Abstracts from the International Pelvic Pain Society (IPPS) Annual Scientific Meeting on Pelvic Pain 2024 in Conjunction with the 6th World Congress on Abdomino-Pelvic Pain

Malinina O, Marchencko V State Hospital 29, Moscow, Russia Introduction: Pudendal neuralgia is the neuropathic pain component of the syndrome caused by pudendal nerve entrapment. Currently, the main treatment method for pudendal neuralgia is surgical decompression. Our objective was to identify a new method of treating pudendal neuropathy using autoplasma enriched with platelet-derived growth factors (PRP). Materials and Methods: Prospective study examining 20 patients with pudendal nerve neuropathy. The patients were divided into 2 groups. The main group included 10 patients who received 3 sessions of PRP therapy with an interval of 14 days. Participants received a 6 mL injection of autoplasma enriched with platelet-derived growth factors under the sacrotuberous ligament at the level of the pudendal nerve. The control group included 10 patients who underwent a series of blockades with glucocorticosteroids in the amount of 3 procedures with an interval of 7 days. Results: Nine men and 11 women, average age 40.4 years ± 4.86 years, participated. All 10 patients injected with glucocorticosteroids, reported ≥50% decrease in pain (VAS score) on the first day; however, 1 month later, 70% (7/10) reported pain levels similar to baseline, P < 0.001. In the PRP group, 70% reported complete regression of pain 1 month after treatment, P < 0.001, while the remaining 30% reported ≥50% relief compared with baseline. This effect was sustained at 6 months without side effects. Therefore, the use of purified autoplasma enriched with a suspension of platelets may be a method of treating pudendal neuralgia caused by its pinching compared with glucocorticoids. Disclosure: None.

Seidman LC, Payne LA McLean Hospital, Belmont, USA Introduction: The number of painful body locations (ie, pain “widespreadness”) a person experiences is an indicator of central sensitization and is a risk factor for chronic pain. However, less is known about the widespreadness of pain specifically during menstruation and how it relates to other measures of functioning. The aim of the current study is to investigate the relationships among pain widespreadness during menstruation and other menstrual and psychosocial domains in adolescents. Materials and Methods: Participants included 141 adolescent girls ages 13 to 19 years with varying levels of menstrual pain. Measures included a body map to indicate the location(s) where participants experience pain when menstruating. Participants also completed validated measures assessing menstrual cycle characteristics and psychosocial functioning. Partial correlations controlling for average menstrual pain were conducted to elucidate relationships among assessed measures. Results: The average number of body regions endorsed was 2.8 (SD = 1.5; min = 0; max = 8). The number of regions endorsed was positively correlated with number of menstrual symptoms (r = 0.369, all P 's ≤ 0.001 unless otherwise indicated), number of premenstrual symptoms (r = 0.411), number of body regions endorsed as painful during the prior month when not menstruating (0.525), pain interference (r = 0.296), sleep disturbance (r = 0.274), sensory hypersensitivity (r = 0.217, P = 0.01), and somatization (r = 0.395). We summarize that those adolescents experiencing greater pain widespreadness during menstruation also experienced more impairment in functioning compared with their peers across several domains. Disclosure: None.

The 27th International Pelvic Pain Society Annual Scientific Meeting was held together with the sixth World Congress on Abdomino-Pelvic Pain in Cartagena, Colombia, October 16 to 19, 2024. This is a multidisciplinary meeting with presentations of peer-reviewed abstracts in the form of posters and oral presentations. Topics included perioperative pain management, multidisciplinary management of chronic pelvic pain, imaging for endometriosis, and pudendal neuralgia.

