Objective To develop best practice guidelines under the auspices of the CNGOF (National college of French Gynaecologist Obstetrician) and Convergences PP (Convergences in Pelviperineal Pain) for the management of endometriosis-associated pelvic pain. Method We organised a literature review and a formal group consensus. A multidisciplinary steering committee composed of 14 healthcare professionals and 2 patients association representatives drafted an argument based on literature analysis, resulting in 7 proposed definitions and 59 best practice recommendations. These proposals were then submitted for review by 108 French healthcare professionals from various specialties and professions. The first two rounds of rating were conducted online between June 2024 and November 2024, followed by a final videoconference meeting in January 2025. Results The participation rate was 68% in the first round (74/108) and 76% in the second round (56/74). In total, 3 definitions and 45 best practice recommendations were retained and distributed across 6 sections: 1) Definition; 2) Assessment of chronic pelvic pain associated with endometriosis; 3) Non-pharmacological management; 4) Pharmacological management; 5) Surgical management; 6) Communication, health education, and therapeutic education. Conclusion This formal consensus process has enabled the development of definitions and best practice guidelines to assist healthcare professionals in managing patients suffering from pain associated with endometriosis, thereby promoting better screening, characterization of pain, and therapeutic management.

INTRODUCTION:Our aim was to evaluate medium-term patient-reported health and quality-of-life after midurethral sling (MUS) insertion and to compare outcomes between retropubic and obturator approaches using data from the French VIGI-MESH registry. MATERIAL:In the prospective cohort linked to the registry, 1789 participants who had undergone midurethral sling insertion responded to a health questionnaire that assessed impression of improvement, self-rated health, and quality of life. Self-rated health in our sample was compared to surveys in the French population. A multivariate analysis including an inverse probability of treatment weighting approach was used to balance baseline differences. RESULTS:A total of 1230 participants received a retropubic sling and 559 received an obturator sling placed by 139 surgeons in 27 French centers. Median follow-up was 34 months. Overall, 78.6% of women reported that they were "much better" or "very much better", and 69.6% reported "good" or "very good" health (13.5% higher than observed in the general population of the same age). The mean quality of life scale was 76.0/100 (3.8 points higher than observed in the general population of the same age). We were unable to demonstrate a difference in patient-reported outcomes between the retropubic and obturator approaches. After adjustment, serious MUS complications were associated with poorer improvement but not with poorer global self-rated health. CONCLUSION:In the medium term following MUS insertion, women participating in the VIGI-MESH registry tended to report good self-rated health and quality-of-life. Patient-reported outcomes did not significantly differ between retropubic and obturator approaches. LEVEL OF EVIDENCE: 3:

Objectif Élaborer des conseils de bonne pratique sous l’égide du CNGOF et de Convergences PP pour la prise en charge des douleurs associées à l’endométriose. Méthode Ces conseils de bonne pratique ont été élaborés selon la méthode de consensus d’experts formalisée. Un comité de pilotage pluridisciplinaire composé de 14 professionnels de santé et de deux représentantes d’associations de patientes a rédigé, après analyse de la littérature, un argumentaire et proposé 7 définitions et 59 conseils de bonne pratique. Ces propositions ont été soumises à 108 professionnels de santé français exerçant diverses spécialités et professions. Les deux premiers tours de cotation ont été effectués en ligne entre juin 2024 et novembre 2024, puis une réunion finale en visioconférence s’est déroulée en janvier 2025. Résultats Le taux de participation a été de 68 % au premier tour (74/108) et de 76 % au second (56/74). Au total, 3 définitions et 45 conseils de bonne pratique ont été retenus et ont été répartis en 6 sections : 1) définition ; 2) bilan de la douleur pelvienne chronique associée à l’endométriose ; 3) prise en charge non médicamenteuse ; 4) prise en charge médicamenteuse ; 5) prise en charge chirurgicale ; 6) communication, éducation en santé et éducation thérapeutique. Conclusion Ce consensus formalisé d’experts a permis d’élaborer des définitions et conseils de bonne pratique pour aider la communication des professionnels de santé prenant en charge les patientes souffrant de douleurs associées à l’endométriose, favorisant ainsi un meilleur dépistage, une meilleure caractérisation des douleurs et une meilleure prise en charge thérapeutique.

