RESUMO
OBJECTIVE: Use clinical pain measurement tools to investigate and compare the prevalence of pelvic loin disoders in women with and without endometriosis. STUDY DESIGN: Chronic pelvic pain (CPP) associated with endometriosis has diverse origins, including musculoskeletal factors. Musculoskeletal dysfunction in the pelvic region is theorized to result from sustained muscular contraction, triggered by altered visceral stimuli and adoption of antalgic postures, causing secondary damage to muscles, ligaments, and joints. CPP significantly impacts quality of life, relationships, sexuality, and mental health. However, limited data exists on musculoskeletal impacts of endometriosis and CPP. It was made a case-control study at Maternidade Escola Assis Chateaubriand from August 2017 to January 2021. Evaluated 71 women: 41 in endometriosis group (EG) and 30 in control group (CG). Data collection included sociodemographic questionnaires, musculoskeletal physiotherapeutic evaluations, pain mapping, pressure pain thresholds, kinesiophobia, and disability measurements. Statistical analysis was performed using Spearman's Rho test to determine correlations. RESULTS: Mean age of participants was 31 years. EG exhibited lower pain threshold variations in lumbopelvic trigger points than CG (P < .05). Significant muscle flexibility differences between groups were observed; EG had reduced flexibility (P < .05). Most common pain areas were hypogastrium in EG (48.78 %) and left lumbar in CG (30 %). EG had higher kinesiophobia values (P = .009). There was a weak association between kinesiophobia-pressure threshold association observed in CG's lumbar pelvic region. CONCLUSION: Women with Endometriosis and CPP exhibit higher prevalence of musculoskeletal disorder, lower pain thresholds, decreased lumbopelvic muscle range of motion, higher kinesiophobia scores, and increased disability indices with low back pain compared to healthy women.
Assuntos
Endometriose , Dor Pélvica , Humanos , Feminino , Endometriose/complicações , Endometriose/fisiopatologia , Estudos de Casos e Controles , Adulto , Dor Pélvica/epidemiologia , Dor Pélvica/fisiopatologia , Medição da Dor , Dor Crônica/epidemiologia , Dor Crônica/fisiopatologia , Limiar da Dor , Adulto JovemRESUMO
BACKGROUND: Chronic pelvic pain is a common disease that affects approximately 4% of women of reproductive age in developed countries. This number is estimated to be higher in developing countries, with a significant negative personal and socioeconomic impact on women. The lack of data on this condition in several countries, particularly those in development and in socially and biologically vulnerable populations such as the indigenous, makes it difficult to guide public policies. OBJECTIVES: To evaluate the prevalence of chronic pelvic pain (dysmenorrhea, dyspareunia, non-cyclical pain) and identify which variables are independently associated with the presence of the condition in indigenous women from Otavalo-Ecuador. DESIGN: A cross-sectional study was carried out including a sample of 2429 women of reproductive age between 14 and 49 years old, obtained from April 2022 to March 2023. A directed questionnaire was used, collected by bilingual interviewers (Kichwa and Spanish) belonging to the community itself; the number of patients was selected by random sampling proportional to the number of women estimated by sample calculation. Data are presented as case prevalence, odds ratio, and 95% confidence interval, with p < 0.05. RESULTS: The prevalence of primary dysmenorrhea, non-cyclic pelvic pain, and dyspareunia was, respectively, 26.6%, 8.9%, and 3.9%.all forms of chronic pain were independently associated with each other. Additionally, dysmenorrhoea was independently associated with hypertension, intestinal symptoms, miscegenation, long cycles, previous pregnancy, use of contraceptives and pear body shape. Pain in other sites, late menarche, exercise, and pear body shape were associated with non-cyclic pelvic pain. And, urinary symptoms, previous pregnancy loss, miscegenation, and pear body shape were associated with dyspareunia. CONCLUSION: The prevalence of primary dysmenorrhea and non-cyclical chronic pelvic pain was notably high, in contrast with the frequency of reported dyspareunia. Briefly, our results suggest an association between dysmenorrhoea and conditions related to inflammatory and/or systemic metabolic disorders, including a potential causal relationship with other manifestations of pelvic pain, and between non-cyclical pelvic pain and signs/symptoms suggesting central sensitization. The report of dyspareunia may be influenced by local cultural values and beliefs.
