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Chapter 14 - Diagnostics and Treatment of Gynecological and Nongynecological Causes of Pelvic Pain

from Section B - Practicing Transgynecology

Published online by Cambridge University Press:  22 December 2022

By
Frances Grimstad  and
Rixt AC Luikenaar
Edited by
Mick van Trotsenburg ,
Rixt A. C. Luikenaar  and
Maria Cristina Meriggiola
Mick van Trotsenburg
Affiliation:
Sigmund Freud PrivatUniversität, Wien
Rixt A. C. Luikenaar
Affiliation:
Rebirth Health Center, Utah
Maria Cristina Meriggiola
Affiliation:
Università di Bologna
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Summary

Pelvic pain can affect every human being. Because surgical and medical transition can lead to changes in anatomy and physiology, the work-up of pelvic pain in transgender patients may differ from cisgender patients. Masculinizing and feminizing hormone therapy can influence the differential diagnosis by increasing (e.g. gastric motility concerns on estrogen) and decreasing (e.g. ovulation-related pain on testosterone) certain pathologies’ frequency. Gender-affirming surgeries can introduce new anatomy (e.g. vaginoplasty) as well as remove anatomy (e.g. hysterectomy), which may influence pelvic pain. Transgender people may also have psychological and social factors which can influence their risk for or management of pain. Little evidence exists to guide understanding how the diagnosis, evaluation, and management of pelvic pain differs in the transgender community, but a few key considerations are emerging in the literature and will be addressed in this chapter.

Type
Chapter
Information
Context, Principles and Practice of TransGynecology
Managing Transgender Patients in ObGyn Practice
 , pp. 103 - 113
Publisher: Cambridge University Press
Print publication year: 2022

