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• CBT effectively improves endometriosis symptoms in adults. • Evidence for CBT is lacking but is needed for adolescents with endometriosis. • We propose a biopsychosocial model using CBT to improve adolescent endometriosis symptoms. Recent advances and interest in nonpharmacological treatment approaches for various chronic pain conditions in adolescent patients have increased. Cognitive behavioral therapy (CBT) is widely regarded as the leading nonpharmacological treatment for chronic pain, encompassing gynecological conditions associated with chronic pelvic pain, such as endometriosis. Adolescents with endometriosis often present with different symptoms than adults and frequently report more comorbid psychiatric disorders than the general public. This review aims to (1) justify the application of CBT interventions in the context of adolescent patients with endometriosis; (2) integrate and analyze existing empirical evidence and reviews; (3) highlight the advantages, constraints, and future research directions in CBT for this demographic; and (4) introduce a novel biopsychosocial conceptual model. This model intricately considers the interplay of thoughts, emotions, behaviors, and physical symptoms specific to adolescents with endometriosis, providing a foundation for targeted CBT interventions. This holistic approach recognizes the multifaceted nature of their experience, paving the way for comprehensive and effective nonpharmacological therapeutic strategies. Given the nuanced and intricate nature of endometriosis in adolescents, there is a pressing need for innovative conceptual models and clinical trials of behavioral interventions explicitly designed for this demographic. [ABSTRACT FROM AUTHOR]

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

Objectives: Pelvic belts are prescribed for back and pelvic pain during pregnancy and postpartum. This study reviews level II literature (randomized clinical trials and clinical trials) considering the effect of pelvic belt application on pain and functional disability in pregnant women with pelvic girdle pain or low back pain. Methods: Two reviewers independently performed a computerized literature search from PubMed/MEDLINE (NLM), Scopus, Web of Science, PEDro and Google Scholar databases. The included studies were agreed upon by the two reviewers, and a third reviewer mediated any disagreements. Data extraction was conducted by the two reviewers and cross-checked by a third reviewer. The quality of each included trial was assessed independently by the two reviewers and scored using the PeDro scale. Any discrepancies in selecting the studies and scoring them were resolved by a third collaborator. Results: A total of 9 studies met the inclusion criteria and were selected for the systematic review. Four fair- and one low-quality study reported more significant pain reduction by the flexible pelvic belt than the usual healthcare or physical therapy. In two fair- and one low-quality study, higher functional improvement was reported by belt than healthcare or physical therapy. Meanwhile, one high- and one fair-quality study showed no added functional ability in the flexible belt for health care or exercise. Discussion: The current review suggests using the flexible belt as a practical treatment approach in alleviating pain in pregnant women with pelvic girdle pain or low back pain (LBP) during pregnancy. However, the added efficacy in functional disabilities is controversial. [ABSTRACT FROM AUTHOR]

Introduction: Xanthogranulomatous oophoritis is a rare ovarian inflammatory disorder characterised by the extensive infiltration of foamy macrophages and chronic inflammation in the ovarian stroma. Background: We report two cases of xanthogranulomatous oophoritis, both of 34 years of age with complaints of chronic pelvic pain with infertility and with abnormal uterine bleeding. Aim: This case study aims to explore the clinical and pathological features of this rare condition while highlighting the challenges in diagnosis and management. [ABSTRACT FROM AUTHOR]

Given the complexities and controversies that exist in diagnosing adult endometriosis, as well as optimizing medical and surgical management, it is not surprising that there is even more ambiguity and inconsistency in the optimal surgical care of endometriosis in the adolescent. This collaborative commentary aimed to provide evidence-based recommendations optimizing the role of surgical interventions for endometriosis in the adolescent patient with input from experts in minimally invasive gynecologic surgery, pediatric and adolescent gynecology, and infertility/reproductive medicine. [ABSTRACT FROM AUTHOR]