Assuntos
Dor Crônica , Dismenorreia , Dor Pélvica , Humanos , Feminino , Adulto , Dor Pélvica/epidemiologia , Estudos Transversais , Prevalência , Adulto Jovem , Dor Crônica/epidemiologia , Pessoa de Meia-Idade , Equador/epidemiologia , Adolescente , Dismenorreia/epidemiologia , Dispareunia/epidemiologia , Povos Indígenas/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Pregnancy and diabetes mellitus promote several musculoskeletal changes predisposing this population to complaints of Lower Back (LB) and Pelvic Pain (PP). OBJECTIVE: To assess the frequency of LB and PP and associated factors in type 1 Diabetic (DM1) pregnant women. METHOD: An observational analytical cross-sectional study. Thirty-six pregnant women with DM1 were evaluated through a postural assessment with a focus on pelvic positioning and what patients reported. The associated factors were assessed using the State-Trait Anxiety Inventory (STAI), the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and the Female Sexual Function Index (FSFI). RESULTS: The frequency of LB and PP was 55.6 % and 30.6 %, respectively. The presence of anxiety was not associated with a higher prevalence of pain. The incidence of sexual dysfunctions was higher in the GD. DM1 duration had a mean of 14.9 years (± 8.2 SD) in the GD and 9.0 years (± 6.9 SD) in the GSD, which was statistically significant (p ≤ 0.050). In the multiple binary regression analysis for the occurrence of pain, the independent factor was DM1 duration ≥ 17 years (OR = 11.2; 95 % CI = 1.02â124.75). The association between DM1 duration ≥ 17 years and being overweight showed a probability of 95 % for the studied population in the analysis of the probabilities of occurrence of the pain event. CONCLUSION: There was a high frequency of LB and PP related to pregnancy in DM1 pregnant women in the second trimester of pregnancy. The incidence of sexual dysfunction and DM1 duration ≥ 17 years increases the chance that DM1 pregnant women will experience pain. There was no association between anxiety. urinary incontinence and pain in DM1 pregnant women.
Assuntos
Diabetes Mellitus Tipo 1 , Dor Lombar , Disfunções Sexuais Fisiológicas , Feminino , Gravidez , Humanos , Gestantes , Dor Lombar/epidemiologia , Dor Lombar/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Estudos Transversais , Dor Pélvica/epidemiologia , Dor Pélvica/etiologia , Inquéritos e QuestionáriosRESUMO
PURPOSE AND OBJECTIVE: To evaluate and compare the incidences of post-operative pelvic pain (PPP) in patients undergoing ablation, enucleation and conventional transurethral resection of the prostate (TURP). METHODS: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Using MEDLINE via PubMed and Cochrane CENTRAL, randomised control trials (RCTs) and observational studies reporting PPP rates post-ablation, enucleation or TURP were identified. The risk of biases (RoB) in RCTs and observation studies were assessed using the Cochrane RoB1.0 tool and the Newcastle-Ottawa Scale, respectively. RESULTS: 62 studies were included for qualitative analysis, while 51 of them reported number of patients with PPP post-intervention. Three observational studies and 13 RCTs compared the rates of PPP in patients undergoing ablation, enucleation or TURP. The most reported types of PPP are dysuria, abdominal pain and irritative symptoms. The pooled incidence of PPP at 1-month follow-up in patients undergoing ablation, enucleation and TURP were 0.15 (95% CI 0.10-0.22), 0.09 (95% CI 0.04-0.19 and 0.10 (95% CI 0.06-0.15), respectively. PPP is no longer prevalent at 3-months and onwards post-operatively. Ablation is associated with a higher risk of PPP than enucleation (RR 2.19, 95% CI 1.04-4.62) and TURP (RR 2.40, 95% CI 1.03-5.62) in observational studies but not RCTs; and there were no significant differences in the rates of PPP upon comparison of other modalities. CONCLUSION: PPP is common after transurethral benign prostatic hyperplasia surgery. Patients undergoing ablation had a higher rate of post-intervention PPP than those undergoing enucleation and TURP in observational studies.
