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Carroll L, Sullivan CO, Doody C, Perrotta C, Fullen BM. Pelvic organ prolapse: Women's experiences of Accessing Care & Recommendations for improvement. BMC Womens Health 2023; 23:672. [PMID: 38114966 PMCID: PMC10729347 DOI: 10.1186/s12905-023-02832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime. Symptoms include pain, bulge, urinary, bowel and sexual symptoms affecting all aspects of a woman's life.Many women with POP symptoms present initially to primary care settings. Research has shown these interactions are often unsatisfactory, with women reporting their health care professional (HCP) trivialized their symptoms or appeared to have poor knowledge about pelvic floor dysfunction (PFD).Aim The aim of this qualitative study was to explore experiences of younger women seeking treatment for POP and their recommendations for improvements.Methods Ethics approval was obtained (LS-21-01-Carroll-Ful). Women with POP were recruited from an online support group (n = 930 members). Inclusion criteria: adult women, diagnosed with POP and aware of their POP stage. Following informed consent, a demographic questionnaire, interview questions and the Central Sensitization Inventory (CSI) were forwarded. Semi-structured zoom audio-recorded interviews were conducted. Thematic analysis was undertaken; transcripts coded, and themes identified.Results Fourteen women aged 32-41, parity 1-3, with POP Grade 1-3 participated. Many women reported HCPs as dismissive or not appreciative of the impact of their condition. Others described interactions with HCPs who they felt listened, understood the impact of their POP, gave simple explanations, a positive prognosis and outlined a realistic treatment plan.Current antenatal education, post-partum care and primary HCP screening for PFD were identified by women as deficient. Many highlighted delays in accessing specialist care for POP. Women made several recommendations for improvements to the current model of care.Conclusions Increased focus on person-centred care, particularly emotional support, information and education may improve younger women's experiences when seeking care for POP.
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Affiliation(s)
- Louise Carroll
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland.
- University College Dublin Centre for Translational Pain Research, Dublin, Ireland.
- Tipperary University Hospital, Clonmel, Co. Tipperary, Clonmel, Ireland.
| | - Cliona O' Sullivan
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Catherine Doody
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
- University College Dublin Centre for Translational Pain Research, Dublin, Ireland
| | - Carla Perrotta
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
| | - Brona M Fullen
- University College Dublin School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland
- University College Dublin Centre for Translational Pain Research, Dublin, Ireland
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Persistent Pelvic Pain in Patients With Endometriosis. Clin Obstet Gynecol 2022; 65:775-785. [PMID: 35467583 DOI: 10.1097/grf.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
As our understanding of chronic pain conditions, including endometriosis-related pain and chronic pelvic pain evolves, the evaluation and management of patients should reflect our increasing appreciation of the role of central sensitization, comorbid conditions and biopsychosocial factors on the pain experience and treatment outcomes. This review provides a systematic approach to persistent pain in patients with endometriosis. Expanding the evaluation and treatment of endometriosis-related pain by all health care providers could limit unnecessary surgical interventions and best meet our patient's needs.
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Orr NL, Wahl KJ, Lisonek M, Joannou A, Noga H, Albert A, Bedaiwy MA, Williams C, Allaire C, Yong PJ. Central sensitization inventory in endometriosis. Pain 2022; 163:e234-e245. [PMID: 34030173 DOI: 10.1097/j.pain.0000000000002351] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT A key clinical problem is identifying the patient with endometriosis whose pain is complicated by central nervous system sensitization, where conventional gynecologic treatment (eg, hormonal therapy or surgery) may not completely alleviate the pain. The Central Sensitization Inventory (CSI) is a questionnaire previously validated in the chronic pain population. The objective of this study was an exploratory proof-of-concept to identify a CSI cutoff in the endometriosis population to discriminate between individuals with significant central contributors (identified by central sensitivity syndromes [CSS]) to their pain compared to those without. We analyzed a prospective data registry at a tertiary referral center for endometriosis, and included subjects aged 18 to 50 years with endometriosis who were newly or re-referred to the center in 2018. The study sample consisted of 335 subjects with a mean age of 36.0 ± 7.0 years. An increasing number of CSS was significantly correlated with dysmenorrhea, deep dyspareunia, dyschezia, and chronic pelvic pain scores (P < 0.001), and with the CSI score (0-100) (r = 0.731, P < 0.001). Receiver operating characteristic analysis indicated that a CSI cutoff of 40 had a sensitivity of 78% (95% CI: 72.7%-84.6%) and a specificity of 80% (95% CI: 70.3%-84.5%) for identifying a patient with endometriosis with ≥3 CSS. In the group with CSI ≥ 40, 18% retrospectively self-reported pain nonresponsive to hormonal therapy and 40% self-reported daily pain, compared with 6% and 20% in the CSI < 40 group (P = 0.003 and 0.002, respectively). In conclusion, a CSI ≥ 40 may be a practical tool to help identify patients with endometriosis with pain contributors related to central nervous system sensitization.
