Levator myalgia: Why bother?

Introduction and hypothesis We report the prevalence of levator myalgia (LM) and describe symptom bother and comorbidities associated with this examination finding. Methods We performed a cross-sectional study of patients referred to urogynecology practices: a private practice (COMM) and a tertiary university-based practice (UNIV). We identified within our population a subset of patients with LM and a reference group without LM. The primary outcome was to report the prevalence of LM within a urogynecology referral population. Our secondary outcomes include mean Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) scores, medication use, medical co-morbidities, and presence of vulvodynia. Results The prevalence of LM was 24 % at the UNIV detected on 5,618 examinations and 9 % at the COMM based on 946 examinations. Women with LM were significantly younger: mean age 56.8 years vs 65.5 (p<0.001). There was no difference in mean parity (2.3),BMI (28.2 kg/m2), and race (94 % white). Patients with LM reported significantly higher mean symptom bother scores (PFDI, PFIQ; p=<0. 001) related to prolapse, defecatory dysfunction, and urinary symptoms. Women with LM were more likely to report a diagnosis of fibromyalgia (OR 4.4 [1.7, 11.0]), depression (OR 1.8 [1.2, 2.7]), a history of sexual abuse (OR 2.4 [1.3, 4.7]), and use narcotic pain medications (OR 2.5 [1.2, 5.2]). Conclusions Levator myalgia is a prevalent condition in urogynecology practice, and is associated with approximately 50 % greater bother in urinary, defecatory, and prolapse symptoms.