Perineal injury after vaginal delivery is common, affecting up to 90% of women. Perineal trauma is associated with both short- and long-term morbidity, including persistent pain, dyspareunia, pelvic floor disorders, and depression, and may negatively affect a new mother's ability to care for her newborn. The morbidity experienced after perineal injury is dependent on the type of laceration incurred, the technique and materials used for repair, and the skill and knowledge of the birth attendant. After all vaginal deliveries, a systematic evaluation including visual inspection and vaginal, perineal, and rectal exams is recommended to accurately diagnose perineal lacerations. Optimal management of perineal trauma after vaginal birth includes accurate diagnosis, appropriate technique and materials used for repair, providers experienced in perineal laceration repair, and close follow-up. In this article, we review the prevalence, classification, diagnosis, and evidence supporting different closure methods for first- through fourth-degree perineal lacerations and episiotomies. Recommended surgical techniques and materials for different perineal laceration repairs are provided. Finally, best practices for perioperative and postoperative care after advanced perineal trauma are reviewed. [ABSTRACT FROM AUTHOR]

Several clinical practice guidelines on the evaluation and management (EM) of chronic pelvic pain (CPP) have been published; however, it is not known whether obstetrics and gynecology (OBGYN) educational milestones are aligned with current practice recommendations. Therefore, this scoping review and structured analysis aims to identify gaps between clinical guidelines for the EM of CPP and OBGYN training milestones published by educational authorities like the Accreditation Council for Graduate Medical Education (ACGME) and the AAGL. The literature search was performed in MEDLINE, PubMed Central, and Bookshelf on the PubMed interface from January 2018 to September 2022. Peer-reviewed publications were included if they were a systematic review of recent practice guidelines and focused on female CPP. Publications that focused on a single pelvic pain condition or focused on a specific treatment were excluded. Two reviewers extracted the data and appraised the study quality following the Critical Appraisal Skills Programme Checklist for systematic reviews. Four articles met inclusion criteria for thematic analysis. A reflexive thematic analysis via the inductive approach was performed to develop clinical themes common to all review articles and presumed important in the EM of CPP. Pelvic pain experts and Delphi methodology was used to assess validity and relevance of each theme in OBGYN training. Validated themes were used in a strengths weaknesses opportunities threats (SWOT) analysis of the ACGME and the AAGL Milestones used for training OBGYN residents and fellows. A SWOT analysis is an organizational tool used to analyze processes in terms of strengths, weaknesses, opportunities for improvement, and threats to implementing a potential change. Twelve clinical themes were conceptualized and achieved ≥ 90% consensus as being important in the EM of CPP. Clinical themes pertained to pathophysiology, biopsychosocial approach, trauma-informed care, history and physical examination, diagnostic testing, multimodal/multidisciplinary management, pain education, and medical and surgical management. SWOT analysis showed that the ACGME Milestones lacked milestones specific to CPP, while the AAGL Milestones had 6 CPP-focused competencies with multiple milestones. Milestones on trauma-informed care and application of biopsychosocial assessment were notably absent. OBGYN educational milestones published by the ACGME and the AAGL are not yet aligned with current clinical guidelines for the EM of CPP. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abdominal wall endometriosis is atypical localization of the extra-pelvic endometriosis with non-specific symptoms and is difficult for diagnosis. Cesarean scar endometriosis (CSE) is the most common type of abdominal wall endometriosis, which usually develops after obstetric operations. We report a case of a 33-year-old woman who had two previous cesarean sections presented with a mass in the subcutaneous tissue of the abdominal wall, approximately 4 cm superior to the Pfannenstiel incision, 5 years after her second lower segment caesarean section. The classic clinical presentation, imaging findings on ultrasonography and computed tomography are analyzed. Treatment with local surgical excision of the mass is discussed. The diagnosis was confirmed with histopathological analysis of the surgical sample. When it comes to the limited painful lesion in the subcutaneous tissue at the cesarean scar, with a pain intensifying during menstruation, the physician should consider cesarean scar endometriosis in women of reproductive age with a history of cesarean section. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is a chronic gynecological condition affecting women of reproductive age and may cause pelvic pain and infertility. MRI is the best imaging technique for mapping and preoperative staging of endometriosis as it provides a tool for the assessment of deep infiltrating endometriosis. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in detection and characterization of endometriosis in correlation between it and the laparoscopic findings according to ENZIAN classification. Methods: We assessed 100 patients by MRI dedicated pelvis protocol for endometriosis with an assessment of the ovaries, uterus, uterosacral ligaments (USL), broad ligaments, and round ligaments, cul-de-sac, rectosigmoid colon, bladder, ureters, and rectovaginal septum. All these patients are submitted for laparoscopy, and then, data from both investigations were correlated. Results: MRI provided a road map for surgeons before laparoscopy. The sensitivity of MRI was 87.5% in small deep infiltrating endometriosis (DIE) (grade A1) and 100% in large DIE (A2). MRI detected 82.3% of uterosacral ligament involvement, specificity 80%. Detection rate in rectal involvement was 71.4%, specificity 75%. There was 100% sensitivity and specificity in adenomyosis and urinary bladder endometriosis. Conclusions: Preoperative detection of endometriotic lesions is recommended using a dedicated MRI endometriosis protocol to choose the surgical approach and for proper multidisciplinary teamwork planning. [ABSTRACT FROM AUTHOR]