Assuntos
Dor Pós-Operatória/epidemiologia , Dor Pélvica/epidemiologia , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/efeitos adversos , Humanos , Incidência , MasculinoRESUMO
BACKGROUND: The quality of life (QoL) of patients with endometriosis and infertility was assessed in different stages and correlated with the clinical features of the cases. METHODS: The present study was a cross-sectional study; 106 women were included, divided in two endometriosis groups (Grade I/II, 26 women, and Grade II/IV, 74 women). All participants attended the Endometriosis and Infertility Outpatient Clinic of the Instituto Ideia Fértil de Saúde Reprodutiva, Faculdade de Medicina do ABC, São Paulo, Brazil, were and responded to the Short Form (SF) Health Survey-36. Convenience sampling was used due to the authors' access to the study population; however, the sample number was calculated to be sufficient for 95% power in both groups. RESULTS: Homogeneity was observed between Grade I/II and Grade III/IV staging, with similar mean ages (35.27, ±3.64 years and 34.04, ±3.39 years, respectively, p = 0.133); types of infertility (p = 0.535); infertility time (p = 0.654); degrees of pain (p = 0.849); and symptoms common to endometriosis, namely, dysmenorrhea (p = 0.841), dyspareunia (0.466), chronic pelvic pain (p = 0.295), and intestinal (p = 0.573) or urinary (p = 0.809) diseases. Comparisons of median scores in the QoL domains demonstrated that the distributions of QoL and clinical symptoms were significantly related between the types of dyspareunia and the following domains: physical functioning (p = 0.017), role- emotional (p = 0.013), and general health (p = 0.001). Regarding pain outside of menstruation, there was significance in the pain domain (p = 0.017), and degree of pain was significance in physical functioning (p = 0.005) and role-physical (p = 0.011) domains. CONCLUSIONS: The present study pointed out that it is not the stage of endometriosis that interferes in the quality of life of women with endometriosis and infertility but rather the clinical manifestations, such as dyspareunia and pain. Thus, we can conclude that the patient's perception of the disease should be considered in health care and that the losses are independent of the degree of endometriosis in this population with the aggravating factor of infertility.
Assuntos
Depressão/etiologia , Dismenorreia/etiologia , Dispareunia/etiologia , Endometriose/complicações , Infertilidade Feminina/diagnóstico , Dor Pélvica/etiologia , Qualidade de Vida/psicologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Dismenorreia/epidemiologia , Dispareunia/epidemiologia , Endometriose/epidemiologia , Endometriose/psicologia , Feminino , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/psicologia , Dor Pélvica/epidemiologiaRESUMO
STUDY OBJECTIVE: To evaluate the long-term impact of laparoscopic excision of endometriosis on quality of life through pain reduction as measured by the Endometriosis Health Profile-30 (EHP-30) in uterine-sparing (preservation of the uterus and at least 1 ovary) and nonuterine-sparing (removal of the uterus) surgery. DESIGN: Cohort study. SETTING: Academic medical center. PATIENTS: Sixty-one women who had undergone laparoscopic excision of endometriosis for pelvic pain were enrolled in a tissue-procurement study. INTERVENTIONS: Patients who had previously completed an EHP-30 preoperatively and at 4 weeks postoperatively were mailed a copy of the EHP-30 2.6 to 6.8 years after their index surgery. MEASUREMENTS AND MAIN RESULTS: The primary outcome was quality of life as measured by changes in the EHP-30 scores before their index surgery and those measured weeks and years later. The secondary outcome was a comparison of the EHP-30 scores between patients who underwent excision of endometriosis alone and those who underwent excision of endometriosis with hysterectomy +/- oophorectomy. From 2011 to 2015, 61 women underwent laparoscopic excision of endometriosis for pelvic pain. Forty-six of the 61 patients completed the EHP-30 for a response rate of 75%. The patients demonstrated significant improvement in all 5 scales of the EHP-30 (pain, control and powerlessness, emotional well-being, social support, and self-image) at 4 weeks postoperatively (p <.001), which persisted for up to 6.8 years in follow-up (p <.001) when compared with their baseline scores. The improvement in EHP-30 scores did not differ by American Society for Reproductive Medicine staging or index surgery. Definitive surgery (total laparoscopic hysterectomy/bilateral salpingo-oophorectomy) was not associated with improved outcomes when compared with uterine-sparing surgery. CONCLUSION: Laparoscopic excision of endometriosis offers improvement in all quality-of-life domains as measured by the EHP-30, including a reduction in pain, an effect that may persist for up to 6.8 years. These findings suggest that laparoscopic excision of endometriosis with uterine preservation can be considered as an option for discussion during counseling for treatment of endometriosis.
