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Title: Exploring a vascular cause for chronic pelvic pain in women
Author: Hansrani, Vivak
ISNI:       0000 0004 6351 6901
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2017
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Objectives: Pelvic vein incompetence (PVI) has been suggested as a cause for chronic pelvic pain. The overall objective of this thesis is to determine how PVI affects women, identify suitable methods of diagnosis and provide evidence regarding its association with chronic pelvic pain. This thesis will also evaluate the evidence behind its treatment. Methods: Four observation studies were completed during this thesis. A characterisation study encompassing 120 participants was performed to determine symptoms commonly experienced by women with PVI. Two observation studies analysed the ability of trans-vaginal ultrasound to detect PVI and compared its accuracy with reflux venography; considered the reference standard. A further 70 participants were recruited in a case-control study to determine the prevalence of PVI in women with and without chronic pelvic pain. A randomised control trial treating women with PVI and pelvic pain was also designed. Results: Women with PVI had an increased frequency of CPP when compared with healthy controls or women with varicose veins. This pain was associated with the menstrual cycle and intercourse. It was also found to frequently radiate into the upper thighs. Trans-vaginal ultrasound was shown to have a sensitivity and positive predictive value of 100% and 95% respectively when compared with reflux venography. The frequency of PVI in women with chronic pelvic pain was found to be 47% compared with 25% in women with no history of CPP (p < 0.001). Conclusion: The results of this thesis suggest PVI to be a possible cause of CPP in women and likely to be under-diagnosed. It can be identified by trans-vaginal ultrasound although the degree of accuracy is still yet to be determined. PVI merits further research and attention from clinicians and researchers. The proposed randomised control trial is needed both to further understanding of the role of PVI in CPP and to assess the efficacy of an under-researched treatment approach currently used in practice.
Supervisor: Mccollum, Charles Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: coil embolisation ; reflux venography ; chronic pelvic pain ; pelvic vein incompetence ; duplex ultrasound