Pelvic Pain Flashcards
Levator ani syndrome and Rome II criteria
A symptom complex of pain, pressure, or discomfort in the region of sacrum, rectum, and coccyx that may be associated with pain in the gluteal region and thighs”
Criteria:
- 12 weeks of chronic or recurrent rectal pain or aching in the last 12 months
- -episodes lasting 20 minutes or longer
- -other causes of pain ruled out
Prepuce mobility testing
Grade 1: mild- 50% of glands covered
Grade 2: moderate- 75% of glands covered
Grade 3: severe- complete inability to expose clitoris
Friedrich’s criteria for Vulvodynia
2/3 must be positive
- severe pain in vulvar vestibule upon touch or attempted vagina entry
- tenderness to pressure localized within vulvar vestibule
- vulvar erythema of varying degrees
Allodynia
Pain due to stimulus that does not normally provoke pain
Hyperalgesia
Increased pain from a stimulus that normally provoked pain
Vulvodynia
Vulvar pain of at least 3 mo duration, without clear identifiable cause, which may have potential associated factors
Predictors: genital pain; burning > 3 mo; 10+ episodes of painful tampon use, intercourse, gynecological exam; pain on contact limits intercourse.
iSSVD classifications for Vulvodynia
Generalized or localized
Provoked
Unprovoked
Mixed
Referred pain patterns:
Pubococcygeus- anterior attachments
Perineum and base of penis. Urethral pain, urge and frequency
Pain referral patterns:
Iliococcygeus
Prostate fullness, refers to ant Levators and prostate. Lateral wall, perineal and anal sphincter
Referred Pain patterns:
Middle and posterior Levator
“Golf ball in the rectum”
Urinary frequency, urgency
Referred pain patterns:
Coccygeus
Pre and post over movement pain
Full bowel sensation and discomfort
Referred pain patterns:
External anal sphincter
Localized to front of back of sphincter
Referred pain patterns:
Coccyx
Immobility can perpetuate pelvic pain
Usually Patient complains of pain with the pelvic floor contraction exercises
Referred pain pattern:
Anterior lower abdominals
Pain and discomfort in bladder and lower abdomen
Referred pain patterns:
Lateral abdominal
Testicular pain, stomach, ribs, and groin referral
Referred pain patterns:
Adductor magnus
“Golf ball in rectum”
Referred pain pattern:
Pyramidalis
Bladder, pubic bone, urethra
Referred pain pattern:
Gluteals
Tailbone, testicles, buttocks, hip, sacrum and hamstrings
Endometriosis staging
1) minimal; few superficial implants
2) mild, more and deeper implants
3) moderate; many deep pressure implants, ovaries involved and adhesions
4) severe, many adhesions
Medical treatment for endo in regards to hormones; estrogen, progesterone, and androgens
Estrogen decreased
Progesterone increased
Androgens increased
PCOS Rotterdam criteria
(2 of 3)
- hyperandrogenism
- ovulation abnormalities
- 12+ cysts on one ovary or 10mL or more in volume
Prostatitis syndrome Categories (NIH)
1) acute bacterial
2) chronic bacterial
3) chronic CPPS
A. Inflammatory
B. Non-inflammatory
4) Asymptomatic inflammatory
Subtypes of PNE
Type 1: at exit of greater sciatic notch with spasm of Piriformis
Type 2: at ischial spine, sacrotuberous lig, and lesser sciatic notch entrance.
Type 3: in association with OI spasm at entrance to Alcock canal
Type 4: distal entrapment of terminal branches
Nantes criteria (pudendal neuralgia)
Pain in territory of PN
Pain while sitting
Pain does not wake at night
Pain with no objective sensory impairment
Pain relieved by nerve block
