EXPLORING A VASCULAR CAUSE FOR CHRONIC PELVIC PAIN IN WOMEN

Abstract

Objectives: Pelvic vein incompetence (PVI) has been suggested as a cause for chronic pelvic pain. The overall objective of this thesis is to determine how PVI affects women, identify suitable methods of diagnosis and provide evidence regarding its association with chronic pelvic pain. This thesis will also evaluate the evidence behind its treatment.Methods: Four observation studies were completed during this thesis. A characterisation study encompassing 120 participants was performed to determine symptoms commonly experienced by women with PVI. Two observation studies analysed the ability of trans-vaginal ultrasound to detect PVI and compared its accuracy with reflux venography; considered the reference standard. A further 70 participants were recruited in a case-control study to determine the prevalence of PVI in women with and without chronic pelvic pain. A randomised control trial treating women with PVI and pelvic pain was also designed. Results: Women with PVI had an increased frequency of CPP when compared with healthy controls or women with varicose veins. This pain was associated with the menstrual cycle and intercourse. It was also found to frequently radiate into the upper thighs. Trans-vaginal ultrasound was shown to have a sensitivity and positive predictive value of 100% and 95% respectively when compared with reflux venography. The frequency of PVI in women with chronic pelvic pain was found to be 47% compared with 25% in women with no history of CPP (p

Date of Award	1 Aug 2017
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Charles Mccollum (Supervisor) & Ann-Louise Caress (Supervisor)