Research Article, J Womens Health Issues Care Vol: 7 Issue: 5
Pelvic Pain in Adolescents women: Prevalence and Associated Sexual Factors in a Student’s Population Survey
*Corresponding Author : Matthes ACS
Department of Gynecology and Obstetrics, University of Ribeirão Preto SP, Brazil
Tel: 55 (16) 3603-7000/l55 (16) 981 45 85 65
E-mail: [email protected]
Received: September 11, 2018 Accepted: October 12, 2018 Published: October 17, 2018
Citation: Matthes ACS, Zucca-Matthes G, Pianta C (2018) Pelvic Pain in Adolescents women: Prevalence and Associated Sexual Factors in a Student’s Population Survey. J Womens Health, Issues Care 7:5. doi: 10.4172/2325-9795.1000323
Abstract Objective: To identify the prevalence and correlates the chronic pelvic pain outside the menstrual period with sexual activity in an adolescents Brazilians students women survey. Design and Setting: Participants provided written informed consent for interviews. We present data from female adolescents, high school students from a public school in a city in the state of São Paulo, Brazil, interviewed between May 2017 and September 2017. This questionnaire focussed on sexual activity, therefore, in the fact of being or not being a virgin, defined as those who report vaginal sex, with one or more partners, at the time of the interview or never having had vaginal penetration defined as virgins. A single teacher interviewed participants at the school. Main outcome measures: It is very high significant the selfreports of Chronic Pelvic Pain in association with sexual intercourse. Results: 104 adolescents aged 15 to 17 years were interviewed and two groups of women were obtained. A group A that included 60 virgins (57, 6%) adolescents who responded were virgins and therefore never maintained sexual activity with vaginal penetration and all these adolescents denied pelvic pain outside the menstrual period; and another group B that included 44 adolescents (42,4%) non virgins who reported not being virgins and who are having sexual activity of at least 1 time per week vaginal penetration. Of these, 24 (54,4%) women reported pelvic pain outside the menstrual period. Conclusions: Rates of pelvic pain in Brazilians student’s women are correlated with sexual activity with vaginal penetration. Women with complain pelvic pain should be investigated about this condition.
Keywords: Adolescents; Pelvic pain; Coitus; Dyspareunia sexual activity
A work  on pain in sexual intercourse does not include 150 women who did not have sexual activity and therefore did not compare their findings of associated factors among women with and without sexual intercourse. How the search for articles about pelvic pain comparing virgins with no virgins is not found in the literature, it is fundamental to perform works with this approach.
We start from the works [2,3] that show that many women experience trauma to the vaginal funds during sexual intercourse and this that leads, at a certain moment, the woman to suffer pelvic pain  yet adolescent sexual activity is totally ignored [5,6].
Evans wrote  “Women with chronic pelvic pain have often experienced pain since adolescence. The management approach outlined in this article  can help to improve outcomes for these patients” and conclude, “Pelvic pain truly is a ‘hidden epidemic”. Throughout the article there is no mention at all of the possibilities that pelvic pain is related to sexual activity and there isn’t pain management guidance, nor is there any reference to non-traumatic sexual practices, probably due to misconceptions that the vagina stretches and accommodates penis of any size without getting injured and forgot that chronic pelvic pain (CPP), depression and anxiety are the consequences and not the causes of dyspareunia .
Virgin women with these complaints never have dyspareunia and probably will not develop chronic pelvic pain, unless they acquire an organic cause or if never having sexual activity, unlike women with sexual activity who may present CPP if they will present relative short vagina syndrome (RSVS) , and or an organic cause, because several papers [9,10] report a correlation between CPP and dyspareunia with a prevalence of CPP, deep dyspareunia, were 80.4 and 30.6, respectively . CPP was correlated with dyspareunia9 .Data on women who were sexually active were analysed. The prevalence was 14.1% for dyspareunia and 21.5% for other CPP; 23.3% of the women did not present pelvic pain of any kind. Severe pain was reported by 7.8% of women with dyspareunia and 20.0% of women with other CPP. There were clear associations between CPP and sexual difficulties .
CPP is often associated with dyspareunia, so this questionnaire aims to know the true reason for the role of vaginal penetration in sexual activity so this questionnaire was carried out in a school in which all the young people had the same demographic and socioeconomic variables and the only difference was the sexual behaviour.
Participants and procedure
Participants provided written informed consent for interviews. We present data from 15 to 17 years old female adolescents, high school students from a state school in a city in the state of São Paulo, Brazil, interviewed between May 2017 and September 2017. A single teacher interviewed participants at the school. This questionnaire focussed on sexual activity, therefore, in the fact of being or not being a virgin, defined as those who report vaginal sex, with one or more partners, at the time of the interview or never having had vaginal penetration defined as virgins. A single teacher interviewed participants at the school. The only related variable was exactly the vaginal penetration, since other variables such as educational level and economic condition did not present differences for this population. Our concern was to obtain two homogeneous groups that had as their only variable different, the fact of never having had sexual intercourse, therefore being a virgin and having already had sexual intercourse, therefore was not a virgin.
