title: Intensity of menstrual pain and estimated angle of uterine flexion.
abstract: OBJECTIVE
  To assess the impact of ultrasound-estimated uterus position on the intensity of pelvic pain.
  
  
  METHODS
  Descriptive analytical study.
  
  
  METHODS
  Tertiary university gynecology unit.
  
  
  METHODS
  181 consecutive patients with pelvic pain.
  
  
  METHODS
  Each woman underwent physical examination, transvaginal sonography and filled self-administered questionnaires on pain using a 10-cm visual analog scale (VAS).
  
  
  METHODS
  Visual analog scale score of menstrual pain, intermenstrual pain and dyspareunia was related to uterine version (ante- or retroversion) and the angle of uterine flexion (actual angle between cervix and uterine body) evaluated by transvaginal sonography.
  
  
  RESULTS
  Estimated uterine version was not associated with the intensity of any type of pain. The estimated angle of flexion was higher in retroverted than in anteverted uteri (182.3° ± 50.3° vs. 142.3° ± 24.2°, p < 0.0001). Intensity of menstrual pain was lowest with flexion between 150° and 210° (4.9 ± 3.1) (p = 0.002), intermediate with flexion <150° (6.3 ± 2.8) and highest with flexion ≥210° (7.9 ± 2.3). Severe menstrual pain was more prevalent with flexion ≥210° (77.7%) than between 150° and 210° (31.4%; p = 0.0008) or <150° (45.2%; p = 0.005). The intensity of intermenstrual pain and dyspareunia were not associated with the angle of flexion. In multiple regression analysis, the angle of flexion was independently related only to the intensity of menstrual pain (r = 0.272; p = 0.002).
  
  
  CONCLUSIONS
  In women with pelvic pain, ultrasound-estimated uterine flexion represents an independent risk for intense menstrual pain.
authors.affiliation: Obstetrics and Gynecology Unit, Department of Obstetrics, Gynecology and Pediatrics, University Hospital of Modena, Modena, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Cagnacci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grandi
authors.forename: Marianna
authors.initials: M
authors.lastname: Cannoletta
authors.forename: Anjeza
authors.initials: A
authors.lastname: Xholli
authors.forename: Ilaria
authors.initials: I
authors.lastname: Piacenti
authors.forename: Annibale
authors.initials: A
authors.lastname: Volpe
mesh_terms: D000328:Adult; D004412:Dysmenorrhea / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D017699:Pelvic Pain / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging*
keywords: Dysmenorrhea; chronic pelvic pain; dyspareunia; retroflexion; retroversion