Purpose The study aims were, firstly, to develop an online-based yoga program for pregnant women with low back pain and pelvic pain and to evaluate the feasibility of the prototype. Secondly, it was to determine changes in the outcomes of the yoga program in terms of location and degree of low back and pelvic pain, degree of daily life disability, and depressive symptoms. Methods This was a feasibility study to examine practicality, acceptability, and continuity of the program, and to clarify changes in outcomes using a before/ after descriptive design. Pregnant women with low back or pelvic pain and no pregnancy problems or complications were included in the study. The yoga program was 8 weeks in duration and consisted of daily yoga practice, pain log entries, and yoga sessions. The feasibility of the program was evaluated using data from survey forms and opinions at yoga sessions regarding practicality (safety and burden), acceptability, and continuity. In addition, changes in the location and degree of back and pelvic pain, degree of daily life disability, and depression were measured before, during, and at the end of the yoga program, and changes at the three time points were compared. St. Luke's International University research ethics review approval was obtained (21-AC094). Results There were five participants enrolled then, one participant dropped-out. Safety: There were no unusual abdominal tensions, mood discomfort, or falls during the program. Burden was generally described as "light," but individual records varied. Acceptability was generally high for the materials, and continuity was high for the daily yoga practice while using the materials, with four participants able to complete the program. All five participants were aware of back pain before starting the program and two at the end of the program at time 3. Pelvic pain was perceived by three of the four participants before the start and by one at the end of the study. Pain severity decreased from a mean of 40 (SD 16.7) before starting, 32 (SD 29.5) during participation, and 32 (SD 29.5) at end; Oswestry Disability Index-mean decreased from 22% before start, 20% during participation, and 14% at end; Edinburgh Postnatal Depression Scale-mean decreased from 6 points before starting, 3 points during participation, and 4 points at end. Conclusion This yoga program is feasible and may reduce low back and pelvic pain. Future improvements are needed to expand the number of participants to reconsider the timing of program initiation, and to increase the number of target facilities and participants. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

What is the effect of a 12-week, home-based, abdominal exercise program containing head lifts and abdominal curl-ups on inter-recti distance (IRD) in women with diastasis recti abdominis (DRA) 6 to 12 months postpartum? What is the effect of the program on: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain? This was a two-arm, parallel-group, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Seventy primiparous or multiparous women 6 to 12 months postpartum, having a single or multiple pregnancy following any mode of delivery, with a diagnosis of DRA (IRD > 28 mm at rest or > 25 mm during a curl-up). The experimental group was prescribed a 12-week standardised exercise program including head lifts, abdominal curl-ups and twisted abdominal curl-ups 5 days a week. The control group received no intervention. The primary outcome measure was change in IRD measured with ultrasonography. Secondary outcomes were: observed abdominal movement during a curl-up; global perceived change; rectus abdominis thickness; abdominal muscle strength and endurance; pelvic floor disorders; and low back, pelvic girdle and abdominal pain. The exercise program did not improve or worsen IRD (eg, MD 1 mm at rest 2 cm above the umbilicus, 95% CI –1 to 4). The program improved rectus abdominis thickness (MD 0.7 mm, 95% CI 0.1 to 1.3) and strength (MD 9 Nm, 95% CI 3 to 16) at 10 deg; its effects on other secondary outcomes were trivial or unclear. An exercise program containing curl-ups for women with DRA did not worsen IRD or change the severity of pelvic floor disorders or low back, pelvic girdle or abdominal pain, but it did increase abdominal muscle strength and thickness. NCT04122924. [ABSTRACT FROM AUTHOR]

