manifests as CPP with associated vulvar and lower-extremity varicosities, left flank pain and hematuria, and lower extremity pain and swelling secondary to obstruction or reflux in the left renal, ovarian, or iliac veins. This article will focus specifically on the most current nomenclature, evaluation, and management of CPP of venous origin. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain (CPP) for a long time remains one of the important medical and social problems due to the variability of clinical manifestations, negative impact on reproductive health and quality of patient’s life. Epidemiological studies indicate that CPP occurs in 15-20% of women of reproductive age. According to many authors, diagnosis and treatment of CPP is not an easy task due to unclear diagnostic criteria, variety of symptoms, insufficient diagnostic tools, etc. The objective: to analyze the diagnostic and therapeutic measures of women with pelvic pain syndrome in routine clinical practice. Materials and methods. A retrospective study of the medical patient’s cards of 557 women of reproductive age (19–49 years old) who were consulted by a gynecologist for CPP was conducted. Results. A significant prevalence of pelvic pain syndrome in patients under 30 years of age (51.2%) was revealed. In 290 women with complaints only for CPP, in 15.9% of cases, in the absence of gynecological pathology, were diagnosed the following pathologies: interstitial cystitis (19.6%), diverticulitis and dolichosigma (17.4%), irritable bowel syndrome (23.9%), myofascial pain (15.2%), pathology of the lumbosacral spine (10.9%). In the same group of women the following gynecological pathologies were found: malformations of the genitourinary system (3.3%), anomalies of the development of the uterus (9.3%), endometriosis (24.2%), adenomyosis (8.8%), leiomyoma of theuterus (8.4%), combined proliferative benign diseases of the genitals (14.9%), pelvic inflammatory diseases (7.9%), pelvic adhesive process (9.8%), pelvic floor dysfunction (13.5%). The diagnosis of CPP was established in 10.0% of women in the absence of gynecological and non-gynecological pathology. Conclusions. Identifying the CPP reasons in women is a difficult diagnostic process, as it can be caused by the presence of endometriosis, combined proliferative benign diseases of the genital organs, anomalies of genitourinary system, adenomyosis, pelvic inflammatory diseases, pelvic adhesions, pelvic floor dysfunction, venocongestion. CPP in women is often a result of non-gynecological pathology or a combination of such with gynecological diseases, which determines the need for an interdisciplinary approach to both diagnosis and treatment of such patients. In routine clinical practice, not enough attention is paid to determine the intensity and characteristics of the pain syndrome, which is often combined with late referral of patients for examination. In more than half of the analyzed cases (51.5%), the reason for women’s referral for examination is not pelvic pain syndrome as such, but a pathology that could be related to or a consequence of diseases causing CPP (abnormal uterine bleeding, infertility, etc.). [ABSTRACT FROM AUTHOR]

Introduction: Growing evidence suggests that acupuncture can improve pelvic pain in women with endometriosis. The treatments used in research vary considerably. It remains unclear which treatment could be recommended for clinical practice. This research project aimed at clarifying how acupuncture could be used when treating this condition. Methods: This research comprised two phases: a systematized literature review to extract acupuncture treatment details from published research, and an e-Delphi study to gain knowledge about details as used by expert acupuncturists. Review: Four databases were searched using predefined eligibility criteria. Data were extracted based on the STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) criteria. e-Delphi: Purposeful sampling from colleagues and international experts. An open first round gathered qualitative data, analyzed with the Framework method. In rounds 2 and 3, experts rated statements to build group consensus, defined as a rating of ≥5 on a 7-point Likert scale by ≥70% of the experts. The strength of agreement was graded using the median score and interquartile range. Results from the literature review and the e-Delphi were compared using the STRICTA items. Results: The literature review (n = 29 unique studies) found a wide range of treatment details with little agreement. The e-Delphi of international experts (n = 20) resulted in agreement on 94 statements (such as key factors for effectiveness); disagreement on a further 29 (such as acupressure); and absence of consensus on 55 statements (such as the number of needle insertions). A comparison of the review and e-Delphi results found little agreement. Conclusions: Details of acupuncture treatment for endometriosis-related pelvic pain were presented. In the absence of acupuncture guidelines for this condition, the researchers of this e-Delphi recommend using the treatment details on which experts agreed as guidance for good practice. The effectiveness of these guidelines should be evaluated in future research. Study registration: Deutsches Register Klinischer Studien, DRKS00022215, June 30, 2020, retrospectively registered. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain syndrome is a complex process and mostly includes several organ systems. The gynecologic aspects of chronic pelvic pain syndrome can be divided into four distinct components: intra-abdominal pain, vaginal pain, pelvic floor pain, and sexual pain. The сommon gynecological causes of chronic pelvic pain are endometriosis, adenomyosis, vulvovaginal pain syndrome, pelvic floor muscle dysfunction, and sexual pain in women. This article describes the gynecological examination of patients with chronic pelvic pain and discusses the most common gynecological diseases and methods of their treatment. A review of the literature was conducted, which included the recommendations of the International Society for Urinary Incontinence, the European Association of Urology, and the International Association for the Study of Pain. Gynecological examination of patients with chronic pelvic pain begins with a history taking and physical examination. Laboratory tests, imaging examinations, and diagnostic procedures can be used additional methods to make a more accurate diagnosis. Treatment methods include physical therapy, medication, trigger point injections, and surgery. Because the diagnosis and treatment of chronic pelvic pain can be complex, it is important that physicians know the various aspects of this syndrome to be able to provide appropriate care for patients. Detailed history taking and physical examination for identifying the cause of the pain can help to determine the next step in evaluation and treatment. However, gynecological pathology is one of many, but not the only, that can be associated with chronic pelvic pain. This, it is necessary to perform a multimodal and multidisciplinary approach in the management of patients with chronic pelvic pain. [ABSTRACT FROM AUTHOR]

The article discusses differential diagnosis for posterior gluteal/hip pain is broad because of the overlap of structures and possible proximal sources with radiation to the area. Topics include bilateral lower limbs. She had pain with hip adduction, external rotation, and was tender to palpation over the ischiofemoral space.

Objective: To characterize Urologic Chronic Pelvic Pain Syndrome (UCPPS) pain and urinary symptom trajectories with up to 9 years of follow-up and evaluate whether initial 1-year trajectories are associated with longer-term changes.Materials and Methods: Data were analyzed from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Network's prospective observational protocols including the Epidemiology and Phenotyping Study (EPS; baseline to Year 1), EPS Extension (EXT; Years 1-5), and Symptom Patterns Study (SPS: 3-year study; Years 3-9). Adults with Interstitial Cystitis/Bladder Pain Syndrome or Chronic Prostatitis/Chronic Pelvic Pain Syndrome provided patient-reported assessments biweekly (EPS), every 4 months (EXT), or quarterly (SPS). Primary outcomes were composite pain (0-28) and urinary (0-25) severity scores. Multi-phase mixed effects models estimated outcomes over time, adjusted for baseline severity and stratified by EPS symptom trajectory.Results: 163 participants (52% women; mean ± SD age 46.4 ± 16.1 years) completed EPS and enrolled in EXT; 67 also enrolled in SPS. Median follow-up was 4.6 years (range 1.3-9.0). After 1 year: 27.6%, 44.8% and 27.6% and 27.0%, 38.0% and 35.0% were improved, stable or worse in pain and urinary symptom severity, respectively. On average, pain and urinary symptom scores did not change further during EXT and SPS periods.Conclusions: Women and men with UCPPS showed remarkable stability in pain and urinary symptom severity for up to 9 years, irrespective of their initial symptom trajectory, suggesting UCPPS is a chronic condition with stable symptoms over multiple years of follow-up. [ABSTRACT FROM AUTHOR]

