Pelvic myofascial pain is associated with restriction of sexual activity in women with pelvic pain: a cross-sectional study.

Background Dyspareunia and restriction of sexual activity are often reported by patients with chronic pelvic pain, but less is known about which conditions or factors contribute most to these symptoms. Methods This is a cross-sectional study of consecutive new patients who presented to a chronic pelvic pain and endometriosis referral clinic between January 2013 and December 2015. Patients completed a detailed questionnaire prior to their first visit and underwent a comprehensive standardised pelvic examination at their first visit.

Association Among Surgeon Volume, Surgical Approach, and Uterine Size for Hysterectomy for Benign Indications.

Objective: To assess the relationship between surgeon volume and surgical approach for patients undergoing hysterectomy for benign indications among uteri of varying sizes.

Methods: This was a retrospective cohort study of patients who underwent hysterectomy for benign indications from 2012 to 2021 within the Michigan Surgical Quality Collaborative registry. For each hysterectomy, the relative annual volume of the performing surgeon was assessed by calculating the proportion of hysterectomy cases contributed by the surgeon each calendar year relative to the total number of hysterectomies in the registry for that year.

Psychosocial predictors of change in sexual activity and sexual function after hysterectomy in women with pelvic pain.

Background: Potential impact on sexual function is an often-cited concern for many patients considering hysterectomy. The existing literature indicates that sexual function remains stable to slightly improved for most patients who undergo hysterectomy, but most studies demonstrate a small subset of patients in whom sexual function declines after surgery. Unfortunately, there is a lack of clarity as to surgical, clinical, and psychosocial factors that may influence the likelihood of sexual activity after surgery or the magnitude and direction of change in sexual function.

Association Between Nociplastic Pain and Pain Severity and Impact in Women With Chronic Pelvic Pain.

Exploring the relationship between nociplastic pain and the severity and impact of pelvic pain symptoms could lend insight into the heterogeneous symptom presentation and treatment response that complicates management of chronic pelvic pain. In this prospective cross-sectional study, we sought to evaluate relationships between degree of nociplastic pain, measured by the Fibromyalgia (FM) Survey Score, and multiple aspects of the chronic pelvic pain (CPP) experience, including severity, frequency, tenderness during pelvic myofascial exam, interference with daily life, and high-impact pain. The study included 303 women who presented to a tertiary referral clinic for chronic pelvic pain and endometriosis.

Approach to Diagnosis and Management of Chronic Pelvic Pain in Women: Incorporating Chronic Overlapping Pain Conditions in Assessment and Management.

Chronic pelvic pain (CPP) is multifactorial in etiology and heterogeneous in presentation. Identification of all pain contributors is essential for successful management. Chronic overlapping pain conditions (COPCs) are a specified group of chronic pain conditions that commonly co-occur in patients.

Effects of Pharmacologic Venous Thromboembolism Prophylaxis in Benign Hysterectomy.

Study Objective: To evaluate whether the addition of pharmacologic prophylaxis to mechanical prophylaxis for venous thromboembolism (VTE) is associated with changes in perioperative outcomes in hysterectomy for benign indications.

Design: Retrospective cohort study.

Setting: Michigan Surgical Quality Collaborative database.

Sexual function after hysterectomy according to surgical indication: a prospective cohort study.

Background: Our aims were to describe characteristics of sexual function prior to and 6months following benign hysterectomy in patients with three common surgical indications, and to identify preoperative factors that influence the magnitude and direction of change in sexual function after the procedure.

Methods: This prospective observational cohort study enrolled women (n =80) undergoing hysterectomy for benign indications. Patients were categorised into three groups according to surgical indication: (1) pelvic pain (PP), (2) abnormal uterine bleeding (AUB), and (3) pelvic organ prolapse (POP).

Incidence and predictors of persistent pelvic pain following hysterectomy in women with chronic pelvic pain.

Background: Chronic pelvic pain is a debilitating problem that afflicts 15% to 20% of women in the United States. Although more than 200,000 hysterectomies are performed annually for the treatment of chronic pelvic pain, previous studies indicate that 1 in 4 women undergo the discomfort and morbidity of hysterectomy without the relief of pain. The factors that predict treatment failure remain poorly characterized.

Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy.

Objective: To evaluate the effects of shared decision making using a simple decision aid for opioid prescribing after hysterectomy.

Methods: We conducted a prospective quality initiative study including all patients undergoing hysterectomy for benign, nonobstetric indications between March 1, 2018, and July 31, 2018, at our academic institution. Using a visual decision aid, patients received uniform education regarding postoperative pain management.