Purpose: Symptom heterogeneity in interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, collectively termed urological chronic pelvic pain syndrome, has resulted in difficulty in defining appropriate clinical trial endpoints. We determine clinically important differences for 2 primary symptom measures, pelvic pain severity and urinary symptom severity, and evaluate subgroup differences. Materials and Methods: The Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns Study enrolled individuals with urological chronic pelvic pain syndrome. We defined clinically important differences by associating changes in pelvic pain severity and urinary symptom severity over 3 to 6 months with marked improvement on a global response assessment using regression and receiver operating characteristic curves. We evaluated clinically important differences for absolute and percent change and examined differences in clinically important differences by sex-diagnosis, presence of Hunner lesions, pain type, pain widespreadness, and baseline symptom severity. Results: An absolute change of -4 was clinically important in pelvic pain severity among all patients, but clinically important difference estimates differed by pain type, presence of Hunner lesions, and baseline severity. Pelvic pain severity clinically important difference estimates for percent change were more consistent across subgroups and ranged from 30% to 57%. The absolute change urinary symptom severity clinically important difference was -3 for female participants and -2 for male participants with chronic prostatitis/ chronic pelvic pain syndrome only. Patients with greater baseline severity required larger decreases in symptoms to feel improved. Estimated clinically important differences had lower accuracy among participants with low baseline symptoms. Conclusions: A reduction of 30%-50% in pelvic pain severity is a clinically meaningful endpoint for future therapeutic trials in urological chronic pelvic pain syndrome. Urinary symptom severity clinically important differences are more appropriately defined separately for male and female participants. [ABSTRACT FROM AUTHOR]

Study Objective: To compare the accuracy of pre-operative ultrasound in predicting the laparoscopically defined 2021 AAGL Endometriosis Staging.Setting: Three specialized endometriosis surgical centers in São Paulo (Brazil), Barcelona (Spain), and Avellino (Italy) participated.Design: Retrospective multicenter study of patients treated at 3 specialized endometriosis centers.Patients: 878 patients aged 15-45 years with no history of pelvic malignancy underwent laparoscopic treatment for suspected endometriosis.Interventions: Retrospective review of preoperative transvaginal and transabdominal ultrasound (index test) assessed for endometriosis at all sites used in the 2021 AAGL Endometriosis Classification and classified patients into AAGL-ultrasound (AAGL-US) stages 1-4. Results were compared to reference-standard laparoscopic (AAGL-LPS) staging.Measurements and Main Results: The AAGL-US and AAGL-LPS stage were concordant in 586 (66.7%) cases [weighted kappa (WK) 0.759; intraclass correlation = 0.906), with the highest agreement observed in patients with no endometriosis (n=70, 75.3% concordance), AAGL-LPS Stage 1 (104, 50.7%) and Stage 4 disease (358, 88.2%). Endometriosis was most accurately diagnosed in the rectum/sigmoid colon (WK 0.862), bladder (WK 0.911) and ovaries (WK 0.835/0.795 for right/left, respectively), and least accurately diagnosed at superficial peritoneal (WK 0.442), tubal (WK 0.391/0.363 for right/left, respectively) and retrocervical/uterosacral ligament (WK 0.656) sites.Conclusion: Sonographic estimation of the 2021 AAGL Endometriosis staging is greatest in AAGL-LPS stages 1 and 4 as well as among patients with no endometriosis. Ultrasound best identifies endometriosis of the ovaries, bladder, and bowel but is more limited for the tubes and superficial peritoneum. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Most studies on interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome use typical or average levels of pelvic pain or urological symptom intensity as their outcome, as both are associated with reduced quality of life. Symptom exacerbations or “flares” have also been found to be associated with reduced quality of life, but no studies, to our knowledge, have investigated whether these associations are independent of typical pelvic pain levels and thus might be useful additional outcome measures (or stated differently, whether reducing flare frequency even without reducing mean pain intensity may be important to patients). Materials and Methods: We used screening visit and weekly run-in period data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain Symptom Patterns Study to investigate associations between flare frequency and multiple measures of illness impact and health care seeking activity, independent of typical nonflare and overall pelvic pain levels. Results: Among the 613 eligible participants, greater flare frequency was associated with worse condition-specific illness impact (standardized b coefficients [0.11-0.68, P trends < .0001) and health care seeking activity (odds ratios [1.52-3.94, P trends .0039 to < .0001) in analyses adjusted for typical nonflare and overall pelvic pain levels. Experiencing 1/d was also independently associated with worse general illness impact (standardized b coefficients[0.11-0.25). Conclusions: Our findings suggest that flare frequency and possibly other flare characteristics may be worth considering as additional outcome measures in urological chronic pelvic pain syndrome research to support the development of new preventive and therapeutic flare strategies. [ABSTRACT FROM AUTHOR]