Garcia Bedoya V, Lastra Rodriguez L Clinica Medellin Poblado, Medellin, Colombia Introduction: Our objective was to evaluate the effect of TECAR therapy on sexual pain. Methods: Before and after, single-cohort study. Data were collected from 10 women with an average age of 43 ± 12 years with a diagnosis of sexual pain, who underwent capacitive endocavitary TECAR (Transferencia Electrica Capacitativa Resistiva) therapy for 5 sessions, 1 session each week lasting 25 to 30 minutes, targeting trigger points within the vulva, vestibule, and vagina. Two scales were applied, the Female Sexual Function Index (FSFI) and the Visual Analog Scale (VAS) for pain before and after the 5 TECAR therapy sessions. Results: Mean VAS pain scores improved from 10 to 1.8 after therapy ( P = 0.004). FSFI domains improved as follows: desire from 3.9 to 2.05 ( P = 0.007) and orgasm from 4 to 2.8 ( P = 0.007). The FSFI domain of satisfaction was not significantly improved. Pain during intercourse decreased significantly from 2.4 to 5.4 ( P = 0.005). Higher scores on the pain domain indicate less pain experienced during intercourse. In this cohort, TECAR therapy improved sexual function. Disclaimer: None.

Moussa AA, Moberg K Alazhar School of Medicine, Elrehab-Cairo, Egypt Introduction: Vaginal atrophy is common after menopause and is often linked to sexual dysfunction, particularly dyspareunia. Our objective was to determine whether oxytocin vaginal gel is effective in reducing vaginal symptoms associated with menopause. Methods: Double-blind randomized controlled trial comparing 600 IU/mL oxytocin gel vs placebo gel applied daily for 2 weeks Results: Fifty postmenopausal women (aged 47–66 years) with vaginal atrophy were randomized to either placebo or gel (hypromellose, pH 3.8). The color of the vaginal mucosa improved in all 25 patients in the oxytocin group and in 4 patients from the control group ( P < 0.001). There was a decrease in the intravaginal pH in the oxytocin groups, with the delta value being greater in the oxytocin group ( P < 0.001). The vaginal maturation index increased in the oxytocin group, but not in the control group ( P < 0.001). In this cohort, it seems that intravaginal treatment with 600 IU/mL of oxytocin counteracts the effects of vaginal atrophy. Disclosure: None.

Lewis H a , Asad Zadeh P-FVK b , Soskin L c , Worful J c , Lamvu G a a Orlando VA Healthcare System, Orlando, USA b Argenx c Bayer Pharmaceuticals Introduction: Our objective was to describe the pattern of opioid prescribing after diagnosis of endometriosis. Methods: Retrospective descriptive analysis of persons aged 16 to 45 years with at least 2 diagnoses of endometriosis (ICD codes) between 2010 and 2019. Those with malignancy and hysterectomy or menopause before index date were excluded. Data were obtained from US OPTUM Clinformatics Datamart. Results: Among 22,317 persons with endometriosis, 70.1% (n = 15,633) used pharmacotherapy, of those, 27.8% (n = 6,205) were prescribed opioids; median time to initiating opioids was 12 weeks. In 12.4% (n = 2,787), opioids were prescribed as a first-line treatment. Among the 6,205 persons who were prescribed opioids, 44.6% (n = 1,243) subsequently underwent surgery, 9.6% (n = 268) received hormonal suppression, and 45.8% (n = 1,276) had no additional treatment. The average time to opioid initiation was shorter in persons with gynecological (2 weeks) vs COPCs (12 weeks) and psychological (13 weeks) comorbidities. In a sensitivity analysis, a subcohort was created, consisting of persons who received opioid prescriptions 2 weeks before and 2 weeks after surgery. Opioid use was lower in this subcohort (10.6%) than in the general postindex population (27.8%). In addition, more Asian persons in this subcohort (17%) used opioids compared with other races. Opioids were frequently prescribed for endometriosis and, in many cases, as a first-line treatment. Nearly half of those who were prescribed opioids received no other treatment. Opioids were used less in the perioperative setting, suggesting utilization for nonsurgical or chronic pain. Disclosure: A.Z.P.F.V.K. is employed by Argenx, S.L. and W.J. are employed by Bayer Pharmaceuticals. The data were obtained through Bayer.