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Affiliation(s)
- Natasha L Orr
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Kate J Wahl
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Michelle Lisonek
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Angela Joannou
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Heather Noga
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Christina Williams
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
| | - Catherine Allaire
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Paul J Yong
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- BC Women's Center for Pelvic Pain and Endometriosis Vancouver, BC, Canada
- Women's Health Research Institute, Vancouver, BC, Canada
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Drage KJ, Aghera M, MacKellar P, Twentyman R, Jacques A, Chalmers KJ, Neumann P, Nurkic I, Thompson J. The relationship between symptom severity, bother and psychological factors in women with pelvic organ prolapse: A cross-sectional observational study. Neurourol Urodyn 2021; 41:423-431. [PMID: 34888916 DOI: 10.1002/nau.24842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 09/23/2021] [Accepted: 10/21/2021] [Indexed: 11/09/2022]
Abstract
AIM The primary aim is to explore the relationship between symptom severity and prolapse bother in women with pelvic organ prolapse (POP). The secondary aim is to determine the association between psychological variables and prolapse bother. METHODS A cross-sectional observational study was conducted via online surveys assessing POP bother (visual analog scale for bother), POP symptom severity (International Consultation on Incontinence Questionnaire-Vaginal Symptoms), and psychological measures of depression and anxiety (Kessler psychological distress scale [K-10]), catastrophizing (modified pain catastrophizing scale [mPCS]), and self-efficacy (modified pain self-efficacy questionnaire [mPSEQ]) in women with self-reported POP. Symptom severity, bother and psychological variables were analyzed using linear regression. RESULTS Seventy-six women with a mean (SD) age of 42.8 (14.57) years were included in analysis. A moderate to strong positive linear relationship (R2 = 0.449, p < 0.001) was found between symptom severity and POP bother. Prolapse bother and psychological variables were moderately correlated, where increased K-10 scores (R2 = 0.230, p = 0.001), higher mPCS scores (R2 = 0.460, p < 0.001), and lower mPSEQ scores (R2 = 0.460, p < 0.001) were associated with increased POP bother. Moderate and severe catastrophizing was associated with significantly higher POP bother, with mean POP bother scores of 7.861 ± 0.45 (p < 0.001) and 8.652 ± 0.45 (p < 0.001), respectively. CONCLUSION A moderate positive relationship between POP bother and symptom severity was found, with greater psychological distress and lower self-efficacy associated with increasing POP bother. Women presenting with POP should be screened for psychological factors to guide management.
