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. 2022 Jun 4;11(11):3214.
doi: 10.3390/jcm11113214.

Angle of Uterine Flexion and Adenomyosis

Anjeza Xholli  1 , Umberto Scovazzi  1   2 , Ambrogio Pietro Londero  2 , Giulio Evangelisti  1   2 , Elena Cavalli  1   2 , Maria Giulia Schiaffino  1   2 , Ilaria Vacca  1   2 , Francesca Oppedisano  1   2 , Mattia Francesco Ferraro  1   2 , Giorgio Sirito  1   2 , Filippo Molinari  1   2 , Angelo Cagnacci  1   2
Affiliations

Angle of Uterine Flexion and Adenomyosis

Anjeza Xholli et al. J Clin Med. .

Abstract

The aim of this study was to assess the prevalence of adenomyosis in symptomatic women in relation to the angle of flexion of the uterus. A total of 120 patients referring to our Chronic Pelvic Pain Center were prospectively enrolled. Each woman scored menstrual pain, intermenstrual pain, and dyspareunia on a 10 cm visual analogue scale and underwent a clinical examination and transvaginal ultrasound. MUSA criteria were used for the diagnosis of adenomyosis. The angle of flexion of the uterus on the cervix was categorized as <150° (75% of cases), between 150° and 210° (6.7% of cases) and >210° (18.3% of cases). Adenomyosis was diagnosed in 76/120 women (63.3%). In women with adenomyosis, the VAS of intermenstrual pain was higher than in women without adenomyosis (4.04 ± 3.79 vs. 2.57 ± 3.34; p < 0.034). The angle of uterine flexion >210° was more prevalent in women with than without adenomyosis (25.0% vs. 6.8%; p < 0.015). The odds ratio of suffering from adenomyosis markedly increased in the presence of an angle of uterine flexion >210° (OR 5.8 95% CI 1.19, 28.3; p > 0.029). The data indicate that the ultrasound-estimated angle of uterine flexion >210° is related to a higher prevalence of adenomyosis.

Keywords: adenomyosis; chronic pelvic pain; dysmenorrhea; dyspareunia; retroverted uterus; transvaginal ultrasound.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Ultrasonographic and schematic representation of angle of uterine flexion measurement.
Figure 2
Figure 2
Data on prevalence of adenomyosis stratified by the angle uterine flexion in women without and with a diagnosis of adenomyosis. * p = 0.015; ** p = 0.004 vs. control.
See this image and copyright information in PMC

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