Pelvic Floor Tenderness in the Etiology of Superficial Dyspareunia

Yong, Paul J.; Mui, Justin; Allaire, Catherine; Williams, Christina

doi:10.1016/s1701-2163(15)30414-x

Cited by 32 publications

(20 citation statements)

References 24 publications

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“…Rate of endometriosis was 6% or the same as in the general population (3%‐6%) but found that endometriosis may be overdiagnosed because of pain complaints, leading to inappropriate treatment and surgical procedures . Literature also supports an association between symptoms of dysmenorrhea and dyspareunia with myofascial pelvic pain . This may suggest a potential explanation for previously noted strong associations and higher rates of dysmenorrhea and dyspareunia in hEDS/JHS groups …”

Section: Introductionmentioning

confidence: 71%

“…29 Literature also supports an association between symptoms of dysmenorrhea and dyspareunia with myofascial pelvic pain. 9,10,30 This may suggest a potential explanation for previously noted strong associations and higher rates of dysmenorrhea and dyspareunia in hEDS/JHS groups. 28,29 There is a paucity of literature specifically addressing the association of HSD/JHS and myofascial pelvic pain, although this has been suggested in studies looking at the etiology of painful pelvic floor muscles in women with other conditions such as hip dysplasia and other musculoskeletal dysfunctions.…”

Section: Introductionmentioning

confidence: 79%

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Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Hastings

Forster

Witzeman

2019

PM&R

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Background Female chronic pelvic pain is estimated to affect up to 24% of adult women, many of whom have a component of myofascial pelvic pain. Although an association of joint hypermobility and pelvic pain has been hypothesized, limited data are available that estimate the prevalence of joint hypermobility in this population. Objective To estimate the prevalence of generalized hypermobility spectrum disorder (G‐HSD) among female patients with chronic myofascial pelvic pain and examine the association between G‐HSD and other frequent pelvic pain‐associated complaints. Study Design Retrospective case control. Setting Tertiary referral center within a university‐affiliated public health system. Patients Adult women who were diagnosed with myofascial pelvic pain during a 1‐year period (n = 77 with G‐HSD and n = 241 without G‐HSD). Methods Data were abstracted via chart review of patients meeting inclusion criteria. Outcomes The primary outcome of this study was the prevalence of G‐HSD among patients with persistent myofascial pelvic pain. Secondary outcomes included the prevalence of dyspareunia, provoked vestibulodynia, stress urinary incontinence, irritable bowel syndrome, hip pain, low back pain, and fibromyalgia in patients with persistent myofascial pelvic pain with and without G‐HSD. Results Twenty‐four percent (N = 77; 95% CI: 19.6, 29.4) of myofascial pelvic pain patients also met criteria for G‐HSD. After adjusting for confounders, the odds in favor of having G‐HSD was 3.55 higher (95% CI: 1.50, 8.40) (P = .004) in females with dyspareunia; 7.46 higher (95% CI: 2.41, 23.1) (P < .001) with low back pain; 3.76 higher (95% CI: 1.35, 10.5) (P = .02) with stress urinary incontinence; 4.72 higher (95% CI: 2.00, 11.2) (P < .001) with irritable bowel syndrome; and 3.12 higher (95% CI: 1.36, 7.13) (P = .007) with hip pain. There was no significant association identified between provoked vestibulodynia or fibromyalgia and G‐HSD. Conclusion The estimated prevalence of G‐HSD is higher in chronic myofascial pelvic pain patients than in the general population with statistically significant associations with several comorbid conditions. Characterizing these associations is the first step in developing effective, evidence‐based screening recommendations. Level of Evidence III

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Section: Introductionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 79%

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Hastings

Forster

Witzeman

2019

PM&R

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“…Inclusion criteria were (i) patient completion of a standardized online questionnaire before assessment by a gynecologist at the center and (ii) full assessment by a gynecologist, including review of the patient questionnaire and patient medical records and performance of a standardized endovaginal ultrasound-assisted pelvic examination to palpate anatomic structures and reproduce deep dyspareunia ( Figure 1 ). 17 , 18 , 19 On average, the questionnaires were completed 2 weeks before the full assessment.…”