Of the women who were sexually active, therefore, not virgins, 59% presented dysmenorrhea with a tendency to greater than virgins, since only 43% had dysmenorrhea; however the difference found in pelvic pain in women with sexual activity was evident, because was present in 54% of the adolescents with sexual activity, against none of the virgin patients. In this study, we did not investigate specifically the pain during the sexual act but, the pelvic pain as a whole.
We use the independent t-test, also called the two-sample t-test, independent-samples t-test or student's t-test that is an inferential statistical test that determines whether there is a statistically significant difference between the means in two unrelated groups and the result was highly significant. Chi square tests were too used to test for differences in pelvic pain by vaginal penetration. The presence of pelvic pain in women with sexual activity was highly significant. Women with no sexual activity in this sample did not present this complaint; therefore, sexual intercourse is certainly a triggering factor for this variable. However, it is not the sexual relationship per se that is responsible for pelvic pain, since 44% of women who reported vaginal sexual activity did not present pelvic pain, which suggests that 54% of women with sexual activity reported pelvic pain, a has a unique variety of sexual intercourse, which is the compatibility of the size between the penis and the vagina, therefore with or without compatibility, and there is pain in those that present with incompatibility.
104 adolescents aged 15 to 17 years were interviewed and two groups of women were interviewed. A group A that included 60 adolescents who responded were virgins and therefore never maintained sexual activity. Of these 26 women reported dysmenorrhea but denied pelvic pain outside the menstrual period; and another group B that included 44 adolescents who reported not being virgins and who are having sexual activity of at least 1 time per week vaginal penetration. Of these 24 women, reported pelvic pain outside the menstrual period and 26 reported having dysmenorrhea.
The Table 1 shows the prevalence of reporting dysmenorrhea in relation to having sexual activity (non-virgin – group B) or not having sexual activity (virgin group A) among adolescent women aged 15-17 years.
Table 1: The prevalence of reporting dysmenorrhea in relation to having sexual activity (non-virgin – group B) or not having sexual activity (virgin group A) among adolescent women aged 15-17 years.
The Table 2 shows the prevalence of reporting pelvic pain in relation to having sexual activity (non-virgin – group B) or not having sexual activity (virgin – group A) among adolescent women aged 15-17 years.
|Cronic pelvic pain (CPP)||Without CPP||Total|
Table 2: The prevalence of reporting pelvic pain in relation to having sexual activity (non-virgin – group B) or not having sexual activity (virgin – group A) among adolescent women aged 15-17 years.
The prevalence of CPP was 23.03% of all participants; however, only adolescents with sexual activity reported CPP, which represented 54.4% of this group B, by non-virgins, since none (zero) of group A, of virgins, reported CPP. The total number of virgins and non-virgins who did not report CPP was 76.97% higher than that reported by Pitt et all10, which showed that 23.3% of the women did not present pelvic pain of any type, but also did not separate virgins from non-virgins and if we compute only non-virgin patients we have a prevalence of 45.45% and that is still higher than those of Pitt et all10 because they exclude adolescents with dysmenorrhea and pain of any kind.
Our research show that the presence of pelvic pain in women with sexual activity was highly significant, 54.4% with pelvic pain in the non-virgin group and 0 (zero) in the virgin group as well as 45.4% without pain in the non-virgin group and 100% without pain in the virgin group.
Women with no sexual activity in this sample did not present this complaint; therefore, sexual intercourse is certainly a triggering factor for this variable and more than half of adolescents with sexual activity had pelvic pain, suggesting a correlation between sexual activity and the presence of pelvic pain. However, it is not the sexual relationship per se responsible for pelvic pain, since 44% of women who reported vaginal sexual activity did not present pelvic pain, suggesting that 54% of women with sexual activity who reported pelvic pain have in sexual relationship, a common variable which is an organic cause, that may be primary, when the penis is larger than the distended vagina or secondary, when there is a pathology in the vaginal fund, such as endometriosis10, which causes a priori deep dyspareunia, followed by pelvic pain, a posteriori.
Strengths and limitations
The strength of our study is that it is based on a very homogeneous population, although a very regional and relatively low condition (104 female adolescents divided into 2 groups, 60 virgins and 44 non-virgins), but with a single non-common variable that was the fact of having had vaginal penetration or not.
One limitation is that our sample was not of national probability, but very restricted and was based exclusively on the subjective response of the interviewees, but highly reliable due to the relationship of the interviewer and interviewees.
Our study did not seek to know or correlate pelvic pain with dyspareunia, but to know if pelvic pain without an apparent cause may be associated with the fact the that intravaginal penile penetration may also be the cause of this pain, eliminating other variables that could influence the cause of pain. Sadly Mitchel's1 work did not include 150 women who had never had a sexual experience and were not directed to the self-completed section of the questionnaire which would be of great importance for comparison with our results These data open however an option to be included to be also related with dyspareunia: Do Women Who Have Pelvic Pain Also Have Dyspareunia? Can there be pelvic pain caused by intercourse without presenting pain in the sexual act?