OBJECTIVE:To develop best practice guidelines under the auspices of the CNGOF and Convergences PP for the management of pain associated with endometriosis. METHOD:We organised a literature review and a formal expert consensus. A multidisciplinary steering committee composed of 14 healthcare professionals and 2 patient association representatives drafted an argument based on literature analysis, resulting in 7 proposed definitions and 59 best practice recommendations. These proposals were then submitted for review by 108 French healthcare professionals from various specialties and professions. The first two rounds of rating were conducted online between June 2024 and November 2024, followed by a final videoconference meeting in January 2025. RESULTS:The participation rate was 68% in the first round (74/108) and 76% in the second round (56/74). In total, 3 definitions and 45 best practice recommendations were retained and distributed across 6 sections: 1) Definition; 2) Assessment of chronic pelvic pain associated with endometriosis; 3) Non-pharmacological management; 4) Pharmacological management; 5) Surgical management; 6) Communication, health education, and therapeutic education. CONCLUSION:This formal expert consensus process has enabled the development of definitions and best practice guidelines to assist healthcare professionals in managing patients suffering from pain associated with endometriosis, thereby promoting better screening, characterization of pain, and therapeutic management.

BACKGROUND:We are lacking data with a high level of evidence on the use of episiotomy during instrumental delivery to prevent anal sphincter injury, which nonetheless presents the highest risk. OBJECTIVE:Our main objective was to assess the protective effect of episiotomy against obstetric anal sphincter injury in nulliparous women during instrumental delivery according to type of instrument. We also investigated its impact on immediate maternal and neonatal morbidity. STUDY DESIGN:We conducted a prospective comparative cohort study for clinical trial emulation by means of propensity score weighting. The study was especially designed for consideration of possible confounders. This was a nationwide observational multicenter study including 111 French public and private maternity units between April 2021 and March 2022. We included nulliparous women, with singleton cephalic fetus, at more than 34 weeks of gestation. We considered vacuum, forceps, and spatula deliveries. We proceeded to a comparative analysis between women with and without episiotomy. The main outcome was obstetric anal sphincter injury occurrence. We used composite criteria for both maternal and neonatal immediate morbidity. RESULTS:The analyses pertained to 11,013 women. Overall prevalence of episiotomy was 23%: 17% for vacuum (N=7007), 37% for forceps (N=2378), and 29% in case of spatula-assisted (N=1628) delivery. Episiotomy was not associated with significantly decreased obstetric anal sphincter injury occurrence in vacuum delivery (from 5.2% without episiotomy to 3.8%, odds ratio=0.73 [0.48-1.03]) or forceps delivery (from 10.9% without episiotomy to 8.8%, odds ratio=0.81 [0.56-1.14]). In contrast, we observed significantly decreased obstetric anal sphincter injury occurrence (from 9.4% without episiotomy to 5.6%) in spatula delivery (odds ratio=0.60 [0.37-0.87]). Episiotomy was associated with increased maternal morbidity using forceps (from 13.6%-18.3%, odds ratio=1.35 [1.01-1.73]) and spatulas (from 9.0%-13.4%, odds ratio=1.51 [1.11-2.00]). We also observed increased neonatal morbidity in vacuum delivery associated with episiotomy (from 9.1%-13.6%, odds ratio=1.49 [1.21-1.79]), but a decrease in case of forceps delivery with episiotomy (from 12.6%-9.2%, odds ratio=0.74 [0.55-0.95]). CONCLUSION:Episiotomy was not associated with a decreased risk of obstetric anal sphincter injury in vacuum or forceps delivery, and a marginal reduction was achieved using spatulas. Our results do not favor extensive episiotomy during instrumental delivery. TRIAL REGISTRATION:ClinicalTrial NCT04446780.