Background: Pelvic girdle pain (PGP) is a type of pregnancy-related lumbopelvic pain. This study aimed to examine the prevalence, severity, and factors associated with postpartum PGP in a selected group of postpartum women in Poland.Methods: This was a prospective, observational study. In phase 1, 411 women were recruited 24-72 h postpartum. The prevalence of PGP was assessed by a physiotherapist using a series of dedicated tests. Pelvic floor muscle function and presence of diastasis recti were assessed via palpation examination. Age, education, parity, mode of delivery, infant body mass, body mass gain during pregnancy, the use of anesthesia during delivery and were recorded. In a phase 2, 6 weeks postpartum, the prevalence of PGP and its severity were assessed via a self-report.Results: In phase 1 (shortly postpartum), PGP was diagnosed in 9% (n = 37) of women. In phase 2 (6 weeks postpartum), PGP was reported by 15.70% of women (n = 42). The univariable analyses showed a higher likelihood of PGP shortly postpartum in women who declared PGP during pregnancy (OR 14.67, 95% CI 4.43-48.61) and among women with abdominal midline doming (OR 2.05, 95% CI 1.04-4.06). The multivariable regression analysis showed significant associations in women with increased age (OR 1.12, 95% CI 1.01-1.21) and declaring PGP during pregnancy (OR 14.83, 95% CI 4.34-48.72).Conclusion: Although the prevalence of postpartum PGP among women in Poland is lower than reported in other countries, it is experienced by almost every tenth women shortly postpartum and every sixth can report similar symptoms 6 weeks later. Age, PGP during pregnancy and abdominal midline doming were associated with experiencing PGP shortly postpartum. [ABSTRACT FROM AUTHOR]

Imperforate hymen is a cause of pelvic pain in adolescent females who have not reached menarche. There is scant literature on adolescent gynecology for the emergency provider. The literature about the adolescent with imperforate hymen is usually in a case report format. A patient with imperforate hymen is presented in this article. The purpose of this case study was to review the urgent presentation of imperforate hymen. Advanced emergency providers need to consider the possibility of imperforate hymen in the list of differential diagnoses for pelvic pain in adolescent females. Prompt diagnosis of imperforate hymen allows the emergency provider to initiate gynecological referral for definitive treatment. [ABSTRACT FROM AUTHOR]

Background: Evidence indicates that women with chronic pelvic pain (CPP) frequently experience negative patient-provider interactions (PPIs) that contribute to diagnosis delays, comorbidity with other conditions, and psychological and socioenvironmental complications. However, specific components of PPIs and their effect on diagnosis and care for women with CPP are poorly understood. Objectives: To determine the themes and patterns of PPIs affecting health care experiences for women with CPP. Study Design: Phenomenological qualitative study using semistructured, in-depth interviews. Methods: Thirteen women, aged 18 to 65 years, with CPP for a minimum of 6 months participated. Transcribed data from standardized, in-person interviews were analyzed with qualitative analysis software to manually code thematic nodes. For interpretive phenomenological analysis, an open and inductive approach with constant comparison was used. Results: Emergent themes were consequences and effects of PPIs on health care. The described consequences of these interactions for women with CPP included increased emotional toll and decreased trust. The effects of these interactions on diagnosis and care influenced health care experiences related to information and resources provided, diagnosis, medical error (eg, misdiagnosis and inappropriate treatment), and plan (eg, treatment, management, and referral). Conclusion: Results of the current analysis demonstrated certain components of PPIs adversely affected health care experiences for women with CPP by contributing to the emotional burden of living with CPP, interfering with communication and trust between patients and providers, and impeding proper diagnosis and treatment for these patients. [ABSTRACT FROM AUTHOR]

Pelvic girdle pain (PGP) is an important postpartum musculoskeletal problem in women and negatively affects pain, quality of life, perceived occupational performance, and satisfaction. In this report, we present the effectiveness of a client-centered intervention consisting of 45-min sessions, 4 days a week for 4 weeks, on pain, quality of life, perceived occupational performance, and satisfaction level in a patient with PGP. We determined that the client-centered intervention positively affected the perceived activity performance and satisfaction level in her daily life. In conclusion, client-centered intervention in women with PGP may be an important solution in ensuring compliance with activities of daily living, reducing pain, and increasing functional levels. [ABSTRACT FROM AUTHOR]

The objective: to study the significance of the levels of tumor necrosis factor α (TNF-α) and brain-derived neurotrophic factor (BDNF) in the blood of patients with chronic pelvic pain syndrome (CPPS). Materials and methods. The examined cohort included 150 patients with CPPS, who according to the clinical manifestations were divided into groups A and B: group A (n=74) included the patients with CPPS and suspicion of endometriosis and group B (n=76) – patients with CPPS and suspicion for benign proliferative diseases of reproductive organs. The control group included healthy women (n=50). Serum TNF-α and plasma BDNF levels were investigated by enzyme-linked immunosorbent assay. A visual analog scale (VAS) was used to study pain intensity. Results. The mean concentration of TNF-α in blood serum was significantly higher in women of group A (10.76±0.55 pg/ml) and group B (14.65±0.95 pg/ml) than in the control one (5.02±0.31 pg/ml). The mean concentration of BDNF in blood plasma was higher in women in group A (1473.88±53.02 pg/ml; p<0.001) and in group B (1711.65±66.79 pg/ml; p<0.01) compared to the control group (1082.91±56.24 pg/ml). The levels of TNF-α (p<0.001) and BDNF (p<0.01) are significantly higher in the blood of patients with CPPS and suspected combined benign proliferative diseases of the reproductive organs (group B) than in patients with CPPS and suspected endometriosis (group A). Between the intensity of pain according to VAS and the level of TNF-α in the blood a direct correlation of medium strength was found (r=0.56) in patients of group A and group B (r=0.62). A strong direct correlation between the intensity of pain according to VAS and the level of BDNF in the blood was established in women of group A (r=0.74) and group B (r=0.83).Between the disease duration and the level of TNF-α in the blood of patients a direct correlation of medium strength (r=0.65) in group A and a direct strong correlation (r=0.72) in group B were determined. Between the duration of the disease and the level of BDNF in the blood of patients a direct correlation of average strength was also establishe, a strong correlation (r=0.67) was determined in group A and a direct strong correlation (r=0.78) – group B. Conclusions. Women with CPPS and suspicion of benign proliferative diseases of the organs of the reproductive system have significantly higher concentrations of TNF-α and BDNF in the blood compared to healthy women (p<0.001). The existence of a direct correlation between the intensity of pain, the duration of the disease, and the levels of TNF-α and BDNF suggest the possibility of their use as objective markers of the effectiveness of diagnostic and therapeutic measures. [ABSTRACT FROM AUTHOR]

Objective: To provide evidence regarding the significance of painful symptoms among women suffering from infertility., Design: An observational retrospective cross-sectional study., Settings: University hospital-based research center., Patients: Infertile patients aged between 18 and 42 years surgically explored for benign gynecological conditions between 01-2004 and 12-2020., Interventions: For each patient, a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon in the month preceding the surgery. Preoperative assessment the pain symptoms was recorded. Pain intensity was assessed with a 10cm visual analog scale (VAS). The pain was considered to be severe when the VAS score was ≥ 7., Measurements and Main Results: Surgery was performed in 839 infertile women. 451 women had severe pelvic pain. Infertile patients with severe pain significantly more often had endometriosis (67.4% versus 30.7% respectively; p <.001) than infertile women without severe pelvic pain, and especially deep infiltrating lesions (43.2% versus 8.5% respectively; p <.001). Moreover, these women more often had intestinal endometriosis lesions (28.4% vs 1.8%; p <.001). After multivariable regression analysis, the presence of endometriosis, irrespective of the phenotype (superficial lesions (OR1.84 [1.19-2.86] and/or ovarian endometrioma OR 2.79 [1.70-4.59] and/or deep infiltrating endometriosis OR 4.49 [2.69-7.51]), and the presence of at least one intestine endometriosis lesion (OR6.49 [2.69-7.51] were significantly associated with severe pelvic pain., Conclusion: Severe pelvic pain is significantly associated with endometriosis and especially deep infiltrating lesions in a population of infertile women. These results demonstrate the importance of thorough questioning regarding pelvic pain symptoms during the initial management of infertile patients., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Aims: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) prevalence varies from 8.4% to 25% of the male population and is associated with diminished health-related quality of life. Managing CP/CPPS remains challenging and there is not any common option to treat all patients effectively because of the complex disease nature. The currently available data for the extracorporeal shockwave therapy (eSWT) effect on pain relief and well-being were analyzed in the present study., Methods: We adhered to PRISMA 2022 guidelines for reporting the quantitative and qualitative data synthesis. A literature search was conducted in March 2023 using PubMed/Medline, Scopus, and Google Scholar. Randomized prospective studies of eSWT alone or eSWT plus conventional medicinal treatment were included. The risk of bias was estimated using the RoB 2.0. Primary outcomes were self-reported scores, including the NIH-CPSI questionnaire and VAS, at 1 month or 2, 3, and 6, months follow-up., Results: The CP/CPPS patients who receive eSWT have more pronounced pain relief and improvement of other subjective NIH-CPSI scores compared with control groups that received placebo or medication therapy. The effect of eSWT seems to be long-lasting and was confirmed in the 6-month follow-up (p < 0.01)., Conclusions: Based on the meta-analysis of accessible studies, we receive the equivalence eSWT applicability for the CP/CPPS treatment and can be offered to patients because of its noninvasiveness, high level of safety, and successful clinical results demonstrated in this analysis., (© 2024 Wiley Periodicals LLC.)