Assuntos
Endometriose/cirurgia , Laparoscopia/efeitos adversos , Dor Pós-Operatória/etiologia , Qualidade de Vida , Adulto , Estudos de Coortes , Endometriose/epidemiologia , Feminino , Seguimentos , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Histerectomia/estatística & dados numéricos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Pessoa de Meia-Idade , Ovariectomia/efeitos adversos , Ovariectomia/métodos , Ovariectomia/estatística & dados numéricos , Dor Pós-Operatória/epidemiologia , Dor Pélvica/epidemiologia , Dor Pélvica/cirurgia , Doenças Peritoneais/epidemiologia , Doenças Peritoneais/cirurgia , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
Background: Chronic pelvic pain (CPP) is a condition characterized by recurring pain in the lower part of the abdomen and it lasts at least six months. Objective: To know the frequency and characteristics of CPP in women from the gynecology consultation. Methods: Women that consecutively attended the gynecology external consultation were questioned about the presence of CPP. Those with CPP were requested to indicate the place where the pain was more intense, and to qualify its magnitude in an analog visual scale. Situations that modified the pain, as well as the medication used were investigated. The life disturbance was evaluated. Those patients with and without CPP were paired by age and compared with Student's t test for independent samples. Results: 711 women were studied, 132 (18.6%) fulfilled criteria for CPP. After comparing patients with and without CPP there were no significant differences between them. The maximum intensity of the pain was of 7.7 ± 1.7 and the most frequent localization was in hypogastrium (53.2%). The factor that more frequently alleviated the pain was to stay in bed (59.5%). Non-steroid anti-inflammatories were the most common medication (56.3%). The most frequent reason for consultation was hypermenorrhea (19.9%) and the most frequent diagnosis was uterine leiomyomatosis (15.1%). Conclusion: The frequency of CPP was similar to that reported by other groups.
Introducción: El dolor pélvico crónico (DPC) está caracterizado por dolor constante o recurrente en la parte baja del abdomen que dura al menos seis meses. Objetivo: Conocer la frecuencia de presentación y características del DPC en mujeres de la consulta de ginecología. Métodos: Se interrogó a mujeres que acudieron consecutivamente a la consulta externa de ginecología sobre la presencia de DPC. En aquellas con DPC se les pidió indicaran el sitio donde el dolor era más intenso, así como la magnitud del mismo en una escala visual análoga. Se interrogaron los factores que modificaban el dolor, así como la medicación utilizada. Se evaluó la afectación en su vida. Las pacientes con y sin DPC se parearon por edad y se compararon con prueba t de Student para muestras independientes. Resultados: Se estudiaron 711 mujeres, 132 (18.6%) cumplieron criterios para DPC. Al comparar a las mujeres pareadas con y sin DPC no hubo diferencias significativas. La máxima intensidad del dolor fue de 7.7 ± 1.7 y la localización más frecuente en hipogastrio (53.2%). El factor que más frecuentemente disminuía el dolor era el acostarse (59.5%). Los antiinflamatorios no esteroideos fueron los medicamentos más utilizados (56.3%), el motivo de consulta más frecuente fue la hipermenorrea (19.9%) y el diagnóstico más frecuente la miomatosis uterina (15.1%). Conclusión: La frecuencia de DPC fue semejante a lo reportado por otros grupos.
Assuntos
Dor Crônica/diagnóstico , Dor Crônica/epidemiologia , Dor Pélvica/diagnóstico , Dor Pélvica/epidemiologia , Adulto , Dor Crônica/terapia , Feminino , Ginecologia , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Medição da Dor , Dor Pélvica/terapiaRESUMO
OBJECTIVE: Review of the diagnosis and management of ovarian masses in children, through the identification of preoperative risk factors of malignancy, the evaluation of surgical management and its results. METHODS: Retrospective study in pediatric patients under 18 years old, managed surgically by ovarian masses. Analyzed data were symptoms, imagining, tumor markers, treatment, outcomes and pathology. The primary endpoint was ovarian malignancy. RESULTS: We identified 54 patients with ovarian masses between 2014 and 2017, of which 49 were benign and 5 malignant; The malignant ovarian masses were significantly larger than the benign, with an average of 19.4 cm vs 6.49 cm (p = 0.0001); had greater solid component in the imaging and positive tumor markers (p = 0.001) and were treated with oophorectomy plus tumor staging surgery. Forty-three patients with benign tumors underwent ovarian preservation surgery. The postoperative follow-up of all the patients was on average 3.4 months (1-25 months) and 20.3% presented pelvic pain associated with alterations of the menstrual cycle in their postoperative control. There are no reports of recurrence or contralateral ovarian tumor. CONCLUSIONS: Large masses with solid components and positive tumor markers were significant predictors of malignancy. Minimally invasive ovarian preserving surgery should be considered as the first treatment option in masses with low risk of malignancy. On the other hand, oophorectomy plus tumor staging surgery should be considered for ovarian tumors with a high risk of malignancy.
