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A Study on the Perception of Pelvic Pain (in) Adult Women
J Kor Phys Ther 2024;36(6):199-207
Published online December 31, 2024;  https://doi.org/10.18857/jkpt.2024.36.6.199
© 2024 The Korea Society of Physical Therapy.

Kwang-Young Hwangbo1, Hwa-Kyung Shin2, Zheng ChangSheng3

1Department of Physical Therapy, The Graduate School, Daegu Catholic University, Daegu, Republic of Korea; 2Department of Physical Therapy, Daegu Catholic University, Daegu, Republic of Korea; 3Daegu Catholic University
Hwa-Kyung Shin
E-mail hkshin1@cu.ac.kr
Received November 18, 2024; Revised December 11, 2024; Accepted December 27, 2024.
This is an Open Access article distribute under the terms of the Creative Commons Attribution Non-commercial License (http://creativecommons.org/license/by-nc/4.0.) which permits unrestricted non-commercial use, distribution,and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: This study aimed to study self-awareness and management of pelvic pain.
Methods: A total of 162 individuals who consented to participate in the study completed the questionnaire. The questionnaire comprises 51 items, including 15 items pertaining to general background information, 12 items related to pelvic pain, and 11 items related to the detailed diagnosis and surgical management of pelvic pain. Data on the general characteristics of the study participants and questions related to pelvic pain were analyzed using SPSS 28.0, frequency analysis, and Chi-square test analysis.
Results: Participants found significant differences in most subcategories. Personal background, pain type, diagnosis and surgery, treatment and rehabilitation. It was significantly higher in two births, one abortion, and moderate health the condition of not exercising in relation to personal background. In terms of diagnosis and surgery, most participants were diagnosed with pelvic pain for the following reasons neurology and orthopedic surgery (p<0.05). In terms of treatment and rehabilitation, electrical therapy was high in neurology and orthopedics (p<0.05), with high injections or drug administration. Treatment was also high in other departments (p<0.05). In addition, the exercise for pelvic floor muscles is as follows most effective (p<0.05) in neurology and orthopedics, and the injections or medications have been shown to be it was effective in other departments. Working out and stretching were high for home remedies method for pelvic pain (p<0.05).
Conclusion: It is becoming increasingly clear that there are a number of factors which can contribute to pelvic pain in women, and that this is not solely a musculoskeletal issue. In light of this, we believe that a more proactive approach to women’s pelvic health and physiotherapy is required. It is our hope that this information will prove useful as a basis for clinical and women’s physiotherapy practice in adult women’s pelvic health.
Keywords : Pelvic pain, Management, Adult women
INTRODUCTION

Chronic pelvic pain is a common and important condition in women, with an estimated prevalence of 3.8% in women. Chronic pelvic pain is a disease in which the pain in the anatomical pelvis lasts for more than six months regardless of the menstrual cycle due to various causes such as gynecological, gastrointestinal, urological, neurological and musculoskeletal, and psychiatric factors, and is recognized as originating from the organs of the pelvis and is associated with negative cognitive, behavioral, sexual, and emotional outcomes as well as symptoms suggesting lower urinary tract, sex, intestinal, pelvic floor, myofascia, or gynecological dysfunction.1

Chronic pelvic pain is characterized by persistent pain or repetition of abdominal and pelvic pain and hypersensitivity or discomfort, aperiodic pain that lasts for more than 6 months in the pelvis, sub-belly abdominal anterior wall, lumbar spine, or hip, fascia and pelvic floor muscle pain due to chronic muscle contraction, and is distinguished from pelvic floor muscle pain and pelvic floor muscle dysfunction, and is characterized by tenderness points and tight bands and pain induction points within the pelvic floor muscle.2-4 Pelvic pain can result from trauma and injury (perineal laceration in vaginal delivery or obstetric anal sphincter injury), compensatory injury with lumbar spine and hip pathology, and pain with urination, defecation, sexual intercourse, or menstruation; it can occur in the vagina, rectum, lower abdomen, pubic symphysis, and posterior pelvis; and pelvic floor muscle dysfunction, including pelvic pain syndrome, urinary and defecation dysfunction, constipation, and sexual dysfunction, can result from overactivity and underactivity of the pelvic floor.4 In addition, endometriosis, adenomyosis, adhesions, pelvic congestion, tubular ovarian inflammation, and residual ovarian syndrome may be major gynecologic causes.3