Objective: To investigate first, the association between endometriosis and preterm birth; second, the associations between endometriosis and preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age infants (assessed by birthweight); and third, the risk of these adverse pregnancy outcomes with and without the use of medically assisted reproduction. Design:Multicenter retrospective cohort study Patients: Deliveries by 368,935 women (377,338 infants) from 1999 through 2016. Exposure: Endometriosis, defined as a single disease entity (endometriosis and/or ademyosis) Main Outcomes Measures: The main outcome was the preterm birth rate (both <37 and <33 weeks). The secondary outcomes were rates of preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age neonates. Results: Women in the endometriosis group had more frequent histories of infertility before the included pregnancy (34.7 vs. 5.0%), more hospitalizations during the pregnancy (27.4 vs. 19.8%), and more planned cesarean sections (14.0 vs. 8.7); they more often were nulliparous (51.7 vs. 43.4%). The prevalence of preterm birth at <37 weeks was 11.1% in the endometriosis group and 7.7% in the unexposed group, and for <33 weeks, it was 3.1% and 2.2%, respectively. The adjusted relative risk for confounding factors was higher in the endometriosis than the unexposed group for preterm delivery <37 weeks (1.40, 95% confidence interval, 1.18-1.67) or <33 weeks (1.53, 95% confidence interval, 1.08-2.16). For the secondary outcomes, the adjusted risk ratios for preeclampsia, placenta previa, postpartum hemorrhage, and small-for-gestational-age status of <10th and <5th percentiles were higher in the endometriosis group. The adjusted risk ratios for stillbirth and small-for-gestational-age status of <3rd percentile did not differ between the two groups, and those after stratification by medically assisted reproduction for preterm birth at <37 and <33 weeks did not differ statistically significantly between them, for the secondary outcomes, only the risk of placenta previa was higher in the medically assisted reproduction and non-medically assisted reproduction subgroups. Conclusion: Pregnant women with endometriosis had higher risks of preterm birth and other poor pregnancy outcomes than women without endometriosis. (Fertil Steril (R) 2025;123:137-47. (c) 2024 by American Society for Reproductive Medicine.) El resumen est & aacute; disponible en Espa & ntilde;ol al final del art & iacute;culo.

Aims: The Antwerp Pelvic Floor Knowledge Questionnaire (APFK-Q) is a self-administered tool used for assessing women's knowledge of the pelvic floor, an essential element of pelvic health education initiatives. The aim of this study was to validate the French version of the APFK-Q and to assess its psychometric properties. Methods: Acceptability of the cultural adaptation of APFK-Q in French (translation/back-translation) was assessed in two groups of women: one group not working in the healthcare sector (non-healthworkers, n = 112), and another of student midwives (n = 29). Twenty-three of the non-healthworkers agreed to take part in a test-retest step to assess reproducibility. Agreement of responses was measured for each question using Cohen's kappa coefficient. Sensitivity to change was assessed before and after a pelvic-floor health education workshop. The proportion of correct answers was compared before and after the workshop using McNemar's Chi2 test. Readability and the reading level required for optimal comprehension were assessed using the Flesch Reading Ease Score (FRES) and Flesch-Kincaid Grade Level test, respectively. Results: Seventy percent (n = 72) of the non-healthworkers and 72 % (n = 21) of the students reported no comprehension difficulties. Agreement was very good (k > 0.8) for 46 % of the items and good (0.6-0.8) for 25 %. The proportion of correct answers was significantly higher for 72 % of the items after the pelvic-floor health education workshop. The French version of the APFK-Q was judged to be easy to understand according to the FRES test, with a score of 60.6. The school level required for optimal comprehension was estimated at 8th grade. Conclusion: The French version of the APFK-Q is an acceptable, reproducible, and easily understandable questionnaire that provides a broad description of women's knowledge of the pelvic-floor sphere. Sensitivity to change was confirmed for most items, making it a useful tool for assessing the impact of pelvic-floor health education initiatives.