OBJETIVO: Revisión del diagnóstico y manejo de las masas ováricas en población infantil, mediante la identificación de factores de riesgo preoperatorios de malignidad, la evaluación del manejo quirúrgico y sus resultados. METODOS: Estudio retrospectivo en pacientes pediátricas menores de 18 años, intervenidas quirúrgicamente por masas ováricas. Se analizaron datos como síntomas, imágenes diagnósticas, marcadores tumorales, tratamiento, resultados y patología. La variable principal fue malignidad ovárica. RESULTADOS: Se identificaron 54 pacientes con masas ováricas entre el año 2014 a 2017, de las cuales 49 fueron benignas y 5 malignas. Las masas ováricas malignas fueron significativamente más grandes que las benignas, con media de 19,4 cm vs 6,49 cm (p = 0,0001); tuvieron mayor componente sólido en los hallazgos imagenológicos y marcadores tumorales positivos (p = 0,001) y fueron tratadas con ooforectomía más cirugía de estadificación tumoral. A 43 pacientes con tumores benignos se les realizó cirugía preservadora de ovario. El seguimiento postoperatorio de todas las pacientes fue en promedio de 3,4 meses (1-25 meses) y el 20,3% presentaron dolor pélvico asociado a alteraciones del ciclo menstrual en su control postoperatorio. No hay reportes de recidiva ni tumor de ovario contralateral. CONCLUSIONES: Masas grandes, con componentes sólidos y marcadores tumorales positivos fueron predictores significativos de malignidad. La cirugía preservadora de ovario por vía mínimamente invasiva debe ser considerada como primera opción de tratamiento en masas con bajo riesgo de malignidad; Por otra parte, la ooforectomía más cirugía de estadificación tumoral, debe ser considerada para los tumores ováricos con alto riesgo de malignidad.
Assuntos
Tratamentos com Preservação do Órgão/métodos , Doenças Ovarianas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Ovariectomia/métodos , Adolescente , Biomarcadores Tumorais/metabolismo , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Lactente , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estadiamento de Neoplasias , Doenças Ovarianas/patologia , Doenças Ovarianas/cirurgia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Dor Pélvica/epidemiologia , Dor Pélvica/etiologia , Estudos RetrospectivosRESUMO
OBJECTIVE: To identify and assess postpartum pelvic floor dysfunction (PFD) between vaginal delivery, elective cesarean delivery (ECD), and intrapartum cesarean delivery (ICD). METHODS: The present prospective observational study included women aged at least 18 years with no history of pelvic surgery or lower urinary tract malformation, and who had not undergone pelvic floor muscle (PFM) training in the preceding 12 months, who underwent delivery at Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil between August 1, 2016, and May 31, 2017. Participants were assessed at 48 hours (phase 1), 1 month (phase 2), and 3 months (phase 3) after delivery. Assessments included the International Consultation on Incontinence Questionnaire, Short Form (ICIQ-SF); the Jorge-Wexner anal incontinence scale; a self-rated visual analog scale for pelvic pain; the pelvic organ prolapse quantification (POP-Q) system; and a PFM perineometer. RESULTS: A total of 227 women were assessed in phase 1 (141 vaginal deliveries; 28 ICDs; and 58 ECDs), 79 in phase 2, and 41 in phase 3. The ICIQ-SF, Jorge-Wexner scale, visual analog scale, and perineometer measurements did not identify significant differences in relation to the type of delivery (P>0.05). CONCLUSION: The type of delivery was not associated with differences in the short-term development of postpartum PFD.