The impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery

Published:August 31, 2021DOI:


      Pelvic pain is a debilitating condition that is common among women with pelvic floor disorders. Limited information is known about the impact of preoperative pelvic pain on outcomes after vaginal reconstructive surgery.


      This study aimed to compare the outcomes after vaginal reconstructive surgery between women with and without preoperative pelvic pain.

      Study Design

      Baseline and postoperative data were analyzed from the “Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial.” The multicenter trial involved women with anterior prolapse without symptoms of stress incontinence randomized to receive either a midurethral sling or sham incisions during a vaginal reconstructive surgery. Participants completed the visual analog scale adapted for suprapubic pain and Pelvic Floor Distress Inventory at baseline, 3 months, and 12 months. Preoperative pelvic pain was defined as a response of “5” or greater on pain on the visual analog scale or answering “moderately” or “quite a bit” on the Pelvic Floor Distress Inventory question, “Do you usually experience pain in the lower abdomen or genital area?” Outcomes and complication rates were compared between women with and without pelvic pain.


      The “Outcomes Following Vaginal Prolapse Repair and Midurethral Sling trial” participants included 112 women with pelvic pain (58 had a midurethral sling and 54 had sham incisions) and 212 women without pelvic pain (105 had a midurethral sling and 107 had sham incisions). Women who had a midurethral sling and pelvic pain were younger than women without pelvic pain (60.3±12.1 vs 65.1±8.6; P=.004). Women who had sham incisions and pelvic pain were more likely of Hispanic ethnicity than women without pelvic pain (27.8% vs 9.4%; P=.002). Patient improvement based on the Patient Global Impression of Improvement scale did not differ between arms. Women with pelvic pain had greater improvement on the visual analog scale pain scores after a surgical procedure at 3 months (−3.1±2.9 vs −0.4±1.6; P<.001) and at 12 months (−3.4±3.0 vs −0.6±1.6; P<.001) than women without pain, although their pain scores remained higher than those without preoperative pelvic pain at all time points (P<.001 for all). Similar improvements were found on the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. The differences observed were not affected by whether women were in the midurethral sling or sham arm of the trial. Postoperative urinary tract infection and incomplete bladder emptying did not differ between the groups.


      Women with preoperative pelvic pain experienced significant improvements in pain and pelvic floor symptoms with vaginal reconstructive surgery and had similar subjective improvement postoperatively compared with women without preoperative pelvic pain. Reassuringly, the performance of a midurethral sling did not have an impact on the results.