OBJECTIVE:To evaluate the health status and recovery of women after mid-urethral sling (MUS) revision in response to complications. DESIGN:Cross-sectional study using a questionnaire sent to women from a registry. SETTING:Twenty-two French surgical centres. POPULATION:A total of 287 women from the VIGI-MESH registry responded, having undergone MUS revision for complications. METHODS:Our sample of women were compared against a representative set of French women taken from the Eurostat database. Multivariate analysis was performed to identify clinical predictors for successful MUS revision. A qualitative analysis was carried out on free-text comments. MAIN OUTCOME MEASURES:Health status, defined by the Minimum European Health Module, and recovery, assessed by Patient Global Impression of Improvement. RESULTS:The response rate was 76% (287/378), with 49% of the women (141/287, 95% CI 43%-55%) reporting good health status, which was 8 points lower than that expected from the comparator French set (57%, 95% CI 55%-58%). Overall, 53% (147/275, 95% CI 47%-59%) of the women reported feeling much better after MUS revision. Just over one-third (35%, 95/275, 95% CI 29%-40%) of respondents reported poor health with little or no improvement. Multivariate analysis showed that being operated on for pain at revision was associated with worse self-perceived health than being operated on for exposure (OR 0.36, 95% CI 0.14-0.95); women with pre-existing comorbidity reported a poorer health status following MUS revision (OR 0.22, 95% CI 0.13-0.38). CONCLUSIONS:Our results suggest that half of the women recovered good health status after MUS revision, whereas a proportion appeared to be seriously affected by an MUS complication despite the revision.

ObjectivesOur objectives were to evaluate the impact of group pelvic floor education workshops on participants' knowledge, their satisfaction, and the modification of their urinary and digestive behaviors, and to compare health care providers' (HCP) knowledge with that of the general population.MethodsFor this prospective observational study, group pelvic floor education workshops were proposed between May 2021 and June 2022 in a web-conference format. Each workshop covered pelvic floor anatomy and physiology, urinary and digestive physiology as well as risk factors of PFD and preventive measures. At the start and the end of the workshops, participants completed a questionnaire on their knowledge and their beliefs about the pelvic floor. Questions about their satisfaction were asked at the end of the workshops. A 2-month questionnaire assessed changes in urinary and digestive habits and whether participants had talked about the workshop around them.ResultsA total of 856, with an average age 40.1 years, participated and completed the questionnaires before and after the workshops; 694 responded at 2 months. The education workshops significantly improved knowledge about the pelvic floor in the "HCP" and "non-HCP" groups. At 2 months, 591 participants (85.2%) 85.2% had talked about the workshop content; 557 (80.3%) reported having changed, or planned to change, their urinary behaviors and 495 (71.3%) their defecatory behaviors.ConclusionsPelvic floor education workshops can increase level of knowledge and thus limit risky behaviors for the pelvic floor. The high rate of participation and the satisfaction of the participants shows the interest for the theme. Group pelvic floor education workshops can increase level of knowledge and thus limit risky behaviors for the pelvic floor.

