Mobile uterine retroversion is associated with dyspareunia and dysmenorrhea in an unselected population of women

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Abstract

Objective

To determine if isolated retroversion is a cause of pelvic pain symptoms.

Study design

One hundred and eleven premenopausal women consulting for routine examination in the gynecology department of two hospitals and two gynecologic private practices were evaluated for chronic pelvic pain symptoms with a self-administered questionnaire. Uterine position and mobility was assessed by pelvic examination. Women with fixed uterus were excluded.

Results

Twenty-seven women (24.3%) had a retroverted uterus, and 84 (75.7%) had an anteverted or intermediate uterus. Uterine retroversion was associated with a higher prevalence of dyspareunia (66.7% versus 42.1%, p = 0.03), a higher visual analogue scale score for dyspareunia (2.7 ± 2.6 versus 1.6 ± 2.4, p = 0.04) and a higher prevalence of severe dysmenorrhea (66.7% versus 42.9% p = 0.03). There was no association between uterine retroversion and noncyclic pain, ovulation pain, or premenstrual pain.

Conclusion

Mobile uterine retroversion is associated with dyspareunia and dysmenorrhea in a population of unselected women.

Introduction

Since the beginning of the last century, numerous surgical procedures have been developed to treat mobile uterine retroversion, a condition which was thought to cause pelvic pain symptoms [1]. The interest of these procedures has increased markedly over the past two decades, with their adaptation to the laparoscopic approach [2], [3]. Several noncomparative studies report quite high cure rates [4], [5], [6], [7] and thus corroborate the common assumption that uterine retroversion is a cause of pelvic pain symptoms.

The relation between pain symptoms and uterine retroversion is nonetheless inconsistent. Pelvic pain symptoms including dysmenorrhea (DM), dyspareunia, and nonmenstrual pain are very common in the general population [8], and uterine retroversion is assumed to be found in at least 20–30% of all women [1]. The frequency of these symptoms and of uterine retroversion clearly raises the question of whether the former can accurately be attributed causally to the latter. To test the hypothesis that mobile uterine retroversion is a cause of pelvic pain symptoms, we performed a multicenter cross-sectional survey of an unselected population of premenopausal women.

Section snippets

Materials and methods

Patients were recruited in the gynecology department of two hospitals and in two private gynecological private practices in Paris. In June and July 2001, all premenopausal women consulting their regular gynecologist for routine examination were asked to participate in the study. Women who had indication for pelvic surgery were generally not enrolled in the study. Other exclusion criteria were: amenorrhea, previous pelvic surgery (endometriosis, salpingitis, myomectomy, hysterectomy, and genital

Results

The inclusion of 30 of the 141 women initially included was erroneous (previous surgery for endometriosis, 11; previous surgery for salpingitis, 1; previous myomectomy, 1; previous hysterectomy, 1; previous surgery for genital prolapse, 1; fixed uterus, 3; myomatous uterus, 5; adnexal masses, 3; post-menopausal women, 4). After their exclusion, the study group included 111 women.

The examinations were performed by 16 different physicians. Uterine retroversion was observed in 27 women (24.3%); 84

Comments

We found that dyspareunia in particular, but also DM, was related to mobile uterine retroversion in an unselected population of premenopausal women.

Our study is, to the best of our knowledge, the first that is specifically designed to evaluate the effect of uterine retroversion in a general population of women consulting for routine examination. Although this study was not randomized, pain symptoms were assessed with a standardized questionnaire, and cases and controls were identified by a

Acknowledgment

We thank the gynecologists who participated in the study (inclusion and pelvic examination): C. Chapron, F.-X. Aubriot, M. Dayan-Lintzer, F. Decuypere, A. Delbès, G. Grangé, J. Hamou (gynecology department of Cochin Hospital in Paris); M.-N. Laveyssière (Gynecology Department of Cochin Hospital in Paris and private practice); F. Sarrot (Gynecology Department of Cochin Hospital in Paris and private practice); A.-M. Bernard, F. Issartel, C. Rémusat, E. Raffowicz, D. Sfoggia-Besserat (Gynecology

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