Ortiz-Fullana MT, Rosado-Torres C, Soto-Soto D, Salgado-Avilés J, Romaguera J, Lozada-Capriles Y Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, Puerto Rico Introduction: This study aims to understand the current state of chronic pelvic pain (CPP) management in Hispanic women in Puerto Rico. Methods: A cross-sectional study of Hispanic women in Puerto Rico aged 21 to 55 years diagnosed with CPP and recruited through social media and Gynecologic Clinics. An online self-administered questionnaire assessed participant profiles, medical history, and management of CPP. Results: The mean age of 169 participants was 34 years. On average, symptoms started at 25 years of age. The most common gynecological conditions reported were endometriosis (100, 59%) and fibroids (56, 33%); 58 (34%) reporting more than 2 gynecological diagnoses. Most (88.2%, 149) were evaluated by primary care and general gynecologists, 25.4% were managed by a CPP specialist, and 35% were also evaluated by physical therapists (PT), chiropractors, psychiatry, urology, or gastroenterologists. Besides medical therapies, 45.6% (77) reported having surgery for pelvic pain, >50% reported not receiving any current treatment for their chronic pelvic pain, and 40.2% (68) reported seeking alternative medicine (48.5% [33] used cannabinoids). In summary, only 25% of participants were evaluated by a CPP specialist and <10% of participants were referred to pelvic floor PT, suggesting gaps in CPP diagnosis and treatment in our population. Disclosure: None.

Herrera-Betancourt AL a , Lopez-Jaramillo JD b , Lopez-Isanoa JD b , Uribe-Perez J a , Villegas-Echeverri JD b a Pelvic Pain and Laparoscopy Unit—Pelvicentro, Bogota, Colombia b Advanced Gynecological Laparoscopy and Pelvic Pain Unit—ALGIA, Pereira, Risaralda, Colombia Introduction: Pelvic congestion syndrome (PCS) is associated with chronic pelvic pain. The diagnostic gold standard for PCS is transuterine pelvic venography using the Beard criteria. The objective of this study was to develop a score for the diagnosis of PCS based on clinical variables. Methods: An analysis was performed on data obtained from 100 patients who underwent transuterine pelvic venography at a clinic in Pereira (Colombia) between 2008 and 2011 for suspected pelvic congestion syndrome, of which 70 were positive. The result of the venography was related to each of the clinical manifestations in terms of sensitivity, specificity, positive predictive value, negative predictive value, positive probability rate, negative probability rate, diagnostic weight, and the P -value through the χ 2 formula. Results: Four clinical variables were found with a P -value less than 0.05, and these were taken to perform the diagnostic test, giving each 1 point (age 30 years and older, premenstrual pain, ovarian point tenderness, and postcoital pain). Subsequently, the diagnostic test was applied to the same population, and the ROC curve calculation was performed, finding an area under the curve of 0.75. We found that patients who presented 0 points, that is, who did not have any of the clinical manifestations included in the diagnostic test, had no probability of having a positive venography, while those who had 4 points, that is, all the clinical variables of the diagnostic test, had a 97% probability of having a positive venography. Disclosure: None.

Kelsey Stewart, Jessica Trinh, Kristin Cole, Isabel Green Mayo Clinic, Rochester, USA Introduction: Our objective was to describe barriers to health care in patients with chronic pelvic pain (CPP). Methods: Patients aged 18 to 55 years with pelvic pain diagnoses in the All of Us database (2018–2024) were included in a CPP group; patients with pregnancy or gynecologic malignancy were excluded. All other reproductive age patients served as controls. Definitions of patient characteristics and health care barriers followed All of Us reporting standards. Univariate and multivariable analysis was conducted. Results: One thousand three hundred six patients with CPP were compared with 49,215 controls. Patients with CPP had less education, lower income, and more often rated their health as “poor.” Most patients experienced at least 1 barrier to care. Patients with CPP reported more delays in care due to mismatched provider race/religion (25.6%, 20.4%), lack of transportation (18.7%, 10.4%), rural location (7.5%, 4.6%), and lack of childcare (10.0%, 6.8%) ( P < 0.001). Patients with CPP faced more barriers in affording follow-up care (17.7%, 11.6%), specialty consultation (20.6%, 15.0%), prescriptions (29.3%, 16.6%), or emergency care (11.2%, 6.5%) ( P < 0.001). Patients with CPP were “very worried” about paying medical bills (24.0%, 20.1%, P = 0.005), described skipping or missing medications, and using alternative therapies more frequently than controls ( P < 0.001). This report shows that patients with CPP reported more barriers related to finances, transportation, childcare, and provider respect. Interventions for barriers merit further exploration. Disclosure: None.