ObjectiveDespite its presence, it is sometimes impossible to detect endometriosis with certainty on an MRI scan. In trained teams, the sensitivity of MRI for diagnosing endometriosis is around 90% [1], [2]. We do not currently know whether surgical treatment of endometriosis that is not visible on MRI can improve symptoms. We wanted to find out whether complete excision of endometriosis improves pain symptoms depending on the MRI diagnosis (invisible, suspicious or typical endometriosis).Study designAn observational prospective cohort study was conducted on 161 surgical records of women who underwent laparoscopic surgical treatment for suspected endometriosis between January 2017 and May 2021 in two French university centers. These patients underwent surgery for suspected deep endometriosis based on their symptoms and/or clinical criteria and in a situation of failure or refusal of hormonal treatment. Inclusion criteria were symptoms and/or clinical examination suggestive of endometriosis, complete surgical excision by laparoscopy, pre- and post-operative questionnaires, pelvic MRI report, and histological analysis if specimen was obtained. Exclusion criteria were as follows : more than 50% missing data for the calculation of the primary endpoint (ENDOPAIN-4D score). Each woman underwent a preoperative pelvic MRI. They were divided into three groups according to the MRI findings : typical form corresponds to an endometriosis nodule or an implant with a compatible location or an endometrioma; suspected endometriosis on MRI corresponds to indirect, non-specific signs of endometriosis (pelvic adhesions, non-nodular thickening of a utero-sacral ligament, uterine laterodeviation, retroverted uterus); no endometriosis or visible benign lesions corresponds to MRIs deemed normal by the radiologist. Each woman completed a pre- and post-operative questionnaire (ENDOPAIN-4D, at least one year after surgery) to assess pain symptoms. ENDOPAIN-4D is a 4-dimensional score for the assessment of pain, dyspareunia, digestive and urinary disorders. 3 It has been previously published and validated in this population [3], [4]. The primary outcome was assessed using analysis of covariance (ANCOVA), with MRI group and baseline values for the dependent variable entered as independent variables in a model. In this analysis, we examine the effect of MRI classification on ENDOPAIN-4D score independent of the variables of age, BMI and baseline symptom intensity. To analyse the variation in the ENDOPAIN-4D score, we used the MCID (minimal clinically important difference), which is the smallest difference in the scores of an instrument that is considered useful by patients. The MCID for the ENDOPAIN-4D score was set at 10.9. [3] This was an observational, noninterventional study. Written informed consent was not required. However, all patients received information about the study and were free to participate or not. Confidentiality of patient data was guaranteed. The Comité de Protection des Personnes (Ethics Committee) of the IVème Sud-Est in France approved this study (#18/002).ResultsOf the 161 patients included, 26 had negative, 21 suspicious and 114 typical MRI scans. Histological analysis confirmed the presence of endometriosis in 83% of women in the group without visible endometriosis on MRI, 95% in women with suspected endometriosis on MRI and 98% in women with typical MRI. (Table, significant difference). The intensity of pain symptoms was similar in each groups before surgery (Table), and significantly decreased in the typical group after surgery compared to the other two groups (Figure). The adjusted mean difference between T0 and T1 was significantly greater for patients with typical MRI than for the other two groups. For the MRI-negative group, this difference just reached the MCID, but its confidence interval included 0 (Figure), meaning that there was no significant effect of surgery in this group. The results are unchanged when patients with negative histology are excluded.ConclusionOur results show that response to surgery is proportional to MRI signal intensity. Endometriosis can take a hidden form that is not visible on MRI scans tests and for which surgical treatment may not provide effective pain relief.