Objective: There is increasing recognition that health systems need to measure and improve the value of patient care by measuring outcomes. Chronic pelvic pain secondary to pelvic venous insufficiency can have a significant impact on the quality of life (QOL) of women affected. Despite growing recognition, pelvic venous disorders (PeVDs), an important cause of chronic pelvic pain, remain underdiagnosed. Developing a core outcome set (COS) for benchmarking care delivery enhances the standardization of care. However, there is no consensus regarding a standardized minimum set of outcomes for PeVD. We aimed to generate a list of outcomes reported in previous PeVD treatment studies to lay the foundation for developing a COS for PeVD., Methods: This scoping review was undertaken according to the PRISMA-ScR guidelines. Initially, screening, full-text review and extraction was conducted on studies published between 2018 and 2023. Subsequently, the search was expanded using 1-year intervals, until, over a 1-year interval, no new outcomes were recorded. Closely related outcomes were classified into domains, and domains into three core areas: disease-specific, treatment-related, and QOL-related outcomes., Results: Of the 1579 records identified, 51 publications were included. From these studies, 108 different outcomes were identified. The median number of outcomes per study was 8 (interquartile range, 6-13). Closely related outcomes were organized into 42 outcome domains, which were then categorized into 3 core outcome areas; 47.6% (20/42) were disease specific, 35.7% (15/42) treatment related, and 16.7% (7/42) were QOL related. Of the 51 included studies, disease-specific outcomes were identified in 96.1% of the studies (49/51), treatment-related outcomes in 94.1% (48/51), and QOL outcomes in only 13.7% (7/51)., Conclusions: There was significant heterogeneity in outcomes reported in PeVD studies. Most PeVD treatment studies evaluated disease-specific and treatment-related outcomes of PeVD, but few reported outcomes that measured the impact on QOL. These findings will inform the next steps in developing a COS for PeVD., Competing Interests: Disclosures None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Pelvic venous disorders (PeVD) encompass a variety of conditions linked to chronic pelvic pain in women. However, PeVD remain underdiagnosed due to the absence of universally accepted diagnostic criteria. The complexity of PeVD classifications across specialties leads to delays in treatment. This scoping review aims to fill a gap in PeVD diagnosis and management by identifying all existing scoring or grading systems to lay the foundation for standardized clinical scoring tools for PeVD., Methods: This scoping review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews. Online databases were searched up to April 2023. Studies implementing a scoring or grading system for patients with confirmed or suspected PeVD were included. Scores or grading systems were classified into four main categories based on their use in the study: screening, diagnosis, measure of disease severity, and measure of response to treatment., Results: Of the 2976 unique records identified, 82 were reviewed in full, and 20 were included in this study. The publication dates ranged from 1984 to 2023 (median, 2018; interquartile range, 2003-2022). A total of 21 scores and/or grading systems were identified. Of these 21 scores, 10 (47.6%) were clinical scores, and 10 (47.6%) were scores based on radiological findings; one study included a score that used both clinical and radiological findings. The identified scores were used in various settings. Of the 21 scores, 2 (9.52%) were used for screening in a tertiary care setting; 3 (14.3%) were used to establish the PeVD diagnosis; 8 (38.1%) were used to assess disease severity; and 8 (38.1%) were used as measures of response to treatment. Of the eight scores assessing disease severity, four (50.0%) assessed the degree of dilatation of pelvic veins and four (50%) assessed the severity of reflux. Only three of the scores were validated., Conclusions: This scoping review identified a range of scoring and grading systems for PeVD. We note a lack of a validated scoring system, both clinical and radiological, for screening and assessment of disease severity. This is an important first step in developing validated disease-specific scoring systems for patient screening, appropriate referral, assessment of symptom severity, and assessment of the response to treatment., Competing Interests: Disclosures None., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the efficacy and safety of 24-week cyclic administration of estetrol (E4) (15 mg)/drospirenone (DRSP) (3 mg) in Japanese patients with endometriosis., Design: A 24-week, multicenter, randomized, double-blind, placebo-controlled, parallel-group study., Setting: Twenty-five study centers in Japan., Patient(s): A total of 162 Japanese women diagnosed with endometriosis., Intervention(s): Participants were randomly allocated to the E4/DRSP group or the placebo group. In the E4/DRSP group, participants were orally administered one tablet containing E4 (15 mg) and DRSP (3 mg) daily for 24 days, followed by one placebo tablet for 4 days for a hormone-free interval, constituting a 1-cycle regimen. One placebo tablet was administered once daily for 28 days to participants in the placebo group. The treatments were continued for six cycles (24 weeks) throughout the confirmatory period., Main Outcome Measure(s): Changes in visual analogue scale (VAS) scores for the most severe pelvic pain (lower abdominal and back pain) from baseline to six treatment cycles at the end of the confirmatory study period., Result(s): Estetrol/drospirenone showed changes in the mean VAS scores for the most severe pelvic pain (-33.2 mm) from baseline to the end of the 6-cycle treatment. The between-group difference was significant (-8.5 mm; 2-sided 95% confidence interval, -16.1 to -0.9 mm), showing superiority to placebo. The responder rates, ≥30% and ≥50% reductions in the VAS scores from baseline, were higher in the E4/DRSP group than in the placebo group: 53.2% vs. 29.6% and 36.4% vs. 12.3%. Objective gynecological findings (induration of the cul-de-sac, pelvic tenderness, and limited uterine mobility) were significantly improved by E4/DRSP treatment, and the proportions of stable and worsened participants were significantly lower than in the placebo group. Estetrol/drospirenone decreased the size of endometriomas and improved quality of life, on the basis of quality of life-related questionnaires and global impression scores. No safety concerns were observed with E4/DRSP treatment. Few differences were observed in the proportion of participants with hemostasis parameters outside the reference range between the E4/DRSP and placebo groups., Conclusion(s): Estetrol/drospirenone effectively treats endometriosis-associated pain and improves gynecological findings. Estetrol/drospirenone may be a safe, new option for endometriosis treatment with a potentially decreased risk of thromboembolic events., Clinical Trial Registration Number: jRCT2011210027., Competing Interests: Declaration of Interests T.H. reports a medical writing and clinical trial advisory fee payment on the basis of the medical expert contract from Fuji Pharma Co., Ltd., and case study meeting fee payment on the basis of the medical expert contracts and medical writing fees for other clinical trials other than this manuscript in accordance with the medical expert contract from Fuji Pharma Co., Ltd. T.K. reports a medical writing and clinical trial advisory fee payment on the basis of the medical expert contract from Fuji Pharma Co., Ltd. A.H. reports a medical writing and clinical trial advisory fee payment on the basis of clinical biostatistics expert contract from Fuji Pharma Co., Ltd., and clinical biostatistics educational seminar fee payment on the basis of clinical biostatistics expert contract from Fuji Pharma Co., Ltd. T.T. reports salary and article processing charges from Fuji Pharma Co., Ltd. M.N. reports salary and article processing charges from Fuji Pharma Co., Ltd.; and patent filed with regard to the improvement of cul-de-sac induration, pelvic tenderness, and uterine mobility in subjects with endometriosis complicated by adenomyosis (Fuji Pharma Co., Ltd., and Mithra Pharmaceuticals). T.M. reports salary and article processing charges from Fuji Pharma Co., Ltd. M.H. reports salary and article processing charges from Fuji Pharma Co., Ltd.; and patent filed with regard to the improvement of cul-de-sac induration, pelvic tenderness, and uterine mobility in subjects with endometriosis complicated by adenomyosis (Fuji Pharma Co., Ltd., and Mithra Pharmaceuticals). J.-M.F. is a member of the Board at Mithra Pharmaceuticals and received financial support for the supervision of this study and consulting fees. Y.O. reports a medical writing and clinical trial advisory fee payment on the basis of the medical expert contract from Fuji Pharma Co., Ltd., and case study meeting fee payment on the basis of the medical expert contracts from Fuji Pharma Co., Ltd., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Endometriosis is a common chronic gynecological condition characterized by the presence of endometrial tissue outside the uterine cavity, leading to chronic inflammation, pelvic nodules and masses, pelvic pain, and infertility. Acupuncture has been shown to improve pain associated with endometriosis by modulating abnormal levels of prostaglandins, β-endorphins, dynorphins, electrolytes, and substance P. This review aims to evaluate the clinical efficacy of acupuncture in treating endometriosis, specifically focusing on its efficacy in relieving pain associated with endometriosis., Methods: A comprehensive search was conducted in eight databases (PubMed, EMBASE, Cochrane, Web of Science, China National Knowledge Infrastructure (CNKI), the China Biology Medicine (CBM), Wanfang, and Weipu database) to identify randomized controlled trials (RCTs) published from database inception to December 16, 2022, which investigated the use of acupuncture for endometriosis-related pain. Two researchers independently screened articles, extracted data, and assessed methodological quality using the Cochrane Collaboration's risk of bias tool. Meta-analysis was performed using Stata statistical software., Results: A total of 1991 articles were identified, and ultimately, 14 studies involving 793 patients (387 in the acupuncture group and 359 in the control group) were included. The control interventions in the included studies included placebo, traditional Chinese medicine (TCM), and Western medicine treatments. Meta-analysis results showed that compared to the control group, acupuncture treatment for pain associated with endometriosis demonstrated significant reductions in pain severity [SMD = - 1.10, 95% CI (- 1.45, - 0.75), P < 0.001], improved response rate [RR = 1.25, 95% CI (1.09, 1.44), P = 0.02], and decreased serum CA-125 levels [SMD = - 0.62, 95% CI (- 1.15, - 0.08), P = 0.024]. Furthermore, subgroup analysis revealed that electroacupuncture and auricular acupuncture were superior to the control group in reducing pain severity, while auricular acupuncture and warm needling showed greater clinical efficacy compared to the control group. However, there were no significant differences between electroacupuncture or fire needling and the control group in terms of pain relief. The findings suggest that acupuncture is effective in improving pain associated with endometriosis., Conclusions: In conclusion, acupuncture is effective in alleviating dysmenorrhea and pelvic pain associated with endometriosis, reducing serum CA-125 levels, decreasing the size of nodules, improving patients' quality of life, and lowering the recurrence rate. However, it should be noted that the current evidence is limited by the design and quality flaws of the original studies, as well as a lack of research specifically focusing on subtypes of acupuncture. Therefore, caution should be exercised when interpreting the results., (© 2024. The Author(s).)