Female patients with chronic pelvic pain (CPP) face complicated healthcare journeys, but narrative perspectives on CPP treatment are lacking. We collected data in English and Spanish from discussion groups and individual interviews with stakeholders around female CPP. A tertiary care center for gynecologic care. Patients with CPP who self-identified as women/female, community healthcare workers, and providers who care for women with CPP. We conducted discussion groups with all 3 types of stakeholders and individual interviews with female patients who have CPP. Patient participants completed condition specific validated questionnaires. De-identified transcripts were coded with NVivo software. We contrasted patient characteristics and codes between patients with CPP who did and did not report opioid use in the last 90 days. The mean pain score of patient participants was 6/10 ± 2/10, and 14 of 47 (28%) reported recent opioid use, without significant differences between patients with and without recent opioid use. Thematic saturation was achieved. Five main themes emerged: the debilitating nature of CPP, emotional impacts of CPP, challenges in CPP healthcare interactions, treatment for CPP, and the value of not feeling alone. Common threads voiced by stakeholders included difficulty discussing chronic pain with others, a sense of inertia in treatment, interest in alternative and less invasive treatments before more involved treatments, and the need for individualized, stepwise, integrated treatment plans. Participants agreed that opioids should be used when other treatments fail, but women recently using opioids voiced fewer concerns about addiction and positive experiences with opioid efficacy. These findings among female patients with CPP and also among community healthcare workers and providers advocate for a move toward patient-centered care, particularly the acknowledgment that every woman experiences pain in a singular way. Furthermore, stakeholders voice a deep need for development of individualized treatment plans. [ABSTRACT FROM AUTHOR]

Background: Pelvic Girdle Pain (PGP) is a musculoskeletal pain that arises between the posterior iliac crest and gluteal fold, at the sacroiliac joint and also radiates posteriorly in the thigh. PGP give rise to very intense pain and disability than Low Back Ache (LBA). It is a common condition during pregnancy and post-delivery. Joint laxity increases pelvic rotation and lumbar lordosis which results in adaptive hip extensor muscle weakness. Hence the studies focus on identifying the lumbar lordosis and hip extensor strength of PGP. Aim of the Study: To identify the association between lumbar lordosis and PGP and to identify the association between hip extensor strength and PGP among post-partum women. Material and Methodology: Based on inclusion and exclusion criteria a total of 80 postpartum women were assessed based on the diagnostic criteria the women were divided into two groups. Group A consists of women with PGP and group B consists of women without PGP. Both groups were assessed for lumbar lordosis using flexicurve and hip extensor strength using a manual muscle tester. Data collected was analyzed using. Outcome Measure: Flexicurve to assess lumbar lordosis. Manual muscle tester to assess hip extensor strength. Result: The study showed that the mean lumbar lordosis was significantly higher in women with PGP than in women without PGP, p = 0.001. There was a 15.46° ± 6.91° higher angle observed in persons who had pelvic girdle pain compared to those who did not have pelvic girdle pain. The mean hip extensor strength for group 'A' (average of right and left side) was 12.74 ± 0.73kg, whereas it was significantly higher in group 'B'. Conclusion: The study concludes that there is a positive association between lumbar lordosis and hip extensor weakness in pelvic girdle pain. [ABSTRACT FROM AUTHOR]

