Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL.
Am J Obstet Gynecol. 2013 Nov;209(5):422.e1-422.e10. doi: 10.1016/j.ajog.2013.08.020. Epub 2013 Aug 22.
The factors that underlie pelvic pain are poorly understood. Specifically, the relative influence of dysmenorrhea and psychological factors in the etiology of noncyclic pelvic pain conditions, such as interstitial cystitis and irritable bowel syndrome, is unknown. To further characterize pelvic pain, we compared the frequency of menstrual, somatosensory, and psychological risk factors between women with and without severe noncyclic pelvic pain symptoms.
A total of 1012 reproductive-aged women completed a 112-item questionnaire with domains including mood, fatigue, physical activity, somatic complaint, and pain. Questionnaire items included existing items for menstrual distress and newly written items derived from qualitative interviews. The relationship of dysmenorrhea and noncyclic pelvic pain complaints (dyspareunia, dyschezia, or dysuria) was modeled using quantile regression.
Among women who menstruate regularly, those with dysmenorrhea had disproportionally more severe noncyclic pelvic pain (54/402, 13%) than women without dysmenorrhea (5/432, 1%; odds ratio, 13; 95% confidence interval, 5-33). In a multivariate-adjusted model, dysmenorrhea (β = .17), activity capability (β = .17), somatic complaint (β = .17), and bodily pain (β = .12) were the primary predictors of noncyclic pelvic pain. Depression (β = .03) and anxiety (β = .01) were not significantly predictive. The presence of dysmenorrhea, somatic complaint, and low activity capability predicted 90% of the cases of women with noncyclic pelvic pain.
The association between dysmenorrhea and noncyclic pelvic pain suggests that menstrual pain is an etiological factor in noncyclic pelvic pain, whereas depression and anxiety may be secondary effects. Longitudinal studies are needed to determine whether dysmenorrhea causally influences development of noncyclic pelvic pain or shares common underlying neural mechanisms.
盆腔疼痛的发病因素尚未完全阐明。具体而言，痛经和心理因素在间质性膀胱炎和肠易激综合征等非周期性盆腔疼痛疾病发病机制中的相对影响尚不清楚。为了进一步明确盆腔疼痛的特征，我们比较了有严重非周期性盆腔疼痛症状和无严重非周期性盆腔疼痛症状的女性的月经、躯体感觉和心理危险因素的发生频率。
共有 1012 名育龄期女性完成了一份 112 项的问卷，问卷内容涵盖了情绪、疲劳、体力活动、躯体抱怨和疼痛等方面。问卷项目包括月经困扰的现有项目和从定性访谈中得出的新编写项目。使用分位数回归来模拟痛经和非周期性盆腔疼痛（性交痛、排便困难或排尿困难）的关系。
在有规律月经的女性中，有痛经的女性比没有痛经的女性（54/402，13%；比值比，13；95%置信区间，5-33）出现更严重的非周期性盆腔疼痛的比例不成比例。在多变量调整模型中，痛经（β=0.17）、活动能力（β=0.17）、躯体抱怨（β=0.17）和躯体疼痛（β=0.12）是预测非周期性盆腔疼痛的主要因素。抑郁（β=0.03）和焦虑（β=0.01）没有显著的预测作用。痛经、躯体抱怨和低活动能力的存在预测了 90%的非周期性盆腔疼痛女性病例。
痛经与非周期性盆腔疼痛之间的关联表明，月经疼痛是非周期性盆腔疼痛的一个病因因素，而抑郁和焦虑可能是继发效应。需要进行纵向研究以确定痛经是否会导致非周期性盆腔疼痛的发生，还是与非周期性盆腔疼痛存在共同的潜在神经机制。