Objective: To evaluate the effect of relugolix combination therapy (relugolix CT; 40 mg relugolix, 1 mg estradiol, and 0.5 mg norethisterone acetate) for up to 2 years in the SPIRIT long-term extension study on functioning and health-related quality of life (QoL), using the Endometriosis Health Profile (EHP)-30 questionnaire, and assess how changes in QoL domains correlated with improvements in dysmenorrhea as well as nonmenstrual pelvic pain (NMPP)., Design: Long-term extension study of the SPIRIT phase 3 trials., Setting: Clinics and University Hospitals., Patient(s): Premenopausal women with moderate-to-severe endometriosis pain who previously completed the randomized SPIRIT trials were eligible to enroll in an 80-week long-term extension where all women received relugolix CT., Intervention(s): Relugolix CT (relugolix 40 mg, estradiol 1 mg, and norethindrone acetate 0.5 mg)., Main Outcome Measure(s): Least squares (LS) mean changes in the EHP-30 domain and total scores from baseline (pivotal) were analyzed using a mixed-effects model. Results up to 104 weeks are reported by a pivotal trial treatment group with a focus on the relugolix CT group (i.e., relugolix CT or placebo for 24 weeks, or delayed relugolix CT [relugolix 40 mg monotherapy for 12 weeks, followed by relugolix CT for 12 weeks]). In addition, the relationships between changes in dysmenorrhea and NMPP as well as changes in EHP-30 scores were assessed., Result(s): In the 277 women treated with relugolix CT, LS mean EHP-30 pain domain scores improved by 57.8% (LS mean change: -32.8; 95% CI: -35.5, -30.1), 66.4% (LS mean change: -37.7; 95% CI: -40.3, -35.0), and 72.2% (LS mean change: -41.3; 95% CI: -43.9, -38.7) at weeks 24, 52, and 104, respectively. The proportions of women with clinically meaningful improvement in the EHP-30 pain domain were 75.9%, 83.6%, and 88.6% at weeks 24, 52, and 104, respectively. Non-pain EHP-30 domain and total scores likewise improved. A positive correlation between changes in dysmenorrhea/NMPP and all EHP-30 domain scores was observed. Results were similar for the delayed relugolix CT and placebo → relugolix CT groups., Conclusion(s): Sustained reduction of endometriosis-associated pain with relugolix CT observed up to 104 weeks was accompanied by improvements in functioning and health-related QoL. These findings complement the results of the pivotal SPIRIT trials, which showed that relugolix combination therapy significantly reduced dysmenorrhea, NMPP, and dyspareunia vs. placebo in premenopausal women with endometriosis-associated pain., Clinical Trial Registration Number: Registration/clinicaltrials.gov identifier: SPIRIT Extension Study (NCT03654274)., Competing Interests: Declaration of Interests S.A. reports personal fees from Myovant Sciences, Bayer, Organon, and UpToDate. M.S.A has nothing to disclose. G.R. has nothing to disclose. K.W. has nothing to disclose. Y.Z. is an employee of Sumitomo Pharma. J.P. is an employee of Sumitomo Pharma. E.H. is an employee of Sumitomo Pharma. G.S. is an employee of Sumitomo Pharma. C.M.B. reports fees from Myovant, grants from Bayer Healthcare, fees from ObsEva all of which went to the University of Oxford, and Chair of ESHRE Endometriosis Guideline Group. The authors did not receive compensation for manuscript writing, review, and revision., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Study Objective: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is characterized by the congenital absence of the uterus and vagina, sometimes with associated extragenital anomalies. Currently, there is limited literature on pelvic pain and comorbid pain syndromes in people with MRKH. The aims of this scoping review were to summarize existing literature on pelvic and generalized persistent pain syndromes associated with MRKH and to identify knowledge gaps for further research into this field., Methods: This scoping review followed the Joanna Briggs Institute framework. The population of interest was patients with a diagnosis of MRKH. MEDLINE, CINAHL, Scopus, Cochrane, Embase, and Emcare databases were searched. Articles that did not meet the inclusion criteria or critical appraisal standards were excluded. The resultant articles were reviewed by 2 independent researchers, and a third was used in cases of disagreement. A descriptive analytical method was used for data analysis., Results: We screened 3348 articles for eligibility. Of these, 39 articles, which described 1353 cases of MRKH, met the criteria. Four studies described baseline pelvic pain in MRKH, 19 described acute presentations, and 13 described postintervention pain levels., Conclusion: Despite the paucity of research, this review found that cyclic pelvic pain was mostly present in women with uterine remnants, whereas pelvic pain in those without remnants was poorly understood. There were no studies exploring generalized persistent pain syndromes in MRKH. Further cross-sectional studies are needed to elucidate the prevalence and levels of pain syndromes in MRKH., Competing Interests: Conflicts of interest RUG, CP, and IW have no potential conflicts to disclose. SRG is a consultant obstetrician and gynecologist and pain medicine specialist at The Royal Children's Hospital, Melbourne. ND is a consultant obstetrician and gynecologist at Cairns Hospital., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)