Espitia de la Hoz FJ Hathor Clinical Sexologica, Armenia, Colombia Introduction: This study evaluated the efficacy and safety of vaginal promestriene in postmenopausal women with early-stage, hormone receptor-positive breast cancer experiencing genitourinary syndrome of menopause (GSM) while receiving anastrozole. Methods: A randomized, double-blind, placebo-controlled trial was conducted with participants assigned to either 1% promestriene cream or placebo for 3 years. Vaginal maturation index (VMI), vaginal pH, and symptom scores for vulvovaginal atrophy were assessed every 6 months. Sexual function was evaluated using the Female Sexual Function Index (FSFI). Serum estradiol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) were also monitored. Results: Seventy-three women (mean age 52.7 years) were included. Promestriene significantly improved VMI (27.38 vs 89.52, P < 0.001), reduced vaginal pH (6.95 vs 4.25, P < 0.001), and decreased GSM symptoms ( P < 0.001) compared with placebo. Significant improvements in sexual function (FSFI score 19.84 vs 27.94, P < 0.001), particularly desire and arousal, were observed in the promestriene group. No significant changes in serum estradiol, FSH, or LH levels were detected with promestriene use. In this study, vaginal promestriene was an effective and safe treatment for GSM in postmenopausal women with breast cancer receiving anastrozole, improving vaginal health, symptom relief, and sexual function without affecting hormone levels. Disclosure: None.

Briggs M, Green I Mayo Clinic, Rochester, USA Introduction: Individuals with chronic pelvic pain (CPP) have higher rates of emergency department (ED) utilization compared with matched individuals without CPP in the United States. Guidelines for CPP management include medications, surgery, and multidisciplinary care but infrequently discuss management of pain exacerbations. The objective was to conduct a scoping review on management of chronic pain exacerbations within the ED, with a focus on CPP. Methods: A comprehensive database search from inception to August 2024 was conducted with a medical librarian's assistance. Included studies focus on the management of chronic pain exacerbations and ED utilization. Two investigators independently screened abstracts. Full-text review is ongoing for thematic analysis. Results: Of the 417 abstracts reviewed, 80 met inclusion criteria. Only 3 studies (4%) investigated management of CPP in the ED. Most studies focused on other chronic pain conditions: general chronic pain (59%) and sickle cell disease (6%). Two studies investigated the effects of multidisciplinary care on ED utilization and 1 case report described the use of a nerve block for acute endometriosis pain. 6-8 Analysis of non-CPP studies elucidated interventions to optimize ED utilization, guide ED evaluation and management, and post-ED care/follow-up. The literature evaluating CPP exacerbation management in the ED is limited. Guidelines and protocols have been created for the management of other chronic pain conditions in the ED, aspects of which could be used to inform future research on the management and evaluation of CPP in this setting. Resources for the management of acute CPP exacerbations are needed. Disclosure: None.

Loktev A, Krotova N, Malinina O, Sizova M, Taevere M Fomin Clinic, Moscow, Russia Introduction: Our objective was to assess corneal small nerve fiber morphology in patients with chronic pelvic pain and to determine the prevalence of SFN in patients with chronic pelvic pain (CPP) using corneal confocal microscopy (CCM). Methods: Retrospective analysis. We studied 25 patients with CPP (male = 14, female = 11) and 10 healthy control subjects. All the participants completed a CPP symptom and neuropathic pain survey. A central corneal thickness scan was obtained with a confocal microscope that uses a diode helium–neon laser with a wavelength of 670 nm as a radiation source. Nerve measurements were made by a single ophthalmologist masked to the clinical diagnosis. Results: Patients with CPP had a stromal nerve thickness of 4.8 ± 1.0 micrometers (mean ± standard deviation) significantly different from control's values (6.0 ± 1.3) P = 0.01. Patients also had significantly greater dendritic cell density 10 ± 2 vs 3 ± 1 of controls P = 0.01. Seventeen of 25 patients with pelvic pain (68%) were positive for SFN using CCM. Comorbid conditions noted in the CPP group included chronic prostatitis (36%), irritable bowel syndrome (32%), endometriosis (28%), vulvodynia (24%), lower back pain (20%), interstitial cystitis (20%), fibromyalgia (16%), and migraine (16%). We summarized that patients with CPP have thinner corneal stromal nerves and greater dendritic cell density when compared with healthy controls. Disclosure: None.

