Conclusion:
A significant amount of physio-pathological evidence supports the
existence of visceral uterine sensitization syndrome.
We call it Painful Uterine Syndrome (PUS).
It can be used to explain a series of pelvic pain symptoms that were
previously difficult to explain in women, including severe dysmenorrhoea
with a negative anatomical assessment.
Diagnostic criteria specific to PUS, which are proposed here with
satisfactory sensitivity, could be made available in order to facilitate
diagnosis.
PUS may be associated with PBS and irritable bowel syndrome through
peripheral viscero-visceral sensitivity mechanisms.
However, the phenomenon most frequently associated with visceral
sensitization is muscular hypercontractility. This is demonstrated in
the uterine myometrium, opening the way for treatment with BTX
injections.
A pilot study reporting the first use of BTX injections under
hysteroscopy in PUS indicated an improvement in dysmenorrhoea and
dyspareunia as well as improved quality of life scores. The prospective
and randomised Uteroxine study is currently underway to confirm the
necessary initial results.
DISCLOSURE OF INTERESTS : the authors do not declare any
conflict of interest.
ETHICS STATEMENT: No ethics approval was necessary for this
work.
FUNDING: No funding was necessary for this work.
CONTRIBUTION TO AUTHORSHIP: EB and CL were at the beginning of
the concept of the Painful Uterine Syndrome and the application to the
botulinum toxin injection into the uterine myometrium. EB was the main
writer with the close help of OF, who made the corrections, the tables
and the figure. CA, CL and DTB were in charge to review the research on
central sensitization and of the references. TB is the anesthesiologist
and pain specialist of the team, in charge of the pain evaluation,
questionnaire and pain medications.