The principles of treatment for chronic pelvic pain are to treat the direct cause of chronic pain and to treat any indirectly related conditions or disorders that may be contributing to chronic pelvic pain; when the cause of the pain is unclear, treatment may be aimed at symptomatic relief.5 Because the exact cause and diagnosis depends on the condition and requires a multidisciplinary approach, successful treatment requires a multidisciplinary team that works well together from all perspectives.6

For the treatment of chronic pelvic pain, the clinical practice currently uses fascia relaxation, posture education, biofeedback treatment, range of motion and pelvic floor muscle strengthening exercise, fibrous diet, Kegel exercise, and extracorporeal magnetic field nerve treatment.

Among them, biofeedback pelvic floor muscle treatment is also used to treat irritable bladder, urgent and postpartum incontinence in adult patients, and extracorporeal magnetic field nerve treatment is also widely used to treat pain in pelvic floor muscles and musculoskeletal problems and has high therapeutic effects.7 In addition, it does not need electrodes, so there is no need to attach them to the skin, there is no energy attenuation from electrical stimulation therapy, so there are no side effects, and it has the great advantage of producing deep nerve tissue.8-11

Chronic pelvic pain treatment requires accurate cause identification and diagnosis, and a multifaceted and comprehensive approach. Therefore, for successful treatment, treatment teams in various fields must cooperate and collaborate from all perspectives.6 For effective and individualized intervention for pelvic pain, it is important to understand the classification of pain, the patient’s medical history, and lifestyle. However, due to the nature of pelvic pain, it is difficult to perform visual tests and palpations, so there is a limit to accurately diagnosing the condition.

Questionnaire-based assessments using questionnaires can provide essential information for understanding the patient’s condition. These assessments can help identify the direct cause of the pelvis. Therefore, this study aims to develop and investigate questionnaires to evaluate perceptions of pelvic pain, pain management, and treatment practices in adult women, thereby providing basic data for future research and physical therapy interventions, including women.

METHODS

1. Subject and duration of study

The study was conducted from August 3 to September 4, 2022, among 162 adult women aged 20 to 60 years living in Daegu and Gyeongbuk.

The selection criteria were those who understood the purpose of the study and agreed to participate voluntarily, who understood the contents and procedures of the study and had no difficulty completing the survey, and who had experienced pelvic pain at least once during the data collection after distributing the online questionnaire.

All subjects were fully informed of the survey procedures before completing the questionnaire and agreed to participate.

2. questionnaire composition

A total of 162 individuals who consented to participate in the study completed the questionnaire. The questionnaire comprises 51 items, including 15 items pertaining to general background information, 12 items related to pelvic pain, and 11 items related to the detailed diagnosis and surgical management of pelvic pain (Table 1).

Organization of the questionnaire

Structure of the questionnaire Content of the questionnaire Number of items
Ⅰ. General characteristics 1. Age 15 items
2. Height
3. Weight
4. Occupation
5. Age at menarche
6. Childbirth in experience
7. Age at first delivery
8. Mode of delivery
9. Childbirth experience
10. Number of children
11. Experience in miscarriage
12. Number of miscarriage experiences
13. Current health status
14. Exercise frequency
15. Residence
Ⅱ. Pelvic pain 1. Presence or absence of discomfort around the pelvic area 11 items
2. Causes of pelvic pain
3. When I first felt the pain in my pelvis
4. Vaginal or lower abdominal pain during and/or after sex
5. When your pelvic pain is the worst of the day
6. Pelvic pain duration
7. Pelvic pain pattern
8. Current pain intensity
9. The presence of hospital visit due to pelvic pain
10. A visiting medical department
11. Examination at the time of visit
Ⅲ. Detailed diagnosis and surgery for pelvic pain 12. Diagnosis and surgery received at the hospital 12 items
12-1. Diagnoses and surgeries for gynecologic conditions
12-2. Diagnoses and surgeries for urologic conditions
12-3. Diagnoses and surgeries for gastroenterological conditions
12-4. Diagnoses and surgeries for neurological and orthopedic conditions
12-5. Diagnoses and surgeries for psychiatric and medical conditions
13. Have you ever had surgery for a pelvic disease
14. Surgery received at the hospital
14-1. Surgery for gynecological diseases
14-2. Surgery for urinary tract disease
14-3. Surgery for gastrointestinal disease
14-4. Surgery for neurological and orthopedic diseases
Ⅳ. Types of treatment for specific conditions, treatment effects & rehabilitation 15-1~16-5. Types of treatment and their effects received after diagnosis or surgery 13 items
17. Relief of pain symptoms following surgery or treatment
18. Home management strategies for dealing with pain or symptoms
19. Discomforts experienced during pelvic treatment
A total of 51 items