Objectives: Male pelvic pain is a common yet poorly understood condition, strongly influencing quality of life of those affected. Research on psychological and sexual factors is lacking, specifically on younger men in family-forming ages. This study aims to explore psychological and sexual factors related to pelvic pain in younger men (<40 years) through a cross-sectional design. Methods: Participants were recruited via social media, and completed a digital survey regarding sexual health and psychological distress (n=2,647). Men with varying levels of pelvic pain were compared on levels of psychological distress and self-reported sexual health. Results: Men with pelvic pain (n=369) reported significantly higher levels of catastrophizing, anxiety and premature ejaculation compared to men without pelvic pain. Furthermore, men with higher pain intensity reported significantly higher levels of catastrophizing, anxiety and depressive symptoms compared to men experiencing lower pain intensity. Hierarchical regression analysis revealed catastrophizing and depressive symptoms as significantly predictors of pain intensity. Conclusions: These findings underscore the role of psychological factors in male pelvic pain, and points to the need for integrating a psychological understanding for further treatment development. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effect of adding core stability to usual care for pregnant women with lumbar and pelvic girdle (LPG) pain. This was a repeated-measures design randomized controlled trial with blinded outcome assessors. Thirty-five pregnant women with LPG pain were recruited from prenatal health care providers. They were allocated to 2 study groups to receive either usual prenatal care (control group, n = 17) or usual care with core stability exercises focusing on the pelvic floor muscles and deep abdominal muscles (exercise group, n = 18) for 10 weeks. The visual analog scale, score on the Oswestry Disability Index, and the World Health Organization's Quality of Life Brief Version (WHOQOL-BREF) were evaluated with analysis of variance at pre-intervention, post-intervention, at the end of pregnancy, and 6 weeks after childbirth. There was a statistically significant interaction of group and time for all outcome measures except for the Social category (P =.18) in the WHOQOL-BREF questionnaire. The analysis of the group within time showed that mean scores in the exercise group were substantially improved at the post-intervention, end of pregnancy, and 6-week follow-up evaluation, except in the Environment category (end of pregnancy: P =.36; 6-week follow-up: P =.75) in the WHOQOL-BREF questionnaire. The results of this study indicate that the addition of core stability exercises was more effective than the usual care alone in pain relief, improving disability, and quality of life of pregnant women with LPG pain. [ABSTRACT FROM AUTHOR]

Cutaneous endometriosis is not a very often seen condition and is broadly classified as primary (spontaneous) and secondary. While perineal endometriosis arising in a previous scar has been reported, spontaneous cutaneous endometriosis in perineum is extremely rare and only three cases occurring in mons pubis have been reported in literature. We report a case of 34-year-old lady presented with a swelling in pubic region and associated dull aching pain of 1-year duration with no history of cyclical variation of symptoms. Investigations finally concluded a diagnosis of endometriosis and a Complete excision with clear margins. Clinicians should be aware that a spontaneous endometriosis in the perineum can occur and can have atypical presentation with no increase in size or pain during menstruation. [ABSTRACT FROM AUTHOR]

Integrative nursing, informed by the complementarity of biomedical and traditional/historical beliefs and practices, is an inclusive, relationship-centered approach to care. The Tao of Integrative Nursing Assessment , an East-West model for precision assessment, utilizes the Eight Principal Patterns Taoist philosophy and the Roy Adaptation Model to identify clients' energetic health patterns. [ABSTRACT FROM AUTHOR]