Lewis H a , Asad Zadeh P-FVK b , Soskin L c , Worful J c , Lamvu G a a Orlando VA Healthcare System, Orlando, USA b Argenx c Bayer Pharmaceuticals Introduction: The use of hysterectomy as a treatment option for endometriosis is not well-studied. Our objective was to describe patterns of hysterectomy after diagnosis of endometriosis. Materials and Methods: Retrospective analysis of persons aged 16 to 45 years with at least 2 diagnoses of endometriosis between 2010 and 2019. Those with malignancy and hysterectomy or menopause before index date were excluded. Surgeries were identified using CPT codes for all hysterectomy types. Data were obtained from US claims databases: MarketScan Commercial Claims and Encounters and OPTUM Clinformatics Datamart. Results: A total of 22,371 and 54,630 persons with endometriosis were identified in OPTUM and MarketScan, respectively. Of these, hysterectomy was performed in 35.8% (n = 7988) of OPTUM and 35.7% (n = 19,510) of MarketScan. In more than 17%, hysterectomy was performed as a first-line treatment. Asian persons were less likely to receive a hysterectomy (27.3%) compared with other races (37.5% Black, 36.5% White). Hysterectomy frequency was higher among persons with comorbidities (COPCs: 38.4% OPTUM, 37.1% MarketScan, psychological: 36.9% OPTUM, 37.3% MarketScan, gynecological: 32.5% OPTUM, 34.4% MarketScan). Frequency of hysterectomy increased with age: 16 to 29 years (23.4% OPTUM, 22.1% MarketScan) vs 40 to 45 years (44.4% OPTUM, 45.8% MarketScan). In 16 to 29-year olds, the average time to surgery was 19 to 20 weeks; 40 to 45-year olds was 15 weeks. In summary, hysterectomy was frequently used for endometriosis with 17.5% receiving it as a first-line intervention. Hysterectomy was more prevalent among older women and those with COPCs. Disclosure: A.Z.P.F.V.K. is employed by Argenx, S.L. and W.J. are employed by Bayer Pharmaceuticals. The data were obtained through Bayer.

Rodríguez Lastra J, Cardona García Y Universidad Alfonso X El Sabio, Villanueva de la Cañada, Madrid, Spain; INNEO, Barcelona, Spain Introduction: This study evaluates a novel intracavitary TECAR (Transferencia Electrica Capacitativa Resistiva) device for treating vaginal symptoms associated with genitourinary syndrome (GSM) and related conditions. The device uses a finger-shaped wand with temperature control (40–45°C) to deliver high energy intravaginally, stimulating collagen production, angiogenesis, and improved circulation. This mechanism aims to enhance vaginal moisture, tissue texture, and pain relief by potentially blocking Na+/K+ ATPase. Methods: One hundred women (22 GSM, 20 vaginal atrophy, 53 endometriosis-related pain, 10 vaginal rejuvenation) received treatment with an active plate on the mons pubis and the intracavitary device. We assessed vaginal pain, sexual function, and satisfaction after treatment. Results: Eighty percent of the cohort reported significant improvements ( P < 0.05) in pain, muscle strength, sexual satisfaction, vaginal dryness, and laxity. Pain scores decreased from 5.90 ± 3.98 to 1.30 ± 2.54, while strength increased from 3.30 ± 1.49 to 4.80 ± 0.42. Vaginal dryness improved from 1.90 ± 0.99 to 4.10 ± 0.56, P = 0.000, and the laxity score improved from 2.17 ± 0.98 to 4.17 ± 0.40, P = 0.003. The Female Sexual Function Index score increased from 3.2 to 4.9 ( P = 0.002). In all cases, an increase in the turgor of the labia and a better appearance of the vulva is observed. Therefore, in this cohort, TECAR therapy addressed vaginal symptoms, appearance, and pain. Disclosure: None.