3. Survey and data collection

The data collection period for this study is from August 3, 2022 to September 4, 2022, and the response time is 15 to 20 minutes. It took about time.

The researcher distributed an online questionnaire or distributed the questionnaire to patients who visited the S Rehabilitation Clinic in Beommul-dong, Suseong-gu, with pelvic pain including the lower abdomen, so that they could fill it out by self-administration.

4. Data analysis and processing

Among the 177 total survey participants, 162 consented to the survey and reported experiencing pelvic pain, while the remaining 15 did not provide consent and were excluded. The data collected in this survey were analyzed using SPSS (version 28.0, IBM Corp., Armonk, NY, USA). Data on the general characteristics of the study participants and questions related to pelvic pain were analyzed using SPSS, frequency analysis, and Chi-square test analysis. The statistical significance level was set at α=0.05.

RESULTS

1. Personal background

1) General characteristics of the study participants

This study aimed to investigate the awareness of pelvic pain among adult women and to assess the current status of pain management. A total of 162 respondents consented to participate in the study, which included a questionnaire consisting of 51 items. Most participants resided in the Daegu-Gyeongbuk region. Among the general characteristics of the study participants, the average age was 44.4±11.1 years, with an average height of 161.3±4.9cm and an average weight of 60.0±10.4kg (Table 2). The largest group of respondents (53 out of 162, or 32.72%) was currently employed in professional occupations. The average age at menarche was 12 years, with 43 out of 162 participants (26.54%) reporting this age. Additionally, 104 out of 162 respondents (64.20%) had experienced childbirth, with the majority (62 out of 104, or 59.62%) having undergone vaginal delivery (Table 3). The average age of first childbirth was 29.3±3.6 years (ranging from 26 to 33 years)(Table 2). Among the 104 respondents with at least one childbirth experience, 61 (58.66%) had given birth twice, and 65 participants (62.50%) reported having two children. Regarding miscarriage history, 110 out of 162 respondents (67.90%) reported no experience of miscarriage, while 28 participants (53.85%) indicated they had experienced one miscarriage. In terms of self-reported health status, 124 out of 162 respondents (76.54%) rated their health as average or above. When asked about exercise frequency sufficient to induce sweating for more than 30 minutes, the most common response was “none,” given by 75 respondents (46.29%), and all differences were statistically significant (p<0.05)(Table 3).

General characteristics of subjects (I)

General characteristics M± SD
I-1 Age (year) 44.4± 11.1
I-2 Height (cm) 161.3± 4.9
I-3 Weight (kg) 60.0± 10.4
I-5 Age at first delivery (year) 29.3± 3.6

M±SD: Mean±standard deviat.


General characteristics (I)

Classification Type F (n) T (%) χ2
I-4. Occupation Profession 53 32.72 81.01
5. Age at menarche Age 12 43 26.54 24.44
6. Childbirth in experience Yes 104 64.20 3.85
8. Mode of delivery Vaginal delivery 62 59.62 13.06
9. Number of children 2 61 58.66 85.62
10. Number of children 2 65 62.50 99.31
11. Experience in miscarriage No 110 67.90 20.77
12. Number of miscarriages One 28 53.85 45.89
13. Current health status Above average 124 76.54 151.40
14. Exercise frequency No exercise participation 75 46.29 130.89
p< 0.001*

The table exclusively displays the number of individuals in the response with the highest response rate. F (n): Frequency (n), T (%): Total (%). *p<0.05.