Although our work is cross-sectional in nature, we believe it is possible to infer causality, since all variables are similar in both groups and it was very significant that women who are not penetrated do was not present pelvic pain in contrast to the highly significant finding of the presence of pelvic pain in women with sexual activity.
Pelvic pain in adolescence can occur due to gynecological organic causes [12-15] such as middle pain (mittel schmertz), pelvic masses and others; the urological, the gastrointestinal, the orthopedic cases, therefore common to both groups, but also due to sexual cause by vaginal fundus trauma due to penetration of the penis, during sex can be mobilized swollen structures may also occur cervices lacerations presenting acute or chronic cervicitis, is common in uterine retro flexion in chronic pelvic inflammatory disease, pelvic varicose vein, so our questionnaire aimed to discard vaginal penetration as a cause of pelvic pain and had as its only variable different in both groups, the vaginal penetration in non-virgin and without penetration in the virgins.
Most of the questionnaires [16-18] on dyspareunia do not specifically focus on the main cause of the pain in the funds vaginal, that is solely and exclusively due to the penis that penetrated it, because if this had not occurred, there would be no disparity. Why did this happen? The answer is very simple and clear: only there is Deep Dyspareunia (DD) if there is a primary dyspareunia which is the size mismatch of the penis with the distended vagina or there is a secondary dyspareunia in which there is an organic cause in the vagina, which may be endometriosis, leiomyoma, pelvic inflammatory disease vaginal atrophy etc. and possibly both conditions.
Many variables investigated  are often consequences and not causes of dyspareunia and others are common to all people. Pelvic pain is often associated with dyspareunia, so this questionnaire aims to know the true reason for the role of vaginal penetration and for this it is necessary to know the prevalence of pelvic pain in virgin women, that is, they have never had vaginal penetration and also of women who are having sexual intercourse, and for the population of the investigated women to be homogeneous it was chosen to do the questionnaire in a school in which all young people had the same demographic and socioeconomic variables and the only difference was the sexual behaviour.
The prevalence of 23% of pelvic pain found outside the menstrual period of the adolescents interviewed corresponds to that found in the literature, but what stands out is the fact that only adolescents with sex life refer. The causal effect of vaginal penetration is very evident. No virgin teenager reported this complaint. What is the explanation for this? The population of adolescents interviewed corresponded to a very homogeneous group with a low age range of 15 to 17 years, which limits the finding of pelvic pain due to organic causes such as ovarian cysts, pain of the medium that could have been found, but they are really rare and even some young woman with pelvic pain complaint could have been found because of a problem of this type, however this was not found in young virgins, who might even have some cyst but probably does not hurt without stimulation, which does not occur with patients with sexual activity who receive great stimulation in the sexual act and could refer to pelvic pain because they have an organic cause stimulated in sexual intercourse or to have pelvic pain without organic cause caused by distension with trauma to the ligaments of the vaginal fundus. The explanation is very clear. The sexual intercourse distends the vaginal fund that has the cervix fixed by fibro elastic ligaments that have limit of extension. In sexual intercourse the movements of the penis extend the bladder pillar, the cardinal ligaments, uterosacros and the broad ligaments that can suffer from micro traumas, the true lacerations that will present with pelvic pain, in the same way as occurs with athletes submitted to physical exercises that courses with in various parts of the body, depending on the affected muscle or ligament [2,3].
The majority of women have vaginas that, when distended, are compatible with the average size of the partner so this does not cause any lesion in the woman, but there are some women whose vaginas are smaller than the penis of some men and when vaginal penetration occurs, the woman suffers a trauma that will present itself with pain and traumas that cause pelvic pain [20-22].
Practical and research recommendations
Our data in demonstrating the strong link between CPP and vaginal penetration bring to the scientific discussion the need for a confirmation in a large sampling. Further research might explore the national population of many countries to comparing exclusively women with or without vaginal penetration.
Our finding of an association between vaginal penetration and CPP promotes new research for the association of pelvic pain and deep dyspareunia, since it has been demonstrated that painful sex is common in younger women, and that half of young women report their first experience of intercourse as painful, which may cause inflammation and traumatism with CPP more lately.
This study provides up-to-date prevalence estimates of CPP in a regional sample of Brazilian women, and needs to be expanded with large national sample and even worldwide cross-wide age range.
As Mitchel et all1 reported: it would seem prudent to ensure that the possibility of pain is discussed openly in sex education and in consultation among young people and health professionals .and also, as Mitchel et all1, our findings are important and relevant to the work of a range of practitioners involved in gynaecology, oncology, psychosexual therapy, and more broadly in therapeutic settings.
Contribution to Authorship
The paper was conceived by ACSM and GZM wrote the first draft, with further contributions from all authors. Statistical analyses were undertaken by GZM and ACSM (Principal Investigator), CP, initial applicants on public School questionnaire design, ethics applications and piloting were undertaken by ACSM and GZM. All authors contributed to data interpretation, reviewed successive drafts and approved the final version of the manuscript.
Details of Ethics Approval
Participants provided oral informed consent for interviews.
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