• Julie Hastings, Jeri E Forster, and Kathryn Witzeman.
• Division of Advanced Gynecology, Department of Obstetrics and Gynecology, Dignity Health Medical Group, St. Joseph's Hospital, Phoenix, AZ.
• PM R. 2019 Nov 1; 11 (11): 1193-1199.

BackgroundFemale chronic pelvic pain is estimated to affect up to 24% of adult women, many of whom have a component of myofascial pelvic pain. Although an association of joint hypermobility and pelvic pain has been hypothesized, limited data are available that estimate the prevalence of joint hypermobility in this population.ObjectiveTo estimate the prevalence of generalized hypermobility spectrum disorder (G-HSD) among female patients with chronic myofascial pelvic pain and examine the association between G-HSD and other frequent pelvic pain-associated complaints.Study DesignRetrospective case control.SettingTertiary referral center within a university-affiliated public health system.PatientsAdult women who were diagnosed with myofascial pelvic pain during a 1-year period (n = 77 with G-HSD and n = 241 without G-HSD).MethodsData were abstracted via chart review of patients meeting inclusion criteria.OutcomesThe primary outcome of this study was the prevalence of G-HSD among patients with persistent myofascial pelvic pain. Secondary outcomes included the prevalence of dyspareunia, provoked vestibulodynia, stress urinary incontinence, irritable bowel syndrome, hip pain, low back pain, and fibromyalgia in patients with persistent myofascial pelvic pain with and without G-HSD.ResultsTwenty-four percent (N = 77; 95% CI: 19.6, 29.4) of myofascial pelvic pain patients also met criteria for G-HSD. After adjusting for confounders, the odds in favor of having G-HSD was 3.55 higher (95% CI: 1.50, 8.40) (P = .004) in females with dyspareunia; 7.46 higher (95% CI: 2.41, 23.1) (P < .001) with low back pain; 3.76 higher (95% CI: 1.35, 10.5) (P = .02) with stress urinary incontinence; 4.72 higher (95% CI: 2.00, 11.2) (P < .001) with irritable bowel syndrome; and 3.12 higher (95% CI: 1.36, 7.13) (P = .007) with hip pain. There was no significant association identified between provoked vestibulodynia or fibromyalgia and G-HSD.ConclusionThe estimated prevalence of G-HSD is higher in chronic myofascial pelvic pain patients than in the general population with statistically significant associations with several comorbid conditions. Characterizing these associations is the first step in developing effective, evidence-based screening recommendations.Level Of EvidenceIII.© 2019 American Academy of Physical Medicine and Rehabilitation.

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