Sexual abuse and chronic pelvic pain in a gynecology outpatient clinic. A pilot study

Introduction and hypothesis Almost 20% of women will suffer from sexual abuse at some point in their lives. This is a known risk factor for developing chronic pelvic pain (CPP), which is a major health problem worldwide. We conducted a pilot study in a Gynecology Outpatient Clinic to find the correlation between these two clinical entities and provide better evidence for their diagnosis and treatment.

A semi-structured interview for the evaluation of sexual violence in women (EVS) was used as a screening tool and a complement to routine gynecological examination to identify patients suffering from sexual abuse. Patients included were also assessed for comorbidities, including CPP, and other coexisting mental health problems.

Of the 61 patients screened, 33 (54.1%) had pelvic pain. Also, 11 patients (18%) had suffered sexual abuse at some point in their lives, which was only disclosed when the specific interview was performed. Ten patients (90.8%) out of 11 that had been sexually abused also had pelvic pain. This was found to be statistically significant in this sample (p = 0.008) with a more than 11-fold greater risk of having pelvic pain (OR, 11.7; 95% CI, 1.4–98.7). Most patients did not have psychological violence (77%) but those that did (23%) had a seven-fold greater risk of having pelvic pain (OR, 7.4; 95% CI, 1.5–36.9).

Specific tools should intentionally be used for evaluating sexual abuse and chronic pelvic pain, since a strong correlation exists between these two entities and they are seldom reported by patients. Similar content being viewed by others Availability of data and material Data are available upon reasonable request.

American College of Obstetricians and Gynecologists. Chronic pelvic pain: ACOG practice bulletin, number 218. Obstet Gynecol. 2020;135(3):e98–e109. https://doi.org/10.1097/aog.0000000000003716. Latthe P, Latthe M, Say L, Gülmezoglu M. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health. 2006;7:1–7. https://doi.org/10.1186/1471-2458-6-177. Daniels JP, Khan KS. Chronic pelvic pain in women. 341 (October). 2010. https://doi.org/10.1136/bmj.c4834. Hansrani V, Abbas A, Bhandari S, A-l C, Seif M, McCollum CN. Transvenous occlusion of incompetent pelvic veins for chronic pelvic pain in women: a systematic review. Eu J Obstetrics Gynecol. 2015;185:156–63. https://doi.org/10.1016/j.ejogrb.2014.12.011. Latthe P, Mignini L, Gray R, Hills R, Khan K. Factors predisposing women to chronic pelvic pain: systematic review. Br Med J. 2006; 55 (February). https://doi.org/10.1136/bmj.38748.697465.55. Beck JJH, Elzevier HW, Pelger RCM, Putter H. Multiple Pelvic Floor Complaints Are Correlated with Sexual. 2009; 193–198. https://doi.org/10.1111/j.1743-6109.2008.01045.x. Black M, Basile K, Breiding M, Smith S, Walters M, Merrick M, Chen J, Stevens M (2011) National intimate partner and sexual violence survey: 2010 summary report. Panisch LS, Tam LM. The Role of Trauma and Mental Health in the Treatment of Chronic Pelvic Pain: A Systematic Review of the Intervention Literature. 2018. https://doi.org/10.1177/1524838018821950. Sanz AM, Viejo CM, Salvador GP. Entrevista semiestructurada para la exploración de la violencia sexual sobre las mujeres en la relación de la pareja ( ES). Información Psicológica. 2016;18:18–34. Secretariado Ejecutivo del Sistema Nacional de Seguridad Pública. Incidencia Delictiva del Fuero Común 2019. SECRETARIADO EJECUTIVO DEL SISTEMA NACIONAL DE SEGURIDAD PÚBLICA, Ciudad de Mexico. 2019. http://secretariadoejecutivo.gob.mx/docs/pdfs/nueva-metodologia/CNSP-Delitos-2019_feb19.pdf. Sarrouf J, Celis A, Pedraza L, Carrera E. Cirugía Mínimamente Invasiva en Ginecología. In: Castañeda J (ed) Libro texto de la Federación Latinoamericana de Sociedades de Obstetricia y Ginecología–FLASOG–Comité Cirugía Mínimamente Invasiva. 2017. Speer L, Mushkbar S, Erbele T. Chronic pelvic pain in women. Am Fam Physician. 2016;93(5):380–7. Oram S, Khalifeh H, Howard LM. Violence against women and mental health. Lancet Psychiatry. 2016;0366(16):1–12. https://doi.org/10.1016/S2215-0366(16)30261-9. Granot M, Yovell Y, Somer E, Beny A, Sadger R, Uliel-mirkin R, Zisman-ilani Y. Trauma, attachment style, and somatization: a study of women with dyspareunia and women survivors of sexual abuse. 2018: 1–6. https://doi.org/10.1186/s12905-018-0523-2. Mert K, Aksoy SD. Working with women in Turkey exposed to childhood sexual abuse. Public Health Nurs. 2018;35(6):517–25. https://doi.org/10.1111/phn.12547. Howard FM. The role of laparoscopy in the chronic pelvic pain patient. Clin Obstet Gynecol. 2003;46(4):749–66. https://doi.org/10.1097/00003081-200312000-00004. Krause DJ, Green SA, Koury SP, Hales TW. Solution-focused trauma-informed care (SF-TIC): an integration of models. J Publ Child Welfare. 2018;12(2):117–35. https://doi.org/10.1080/15548732.2017.1348312. Price J, Farmer G, Harris J, Hope T, Kennedy S, Mayou R. Attitudes of women with chronic pelvic pain to the gynaecological consultation: a qualitative study. 2006: 446–452. https://doi.org/10.1111/j.1471-0528.2006.00862.x. Acknowledgments We thank Sergio Lozano-Rodriguez, MD, for his help in editing the manuscript. Funding Funding was provided by the Obstetrics and Gynecology Department. Author information Authors and Affiliations Contributions JG Garza-Leal: Protocol/project development; data analysis. FJ Sosa-Bravo: Data collection and management; data analysis; manuscript writing/editing. JG Garza-Marichalar: Data collection and management; data analysis; manuscript writing/editing. G Soto-Quintero: Data collection and management; data analysis; manuscript writing/editing. L Castillo-Saenz: Protocol/project development; data analysis. S Fernández-Zambrano: Protocol/project development; data analysis. Corresponding author Ethics declarations Ethics approval This trial was registered and approved by the Ethics Committee on October 20, 2020, with registration no. PS20–00019. Consent to participate This was a retrospective study. An analysis of databases was made. Informed consent from patients was not required. Conflict of interest None. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Garza-Leal, J.G., Sosa-Bravo, F.J., Garza-Marichalar, J.G. et al. Sexual abuse and chronic pelvic pain in a gynecology outpatient clinic. A pilot study. Int Urogynecol J 32, 1285–1291 (2021). https://doi.org/10.1007/s00192-021-04772-4 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00192-021-04772-4