Objective: Pelvic floor health education workshops for women appear to improve women's knowledge and pelvic floor symptoms. Our aim was to obtain expert consensus on the content and format of a pelvic floor health education program using the Delphi method. Material and methods: A two-round Delphi study was conducted involving French-speaking multidisciplinary experts in pelvic floor dysfunction management. The first round questionnaire contained 44 items (31 about the program's content and 13 about the materials). They were also consulted about the optimal format of the program (duration and number of workshops) as open questions. Participants rated their level of agreement with each item on a Likert scale from 1-9. Consensus was defined by a level of agreement > 80% and a median > 7. Non-consensus items were reworked and resubmitted to the experts for the second round. Results: Of the 110 experts contacted, 52 responded for the first and second rounds. Sixty-one percent of the proposed items met with consensus in the first round and 60% in the second. The final program comprises 33 items: eight on anatomy, four on biomechanics, nine on urinary and defecatory physiology, seven on risk factors, and five on materials. The format selected by the experts consisted of four or five 75-minute health education sessions with a paper summary hand out at the end of the program. Conclusions: This study defined the content of a pelvic floor health education program for the general population of adult women validated by a consensus of experts. After validation of an English version, it should be evaluated in international interventional studies. Level of evidence: LE5 (expert opinion). (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Environ 90 % des femmes présentent des dysménorrhées notamment les femmes âgées de 18 à 25 ans, les femmes jeunes adultes, qui sont les plus touchées mais ne consultent pas pour ce symptôme. L’intensité de la douleur des règles ne peut, à elle seule, être prise comme moyen de dépistage car il est impossible de fixer un seuil à partir duquel proposer une consultation spécialisée. L’étude du retentissement des dysménorrhées et donc la notion de dysménorrhée invalidante pourrait permettre de dépister les femmes à risques de complications douloureuses chroniques, qui sont en besoin de soins mais ne le demandent pas. L’objectif de ce travail est de concevoir un outil fiable pour identifier la dysménorrhée invalidante chez les femmes jeunes adultes en population générale. Une étude transversale nationale de femmes âgées de 18 à 25 ans issues de la cohorte CONSTANCES est réalisée. L’invalidité est évaluée à l’aide de l’indice global de limitation des activités, indicateur validé au niveau national et européen (se sentir limité au cours des 6 derniers mois par rapport à une personne du même âge : Non ; Oui, limité ; ou Oui, sévèrement limité). L’intensité de la dysménorrhée et les autres symptômes de douleur pelvienne chronique (dyspareunie et douleur non menstruelle) sont évalués selon un questionnaire spécifique. La probabilité d’invalidité a été estimée à l’aide d’un modèle de prédiction logistique en fonction de l’intensité de la dysménorrhée, d’autres indicateurs de symptômes de douleur pelvienne et d’autres covariables évidentes. Les résultats du modèle prédictif de la dysménorrhée invalidante sont présentés sur un nomogramme. Parmi 6377 femmes, le taux d’invalidité est estimé à 7,4 %. L’augmentation de l’intensité de la dysménorrhée (OR=1. 08, IC 95 % [1,04–1,13]), l’augmentation de la fréquence de la dyspareunie (OR=1,69 IC 95 % [1,06–1,89], jusqu’à OR=3,41 IC 95 % [2,16–5,38]), les douleurs pelviennes chroniques non menstruelles (OR=1,75, IC 95 % [1,40–2,19]), un BMI>25 (OR=1,45, IC 95 % [1,17–1,80]), et la non-utilisation de la pilule contraceptive hormonale (OR=1,29, IC 95 % [1,05–1,59]) sont significativement associés à l’invalidité. Selon le nomogramme, une consultation spécialisée pourrait être proposée aux jeunes femmes qui présenteraient une probabilité d’invalidité de 15 % ou plus représentant 4,6 % des femmes jeunes femmes adultes qui pourraient bénéficier d’un parcours de soins adapté. L’utilisation de ce nomogramme, sous la forme d’une application numérique, pourrait permettre de détecter les femmes à risque de dysménorrhées invalidantes en population générale. Sa validité doit être testée auprès d’établissements d’enseignement supérieur.

ObjectiveTo understand what leads to the non-adherence to the cervical cancer screening (CCS) recommendations during a consultation.DesignFor this qualitative study, in-depth semistructured interviews were carried out with French healthcare professionals. An interview guide was developed and tested. It included the following themes: CCS recommendations, patients’ profiles, relationship with patients, emotional work, over-screening and under-screening. Interviews were carried out until data saturation (no new data, theoretical diversity reached). The grounded theory was used for data analysis.ParticipantsGynaecologists, midwives and general practitioners (GPs). The sample diversity was achieved using the following criteria: place of work, type of healthcare profession, type of patients, private-sector or hospital professional.SettingInterviews were conducted between July and December 2022 in six regions in France.ResultsIn-depth semistructured interviews were carried out with 15 midwives, 24 GPs and 11 gynaecologists from six French regions. Their analysis highlighted that the following factors contributed to the non-adherence to the CCS recommendation: burden of caring for family members for some women, adhesion to the principle of yearly screening by healthcare professionals and patients, need of negotiating the respect of the CCS recommendations, use of emotions, and arbitration to prioritise what is needed for good health maintenance. The search for mutual emotional comfort led some healthcare professionals to adopt attitudes towards the CCS that avoid positioning conflicts, even if this means departing from the recommendations.ConclusionCCS can be correctly performed if healthcare professionals and patients agree on the need of actively taking care of their health, which is difficult for women from lower sociocultural backgrounds. During the one-to-one meeting with their patients, healthcare professionals may find difficult to apply the CCS recommendations, although they know and agree with them.