2. Questions related to pelvic pain

Out of the 162 respondents, 142 participants (87.65%) reported experiencing discomfort in the pelvic region (including the lower back). Among them, 91 participants (56.17%) identified neurological or orthopedic conditions as the primary cause of their pelvic pain. Additionally, the largest proportion (41 out of 142 respondents, or 28.87%) reported first experiencing pelvic pain before and after menstruation. Additionally, 116 out of 162 respondents (71.60%) reported that they did not experience any vaginal or lower abdominal pain during or after sexual intercourse. Among those who experienced pelvic pain, 33 out of 142 respondents (23.24%) indicated that their pain was most intense during movement. Regarding pain duration, 109 out of 142 respondents (76.76%) reported that their pain occurred intermittently, alternating between periods of pain and relief. Among the 281 responses, 85 respondents (30.25%) reported experiencing a persistent sensation of pelvic tightness. Regarding the intensity of current pain, 86 out of 162 respondents (53.09%) described their pain as mild. Additionally, 49 out of 96 respondents (51.04%) reported visiting neurology or orthopedic clinics, with 45 out of 105 respondents (42.86%) indicating that they had undergone X-ray examinations during these visits. Following their consultations, 53 out of 162 respondents (60.92%) were most commonly diagnosed by neurologists or orthopedic specialists. All observed differences were statistically significant (p<0.05)(Table 4).

Questions related to pelvic pain (II)

Classification Cause of pelvic pain F (n) T (%) χ2
II-1. Presence or absence of discomfort around the pelvic area Yes 142 87.65 91.88
2. Cause of pelvic pain Neurological and orthopedic diseases 91 56.17 190.35
3. When I first felt the pain in my pelvis Before and after menstruation 41 28.87 95.75
4. Vaginal or lower abdominal pain during and/or after sex No 116 71.60 30.25
5. When your pelvic pain is the worst of the day On the move 33 23.24 14.68
6. Pelvic pain duration Intermittent pain 109 76.76 372.39
7. Pelvic pain pattern Stiffness 85 30.25 228.93
8. Current pain intensity Mild pain 86 53.09 114.44
9. The presence of hospital visit due to pelvic pain No 91 56.17 2.47
10. A visiting medical department Neurology and orthopedic surgery 49 51.04 74.21
11. Examination at the time of visit X-ray 45 42.86 84.66
12. A diagnosis received at the hospital Neurological and orthopedic diseases 53 60.92 76.82
p< 0.001*

The table exclusively displays the number of individuals in the response with the highest response rate. F (n): Frequency (n), T (%): Total (%). *p<0.05.



3. Questions about detailed diagnosis and surgery of pelvic pain

In gynecology, the most common diagnosis was endometriosis, reported by 18 out of 55 respondents (32.73%). In urology, cystitis was the most frequently reported condition, with 13 out of 30 respondents (43.33%) diagnosed. In gastroenterology, 20 out of 41 respondents (48.77%) were diagnosed with gastritis/esophagitis. In psychiatry, depression was reported by 4 out of 28 respondents (14.29%). Regarding surgical history for pelvic or surrounding pelvic conditions, 61 out of 71 respondents (85.91%) answered “No,” and this difference was statistically significant (p<0.05). However, in neurology and orthopedics, 20 out of 55 respondents (36.36%) were diagnosed with a herniated disc (p=0.06). Among surgical treatments, gynecological surgeries were the most common, with 6 out of 10 respondents (60%) undergoing such procedures (p=0.15). Among those who had gynecological surgery, 4 out of 8 respondents (50%) underwent laparoscopic surgery (p=1.00). Additionally, in neurology and orthopedic surgeries, nerve block procedures were reported by 1 out of 5 respondents (20%), though these differences were not statistically significant (Table 5).

Detailed diagnosis of pelvic pain and presence of surgery (III)

Diagnosis Diagnosis name F (n) T (%) χ2 p
Diagnosis from gynecology Endometriosis 18 (55) 32.73 16.91 < 0.001*
Diagnosis from urology Cystitis 13 (30) 43.33 38.40 < 0.001*
Diagnosis from gastroenterology Gastritis/Esophagitis 20 (41) 48.77 16.46 < 0.001*
Diagnosis from neurology and orthopedics Disc herniation 20 (55) 36.36 7.33 0.06
Diagnosis from psychiatry Depression 4 (28) 14.29 18.29 < 0.001*
Presence or absence of intra-pelvic or peri-pelvic disease surgery No 61 (71) 85.91 36.63 < 0.001*
Medical department where surgery was performed Gynecologic surgery 6 (10) 60 3.80 0.15
Gynecological surgery Laparoscopic surgery 4 (8) 50 0.00 1.00
Neurological and orthopedic surgery Nerve block 1 (5) 20 1.80 0.18

The table exclusively displays the number of individuals in the response with the highest response rate. F (n): Frequency (n), T (%): Total (%). *p<0.05.