Background: Fecal incontinence, constipation, and pelvic pain are common pelvic floor symptoms (PFS), and frequently coexist with lower urinary tract symptoms (LUTS). However, their association with the longitudinal trajectory of LUTS have not been well described. Our objective was to investigate the association between PFS and the course of LUTS in community-dwelling men and women., Methods: Men and women aged ≥16 years were invited to participate in a prospective observational cohort study. At baseline, and after 12 and 24 months, participants filled in the International Consultation on Incontinence Modular Questionnaire (ICIQ-MLUTS and ICIQ-FLUTS) for men and women respectively, the Wexner incontinence and constipation scale, and a questionnaire on pelvic pain. Generalized estimating equations were used to examine the association between change scores in defecation problems and pelvic pain, and LUTS change scores., Results: A total of 694 men and 997 women gave informed consent, with 417 men and 566 women included in the analysis. The mean age was 63.2 ± 12.7 years for men and 58.6 ± 14.8 years for women. The study showed minor changes in LUTS scores over the 0-12 and 12-24-month periods. Generalized estimating equations revealed positive associations between changes in constipation and fecal incontinence and LUTS changes in both sexes. For instance, a one-point increase in Wexner constipation score was associated with 0.376 (0.165, 0.587) points higher LUTS change in men and 0.223 (0.109, 0.336) points in women during the 0-12-month follow-up. However, associations between changes in pain and LUTS scores varied across sexes and time periods., Conclusions: We observed minor changes in LUTS over time and weak associations between PFS and LUTS that sometimes differed between males and females, emphasizing the need for sex-specific considerations. These insights can provide valuable guidance for the development of targeted prevention trials, ultimately aiming to enhance overall pelvic health and patient well-being., (© 2024 The Author(s). Neurourology and Urodynamics published by Wiley Periodicals LLC.)

Background: Urologic chronic pelvic pain syndrome (UCPPS) encompasses several common, costly, diagnoses including interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome that are poorly understood and inadequately treated with conventional medical therapies. Behavioral strategies, recommended as a first-line treatment for managing symptoms, are largely inaccessible, time and labor intensive, and technically complex. The Easing Pelvic Pain Interventions Clinical Research Program (EPPIC) is a clinical trial examining the efficacy of low-intensity cognitive behavioral therapy (Minimal Contact CBT or MC-CBT) for UCPPS and its durability 3 and 6 months post treatment. Additional aims include characterizing the operative processes (e.g., cognitive distancing, context sensitivity, coping flexibility, repetitive negative thought) that drive MC-CBT-induced symptom relief and pre-treatment patient variables that moderate differential response.Methods: UCPPS patients (240) ages 18-70 years, any gender, ethnicity, and race, will be randomized to 4-session MC-CBT or a credible, non-specific education comparator (EDU) that controls for the generic effects from simply going to treatment. Efficacy assessments will be administered at pre-treatment, 2 weeks, and 3 and 6 months post treatment-week acute phase. A novel statistical approach applied to micro-analytic mediator assessment schedule will permit the specification of the most effective CBT component(s) that drive symptom relief.Discussion: Empirical validation of a low-intensity self-management therapy transdiagnostic in scope has the potential to improve the health of chronic pelvic pain patients refractory to medical therapies, reduce social and economic costs, conserve health care resources, as well as inform evidence-based practice guidelines. Identification of change mechanisms and moderators of treatment effects can provide proactive patient-treatment matching fundamental to goals of personalized medicine.Trial Registration: Clinicaltrials.gov NCT05127616. Registered on 9/19/21. [ABSTRACT FROM AUTHOR]

Abstract: Endometriosis is a chronic and debilitating condition, commonly characterised by chronic pelvic pain (CPP) and infertility. Chronic pelvic pain can be experienced across multiple pelvic organs, with comorbidities commonly effecting the bowel, bladder, and vagina. Despite research efforts into endometriosis pathophysiology, little is known about how endometriosis induces CPP, and as such, therapeutic interventions are lacking. The aim of this study was to characterise a syngeneic mouse model of endometriosis that mimics naturally occurring retrograde menstruation, thought to precede endometriosis development in patients, and determine whether these mice exhibit signs of CPP and altered behaviour. We characterised the development of endometriosis over 10 weeks following uterine tissue inoculation, measured in vivo and ex vivo hypersensitivity to mechanical stimuli across multiple visceral organs, and assessed alterations in animal spontaneous behaviour. We confirmed that inoculated uterine horn tissue formed into endometriosis lesions throughout the peritoneal cavity, with significant growth by 8 to 10 weeks post inoculation. Additionally, we found that mice with fully developed endometriosis displayed hypersensitivity evoked by (1) vaginal distension, (2) colorectal distension, (3) bladder distension, and (4) cutaneous thermal stimulation, compared to their sham counterparts. Moreover, endometriosis mice displayed alterations in spontaneous behaviour indicative of (5) altered bladder function and (6) anxiety. This model creates a foundation for mechanistical studies into the diffuse CPP associated with endometriosis and the development of targeted therapeutic interventions to improve the quality of life of women with endometriosis. [ABSTRACT FROM AUTHOR]

Purpose: There is no definite treatment method for chronic pelvic pain syndrome (CPPS). The purpose of this study was to compare and assess the effectiveness and safety of low-intensity extracorporeal shockwave therapy (Li-ESWT) versus placebo treatment in CPPS IIIb patients. Materials and Methods:Materials and Methods: Thirty participants with CPPS IIIb were included and randomized in this prospective, double-blind, placebo-controlled study. Li-ESWT was performed at the perineum without anesthesia once per week for 8 weeks. CPPS- related symptoms were evaluated using the National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI). Pain and erectile function were appraised using the Visual Analogue Scale (VAS) and International Index of Erectile Function- Erectile Function (IIEF-EF), respectively. The Global Efficacy Assessment Question (GEAQ) was also assessed. The parameters were evaluated immediately after the last Li-ESWT treatment and 4 weeks after Li-EWST treatment. Results:Results: Fifteen subjects each in the Li-ESWT and placebo groups completed this study. Amelioration of NIH-CPSI total, pain, and quality of life score in the Li-ESWT group was found compared to the placebo group (p=0.002, 0.02, 0.001, respec- tively). Improvement of the VAS score was observed in the Li-ESWT group (p=0.002). The differences in the GEAQ “Yes” re- sponses were also significant in the Li-ESWT group. No patients experienced side effects related to ESWT during therapeutic period or follow-up duration. Conclusions:Conclusions: Results indicated that Li-ESWT improved the NIH-CPSI score, pain, and the quality of life in CPPS IIIb patients. Li-ESWT could be an effective alternative treatment modality for CPPS IIIb. [ABSTRACT FROM AUTHOR]

