Persistent Pelvic Pain Prevalence: Comparing Estimates from a Single-Item Question and a Body Diagram Approach in the HUNT Study

Persistent Pelvic Pain Prevalence: Comparing Estimates from a Single-Item Question and a Body Diagram Approach in the HUNT Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Persistent Pelvic Pain Prevalence: Comparing Estimates from a Single-Item Question and a Body Diagram Approach in the HUNT Study Francesca Sofie Weinhold, Signe Nilssen Stafne, Mari Glette, Tom Ivar Lund Nilsen, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-10379734/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 15 You are reading this latest preprint version Abstract Background: Persistent pelvic pain (PPP) affects many women in the population but remains under-recognized and inconsistently measured. We aimed to assess the validity of a previously used single-item question for identifying PPP by comparing it with a body diagram-based reference. In addition, we wanted to estimate the PPP population prevalence among Norwegian women and explore the distribution of pain within the pelvic region. Methods: In 2024, a digital questionnaire was distributed to 25,528 women who had previously participated in the fourth Nord-Trøndelag Health survey (HUNT4, 2017–2019) in Norway. It included a single-item question on pelvic pain lasting ≥ 6 months and a second question asking whether participants had pain lasting ≥ 6 months in one or more body areas defined as the pelvic region on an accompanying body diagram. We defined the latter as the reference standard. Sensitivity, specificity, and positive and negative predictive values were calculated to assess the validity of the single-item question. Age-standardized prevalence estimates were derived, and pain distribution was assessed using the digital body map Graphical Index of Pain (GRIP), in which participants marked body areas where they experienced pain during the previous 4 weeks. Results: The single-item question showed high specificity (98.0%: 95% confidence interval (CI) 97.7–98.3) and positive predictive value (84.9%: 95% CI 82.8–87.0), but low sensitivity (41.3%: 95% CI 39.3–43.3), particularly among women aged ≥ 55 years. The age-standardized prevalence of PPP was 10% using the single-item question and 22% using the body diagram. GRIP revealed only modest overlap in pain distribution across pelvic regions. Conclusion: The single-item question accurately identified women with PPP, but showed limited sensitivity, resulting in substantial under-detection. The discrepancy between measures suggests variation in how women perceive and report pelvic pain, indicating that reliance on a single verbal question may substantially underestimate the population burden of PPP. These findings support the need for more comprehensive assessment tools, such as body diagrams, when identifying women with PPP in research and clinical practice. Trial registration: Not applicable Persistent pelvic pain chronic pelvic pain prevalence validation pain location pain distribution assessment Full Text Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.docx AdditionalFile2.docx AdditionalFile3.docx Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 25 Aug, 2026 Reviews received at journal 24 Aug, 2026 Reviews received at journal 23 Aug, 2026 Reviewers agreed at journal 22 Aug, 2026 Reviews received at journal 21 Aug, 2026 Reviewers agreed at journal 21 Aug, 2026 Reviews received at journal 21 Aug, 2026 Reviewers agreed at journal 20 Aug, 2026 Reviewers agreed at journal 20 Aug, 2026 Reviewers agreed at journal 20 Aug, 2026 Reviewers invited by journal 20 Aug, 2026 Editor invited by journal 10 Aug, 2026 Editor assigned by journal 07 Aug, 2026 Submission checks completed at journal 06 Aug, 2026 First submitted to journal 05 Aug, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-10379734","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":704314349,"identity":"db35a28d-8c32-4b83-8bad-c516fb673749","order_by":0,"name":"Francesca Sofie Weinhold","email":"","orcid":"","institution":"Norwegian University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Francesca","middleName":"Sofie","lastName":"Weinhold","suffix":""},{"id":704314351,"identity":"4e0237b9-a833-4f72-aec9-745cfa4b9439","order_by":1,"name":"Signe Nilssen 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Study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC 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We aimed to assess the validity of a previously used single-item question for identifying PPP by comparing it with a body diagram-based reference. In addition, we wanted to estimate the PPP population prevalence among Norwegian women and explore the distribution of pain within the pelvic region.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eIn 2024, a digital questionnaire was distributed to 25,528 women who had previously participated in the fourth Nord-Tr\u0026oslash;ndelag Health survey (HUNT4, 2017\u0026ndash;2019) in Norway. It included a single-item question on pelvic pain lasting\u0026thinsp;\u0026ge;\u0026thinsp;6 months and a second question asking whether participants had pain lasting\u0026thinsp;\u0026ge;\u0026thinsp;6 months in one or more body areas defined as the pelvic region on an accompanying body diagram. We defined the latter as the reference standard. Sensitivity, specificity, and positive and negative predictive values were calculated to assess the validity of the single-item question. Age-standardized prevalence estimates were derived, and pain distribution was assessed using the digital body map Graphical Index of Pain (GRIP), in which participants marked body areas where they experienced pain during the previous 4 weeks.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe single-item question showed high specificity (98.0%: 95% confidence interval (CI) 97.7\u0026ndash;98.3) and positive predictive value (84.9%: 95% CI 82.8\u0026ndash;87.0), but low sensitivity (41.3%: 95% CI 39.3\u0026ndash;43.3), particularly among women aged\u0026thinsp;\u0026ge;\u0026thinsp;55 years. The age-standardized prevalence of PPP was 10% using the single-item question and 22% using the body diagram. GRIP revealed only modest overlap in pain distribution across pelvic regions.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThe single-item question accurately identified women with PPP, but showed limited sensitivity, resulting in substantial under-detection. The discrepancy between measures suggests variation in how women perceive and report pelvic pain, indicating that reliance on a single verbal question may substantially underestimate the population burden of PPP. These findings support the need for more comprehensive assessment tools, such as body diagrams, when identifying women with PPP in research and clinical practice.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Persistent Pelvic Pain Prevalence: Comparing Estimates from a Single-Item Question and a Body Diagram Approach in the HUNT Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-08-28 09:55:08","doi":"10.21203/rs.3.rs-10379734/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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