There is no comprehensive questionnaire to assess pelvic pain in women. Chronic pelvic pain (CPP) accounts for 20% of women’s health outpatient appointments, making it the most common indication for referral to secondary care (1). CPP is a debilitating condition which often hinders patient quality of life (QoL). It is difficult to identify whether pain is associated with, or separate to, other presenting symptoms such as those of the lower urinary tract. It is also important to fully assess pain quality and its impact on QoL to be able to plan clinical management and manage expectations. There is no single questionnaire assessing CPP. This study uses a single questionnaire to identify whether there is an association between presence of pelvic organ symptoms and pelvic/body pain, such as dysuria, dysmenorrhoea and dyspareunia, and QoL scores in women.

The questionnaire was developed using the ICS standardisation for terminology document following a literature review of established pain assessment questionnaires currently in use. Content validity of the new questionnaire was assessed in consultation with urogynaecology and urology consultants. Face validity was assessed in a pilot test with 20 patients attending outpatient clinic. 

Pain location was assessed using body maps. Pain triggers such as bladder habits, menstruation and sexual intercourse were assessed using frequency and severity scales. Effect of pain on lifestyle was assessed using frequency scales and converted into a QoL score, which ranged from 0 – 48, with a higher score indicating a lower QoL. These scores were then converted into categories: good (0-10), average (11-20), poor (21-30), very poor (31-40) and extremely poor (41-48).  

All women attending the urogynaecology outpatient department at a large tertiary centre were asked to anonymously complete a newly devised questionnaire assessing pelvic pain, its exacerbating factors, and its impact on QoL. Completed questionnaires from women with no pain became the control group.  

Statistical analysis was performed using SPSS version 26.

In total, 75 women completed the questionnaire. Of these, 57 (76%) reported having pelvic pain and 18 (24%) described no pelvic pain and were the control group. 

Of the women with pelvic pain:
•	3% reported no dysuria, dysmenorrhea or dyspareunia.
•	20% reported 1 associated symptom (dysuria (92%), dysmenorrhea (8%))
•	56% reported 2 associated symptoms (dysuria and dysmenorrhea (30%), dysuria and dyspareunia (61%), dysmenorrhea and dyspareunia (9%))
•	20% reported 3 associated symptoms of dysuria, dysmenorrhea and dyspareunia

Women complaining of dysuria associated with dysmenorrhea or dyspareunia had a higher QoL score of 20 (average). Dysuria specifically, or associated with both dysmenorrhea and dyspareunia, had a reported average QoL score of 20 (average). Dysmenorrhea exclusively or associated with dyspareunia was correlated with a QoL score of 7 (good) and 15 (average) respectively. (Table 1)

The presence of dysuria, dysmenorrhoea and/or dyspareunia significantly decreases QoL compared with controls, and a combination of two or more of these symptoms significantly decreases QoL further. Interestingly, women with three types of pain were associated with a lower QoL score than women with 2 types of pain (20 vs 25, 25 and 15).

Women reporting one or more types of pain had a higher QoL score than woman who did not report any pain (Chi-square = 26.182, p<0.005). 
Women reporting 2 or more types of pain had a higher QoL score than women who only had one type of pain (Chi-square = 14.633, p<0.005). 
Women reporting 2 or more types of pain had a lower QoL score than women who had 3 types of pain (Chi square = 3.017, p=0.594).

Pelvic pain is common in women and frequently occurs with dysuria, dysmenorrhoea and dyspareunia. The most common combination of symptoms reported with pelvic pain in women attending urogynaecology outpatient clinic was dysuria with dyspareunia, reported in 27% of women. Women with pelvic pain who report symptoms of dysuria, dysmenorrhoea and dyspareunia have a poorer QoL than women without these symptoms. 
QoL does not worsen with increasing categories of pain reported. This suggests different sources of pain may have differences in impact on the woman. This new questionnaire allows for a detailed assessment and understanding of pelvic pain and its impact on patient QoL. It could also be used to direct and evaluate the success of pelvic pain management, as well as being a valuable validated tool in research.

BMC Public Health. 2006 Jul 6;6(1):177.