Objective. Excessive pelvic floor muscle activity has been suggested as a source of pain in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Our objective was to determine whether men with CP/CPPS have changes in neural drive that impair their ability to relax pelvic floor muscles. Methods. We recruited 90 men (42 with CP/CPPS and 48 in the control group [without a history of pelvic pain]). All completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). We quantified the ability to relax by comparing resting pelvic floor muscle activity under 2 conditions: a "rest-only" condition, in which participants were instructed to simply relax, and a "rest-between-contraction" condition, in which participants were instructed to rest for several seconds between voluntary pelvic floor muscle contractions. We used multivariate mixed-effects models to examine differences between the groups (men with CP/CPPS and men in the control group) as well as the effect of 6 symptoms captured by the NIH-CPSI: pain related to location (perineum, testicles, penis, suprapubic region) and activity (urination, ejaculation). Results. Men with CP/CPPS were significantly different from men in the control group; men with CP/CPPS had higher resting activity in the rest-between-contraction condition than in the rest-only condition, whereas men in the control group had similar resting activities in both conditions. This effect was strongest in men who reported ejaculation-related pain, which was 70% of the CP/CPPS group. Conclusion. Men without a history of pelvic pain were able to relax their pelvic floor muscles back to baseline after performing voluntary pelvic floor muscle contractions. In contrast, men with CP/CPPS, particularly those with ejaculation-related pain, had an impaired ability to relax their pelvic floor muscles. Impact. This study may support the investigation of more personalized physical therapist approaches for CP/CPPS that enhance the ability to relax pelvic floor muscles as a mechanism for pain reduction. [ABSTRACT FROM AUTHOR]

Symptomatic pelvic venous insufficiency (PVI) is defined as chronic pelvic pain resulting from dilated pelvic veins. It is a controversial area, with ongoing debate surrounding the underlying aetiology of pain, as well as how best to investigate and manage these patients. Multiple distinct underlying pathophysiological processes have been implicated and can broadly be classified as primary venous reflux, normally involving the ovarian veins, and secondary venous obstruction, which may involve either the ovarian or internal iliac veins. Multiple terms have been used to describe this spectrum of conditions including pelvic congestion, May-Thurner and nutcracker syndromes; however, this terminology is imprecise and fails to define the underlying pathological process. A recent consensus classification of pelvic venous disorders aims to improve this nomenclature to aid clinical communication, decision-making, and future research. This is important as the treatment options differ according to the underlying cause. Imaging plays an essential role in the diagnostic process, both to define the underlying pathophysiology and to help plan treatments. Minimally invasive radiologically guided embolisation and/or venous stenting now form the mainstay of management with good reported outcomes. The present article discusses the proposed pathophysiology and aetiology of pain in PVI, reviews the role of imaging in the diagnosis, and considers the role of catheter-directed treatments. [ABSTRACT FROM AUTHOR]

Objective: To identify metabolites in presurgical blood associated with risk of persistent postsurgical pelvic pain 1 year after endometriosis surgery in adolescent and young adult patients.Design: Prospective observational study within the Women's Health Study: From Adolescence to Adulthood, a US-based longitudinal cohort of adolescents and women enrolled from 2012-2018.Setting: Two tertiary care hospitals.Patient(s): Laparoscopically confirmed endometriosis patients (n = 180) with blood collected before their endometriosis surgery. Of these, 77 patients additionally provided blood samples 5 weeks to 6 months after their surgery. We measured plasma metabolites using liquid chromatography tandem mass spectrometry, and a total of 390 known metabolites were included in our analysis.Intervention(s): None.Main Outcome Measure(s): Persistent postsurgical pelvic pain, defined as severe, life-impacting pelvic pain 1 year after endometriosis surgery.Result(s): Most patients (>95%) were at stage I/II of the revised American Society for Reproductive Medicine classification. Their average age at diagnosis was 18.7 years, with 36% reporting persistent postsurgical pelvic pain. Of the 21 metabolites in presurgical blood that were associated with risk of persistent postsurgical pelvic pain, 19 metabolites, which were mainly lipid metabolites, were associated with increased risk. Only 2 metabolites-pregnenolone sulfate (odds ratio = 0.64, 95% confidence interval = 0.44-0.92) and fucose (odds ratio = 0.69, 95% confidence interval = 0.47-0.97)-were associated with decreased risk. Metabolite set enrichment analysis revealed that higher levels of lysophosphatidylethanolamines (false discovery rate = 0.01) and lysophosphatidylcholines (false discovery rate = 0.01) in presurgical blood were associated with increased risk of persistent postsurgical pelvic pain.Conclusion(s): Our results suggest that dysregulation of multiple groups of lipid metabolites may play a role in the persistence of pelvic pain postsurgery among young endometriosis patients. [ABSTRACT FROM AUTHOR]

Objective: To examine how often urologic chronic pelvic pain syndrome (UCPPS) patients progressed from Pelvic Pain Only at baseline to Widespread Pain, or vice versa, during 1-year longitudinal follow-up.Methods: Men and women with UCPPS enrolled in the MAPP-I Epidemiology and Phenotyping Study completed a self-report body map to indicate their locations of pain every 2 months over 12 months. Patients were categorized at each assessment into one of three pain phenotypes: (1) Pelvic Pain Only, (2) an Intermediate group, (3) Widespread Pain. Only patients who completed 3 or more follow-ups were included in this longitudinal analysis. The primary outcome measure was pain classification at the majority (≥60%) of follow-up assessments. Longitudinal trends of somatic symptom burden were also assessed.Results: Among the 93 UCPPS participants with Pelvic Pain Only at baseline, only 2% (n = 2) showed a Widespread Pain phenotype for the majority of assessments over 12 months. Among the 121 participants who had Widespread Pain at baseline, 6% (n = 7) demonstrated Pelvic Pain Only for the majority of assessments over 12 months. Over half of participants (≥53%) stayed in their baseline phenotypic group. Somatic symptom burden remained stable over 12 months for each of the groups with high intra-class correlation coefficient (0.67 to 0.82).Conclusion: It was uncommon for UCPPS patients to progress from Pelvic Pain Only to Widespread Pain, or vice versa, over 12 months. These data suggest that Pelvic Pain Only and Widespread Pain are distinct UCPPS phenotypes that are relatively stable over 12 months of follow up. [ABSTRACT FROM AUTHOR]

Abstract: Excess pain after visceral provocation has been suggested as a marker for chronic pelvic pain risk in women. However, few noninvasive tests have been validated that could be performed readily on youth in early risk windows. Therefore, we evaluated the validity and reliability of a noninvasive bladder pain test in 124 healthy premenarchal females (median age 11, [interquartile range 11-12]), as previously studied in adult women. We explored whether psychosocial, sensory factors, and quantitative sensory test results were associated with provoked bladder pain and assessed the relation of bladder pain with abdominal pain history. Compared with findings in young adult females (age 21 [20-28]), results were similar except that adolescents had more pain at first sensation to void (P = 0.005) and lower maximum tolerance volume (P < 0.001). Anxiety, depression, somatic symptoms, and pain catastrophizing predicted provoked bladder pain (P's < 0.05). Bladder pain inversely correlated with pressure pain thresholds (r = -0.25, P < 0.05), but not with cold pressor pain or conditioned pain modulation effectiveness. Bladder pain was also associated with frequency of abdominal pain symptoms (r = 0.25, P = 0.039). We found strong retest reliability for bladder pain at standard levels of sensory urgency in 21 adolescents who attended repeat visits at 6 to 12 months (intraclass correlations = 0.88-0.90). Noninvasive bladder pain testing seems reproducible in adolescent females and may predict abdominal pain symptomatology. Confirmation of our findings and further investigation of the bladder test across menarche will help establish how visceral sensitivity contributes to the early trajectory of pelvic pain risk. [ABSTRACT FROM AUTHOR]

Chronic pelvic pain is a major public health problem that impacts all areas of a woman's life. The diagnosis is frequently difficult and delayed with women often presenting to a variety of specialties and undergoing multiple investigations before a diagnosis is reached. Aetiology is frequently multifactorial with both precipitating and perpetuating factors. Optimal management is within a multidisciplinary team who can fully address the range of factors that may maintain pelvic pain. [ABSTRACT FROM AUTHOR]