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References

Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: National Academies Press, 2011. Available from: www.ncbi.nlm.nih.gov/books/NBK91497/Google Scholar
Emans, SJ, Laufer, MR. Emans, Laufer, Goldstein’s Pediatric and Adolescent Gynecology, 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2011.Google Scholar
Aloisi, AM, Bachiocco, V, Costantino, A, et al. Cross-sex hormone administration changes pain in transsexual women and men. Pain 2007;132(Suppl 1):S60–67. https://doi.org/10.1016/j.pain.2007.02.006Google Scholar
Valashany, BT, Janghorbani, M. Quality of life of men and women with gender identity disorder. Health Qual Life Outcomes 2018;16(1):167. https://doi.org/10.1186/s12955-018-0995-7CrossRefGoogle ScholarPubMed
Dragon, CN, Guerino, P, Ewald, E, Laffan, AM. Transgender medicare beneficiaries and chronic conditions: exploring fee-for-service claims data. LGBT Health 2017;4(6):404–411. https://doi.org/10.1089/lgbt.2016.0208Google Scholar
Strath, LJ, Sorge, RE, Owens, MA, et al. Sex and gender are not the same: why identity is important for people living with HIV and chronic pain. J Pain Res 2020;13:829–835. https://doi.org/10.2147/JPR.S248424CrossRefGoogle Scholar
Guillamon, A, Junque, C, Gómez-Gil, E. A review of the status of brain structure research in transsexualism. Arch Sex Behav 2016;45:1615–1648. https://doi.org/10.1007/s10508-016-0768-5CrossRefGoogle ScholarPubMed
Hardacker, CT, Baccellieri, A, Mueller, ER, et al. Bladder health experiences, perceptions and knowledge of sexual and gender minorities. Int J Environ Res Public Health 2019;16(17):3170. https://doi.org/10.3390/ijerph16173170CrossRefGoogle Scholar
Detloff, M. Gender please, without the gender police: rethinking pain in archetypal narratives of butch, transgender, and FTM masculinity. J Lesbian Stud 2006;10(1–2):87–105. https://doi.org/10.1300/J155v10n01_05CrossRefGoogle ScholarPubMed
James, SE, Herman, JL, Keisling, M, Mottet, L, Anafi, M. The Report of the 2015 US Transgender Survey. Washington, DC: National Center for Transgender Equality, 2016.Google Scholar
Weyers, S, Elaut, E, De Sutter, P, et al. Long-term assessment of the physical, mental, and sexual health among transsexual women. J Sex Med 2009;6(3):752–760. https://doi.org/10.1111/j.1743-6109.2008.01082.xGoogle Scholar
Tree-McGrath, CAF, Puckett, JA, Reisner, SL, Pantalone, DW. Sexuality and gender affirmation in transgender men who have sex with cisgender men. Int J Transgend 2018;19(4):389–400. https://doi.org/10.1080/15532739.2018.1463584Google Scholar
Grimstad, FW, Boskey, E, Grey, M. New-onset abdominopelvic pain after initiation of testosterone therapy among trans-masculine persons: a community-based exploratory survey. LGBT Health 2020;7(5):248–253. https://doi.org/10.1089/lgbt.2019.0258CrossRefGoogle ScholarPubMed
White Hughto, JM, Reisner, SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgend Health 2016;1(1):21–31. https://doi.org/10.1089/trgh.2015.0008CrossRefGoogle Scholar
Lutgendorf, MA. Intimate partner violence and women’s health. Obstet Gynecol 2019;134(3):470–480. https://doi.org/10.1097/AOG.0000000000003326CrossRefGoogle ScholarPubMed
Raja, S, Hasnain, M, Hoersch, M, Gove-Yin, S, Rajagopalan, C. Trauma informed care in medicine: current knowledge and future research directions. Fam Community Health 2015;38(3):216–226. https://doi.org/10.1097/FCH.0000000000000071CrossRefGoogle Scholar
Poteat, T, Malik, M, Cooney, E. Understanding the health effects of binding and tucking for gender affirmation. J Clin Transl Sci 2018;2(S1):76–76. https://doi.org/10.1017/cts.2018.268CrossRefGoogle Scholar
Anandan, L, Mohammed, A. Surgical management of buried penis in adults. Cent European J Urol 2018;71(3):346–352. https://doi.org/10.5173/ceju.2018.1676Google Scholar
Wein, AJ, Kavoussi, LR, Partin, AW, Peters, CA. Campbell-Walsh Urology: 4-Volume Set, 11th ed. Amsterdam: Elsevier, 2015.Google Scholar
Bouskine, A, Nebout, M, Mograbi, B, et al. Estrogens promote human testicular germ cell cancer through a membrane-mediated activation of extracellular regulated kinase and protein kinase A. Endocrinology 2008;149(2):565–573. https://doi.org/10.1210/en.2007-1318CrossRefGoogle ScholarPubMed
Wynder, JL, Nicholson, TM, DeFranco, DB, Ricke, WA. Estrogens and male lower urinary tract dysfunction. Curr Urol Rep 2015;16(9):61. https://doi.org/10.1007/s11934-015-0534-6Google Scholar
Sidhu, S, Parikh, T, Burman, KD. Endocrine changes in obesity. In Feingold, KR, Anawalt, B, Boyce, A, et al., Eds. Endotext. MDText.com Inc., 2000. Available from: www.ncbi.nlm.nih.gov/books/NBK279053/Google Scholar