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Affiliation(s)
- Katie-Jay Drage
- Masters of Clinical Physiotherapy (Continence and Women's Health) Program, Curtin University, Perth, Western Australia, Australia
| | - Mansi Aghera
- Masters of Clinical Physiotherapy (Continence and Women's Health) Program, Curtin University, Perth, Western Australia, Australia
| | - Phoebe MacKellar
- Masters of Clinical Physiotherapy (Continence and Women's Health) Program, Curtin University, Perth, Western Australia, Australia
| | - Rhea Twentyman
- Masters of Clinical Physiotherapy (Continence and Women's Health) Program, Curtin University, Perth, Western Australia, Australia
| | - Angela Jacques
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - K Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia.,School of Health Sciences, Western Sydney University, Penrith, New South Wales, Australia
| | - Patricia Neumann
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Irena Nurkic
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Judith Thompson
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
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Orr NL, Wahl KJ, Noga H, Allaire C, Williams C, Bedaiwy MA, Albert A, Smith KB, Yong PJ. Phenotyping Sexual Pain in Endometriosis Using the Central Sensitization Inventory. J Sex Med 2020; 17:761-770. [PMID: 31983669 DOI: 10.1016/j.jsxm.2019.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 12/10/2019] [Accepted: 12/13/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Deep dyspareunia, a common symptom in endometriosis, has previously been associated with bladder and/or pelvic floor tenderness (BPFT), which suggests a role for central nervous system sensitization. The Central Sensitization Inventory (CSI, 0-100) is a validated self-reported scale for patients with central sensitization. AIM The objective of this study was to phenotype deep dyspareunia using BPFT and the CSI. METHODS The methods included cross-sectional analysis from a prospective registry from January 2018 to June 2018 at a tertiary center for endometriosis (ClinicalTrials.gov #NCT02911090). Included were women aged 18-50 years with endometriosis (previously surgically diagnosed, current visualized endometrioma on ultrasound, or current palpable or visualized nodule on ultrasound), who were newly or re-referred to the center. Severity of deep dyspareunia was self-reported using an 11-point numeric rating scale (0 = no pain; 10 = worst pain imaginable), categorized as no or low deep dyspareunia (0-4) and high deep dyspareunia (5-10). We identified the subgroup with high deep dyspareunia and presence of BPFT, where we hypothesized a central component of the sexual pain. This subgroup was compared with 2 other subgroups: no or low deep dyspareunia and high deep dyspareunia but no BPFT. The CSI was compared between the groups using analysis of variance, followed by post hoc testing (P < .05). MAIN OUTCOME MEASURE The main outcome measure was the CSI score ranging from 0 to 100. RESULTS Data from 163 women with endometriosis were analyzed. The mean age of this cohort was 36.4 ± 6.8 years, and the mean CSI score was 41.0 ± 18.6. 37 percent (61/163) had high deep dyspareunia and BPFT; 29% (47/163) had high deep dyspareunia and no BPFT; and 34% (55/163) had no or low deep dyspareunia. The CSI significantly differed between the 3 groups (analysis of variance: F = 22.4, P < .001). In post hoc testing, the CSI was higher in women with high deep dyspareunia and BPFT (51.3 ± 16.9), compared with women with no or low deep dyspareunia (30.9 ± 15.4, P < .001) and compared with women with high deep dyspareunia but no BPFT (39.4 ± 17.2, P = .001). CLINICAL IMPLICATIONS The CSI could be used to classify and phenotype patients with endometriosis-associated sexual pain. STRENGTH & LIMITATIONS Strengths include a prospective registry with integrated pain scores, validated questionnaires, and physical examination findings. Limitations include the lack of quantitative sensory testing for central sensitization. CONCLUSIONS In women with endometriosis, the subgroup with high deep dyspareunia and bladder and/or pelvic floor tenderness had a significantly higher score on the CSI than other subgroups, suggesting that this group may have a central component to their sexual pain. Orr NL, Wahl KJ,Noga H, et al. Phenotyping Sexual Pain in Endometriosis Using the Central Sensitization Inventory. J Sex Med 2020;17:761-770.
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Affiliation(s)
- Natasha L Orr
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Kate J Wahl
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Heather Noga
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Catherine Allaire
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada
| | - Christina Williams
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada
| | - Arianne Albert
- Women's Health Research Institute, Vancouver, BC, Canada
| | - Kelly B Smith
- BC Centre for Vulvar Health, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, Canada
| | - Paul J Yong
- BC Women's Centre for Pelvic Pain and Endometriosis, Vancouver, BC, Canada; Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; Women's Health Research Institute, Vancouver, BC, Canada; BC Centre for Vulvar Health, Gordon and Leslie Diamond Health Care Centre, Vancouver, BC, Canada.
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