Section: Methodsmentioning

confidence: 99%

Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia

et al. 2017

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IntroductionDeep dyspareunia negatively affects women’s sexual function. There is a known association between deep dyspareunia and endometriosis of the cul-de-sac or uterosacral ligaments in reproductive-age women; however, other factors are less clear in this population.AimTo identify anatomic sites and associated clinical factors for deep dyspareunia in reproductive-age women at a referral center.MethodsThis study involved the analysis of cross-sectional baseline data from a prospective database of 548 women (87% consent rate) recruited from December 2013 through April 2015 at a tertiary referral center for endometriosis and/or pelvic pain. Exclusion criteria included menopausal status, age at least 50 years, previous hysterectomy or oophorectomy, and not sexually active. We performed a standardized endovaginal ultrasound-assisted pelvic examination to palpate anatomic structures for tenderness and reproduce deep dyspareunia. Multivariable regression was used to determine which tender anatomic structures were independently associated with deep dyspareunia severity and to identify clinical factors independently associated with each tender anatomic site.Main Outcome MeasureSeverity of deep dyspareunia on a numeric pain rating scale of 0 to 10.ResultsSeverity of deep dyspareunia (scale = 0–10) was independently associated with tenderness of the bladder (b = 0.88, P = .018), pelvic floor (levator ani) (b = 0.66, P = .038), cervix and uterus (b = 0.88, P = .008), and cul-de-sac or uterosacral ligaments (b = 1.39, P < .001), but not with the adnexa (b = −0.16, P = 0.87). The number of tender anatomic sites was significantly correlated with more severe deep dyspareunia (Spearman r = 0.34, P < .001). For associated clinical factors, greater depression symptom severity was specifically associated with tenderness of the bladder (b = 1.05, P = .008) and pelvic floor (b = 1.07, P < .001). A history of miscarriage was specifically associated with tenderness of the cervix and uterus (b = 2.24, P = .001). Endometriosis was specifically associated with tenderness of the cul-de-sac or uterosacral ligaments (b = 3.54, P < .001).ConclusionsIn reproductive-age women at a tertiary referral center, deep dyspareunia was independently associated not only with tenderness of the cul-de-sac and uterosacral ligaments but also with tenderness of the bladder, pelvic floor, and cervix and uterus.Yong PJ, Williams C, Yosef A, et al. Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia. Sex Med 2017;5:e184–e195.

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“… PF, pelvic floor; LA, levator ani; OI, obturator internus; TP, transverse perineal muscles; ATFP, arcus tendineus fascia pelvis; USL, uterosacral ligament. * Abdominal wall includes rectus abdominis. ** Other sites examined include the adnexa 28,47,52 , bladder and urethra 27,35,43,51,52,55,58,62 anorectal raphae 35 , anus/rectum 36,44,50,53,55,59,60 , pelvis 39 , buttock 39 , sacroiliac joint 39,55 , Iliopsoas 39 , hamstring 39 , hip flexor 39 , and coccyx 44,50,59,60 , sphincter urethra and compressor urethra 3,46 , cervix 47,52,53 , adductor muscles 49 , clitoris 50 , pubovaginalis 50,54 , uterus 51 , sacrococcygeus ligaments 53,59,60 , urogenital triangle 53 , quadratus lumborum 54,61 , gluteal muscles 49,54,59,61 , pubic symphysis 55,59,60 , anterior superior iliac spines 55 , iliopsoas 61 , anal sphincter 60,61,62 . …”

Section: Figurementioning

confidence: 99%

Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review

Meister

Shivakumar

Sutcliffe

et al. 2018

American Journal of Obstetrics and Gynecology

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Physical examination methods to evaluate pelvic musculature for presence of myofascial pain varied significantly and were often undefined. Given the known role of pelvic floor myofascial pain in chronic pelvic pain and link between pelvic floor myofascial pain and lower urinary tract symptoms, physicians should be trained to evaluate for pelvic floor myofascial pain as part of their physical examination in patients presenting with these symptoms. Therefore, the development and standardization of a reliable and reproducible examination is needed.

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Pelvic Floor Tenderness in the Etiology of Superficial Dyspareunia

Cited by 32 publications

References 24 publications

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Joint Hypermobility among Female Patients Presenting with Chronic Myofascial Pelvic Pain

Anatomic Sites and Associated Clinical Factors for Deep Dyspareunia

Physical examination techniques for the assessment of pelvic floor myofascial pain: a systematic review

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