4. Questions about detailed types of treatment and treatment effects and rehabilitation by disease

Among the diagnostic or postoperative treatments, injection and drug therapy were the most common in gynecology, reported by 33 out of a total of 89 respondents with overlapping responses (37.08%). In urology, injection and drug therapy were also predominant, with 9 out of 22 respondents (40.91%) selecting this option, and in gastroenterology, 17 out of 31 respondents (54.84%) reported receiving injection and drug therapy. In neurology and orthopedic treatments, electrical and light therapy were the most common, with 33 out of 100 respondents (26.83%) reporting this type of treatment. All differences were statistically significant (p<0.05)(Table 6).

Types of treatment received after diagnosis or surgery (IV)

Types of treatment/Classification Gynecologic conditions Urologic conditions Gastroenterological conditions Neurological & orthopedic conditions Psychiatric conditions





F (n) T (%) F (n) T (%) F (n) T (%) F (n) T (%) F (n) T (%)
Electrotherapy and phototherapy 13 14.61 0 0 2 6.45 33 26.83 0 0
Thermal and cryotherapy 16 17.98 2 9.09 1 3.23 23 18.70 0 0
Injection or pharmaco therapy 33 37.08 9 40.91 17 54.84 23 18.70 3 20
Pelvic floor exercises and rehabilitation therapy 9 10.11 0 0 1 3.23 21 17.07 0 0
Oriental medicine treatment 12 13.48 2 9.09 3 9.68 18 14.63 1 6.67
Others 6 6.74 9 40.91 7 22.58 5 4.07 11 73.33
Total 89 100 22 100 31 100 123 100 15 100
χ2 30.66 8.91 26.26 39.40 11.20
p< 0.001*

The table exclusively displays the number of individuals in the response with the highest response rate. F (n): Frequency (n), T (%): Total (%). *p<0.05.



Regarding the effects of diagnostic or postoperative treatments, injection and drug therapy remained the most frequently reported in gynecology, with 28 out of 62 respondents with overlapping responses (45.16%). Similarly, injection and drug therapy were predominant in urology, reported by 9 out of 23 respondents (39.13%), and in gastroenterology, with 15 out of 31 respondents (48.39%) selecting this treatment. Additionally, in neurology and orthopedic treatments, pelvic floor muscle exercises and rehabilitation treatments were the most common, reported by 16 out of 57 respondents (28.07%), while in psychiatric treatments, injection and drug therapy were reported by 5 out of 16 respondents (31.25%). All observed differences were statistically significant (p<0.05)(Table 7).

Effectiveness of diagnosis or postoperative treatment

Types of treatment/Classification Gynecologic conditions Urologic conditions Gastroenterological conditions Neurological & orthopedic conditions Psychiatric conditions





F (n) T (%) F (n) T (%) F (n) T (%) F (n) T (%) F (n) T (%)
Electrotherapy and phototherapy 5 8.07 0 0 1 3.23 11 19.30 0 0
Thermal and cryotherapy 5 8.07 0 0 1 3.23 4 7.02 0 0
Injection or pharmaco therapy 28 45.16 9 39.13 15 48.39 12 21.05 5 31.25
Pelvic floor exercises and rehabilitation therapy 11 17.74 3 13.04 4 12.90 16 28.10 0 0
Oriental medicine treatment 9 14.52 2 8.70 3 9.68 7 12.28 1 6.25
Other 4 6.45 9 39.13 7 22.58 7 12.28 10 62.5
Total 62 100 23 100 31 100 57 100 16 100
χ2 26.87 20.96 17.87 7.30 7.63
p < 0.001* < 0.001* < 0.001* 0.12 0.02*

The table exclusively displays the number of individuals in the response with the highest response rate. F (n): Frequency (n), T (%): Total (%). *p<0.05.