Purpose: Prior studies suggest that certain foods exacerbate interstitial cystitis/bladder pain syndrome symptoms. However, these studies were limited in size and demographics. We assessed the presence of diet sensitivities among patients with interstitial cystitis/bladder pain syndrome and compared them with patients with other pelvic pain conditions and healthy controls. Materials and Methods: We identified Veterans Affairs patients nationwide by querying ICD-9/10 codes for interstitial cystitis/bladder pain syndrome. Patients were assigned to interstitial cystitis, other pelvic pain, or healthy control cohorts after chart review. We mailed all patients the Shorter-Moldwin Food Sensitivity Questionnaire to evaluate the self-perceived effects of specific foods/beverages on urinary symptoms and/or bladder pain. Results: In the interstitial cystitis/bladder pain syndrome cohort, 70% had ≤ 1 food sensitivity vs 37% of the other pelvic pain cohort and 32% of healthy controls (P < .001). The average number of sensitivities were similar between other pelvic pain conditions and healthy control cohorts, which were significantly less than in interstitial cystitis/bladder pain syndrome patients. Interstitial cystitis/bladder pain syndrome patients were more sensitive to acidic, spicy foods, and certain beverages vs other cohorts (all P < .001). Within the interstitial cystitis/bladder pain syndrome cohort, Black patients had significantly higher sensitivity to alcoholic and noncaffeinated beverages than Whites. Black patients did report significantly worsened urinary urgency than Whites (P < .05). Conclusions: In a diverse population of veterans, interstitial cystitis/bladder pain syndrome patients had significantly more food sensitivities than those without interstitial cystitis/bladder pain syndrome. This suggests that food sensitivities could be suggestive of interstitial cystitis/bladder pain syndrome, which could make the Shorter-Moldwin Food Sensitivity Questionnaire a helpful diagnostic tool and aid in distinguishing interstitial cystitis/bladder pain syndrome from conditions often confused with interstitial cystitis/bladder pain syndrome. [ABSTRACT FROM AUTHOR]

Qualitative studies have shown that people with endometriosis report feeling discontent with their bodies relating to the visual and functional effects of the disease. However, few studies exist which compare people with endometriosis to those without, leaving it largely unknown as to whether this discontentment differs from that regularly experienced by women. The current study therefore aimed to 1) quantitatively assess body image, namely appearance satisfaction and functionality appreciation, in people with and without endometriosis, and 2) explore the relationship between endometriosis-related pelvic pain and body image. Australians aged 18 and over were recruited for two groups: those with endometriosis (n = 312, 99 % female, M age = 30.78, SD age = 7.40) and a control group without suspected or diagnosed endometriosis (n = 74, 100 % female, M age = 32.38, SD age = 8.84). Participants completed an online survey consisting of measures of appearance satisfaction, functionality appreciation, and pelvic-pain impact. The endometriosis group demonstrated significantly poorer body image when compared to the control group, and endometriosis-related pelvic pain was shown to negatively correlate with body image. These findings demonstrate the likely negative effects endometriosis and pelvic pain have on body image and provide much needed insight to help develop interventions tailored to endometriosis. • Satisfaction with body appearance is lower in those with endometriosis. • Appreciation of body functionality is lower in those with endometriosis. • Endometriosis-related pelvic pain is associated with reduced appearance satisfaction and functionality appreciation. [ABSTRACT FROM AUTHOR]

