title: Levator myalgia: why bother?
abstract: OBJECTIVE
  We report the prevalence of levator myalgia (LM) and describe symptom bother and comorbidities associated with this examination finding.
  
  
  METHODS
  We performed a cross-sectional study of patients referred to urogynecology practices: a private practice (COMM) and a tertiary university-based practice (UNIV). We identified within our population a subset of patients with LM and a reference group without LM. The primary outcome was to report the prevalence of LM within a urogynecology referral population. Our secondary outcomes include mean Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) scores, medication use, medical co-morbidities, and presence of vulvodynia.
  
  
  RESULTS
  The prevalence of LM was 24% at the UNIV detected on 5,618 examinations and 9% at the COMM based on 946 examinations. Women with LM were significantly younger: mean age 56.8 years vs 65.5 (p < 0.001). There was no difference in mean parity (2.3), BMI (28.2 kg/m(2)), and race (94% white). Patients with LM reported significantly higher mean symptom bother scores (PFDI, PFIQ; p = <0. 001) related to prolapse, defecatory dysfunction, and urinary symptoms. Women with LM were more likely to report a diagnosis of fibromyalgia (OR 4.4 [1.7, 11.0]), depression (OR 1.8 [1.2, 2.7]), a history of sexual abuse (OR 2.4 [1.3, 4.7]), and use narcotic pain medications (OR 2.5 [1.2, 5.2]).
  
  
  CONCLUSIONS
  Levator myalgia is a prevalent condition in urogynecology practice, and is associated with approximately 50% greater bother in urinary, defecatory, and prolapse symptoms.
authors.affiliation: Oregon Health and Science University, 3181 Sam Jackson Park Road, Portland, OR, Mail Code L466, 97239, USA, adamske@ohsu.edu.
authors.forename: Kerrie
authors.initials: K
authors.lastname: Adams
authors.forename: W Thomas
authors.initials: WT
authors.lastname: Gregory
authors.forename: Blake
authors.initials: B
authors.lastname: Osmundsen
authors.forename: Amanda
authors.initials: A
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001004:Anus Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D063806:Myalgia / Q000175:diagnosis* / Q000453:epidemiology*; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology*; D056887:Pelvic Organ Prolapse / Q000453:epidemiology; D015995:Prevalence; D014549:Urinary Incontinence / Q000453:epidemiology