Chidi-Ogbolu, N, Baar, K. Effect of estrogen on musculoskeletal performance and injury risk. Front Physiol 2019;9:1834. https://doi.org/10.3389/fphys.2018.01834CrossRefGoogle ScholarPubMed
Gyang, A, Hartman, M, Lamvu, G. Musculoskeletal causes of chronic pelvic pain: what a gynecologist should know. Obstet Gynecol 2013;121(3):645–650. https://doi.org/10.1097/AOG.0b013e318283ffeaCrossRefGoogle ScholarPubMed
Jiang, Y, Greenwood-Van Meerveld, B, Johnson, AC, Travagli, RA. Role of estrogen and stress on the brain-gut axis. Am J Physiol Gastrointest Liver Physiol 2019;317(2):G203–G209. https://doi.org/10.1152/ajpgi.00144.2019CrossRefGoogle ScholarPubMed
Shanthanna, H. Successful treatment of genitofemoral neuralgia using ultrasound guided injection: a case report and short review of literature. Case Rep Anesthesiol (online) 2014;2014. https://doi.org/10.1155/2014/371703Google ScholarPubMed
Ferrando, CA. Vaginoplasty complications. Clin Plast Surg 2018;45(3):361–368. https://doi.org/10.1016/j.cps.2018.03.007CrossRefGoogle ScholarPubMed
Massie, JP, Morrison, SD, Van Maasdam, J, Satterwhite, T. Predictors of patient satisfaction and postoperative complications in penile inversion vaginoplasty. Plast Reconstr Surg 2018;141(6):911e–921e. https://doi.org/10.1097/PRS.0000000000004427Google Scholar
Cornelisse, VJ, Jones, RA, Fairley, CK, Grover, SR. The medical care of the neovagina of transgender women: a review. Sex Health 2017;14(5):442–450. https://doi.org/10.1071/SH17044Google Scholar
Grimstad, F, McLaren, H, Gray, M. The gynecologic examination of the transfeminine person after penile inversion vaginoplasty. Am J Obstet Gynecol (online) 2020. https://doi.org/10.1016/j.ajog.2020.10.002Google Scholar
Weyers, S, Verstraelen, H, Gerris, J, et al. Microflora of the penile skin-lined neovagina of transsexual women. BMC Microbiol 2009;9:102. https://doi.org/10.1186/1471-2180-9-102Google Scholar
Workowski, K, Bolan, G, Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines. 2015:64(No. RR-3):1–137.Google Scholar
Huh, WK, Ault, KA, Chelmow, D, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Gynecol Oncol 2015;136(2):178–182. https://doi.org/10.1016/j.ygyno.2014.12.022CrossRefGoogle ScholarPubMed
Bucci, S, Mazzon, G, Liguori, G, et al. Neovaginal prolapse in male-to-female transsexuals: an 18-year-long experience. Biomed Res Int (online) 2014;2014. https://doi.org/10.1155/2014/240761Google Scholar
Sigurjónsson, H, Möllermark, C, Rinder, J, Farnebo, F, Lundgren, TK. Long-term sensitivity and patient-reported functionality of the neoclitoris after gender reassignment surgery. J Sex Med 2017;14(2):269–273. https://doi.org/10.1016/j.jsxm.2016.12.003CrossRefGoogle ScholarPubMed
Stowell, JT, Grimstad, FW, Kirkpatrick, DL, et al. Imaging findings in transgender patients after gender-affirming surgery. Radiographics 2019;39(5):1368–1392. https://doi.org/10.1148/rg.2019190010Google Scholar
Maycock, LB, Kennedy, HP. Breast care in the transgender individual. J Midwifery Womens Health 2014;59(1):74–81. https://doi.org/10.1111/jmwh.12066CrossRefGoogle ScholarPubMed
Lungu, E, Thibault-Lemyre, A, Dominguez, JM, Trudel, D, Bureau, NJ. A case of recurrent leg necrotic ulcers secondary to silicone migration in a transgender patient: radiographic, ultrasound and MRI findings. BJR Case Rep 2016;2(1):20150309. https://doi.org/10.1259/bjrcr.20150309Google Scholar
Phillips, CJ. The cost and burden of chronic pain. Rev Pain 2009;3(1):2–5. https://doi.org/10.1177/204946370900300102CrossRefGoogle ScholarPubMed
Grimstad, FW, Fowler, KG, New, EP, et al. Uterine pathology in transmasculine persons on testosterone: a retrospective multicenter case series. Am J Obstet Gynecol 2018;220(3):257.e1–257.e7.Google Scholar
Shim, JY, Laufer, MR, Grimstad, FW. Dysmenorrhea and endometriosis in transgender adolescents. J Pediatr Adolesc Gynecol 2020;33(5):524–528. https://doi.org/10.1016/j.jpag.2020.06.001Google Scholar
Carneiro, MM, Morsch, DM, Camargos, AF, Reis, FM, Spritzer, PM. Androgen receptor and 5alpha-reductase are expressed in pelvic endometriosis. BJOG 2008;115(1):113–117. https://doi.org/10.1111/j.1471-0528.2007.01521.xGoogle Scholar
Loverro, G, Resta, L, Dellino, M, et al. Uterine and ovarian changes during testosterone administration in young female-to-male transsexuals. Taiwan J Obstet Gynecol 2016;55(5):686–691.Google Scholar
Liu, L, Li, Y, Xie, N, et al. Proliferative action of the androgen receptor in human uterine myometrial cells: a key regulator for myometrium phenotype programming. J Clin Endocrinol Metab 2013;98(1):218–227. https://doi.org/10.1210/jc.2012-2451Google Scholar
Grimstad, FW, Fowler, KG, New, EP, et al. Ovarian histopathology in transmasculine persons on testosterone: a multicenter case series. J Sex Med 2020;17(9):1807–1818. https://doi.org/10.1016/j.jsxm.2020.05.029CrossRefGoogle ScholarPubMed