Although endometriosis is a common condition—affecting ∼10% of premenopausal individuals—its etiology is unknown. Diet receives a lot of attention from patients, but studies of the role of diet are limited. Examining dietary patterns is essential to provide new insight. We sought to determine whether dietary patterns are associated with laparoscopically-confirmed endometriosis diagnosis. We conducted a prospective cohort study among 81,997 premenopausal participants of the Nurses' Health Study II, who were followed from 1991–2015. Diet was assessed with validated food frequency questionnaires every 4 years. We examined 6 dietary patterns: Western, Prudent, Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, an estrogen-associated pattern, and a proinflammatory pattern. Cox proportional hazard ratios and 95% confidence intervals were used to quantify the association between each of these patterns and laparoscopically-confirmed endometriosis diagnosis. Three thousand eight hundred ten incident cases of endometriosis were diagnosed during 24 years of follow-up. Adherence to the Alternative Healthy Eating Index, reflecting a healthier dietary pattern, was associated with a 13% lower risk of endometriosis diagnosis (fifth vs first quintile 95% confidence interval, 0.78–0.96; P trend =.02). Participants in the highest quintile of the Western dietary pattern, characterized by high intake of red meat, processed meat, refined grains, and desserts, had a 27% higher risk of endometriosis diagnosis than those in the lowest quintile (95% confidence interval, 1.09–1.47; P trend =.004). The Prudent, Dietary Approaches to Stop Hypertension, and estrogen-associated dietary patterns did not demonstrate clear associations with endometriosis risk, and there was the suggestion of a higher risk of endometriosis diagnosis among those with a higher proinflammatory diet score (hazard ratio for fifth vs first quintile, 1.10 [95% confidence interval, 0.99–1.23]; P trend =.01). Our results suggest that consuming a dietary pattern that adheres to the Alternative Healthy Eating Index-2010 recommendations lowers the risk of endometriosis diagnosis, potentially through a beneficial impact on pelvic pain. In addition, consuming a less healthy diet high in red/processed meats and refined grains may have a detrimental impact on endometriosis symptoms. [ABSTRACT FROM AUTHOR]

Tubulovillous adenomas are colonic polyps with a relatively high potential for malignancy that are typically identified on colonoscopy. We present a case of colonic tubulovillous adenoma first discovered on gynecologic transvaginal ultrasound. The patient was a 42-year-old gravida 2 para 2 female with symptoms suggestive of endometriosis, including left lower quadrant pain, heavy menstrual bleeding, urinary urgency, and dyschezia. The patient underwent transvaginal ultrasound following the International Deep Endometriosis Analysis protocol that identified an intermediate echogenicity, vascular solid mass of the rectosigmoid lumen. Consequent colonoscopy and polypectomy revealed tubulovillous tissue negative for high-grade dysplasia or malignancy. This case report highlights the importance of gynecologists developing an acute awareness of colonic pathologies that might be encountered while performing endometriosis ultrasounds with direct assessment of the rectum. [ABSTRACT FROM AUTHOR]

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Endometriosis is the leading cause of chronic pelvic pain. Alterations in brain functional connectivity have been reported in adult women with endometriosis-associated pain (EAP), however, it is still unknown if similar patterns of changes exist in adolescents. Methods : In this pilot study, resting-state fMRI scans were obtained from 11 adolescent and young women with EAP and 14 healthy female controls. Using a seed-to-voxel approach, we investigated functional connectivity between the anterior insula, medial prefrontal cortex, and the rest of the brain. Furthermore, we explored whether potential functional connectivity differences were correlated with clinical characteristics including disease duration, pain intensity, and different psychosocial factors (pain catastrophizing, fear of pain, functional disability, anxiety, and depression). Results : Our findings revealed that patients with EAP demonstrated significantly decreased connectivity between the right anterior insula and two clusters: one in the right cerebellum, and one in the left middle frontal gyrus compared to controls. Additionally, functional connectivity between the right anterior insula and the right cerebellum was positively associated with pain intensity levels. In patients with EAP, brain changes were also correlated with state anxiety and fear of pain. Conclusions: Our results are relevant not only for understanding the brain characteristics underlying EAP at a younger age, but also in enhancing future pain treatment efforts by supporting the involvement of the central nervous system in endometriosis. • Altered brain function in young patients with endometriosis-associated pain (EAP). • Less functional connectivity between the right anterior insula and pain-related regions. • Anterior insula and cerebellum connectivity was linked to greater pain intensity. • Alterations in the pain regulatory pathways in endometriosis. • Endometriosis management should include centrally mediated treatments. [ABSTRACT FROM AUTHOR]

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