Lower Urinary Tract Symptoms in a Chronic Pelvic Pain Population.

Objectives: This study aimed to characterize the prevalence of lower urinary tract symptoms in a chronic pain population.

Methods: In this observational cohort study, patients referred to a female pelvic pain clinic completed several validated questionnaires assessing bladder symptoms, central sensitization, pain symptoms, depression, anxiety, and neuropathic pain. Patients diagnosed as having interstitial cystitis were excluded.

Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment.

Patients with pelvic pain suffer from psychological conditions at a disproportionately high rate compared with their peers. We review environmental, genetic, inflammatory, and neurobiological factors that increase vulnerability to developing both of these conditions. We review treatment strategies for chronic pelvic pain in patients who have comorbid psychological conditions, including both nonpharmacologic and pharmacologic options.

McCall Culdoplasty during Total Laparoscopic Hysterectomy: A Pilot Randomized Controlled Trial.

Study Objective: To assess the feasibility and safety of a McCall culdoplasty at the time of total laparoscopic hysterectomy and to evaluate the differences in the total vaginal length, vaginal apex during Valsalva, and sexual function 12 months after McCall culdoplasty compared with standard cuff closure.

Design: A pilot randomized controlled, single-masked trial (Canadian Task Force classification I).

Setting: An academic tertiary care hospital.

The Use of Opportunistic Salpingectomy at the Time of Benign Hysterectomy.

Study Objective: To delineate the use of opportunistic salpingectomy over the study period, to examine factors associated with its use, and to evaluate whether salpingectomy was associated with perioperative complications.

Design: A retrospective cross-sectional study (Canadian Task Force classification II-2).

Setting: The Michigan Surgical Quality Collaborative.

Patients' Knowledge and Perceptions of Morcellation.

Background And Objectives: Morcellation has received increased media and professional attention, but it remains unclear how much the average patient knows about this topic. We sought to evaluate patients' knowledge of morcellation, assess their perceptions of the risks and benefits, and determine how these perceptions affect their decision regarding the route of surgery.

Methods: Anonymous paper surveys were administered to 500 patients attending gynecologic appointments at the University of Michigan.

The role of nonpharmacologic therapies in management of chronic pelvic pain: what to do when surgery fails.

Purpose Of Review: To provide an update on nonsurgical and nonpharmacologic strategies for the management of chronic pelvic pain (CPP).

Recent Findings: Effective treatment of patients with CPP requires a multifaceted approach, with thoughtful consideration of surgical, pharmacologic, and nonpharmacologic strategies. Evidence for physical therapy and trigger point injections for treatment of myofascial components of CPP is increasing.

Reducing surgical site infections after hysterectomy: metronidazole plus cefazolin compared with cephalosporin alone.

Background: Organisms that are isolated from vaginal cuff infections and pelvic abscesses after hysterectomy frequently include anaerobic vaginal flora. Metronidazole has outstanding coverage against nearly all anaerobic species, which is superior to both cefazolin and second-generation cephalosporins. Cefazolin plus metronidazole has been demonstrated to reduce infectious morbidity compared with either cefazolin or second-generation cephalosporins in other clean-contaminated procedures, which include both as colorectal surgery and cesarean delivery.

Pharmacological Management of Chronic Pelvic Pain in Women.

Chronic pelvic pain (CPP) is a multifaceted condition that often has both peripheral and central generators of pain. An understanding of neurobiology and neuropsychology of CPP should guide management. Successful treatment of CPP is typically multimodal, and pharmacologic treatment strategies include analgesics, hormonal suppression, anesthetics, antidepressants, membrane stabilizers, and anxiolytics.

Management considerations for patients with uterine fibroids and concurrent venous thromboembolism.

Purpose Of Review: The purpose is to provide an update on management strategies for uterine fibroids in the setting of venous thromboembolism (VTE).

Recent Findings: Uterine fibroids and VTE are independently associated with morbidity and increasing healthcare costs. Women with large uterine fibroids have a higher likelihood of VTE.

Incentives for increasing prenatal care use by women in order to improve maternal and neonatal outcomes.

Background: Prenatal care is recommended during pregnancy as a method to improve neonatal and maternal outcomes. Improving the use of prenatal care is important, particularly for women at moderate to high risk of adverse outcomes. Incentives are sometimes utilized to encourage women to attend prenatal care visits.