Bladder base tenderness in the etiology of deep dyspareunia

Nourmoussavi M, Melica Nourmoussavi, Bodmer-Roy S, Sonja Bodmer-Roy, Justin Mui, Mawji N, Narissa Mawji, Williams C, Christina Williams, Catherine Allaire, Allaire C, Paul J. Yong
The journal of sexual medicine · 2014 · vol. 11(12) , pp. 3078–3084 · doi:10.1111/jsm.12708 · PMID:25244182 · W1541133762
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This study found bladder base tenderness in 34% of women with pelvic pain, independently associated with deep dyspareunia, abdominal wall trigger points, and pelvic floor tenderness.

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Abstract

INTRODUCTION: Bladder base tenderness can be present on pelvic exam in women with pelvic pain. However, its exact prevalence and clinical implications are not well understood. AIM: The aim of this study was to determine whether bladder base tenderness is associated with specific symptoms or signs in women, particularly dyspareunia. METHODS: Retrospective review of 189 consecutive women seen by a gynecologist in 2012 at a tertiary referral center for pelvic pain was conducted. Associations were tested between bladder base tenderness and variables on history/examination using bivariate analyses and multiple logistic regression. MAIN OUTCOME MEASURE: Deep dyspareunia and superficial dyspareunia (present/absent) were the main outcome measures. RESULTS: Bladder base tenderness was present in 34% of pelvic pain patients (65/189), which was significantly greater than the prevalence of bladder base tenderness of 3% (1/32) in a control sample of women without pelvic pain (odds ratio [OR] = 16.3, 95% confidence interval [CI] 2.17-121.7, Fisher exact test, P < 0.001). For the pelvic pain patients, on bivariate analyses, bladder base tenderness was significantly associated with deep dyspareunia (P < 0.001), superficial dyspareunia (P < 0.001), bladder symptoms (P = 0.026), abdominal wall trigger point (P < 0.001), and pelvic floor tenderness (P < 0.001). In contrast, bladder base tenderness was similarly present in women with or without endometriosis. On logistic regression, bladder base tenderness was independently associated with only deep dyspareunia (OR = 6.40, 95% CI: 1.25-32.7, P = 0.011), abdominal wall trigger point (OR = 3.44, 95% CI: 1.01-11.7, P = 0.037), and pelvic floor tenderness (OR = 8.22, 95% CI: 3.27-20.7, P < 0.001). CONCLUSIONS: Bladder base tenderness is present in one-third of women with pelvic pain, and contributes specifically to the symptom of deep dyspareunia. Bladder base tenderness was also associated with the presence of an abdominal wall trigger point and with pelvic floor tenderness, suggesting a myofascial etiology and/or nervous system sensitization.

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Condition tags

dysmenorrheadyspareuniaendometriosischronic_pelvic_pain

MeSH descriptors

Dyspareunia Urinary Bladder Diseases Adult Adult Dysmenorrhea Dysmenorrhea Dysmenorrhea Dyspareunia Dyspareunia Endometriosis Endometriosis Endometriosis Female Female Humans Humans Logistic Models Logistic Models Pelvic Floor Pelvic Floor

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References (21)

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