Conclusion:
A significant amount of physio-pathological evidence supports the existence of visceral uterine sensitization syndrome.
We call it Painful Uterine Syndrome (PUS).
It can be used to explain a series of pelvic pain symptoms that were previously difficult to explain in women, including severe dysmenorrhoea with a negative anatomical assessment.
Diagnostic criteria specific to PUS, which are proposed here with satisfactory sensitivity, could be made available in order to facilitate diagnosis.
PUS may be associated with PBS and irritable bowel syndrome through peripheral viscero-visceral sensitivity mechanisms.
However, the phenomenon most frequently associated with visceral sensitization is muscular hypercontractility. This is demonstrated in the uterine myometrium, opening the way for treatment with BTX injections.
A pilot study reporting the first use of BTX injections under hysteroscopy in PUS indicated an improvement in dysmenorrhoea and dyspareunia as well as improved quality of life scores. The prospective and randomised Uteroxine study is currently underway to confirm the necessary initial results.
DISCLOSURE OF INTERESTS : the authors do not declare any conflict of interest.
ETHICS STATEMENT: No ethics approval was necessary for this work.
FUNDING: No funding was necessary for this work.
CONTRIBUTION TO AUTHORSHIP: EB and CL were at the beginning of the concept of the Painful Uterine Syndrome and the application to the botulinum toxin injection into the uterine myometrium. EB was the main writer with the close help of OF, who made the corrections, the tables and the figure. CA, CL and DTB were in charge to review the research on central sensitization and of the references. TB is the anesthesiologist and pain specialist of the team, in charge of the pain evaluation, questionnaire and pain medications.