Background: Many women suffer from undiagnosed pelvic pain, potentially due to pelvic neuropathies, but are often treated symptomatically without addressing underlying causes. Pelvic neuropathies can cause severe symptoms, affecting quality of life and psychological well-being. Objectives: To provide an overview of all known aetiologies of pelvic neuropathies. Search Strategy: Database searches of PubMed, Embase.com, and Web of Science (Core Collection), as well as citations and reference lists published up to November 13, 2023. Selection criteria: For inclusion, the study needed to describe an aetiology of a located pelvic neuropathy that can occur in women. Excluded studies were those describing idiopathic neuropathy, reviews, and opinion articles. Main results: In total, 306 studies were included (268 case reports and series, 38 cohort studies), describing 2413 patients. Aetiologies of the included studies were divided into five categories and their subcategories, namely: iatrogenic (n=1094 patients, 45%), nerve invasion - mainly endometriosis (n=614 patients, 25%), pregnancy and birth (n=93 patients, 4%), trauma (n=202 patients, 8%), and compression (n=409 patients, 17%). Pelvic neuropathies were mainly described in the sciatic, femoral, obturator, lumbosacral roots, pudendal, lateral femoral cutaneous, and Ilioinguinal nerve. Conclusions: The vast majority of all described pelvic neuropathies were seen after surgery in the lower abdomen or pelvis. The second largest group of patients exhibited neuropathy caused by deep endometriosis of the sacral plexus and/or sciatic nerve. The five categories from this paper can assist clinicians in diagnosing and treating neuropathic pelvic pain. Funding: This study was not funded.

BACKGROUND: About 8,800-34,200 Gender Dysphoria (GD)- and 39,000-650,800 Mayer-Rokitansky-Küster-Hauser (MRKH)-patients undergo vaginoplasty annually. Various procedures are available, but comparisons are lacking. OBJECTIVES: To highlight information gaps, weaknesses and strengths of vaginoplasty techniques, to aid well-informed decision making by patients and healthcare professionals. SEARCH STRATEGY: A systematic search in Medline, EMBASE, Web of Science and Scopus until October 6, 2022, by PICO method and PROSPERO registration. SELECTION CRITERIA: Original retrospective studies on complete neovaginal creation in adult GD- and MRKH-patients and discussing anatomy, Quality of Life (QoL), satisfaction, sexual function, complications or complaints. DATA COLLECTION AND ANALYSIS: The 95% confidence intervals were calculated with DerSimonian and Laird random-effects. Methodological quality and potential bias were assessed. MAIN RESULTS: In total, 35 GD- and 16 MRKH-studies were eligible. Vagina length was 11.6 and 9.5 cm, respectively. In GD-patients, Hemorrhage (6%), prolapse (1%), gastrointestinal complications (1%), revisions (26%), pain (6%), regret (1%), fecal- (11%) and urinary issues (17%) were reported. Necrosis, stenosis, dyspareunia and revisions decreased, while duration increased with higher graft quantity. Intestinal-vaginoplasty reported 100% sensation. MRKH-patients reported more necrosis (17%) [McIndoe] and average satisfaction with sexual function (91%) and vaginal discharge (32%). They were more sexually active (86%) and had 100% anatomical satisfaction. Only Intestinal-vaginoplasty reported overall dissatisfaction. CONCLUSIONS: For GD- and MRKH-patients, multiple safe vaginoplasty techniques demonstrated acceptable outcomes, with significantly improved QoL and self-image. However, standardized validation tools are needed for well-informed decision-making. Direct technique comparisons per patient-cohort and exploration of tissue-engineering methods are critical for future surgical advancements.

BACKGROUND: About 430,000-1,000,000 Gender Dysphoria- and Mayer-Rokitanksy-Küster-Hauser-patients undergo vaginoplasty each year. Various surgical procedures are available, but direct comparisons are lacking. This inhibits well-informed decision making by patients and healthcare professionals. OBJECTIVES: Highlight information gaps, weaknesses and strengths of todays vaginoplasty techniques. SEARCH STRATEGY: A systematic search in Medline, EMBASE, Web of Science and Scopus until March 8, 2022 was conducted, by PICO method and PROSPERO registration. SELECTION CRITERIA: Original retrospective studies on complete neovaginal creation in adult Gender Dysphoria- and Mayer-Rokitanksy-Küster-Hauser-patients and discussing anatomical outcome, Quality of Life, satisfaction, sexual function, complications and/or complaints. DATA COLLECTION AND ANALYSIS: Data was extracted and methodological quality and potential bias were assessed. The 95% confidence intervals were calculated with DerSimonian and Laird random-effects. MAIN RESULTS: A total of 47 articles were eligible. Surgery took 198 minutes with 10.2 cm vaginal length. Major complications included 5% hemorrhage, 1% gastrointestinal complications, 1% prolapse, 3% tissue necrosis and 6% stenosis, with 31% revisions. Patients reported 25% excessive discharge, 6% pain, 11% fecal- and 17% urinary issues and one case of hair growth. Patients also reported 95% aesthetic- and 93% anatomical satisfaction, 10% overall dissatisfaction and 1% regret. Reports showed 75% sexual activity, 13% dyspareunia, 87% sensation and 84% overall functional satisfaction. CONCLUSIONS: Multiple vaginoplasty techniques demonstrated safe and acceptable outcomes, with significant improvement of Quality of Life and self-image. However, standardized validation tools are needed for well-informed decision-making. Direct technique comparisons with similar cohorts and exploration of tissue-engineering methods are critical for future surgical advancements.