Background: Pelvic girdle pain (PGP) is defined as pain experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the sacroiliac joint. Pelvic girdle pain is common postpartum, may result from pregnancy-related factors, and is a leading cause of disability postpartum. The purpose of this clinical practice guideline is to provide evidence-based recommendations for physical therapist management of PGP in the postpartum population. Key Points: Postpartum individuals may experience PGP beginning during pregnancy, immediately after childbirth, or up to 2 years after delivery. Although most cases of PGP in pregnancy resolve spontaneously, a subset of postpartum individuals may experience persistent pain. Based upon critical appraisal of literature and expert opinion, 23 action statements for risk factors, systems screening, examination, diagnosis, prognosis, theoretical models of care, and intervention for postpartum individuals with PGP are linked with explicit levels of evidence. A significant body of evidence exists to support physical therapist intervention with postpartum clients with PGP to reduce pain and disability. Emerging evidence suggests that further investigation of biopsychosocial factors is warranted, especially factors that influence the development of persistent pain in the postpartum population. Future research is needed in several areas to optimize examination and intervention strategies specific to postpartum individuals and guided by a classification system for PGP that includes elements of pain, movement, and biopsychosocial factors. The authors provide clinical practice guidelines for providing physical therapy to postpartum individuals with PGP. [ABSTRACT FROM AUTHOR]

Chronic prostatitis / chronic pelvic pain syndrome is a common urological disease that is the most common clinical form of chronic prostatitis. The combination in its pathogenesis of chronic inflammation of the prostate and chronic pain creates difficulties in diagnosis and treatment. This review aims to highlight modern approaches and diagnostic tools most commonly used in the practice of urology. The article presents the main clinical manifestations, modern classification and methods of research of patients with chronic prostatitis / chronic pelvic pain syndrome. Clinical and laboratory signs of certain forms of prostatitis with emphasis on the joint manifestations of chronic bacterial prostatitis and chronic prostatitis / chronic pelvic pain syndrome are considered. Diagnostic criteria, bases of laboratory and differential diagnosis of chronic prostatitis are considered. Particular attention is paid to the difficulties of laboratory diagnosis of chronic prostatitis / chronic pelvic pain syndrome, in particular, evaluation of the results of repeated microscopic and cultural examinations of the secretion of the prostate, ejaculate and post-massage urine. The actual questionnaire of patients for objectification and monitoring of their complaints is presented; the possibility of individualization of treatment according to the patient’s phenotype and the implementation of a multimodal approach to the provision of medical care for prostatitis. The peculiarities of communication with the patient and the most common scales for assessing the condition of patients as a tool for objectifying complaints are presented. The place of instrumental methods in the diagnostic algorithm for chronic prostatitis is presented. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of two different treatment regimens of dydrogesterone in the management of endometriosis-related chronic pelvic pain.Design: Observational, prospective cohort study over six months.Setting: Twenty gynecology clinics in the Russian Federation.Patient(s): Three hundred fifty women from 18 to 45 years of age with endometriosis and chronic pelvic pain with or without dysmenorrhea.Intervention(s): Dydrogesterone 10 mg 2 or 3 times daily, either between the 5th and 25th days of the menstrual cycle (prolonged cyclical treatment regimen) or continuously (continuous treatment regimen). For all patients, the data cutoff was at six months of treatment.Main Outcome Measure(s): Intensity of chronic pelvic pain on the 11-point numerical rating scale (after 6 months).Result(s): A marked reduction in chronic pelvic pain was observed with both the prolonged cyclical and continuous treatment regimens (mean ± standard deviation change from baseline -3.3 ± 2.2 and -3.0 ± 2.2, respectively), with no significant difference between the two groups. With both regimens, patients experienced significant improvements in the intensity of chronic pelvic pain, number of days in which analgesics were required, severity of dysmenorrhea, sexual well-being, and health-related quality-of-life parameters. A favorable safety profile of dydrogesterone was confirmed, and no serious adverse drug reactions were reported during the study.Conclusion(s): Prolonged cyclical and continuous treatment regimens of dydrogesterone therapy both demonstrated a pronounced and similar reduction in the severity of chronic pelvic pain and dysmenorrhea and led to marked improvements in all study parameters related to quality of life and sexual well-being.Registration Number: NCT03690765. [ABSTRACT FROM AUTHOR]

