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Published on: June 23, 2009
Cervical Tenderness (Parametropathy) is a Diagnostic Tool for the Chronic Pelvic Pain Syndrome
Stefan Weinschenk1,2,3, Thomas Strowitzki4, Nura Fitnat Topbas Selcuki5,6
1Department of General Gynecology, Women's Hospital, Heidelberg University, Im Neuenheimer Feld 440, 69120, Heidelberg, Germany. stefan.weinschenk@med.uni-heidelberg.de.
Introduction:
Chronic pelvic pain syndrome (CPPS) is a diagnosis of exclusion in the absence of pathological findings. We aimed to test the hypothesis that cervical motion tenderness (or parametropathy) may serve as a diagnostic tool for CPPS.
Methods:
We examined the prevalence of parametropathy in patients with and without chronic pelvic pain by analyzing consecutive vaginal examinations in 155 women ≥ 18 years. Patients with malignant pelvic tumors, acute inflammatory disease, abnormal bleeding, genital atrophy, or pregnancy were excluded. Results from repeat examinations were also excluded. Parametropathy was defined as tenderness at three different points (left, middle, and right vaginal fornix) on bimanual examination, expressed by the patient on a three-digit scale: Pain index 0, absent; 1, slight tenderness; 2, remarkable tenderness. A pain index (PI) of 2 at one or more sites was considered positive.
Results:
We included 155 first examinations, 125 for preventive screening (control group), and 30 examinations from patients with lower abdominal pain for ≥ 6 months. Parametropathy with a PI ≥ 2 in ≥ 1 site was found in 96.7% of the pain group, and in 7.2% of the control group (p < 0.001). The diagnostic value of parametropathy for chronic pelvic pain was 96.7% sensitivity and 92.8% specificity. Vaginal ultrasound probe pressure revealed a similar tenderness rate (agreement kappa 0.94-1.00), but with a lower sensitivity of 86.7% and specificity of 92.0%. The prevalence of parametropathy in both groups was higher on the left side (p = 0.03).
Conclusions:
Parametropathy, defined as cervical motion tenderness, is a positive sign of chronic pelvic pain syndrome. The cervical motion test to detect parametropathy can be used both as a screening tool and to confirm suspected chronic pelvic pain syndrome. We suggest including this easy-to-perform clinical test in every gynecological examination. By doing so, chronic pelvic pain syndrome will no longer be a diagnosis of exclusion.
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