DISCUSSION

The purpose of this study was to investigate the awareness and management status of pelvic pain among adult women. A significant number of respondents selected neurology and orthopedic surgery as their medical departments of choice for the cause and diagnosis of pelvic pain. Additionally, 30.03% of patients identified female diseases as the cause of their pelvic pain, indicating an awareness of the association between female conditions and pelvic pain. The majority of respondents who selected neurology and orthopedic surgery also reported undergoing X-ray examinations during their visits. X-ray is a basic examination that can be performed for various musculoskeletal conditions beyond pelvic pain. Furthermore, ultrasound examinations based on symptoms appear to serve as both a primary diagnostic tool and a definitive test for female patients complaining of acute pelvic pain.12 Pelvic pain can be influenced not only by neurological and musculoskeletal disorders, which are commonly recognized, but also by various other conditions across different medical fields. Therefore, precise identification of the causes and diagnosis of pelvic pain is crucial. The section of this paper discussing the initial experience of pelvic pain during pregnancy and childbirth is consistent with previous studies indicating that about 50% of pregnant women experience low back pain or pelvic pain, which can lead to significant psychological, social, and physical changes. Thus, the diagnosis and management of low back pain and pelvic pain postpartum are of paramount importance.13

Among gynecological diseases, endometriosis was the most prevalent, which may be associated with research indicating that major gynecological causes include endometriosis, adhesions, adenomyomas, ovarian cysts, interstitial cystitis, and vulvar pain, all of which can be caused by body systems outside of the urinary reproductive system, including gastrointestinal, musculoskeletal, urinary tract, and psychological issues.14 Additionally, it has been noted that the most common causes of secondary dysmenorrhea and chronic pelvic pain are attributed to endometriosis. Representative urinary system diseases that cause chronic pelvic pain include interstitial cystitis and chronic urethral syndrome. Research by Mathias suggests that the proximity of the urinary, reproductive, and certain gastrointestinal systems to the pelvic cavity allows for some pain from various causes to progress to chronic pain. This supports the findings of the present study, where the diagnosis of cystitis was most frequently reported in the urology department among the detailed diagnoses of pelvic pain.6

The study by Droz et al.15 titled “Use of the Short-Form McGill Pain Questionnaire as a Diagnostic Tool in Women with Chronic Pelvic Pain” aimed to assess the utility of pain descriptors in diagnosing chronic pelvic pain. The study found that while the McGill Pain Questionnaire (MPQ) descriptors had high negative predictive values, suggesting their usefulness in excluding certain diagnoses like endometriosis, interstitial cystitis, and irritable bowel syndrome, they were not robust enough as definitive diagnostic tools. For instance, descriptors like “cramping” had significant correlations with specific conditions, but overall, the MPQ’s diagnostic value was limited. Based on this, it is believed that a more comprehensive survey will provide crucial foundational data in understanding adult women’s perceptions of pelvic pain and the patients’ conditions. This will contribute to advancing the understanding and management of pelvic pain in clinical settings. In neurological and orthopedic diseases, the response to disk diagnosis was the most common, but Gunter16 explained that 61% of female patients complaining of chronic pelvic pain could not make a definitive diagnosis.

Psychiatric diseases are less related to pelvic pain than other diseases, so the most respondents chose other, but about 30% of the respondents chose depression, insomnia, and bipolar disorder. This is said that the individualized treatment and communication referred to in Daluiso-King17 study are related to understanding and bonding with patients. And Chalmers et al.18 the PPIQ for women has high utility and excellent psychometric properties. It assesses the impact of pelvic pain on women’s lives and is suitable for use in clinical practice in primary, secondary, and tertiary care settings and in research. In the treatment that is effective for pelvic pain, injection and drug treatment were the most effective, and 82% of the respondents said that pelvic pain was reduced by applying various other treatments appropriately. This is a very positive result compared to the fact that pelvic pain is not properly treated because symptoms appear due to effects other than organic lesions and it is difficult to find the actual root cause. In addition, studies by Yoon3 and others showed that in hospitalized female patients with chronic pelvic pain, herbal treatments such as acupuncture, Jeong Song-yul herbal acupuncture, and moxibustion were performed, and as a result of performing physical treatments such as acupuncture, acupuncture, moxibustion, etc. After treatment, pelvic pain decreased by more than 50% and other symptoms improved. The fact that oriental medical treatment for chronic pelvic pain accompanied by gynecological diseases was proven to be effective supports the results of this paper’s oriental medicine treatment to relieve symptoms. Most respondents said they exercise and stretch as a treatment at home when they have pain or symptoms, followed by heat and cold therapy, massage, drug use, and oriental medicine.