American College of Obstetricians and Gynecologists Committee on Practice Bulletins: Gynecology. ACOG Practice Bulletin No. 194: Polycystic Ovary Syndrome. Obstet Gynecol 2018;131(6):e157–e171. https://doi.org/10.1097/AOG.0000000000002656Google Scholar
Taub, RL, Ellis, SA, Neal-Perry, G, et al. The effect of testosterone on ovulatory function in transmasculine individuals. Am J Obstet Gynecol 2020; 223(2):229.e1–229.e8. https://doi.org/10.1016/j.ajog.2020.01.059Google Scholar
Gibson, DA, Simitsidellis, I, Collins, F, Saunders, PTK. Androgens, oestrogens and endometrium: a fine balance between perfection and pathology. J Endocrinol 2020;246(3):R75–R93. https://doi.org/10.1530/JOE-20-0106Google Scholar
Carswell, JM, Roberts, SA. Induction and maintenance of amenorrhea in transmasculine and nonbinary adolescents. Transgend Health 2017;2(1):195–201. https://doi.org/10.1089/trgh.2017.0021Google Scholar
Hembree, WC, Cohen-Kettenis, PT, Gooren, L, et al. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2017;102(11):3869–3903. https://doi.org/10.1210/jc.2017-01658Google Scholar
Pinkerton, JV, Goldstein, SR. Endometrial safety: a key hurdle for selective estrogen receptor modulators in development. Menopause 2010;17(3):642–653. https://doi.org/10.1097/gme.0b013e3181c4f1d6Google Scholar
Winston McPherson, G, Long, T, Salipante, SJ, et al. The vaginal microbiome of transgender men. Clin Chem 2019;65(1):199–207. https://doi.org/10.1373/clinchem.2018.293654Google Scholar
Moulder, J, Carrillo, J, Carey, E. Pelvic pain in the transgender man. Curr Obstet Gynecol Rep (online) 2020;9(6). https://doi.org/10.1007/s13669-020-00293-xCrossRefGoogle Scholar
Bachmann, G, Bouchard, C, Hoppe, D, et al. Efficacy and safety of low-dose regimens of conjugated estrogens cream administered vaginally. Menopause 2009;16(4):719–727. https://doi.org/10.1097/gme.0b013e3181a48c4eCrossRefGoogle ScholarPubMed
Mayoglou, L, Dulabon, L, Martin-Alguacil, N, Pfaff, D, Schober, J. Success of treatment modalities for labial fusion: a retrospective evaluation of topical and surgical treatments. J Pediatr Adolesc Gynecol 2009;22(4):247–250. https://doi.org/10.1016/j.jpag.2008.09.003Google Scholar
American College of Obstetricians and Gynecologists Committee on Gynecologic Practice, American Society for Colposcopy and Cervical Pathology (ASCCP). Committee Opinion No 673: Persistent Vulvar Pain. Obstet Gynecol 2016;128(3):e78–84. https://doi.org/10.1097/AOG.0000000000001645Google Scholar
UCSF Transgender Care, Department of Family and Community Medicine, University of California San Francisco. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People, 2nd ed. Edited by MB Deutsch. Published 2016. Available from: transcare.ucsf.edu/guidelinesGoogle Scholar
Yang, CC, Miller, JL, Omidpanah, A, Krieger, JN. Physical examination for men and women with urological chronic pelvic pain syndromes: a MAPP network study. Urology 2018;116:23–29. https://doi.org/10.1016/j.urology.2018.03.021Google Scholar
Matsuo, K, Ichihara, K, Gotoh, M, Masumori, N. Comparison of the uroflowmetry parameter results between transgender males undergoing gender-affirming hormone therapy and age-matched cisgender females: preliminary data. Transgend Health 2019;4(1):152–156. https://doi.org/10.1089/trgh.2019.0025Google Scholar
Raz, R. Urinary tract infection in postmenopausal women. Korean J Urol 2011;52(12):801–808. https://doi.org/10.4111/kju.2011.52.12.801Google Scholar
Brandsborg, B, Nikolajsen, L, Hansen, CT, Kehlet, H, Jensen, TS. Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study. Anesthesiology 2007;106(5):1003–1012. https://doi.org/10.1097/01.anes.0000265161.39932.e8Google Scholar
Remington, AC, Morrison, SD, Massie, JP, et al. Outcomes after phalloplasty: do transgender patients and multiple urethral procedures carry a higher rate of complication? Plast Reconstr Surg 2018;141(2):220e–229e. https://doi.org/10.1097/PRS.0000000000004061CrossRefGoogle ScholarPubMed
Pigot, GLS, Al-Tamimi, M, Ronkes, B, et al. Surgical outcomes of neoscrotal augmentation with testicular prostheses in transgender men. J Sex Med 2019;16(10):1664–1671. https://doi.org/10.1016/j.jsxm.2019.07.020Google Scholar
van der Sluis, WB, Pigot, GLS, Al-Tamimi, M, et al. A retrospective cohort study on surgical outcomes of penile prosthesis implantation surgery in transgender men after phalloplasty. Urology 2019;132:195–201. https://doi.org/10.1016/j.urology.2019.06.010Google Scholar
Shah, T, Wang, R. A review of factors affecting patient satisfaction with inflatable penile prosthesis. Sex Med Rev (online) 2020. https://doi.org/10.1016/j.sxmr.2020.04.001Google Scholar

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