Pelvic Pain

Question 1

Levator ani syndrome and Rome II criteria

Answer 1

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

Question 2

Prepuce mobility testing

Answer 2

Grade 1: mild- 50% of glands covered

Grade 2: moderate- 75% of glands covered

Grade 3: severe- complete inability to expose clitoris

Question 3

Friedrich’s criteria for Vulvodynia

Answer 3

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

Question 4

Allodynia

Answer 4

Pain due to stimulus that does not normally provoke pain

Question 5

Hyperalgesia

Answer 5

Increased pain from a stimulus that normally provoked pain

Question 6

Vulvodynia

Answer 6

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.

Question 7

iSSVD classifications for Vulvodynia

Answer 7

Generalized or localized
Provoked
Unprovoked
Mixed

Question 8

Referred pain patterns:

Pubococcygeus- anterior attachments

Answer 8

Perineum and base of penis. Urethral pain, urge and frequency

Question 9

Pain referral patterns:

Iliococcygeus

Answer 9

Prostate fullness, refers to ant Levators and prostate. Lateral wall, perineal and anal sphincter

Question 10

Referred Pain patterns:

Middle and posterior Levator

Answer 10

“Golf ball in the rectum”

Urinary frequency, urgency

Question 11

Referred pain patterns:

Coccygeus

Answer 11

Pre and post over movement pain

Full bowel sensation and discomfort

Question 12

Referred pain patterns:

External anal sphincter

Answer 12

Localized to front of back of sphincter

Question 13

Referred pain patterns:

Coccyx

Answer 13

Immobility can perpetuate pelvic pain

Usually Patient complains of pain with the pelvic floor contraction exercises

Question 14

Referred pain pattern:

Anterior lower abdominals

Answer 14

Pain and discomfort in bladder and lower abdomen

Question 15

Referred pain patterns:

Lateral abdominal

Answer 15

Testicular pain, stomach, ribs, and groin referral

Question 16

Referred pain patterns:

Adductor magnus

Answer 16

“Golf ball in rectum”

Question 17

Referred pain pattern:

Pyramidalis

Answer 17

Bladder, pubic bone, urethra

Question 18

Referred pain pattern:

Gluteals

Answer 18

Tailbone, testicles, buttocks, hip, sacrum and hamstrings

Question 19

Endometriosis staging

Answer 19

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

Question 20

Medical treatment for endo in regards to hormones; estrogen, progesterone, and androgens

Answer 20

Estrogen decreased
Progesterone increased
Androgens increased

Question 21

PCOS Rotterdam criteria

Answer 21

(2 of 3)

• hyperandrogenism
• ovulation abnormalities
• 12+ cysts on one ovary or 10mL or more in volume

Question 22

Prostatitis syndrome Categories (NIH)

Answer 22

1) acute bacterial
2) chronic bacterial

3) chronic CPPS
A. Inflammatory
B. Non-inflammatory

4) Asymptomatic inflammatory

Question 23

Subtypes of PNE

Answer 23

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

Question 24

Nantes criteria (pudendal neuralgia)

Answer 24

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

Question 25

Commonly caused by STD’s; chlamydia, gonorrhea

Answer 25

Chronic pelvic inflammatory disease