Study Question: Do adolescents and young adult women (YAW) with histologically proven endometriosis present a specific clinical history?, Summary Answer: Questionnaire screening of adolescents and YAW can identify clinical markers associated with histologically proven endometriosis., What Is Known Already: Some validated questionaries can contribute to an earlier endometriosis diagnosis in adults. None of these scores, however, have been validated for adolescents or YAW., Study Design, Size, Duration: This was an observational cross-sectional study using prospectively recorded data performed between January 2005 and January 2020 in a single university tertiary referral centre for endometriosis diagnosis and management. After a thorough surgical examination of the abdomino-pelvic cavity, women with histologically proven endometriosis were allocated to the endometriosis group, and symptomatic women without evidence of endometriosis were allocated to the endometriosis-free control group. The endometriotic patients were allocated into two sub-groups according to their age: adolescent (≤20 years) and YAW (21-24 years)., Participants/materials, Setting, Methods: Adolescents and YAW ≤24 years of age were operated for a symptomatic benign gynaecological condition with signed informed consent. A standardized questionnaire was prospectively completed in the month before the surgery and included epidemiological data, pelvic pain scores, family history of endometriosis, and symptoms experienced during adolescence. The study searched for correlations by univariate analysis to determine clinical markers of endometriosis in adolescents and YAW compared with endometriosis-free control patients., Main Results and the Role of Chance: Of the 262 study participants, 77 women were adolescents (≤20 years of age) and 185 patients (70.6%) were YAW. The endometriosis group included 118 patients (45.0%) and 144 (55.0%) were assigned to the control group. A family history of endometriosis, absenteeism from school during menstruation, history of fainting spells during menstruation, and prescription of oral contraceptive pills for intense dysmenorrhea were significantly more frequently observed in the endometriotic patients. The prevalence and mean pain scores for dysmenorrhea, deep dyspareunia, non-cyclic chronic pelvic pain and gastrointestinal and lower urinary tract symptoms were significantly greater in the endometriosis group, as was experienced rectal bleeding., Limitations, Reasons for Caution: The study was performed in a single referral centre that treats patients with potentially more severe disease. This questionnaire was evaluated on a population of patients with an indication for endometriosis surgery, which can also select patients with more severe disease. Women with asymptomatic endometriosis were not considered in this study. These factors can affect the external validity of this study., Wider Implications of the Findings: Patient interviews are relevant to the diagnosis of endometriosis in adolescents and YAW. Combined with imaging and clinical examination, this approach will enable earlier diagnosis and treatment, while remaining non-invasive and rapid., Study Funding/competing Interest(s): The study received no funding from external sources. There are no conflicts of interest., Trial Registration Number: N/A., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: The World Endometriosis Research Foundation established the Endometriosis Phenome and Biobanking Harmonisation Project (EPHect) to create standardized documentation tools (with common data elements) to facilitate the comparison and combination of data across different research sites and studies. In 2014, 4 data research standards were published: clinician-reported surgical data, patient-reported clinical data, and fluid and tissue biospecimen collection. Our current objective is to create an EPHect standard for the clinician-reported physical examination (EPHect-PE) for research studies., Design: An international consortium involving 26 clinical and academic experts and patient partners from 11 countries representing 25 institutions and organizations. Two virtual workshops, followed by the development of the physical examination standards underwent multiple rounds of iterations and revisions., Subjects: N/A MAIN OUTCOME MEASURE(S): N/A RESULT(S): The EPHect-PE tool provides standardized assessment of physical examination characteristics and pain phenotyping. Data elements involve examination of back and pelvic girdle; abdomen including allodynia and trigger points; vulva including provoked vestibulodynia; pelvic floor muscle tone and tenderness; tenderness on unidigital pelvic examination; presence of pelvic nodularity; uterine size and mobility; presence of adnexal masses; presence of incisional masses; speculum examination; tenderness and allodynia at an extra-pelvic site (e.g., forearm); and recording of anthropometrics., Conclusion(s): The EPHect-PE standards will facilitate the standardized documentation of the physical examination, including the assessment and documentation of examination phenotyping of endometriosis-associated pelvic pain., Competing Interests: Declaration of Interests T.L. has nothing to disclose. C.A. reports consultancy fees from AbbVie and Pfizer. S.A.-S reports consultancy fees from Myovant-Pfizer, Organon, and Bayer. P.S. has received royalties from UpToDate for a section about acute pelvic pain and from Frontiers in Reproductive Health as Specialty Editor for Gynecology, and participated in an AbbVie advisory board and is part of a team that received botulinum toxin and funds for monitoring a clinical trial that were provided by Allergan, Inc. through a Clinical Trials Agreement with the National Institutes of Health (NIH). K.V. has received research funding from Bayer AG and honoraria for consultancy from Bayer AG, Eli Lilly, AbbVie, and Reckitts. G.D.A. reports consultancy fees from Organon, Labcorp, and Cooper, and is the CEO of and has equity in ARC Fertility. L.A.-N. has nothing to disclose. D.B. is the owner of EPP Coaching and Consulting and has received travel expenses and speaking fees from Myovant and Guerbet. F.J., J.L and L.R., have nothing to disclose. J.S. is part of a team that received botulinum toxin and funds for monitoring a clinical trial that was provided by Allergan, Inc. through a Clinical Trials Agreement with the NIH. A.T. has nothing to disclose. L.H. is remunerated by WERF as the EPHect-PE project manager. S.A.M. reports consultancy and grant funding from AbbVie for population-based research unrelated to this project and from Frontiers in Reproductive Health as Field Chief Editor. P.J.Y. has nothing to disclose. The WERF EPHect Working Group (not listed in the author list): E.A. has nothing to disclose. J.C. is the IPPS vice-president and a consultant for SoLa Therapy, AbbVie, and Myovant; E.C. is an employee of Endometriosis UK; H.C.G has nothing to disclose. A.W.H.’s institution (University of Edinburgh) has received payment for consultancy and grant funding from Roche Diagnostics to assist in the early development of a possible blood diagnostic biomarker for endometriosis, consultancy fees from Gesynta and Joii, and grant funding from the UKRI, NIHR, CSO, and Wellbeing of Women for endometriosis research. A.W.H. has received payment for a lecture from Theramex, is president-elect of the World Endometriosis Society, co-editor in chief of Reproduction and Fertility, was a member of the NICE and ESHRE Endometriosis Guideline Groups, and is a trustee and medical advisor to Endometriosis UK; A.J. has nothing to disclose. G.L. is an employee of the US Veterans Health Administration, reports research funding from the NIH and Department of Defence, and has served as a consultant for Myovant, AbbVie, and Pelvic Sola Therapy. D.C.M. and O.C.N. have nothing to disclose. F.F.T. has royalties from Wolters Kluwer, has consulted for Bayer and Tremeau Pharmaceuticals, and received research support from Dot Laboratories., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Research Question: How do different warning indicators help to identify disabling dysmenorrhoea among women in young adulthood?, Design: A nationwide cross-sectional study of women aged 18-25 years from the CONSTANCES cohort was constructed. Disability was assessed with the Global Activity Limitation Indicator question 'For the past 6 months, have you been limited in routine activities?Yes, severely limited/Yes, limited/ No, not limited'. Dysmenorrhoea pain intensity and other chronic pelvic pain symptoms (dyspareunia and non-menstrual pain) were evaluated according to questions from a specific questionnaire. Probability of disability was estimated using a logistic prediction model according to dysmenorrhoea intensity, other indicators of pelvic pain symptoms and other obvious covariates. The results of the predictive model of disabling dysmenorrhoea were presented on a nomogram., Results: Among 6377 women, the rate of disability was estimated at 7.5%. Increased intensity of dysmenorrhoea (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13), increased frequency of dyspareunia (from OR 1.69, 95% CI 1.33-2.14 up to OR 3.41, 95% CI 2.16-5.38) non-menstrual chronic pelvic pain (OR 1.75, 95% CI 1.40-2.19), body mass index over 25 kg/m 2 (OR 1.45, 95% CI 1.17-1.80) and non-use of the hormonal contraceptive pill (OR 1.29, 95% CI 1.05-1.59) were significantly associated with disability. According to the nomogram, a predicted probability of 15% or more could be chosen as a threshold. This represents almost 4.6% of young women in this sample being classified at risk of disabling dysmenorrhoea., Conclusions: Dysmenorrhoea pain intensity and associated pelvic pain symptoms are warning indicators that can be measured to help screen young women who may suffer from disabling dysmenorrhoea., (Copyright © 2024 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Prostatitis is a common clinical syndrome classified into four categories: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain syndrome, and asymptomatic. Bacterial prostatitis (acute and chronic) is primarily diagnosed with history and microbiologic studies, although physical examination can be helpful to localize infection within the genitourinary system. Bacterial prostatitis is treated with antibiotics; the span of treatment is guided by the duration of symptoms and presence of complications. Chronic prostatitis/chronic pelvic pain syndrome is the most common form of prostatitis and is a diagnosis of exclusion with no standardized treatments. Asymptomatic prostatitis does not require treatment and is usually diagnosed incidentally during the workup for other urologic presentations.

Introduction and Hypothesis: Bladder pain syndrome (BPS) is poorly understood with both the aetiology and pathophysiology being unknown. Symptoms overlap with other disorders, such as overactive bladder (OAB) and chronic pelvic pain disorders such as endometriosis, making a consensus on how to diagnosis and manage patients challenging. The development of biomarkers for BPS may be the key to understanding more about its pathophysiology, as well as aiding diagnosis, subclassification, and discovering new drug targets for its management. As inflammation is widely understood to hold a central role in BPS, the evaluation of cytokines has gained interest. This article summarises the current literature and understanding of urinary, serum, and bladder tissue cytokines found elevated in patients with bladder pain syndrome., Methods: literature search using Pub Med with the keywords "bladder pain syndrome", "painful bladder syndrome", "bladder pain", "Interstitial cystitis" AND "cytokines" or "inflammation". This study was except from institutional approval., Results: Thirty-six cytokines have been identified as being statistically significantly elevated in either the serum, urine, or bladder tissue of patients with bladder pain syndrome in the 22 studies identified in this review of the literature. These cytokines include those from the interleukin group (n = 14), the CXC chemokine group (n = 5), and the C-C chemokine group (n = 7)., Conclusions: CXCL-1, CXCL-8, CXCL-9, CXCL-10, CXCL-11 from the CXC chemokine group, and CCL2, CCL4, CCL5, CCL7, and CCL11 from the C-C chemokine group have been found to be significantly elevated in patients with bladder pain in the literature. Many of these analytes also have supporting evidence for their roles in bladder pain from animal models and studies in other chronic inflammatory conditions. It is likely that a single cytokine will not serve as an adequate biomarker of disease in bladder pain syndrome for either diagnosis or disease severity. Instead, panels of inflammatory mediators may reveal more about the different pathways of inflammation leading to similar presentations of bladder pain in patients., (© 2024. Crown.)

Abstract: Patient education has a critical role in the management of pain. There is considerable heterogeneity in patient education for females with persistent pelvic pain (PPP), and it remains unclear what is considered best clinical practice. Therefore, this systematic review identified and summarised recommendations for patient education in the management of benign gynaecological and urological conditions associated with PPP, as endorsed by international guidelines. Academic and relevant guideline databases were searched from inception to May 2022. Included guidelines were those for the management of benign gynaecological and urological conditions associated with PPP in adult females published in English, of any publication date, and endorsed by a professional organisation or society. Two independent reviewers screened 3097 records; 17 guidelines were included in the review. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Recommendations were pooled using descriptive synthesis. Persistent pelvic pain guideline quality was generally poor. Three guidelines were classified as "excellent" (The NICE, RANZCOG, and ESHRE endometriosis guidelines) and therefore recommended for use. Eleven guidelines (64.7%) recommended patient education for females with PPP. Recommendations for education content were variable, however most frequently covered treatment strategies and pelvic pain diagnoses. For education delivery, the most frequent recommendations were for support groups and written/printed materials. Further research into tailored education interventions is needed for females with PPP., (Copyright © 2023 International Association for the Study of Pain.)