      Key words

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        • Howard F.M.
        Chronic pelvic pain.
        Obstet Gynecol. 2003; 101: 594-611
        • Mathias S.D.
        • Kuppermann M.
        • Liberman R.F.
        • Lipschutz R.C.
        • Steege J.F.
        Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates.
        Obstet Gynecol. 1996; 87: 321-327
        • Lawrence R.C.
        • Felson D.T.
        • Helmick C.G.
        • et al.
        Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II.
        Arthritis Rheum. 2008; 58: 26-35
        • Khuri S.F.
        • Henderson W.G.
        • Daley J.
        • et al.
        Successful implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the private sector: the Patient Safety in Surgery study.
        Ann Surg. 2008; 248: 329-336
        • Berry S.H.
        • Elliott M.N.
        • Suttorp M.
        • et al.
        Prevalence of symptoms of bladder pain syndrome/interstitial cystitis among adult females in the united states.
        J Urol. 2011; 186: 540-544
        • Dwarica D.S.
        • Rubenstein A.R.
        • Boccaccio R.B.
        • et al.
        Opioid pain medication use in new urogynecology patients.
        Female Pelvic Med Reconstr Surg. 2020; 26: 622-625
        • Heit M.
        • Rosenquist C.
        • Culligan P.
        • Graham C.
        • Murphy M.
        • Shott S.
        Predicting treatment choice for patients with pelvic organ prolapse.
        Obstet Gynecol. 2003; 101: 1279-1284
        • Hartmann K.E.
        • Ma C.
        • Lamvu G.M.
        • Langenberg P.W.
        • Steege J.F.
        • Kjerulff K.H.
        Quality of life and sexual function after hysterectomy in women with preoperative pain and depression.
        Obstet Gynecol. 2004; 104: 701-709
        • Hillis S.D.
        • Marchbanks P.A.
        • Peterson H.B.
        The effectiveness of hysterectomy for chronic pelvic pain.
        Obstet Gynecol. 1995; 86: 941-945
        • Bayman E.O.
        • Parekh K.R.
        • Keech J.
        • Selte A.
        • Brennan T.J.
        A prospective study of chronic pain after thoracic surgery.
        Anesthesiology. 2017; 126: 938-951
        • Poobalan A.S.
        • Bruce J.
        • King P.M.
        • Chambers W.A.
        • Krukowski Z.H.
        • Smith W.C.S.
        Chronic pain and quality of life following open inguinal hernia repair.
        Br J Surg. 2001; 88: 1122-1126
        • Page B.
        • Paterson C.
        • Young D.
        • O’Dwyer P.J.
        Pain from primary inguinal hernia and the effect of repair on pain.
        Br J Surg. 2002; 89: 1315-1318
        • Montes A.
        • Sabate S.
        • Roca G.
        • Canet J.
        Preoperative prediction of chronic postsurgical pain after thoracotomy: need for adequately sized population-based samples.
        Anesthesiology. 2018; 128: 224
        • Wei J.
        • Nygaard I.
        • Richter H.
        • et al.
        Outcomes following vaginal prolapse repair and mid urethral sling (OPUS) trial--design and methods.
        Clin Trials. 2009; 6: 162-171
        • Wei J.T.
        • Nygaard I.
        • Richter H.E.
        • et al.
        A midurethral sling to reduce incontinence after vaginal prolapse repair.
        N Engl J Med. 2012; 366: 2358-2367
        • Hartanto V.H.
        • DiPiazza D.
        • Ankem M.K.
        • Baccarini C.
        • Lobby N.J.
        Comparison of recovery from postoperative pain utilizing two sling techniques.
        Can J Urol. 2003; 10: 1759-1763
        • Barber M.D.
        • Kuchibhatla M.N.
        • Pieper C.F.
        • Bump R.C.
        Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders.
        Am J Obstet Gynecol. 2001; 185: 1388-1395
        • Yalcin I.
        • Bump R.C.
        Validation of two global impression questionnaires for incontinence.
        Am J Obstet Gynecol. 2003; 189: 98-101
        • Jensen M.P.
        • Chen C.
        • Brugger A.M.
        Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain.
        J Pain. 2003; 4: 407-414
        • Geller E.J.
        • Babb E.
        • Nackley A.G.
        • Zolnoun D.
        Incidence and risk factors for pelvic pain after mesh implant surgery for the treatment of pelvic floor disorders.
        J Minim Invasive Gynecol. 2017; 24: 67-73
        • Cadish L.A.
        • Hacker M.R.
        • Modest A.M.
        • Rogers K.J.
        • Dessie S.
        • Elkadry E.A.
        Characterization of pain after inside-out transobturator midurethral sling.
        Female Pelvic Med Reconstr Surg. 2014; 20: 99-103
        • Skrejborg P.
        • Petersen K.K.
        • Kold S.
        • et al.
        Presurgical comorbidities as risk factors for chronic postsurgical pain following total knee replacement.
        Clin J Pain. 2019; 35: 577-582
        • Rabbitts J.A.
        • Fisher E.
        • Rosenbloom B.N.
        • Palermo T.M.
        Prevalence and predictors of chronic postsurgical pain in children: a systematic review and meta-analysis.
        J Pain. 2017; 18: 605-614
        • Dave A.J.
        • Selzer F.
        • Losina E.
        • et al.
        The association of pre-operative body pain diagram scores with pain outcomes following total knee arthroplasty.
        Osteoarthritis Cartilage. 2017; 25: 667-675
        • Lopez-Lopez J.
        • Ramezanzade S.
        • Atabaki M.S.
        • Sadeghi E.
        Psychologic status and influence of surgery techniques on acute nonneuropathic pain after dental implant surgery: systematic review and meta-analyses.
        Int J Oral Maxillofac Implants. 2021; 36: 248-269
        • Yang M.M.H.
        • Hartley R.L.
        • Leung A.A.
        • et al.
        Preoperative predictors of poor acute postoperative pain control: a systematic review and meta-analysis.
        BMJ Open. 2019; 9e025091
        • Macrae W.A.
        Chronic post-surgical pain: 10 years on.
        Br J Anaesth. 2008; 101: 77-86
        • Fregoso G.
        • Wang A.
        • Tseng K.
        • Wang J.
        Transition from acute to chronic pain: evaluating risk for chronic postsurgical pain.
        Pain Physician. 2019; 22: 479-488
        • Jarrell J.
        • Ross S.
        • Robert M.
        • et al.
        Prediction of postoperative pain after gynecologic laparoscopy for nonacute pelvic pain.
        Am J Obstet Gynecol. 2014; 211: 360.e1-360.e8
        • Jarrell J.
        • Robert M.
        • Giamberardino M.A.
        • Tang S.
        • Stephenson K.
        Pain, psychosocial tests, pain sensitization and laparoscopic pelvic surgery.
        Scand J Pain. 2018; 18: 49-57
        • Brandsborg B.
        • Nikolajsen L.
        • Hansen C.T.
        • Kehlet H.
        • Jensen T.S.J.
        Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study.
        Anesthesiology. 2007; 106: 1003-1012
        • Lunde S.
        • Petersen K.K.
        • Søgaard-Andersen E.
        • Arendt-Nielsen L.
        Preoperative quantitative sensory testing and robot-assisted laparoscopic hysterectomy for endometrial cancer: can chronic postoperative pain be predicted?.
        Scand J Pain. 2020; 20: 693-705