This is also closely related to advice on the results and lifestyle of home exercise programs, focusing mainly on the effects of low-activity or hypersensitivity pelvic fundamental muscle treatment, pain or symptoms, morphological characteristics and functional anatomy of pelvis and surrounding muscles in biomedical and educational factors.19-22 In particular, pelvic fundus exercise therapy is also one of the recommended treatment methods for both urinary incontinence and sexual dysfunction.23 In addition, the study by Kim and Seo24 showed more positive results in the pelvic stabilization exercise group (PSG) among the intervention methods for improving symptoms of female patients complaining of pain due to hip joint dysfunction, and it was found that drug treatment, manual treatment, stretching, pelvic exercise, and general physical therapy were applied as in this study.

Lee and Nam25 said that the active relaxation technique is effective in improving pelvic tilt and pelvic rotation by removing the adhesion of soft tissue and reducing tissue tension, which also showed positive results for chronic pelvic pain and back pain.

According to Kim and Cho26, chronic pelvic pain is very difficult to treat because it requires a variety of complex treatments based on the exact cause and diagnosis, which supports the results of many respondents who say it is difficult to explain the pain in detail during pelvic treatment in this paper. The purpose of the study conducted by Al-Abbadey, et al.27 was to evaluate the validity, reliability, and factor structure of the Female Chronic Pelvic Pain Questionnaire (IF-CPPQ). The final 26-item questionnaire was structured into five factors (psychological impact, sexual impact, relational impact, occupational impact, and emotional impact). The results suggested good convergent and discriminant validity and internal consistency. Consequently, the validity and reliability of the pelvic pain questionnaire developed in this study can serve as a reliable physical therapy evaluation instrument. And questionnaires developed to assess CPP regardless of diagnosis include the CPP questionnaire28 and the CPP questionnaire (CPPQ)-Mohedo test.29

Although the pelvis is located at the center of the body and is sensitive, it may be somewhat difficult to express the pain pattern because there are various causes and symptoms caused by many diseases and diseases around the pelvis or inside the pelvis. This is a part where the role of therapists should be further subdivided and expanded to develop continuous learning, research, and therapeutic development, and I think that therapists should be able to help improve their quality of life by reflecting physical, emotional and selective dimensions in order to establish effective exercise prescriptions, correct cognitive and comprehension training for patients, and optimal learning environments for patients.

Based on the results of this study, the questionnaire on pelvic pain is an expression of only adult women, so there are areas to be supplemented in generalizing the results of this study to all women. First, it is necessary to further subdivide the criteria for selecting survey subjects with the subjective evaluation of the respondents, and to study various evaluations and physical treatments suitable for them. Second, there may be personal differences in the subjective part of pelvic pain depending on personal background or characteristics, perception of pelvic pain, and how to deal with pain management, so future research is needed to identify the causal relationship between these variables. Finally, based on the results of this study, it is necessary to verify the effectiveness of adult women’s perception of pelvic pain, how to cope with pain management, and the development of various physical therapy intervention programs.

This study came to the following conclusions after completing a survey to find out the subject’s perception of pelvic pain and the current status and status of pain management according to the degree of pelvic pain in adult women. In musculoskeletal diseases, most pelvic or pelvic pain is considered low back pain, and neurology and orthopedic surgery are often visited, but from a more in-depth perspective, it is necessary to carefully observe and evaluate whether the cause of low back pain or pelvic pain that we easily recognize is pain caused by other causes, including feminine diseases, as well as neurological and musculoskeletal diseases. Therefore, our physiotherapists should have a comprehensive interest in women’s physical therapy, including women’s pelvic pain, and be able to use various treatments related to pelvic pain properly and well. With an interest in physical therapy for each female disease related to this, it is intended to be helpful as basic data for clinical and practice on pelvic health of adult women.

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