{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T15:07:10Z","timestamp":1787929630092,"version":"build-2784847793"},"reference-count":76,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:p>Introduction: Chronic pelvic pain (CPP) is a diagnostic and therapeutic challenge affecting women of all ages globally. The syndrome is not well understood, but the association of interstitial cystitis (IC) with endometriosis in causing CPP should not be overlooked in managing this cohort. Herein, we present a mini review of this association to evaluate the literature in determining the prevalence of endometriosis and IC concomitantly in patients with CPP, diagnostic limitations, and clinical implications.<\/jats:p>\n                  <jats:p>Methods: A Medline search of the key words \u201cevil twins\u2019 syndrome,\u201d \u201cinterstitial cystitis,\u201d \u201cbladder pain syndrome,\u201d and \u201cendometriosis\u201d was conducted for full-text articles published in English over the past 20 years. The search yielded 40 articles, of which 21 were selected. Cross-referencing bibliographies of each publication yielded an additional 25 references.<\/jats:p>\n                  <jats:p>Results: Both endometriosis and IC share a similar array of symptoms that are often exacerbated during the perimenstrual period. Multiple authors have reported the frequent coexistence of these two conditions. Over 80% of patients with CPP were found to have both conditions. The prevalence of endometriosis and IC coexistence was greater than that of each condition separately.<\/jats:p>\n                  <jats:p>Conclusions: It is crucial to look beyond the traditionally diagnosed endometriosis as the cause of CPP. This is true especially in patients whose previous treatment was ineffective. Simultaneous assessment for both conditions is essential to avoid the frequently delayed diagnosis and prevent unsuccessful medical and surgical therapies.<\/jats:p>","DOI":"10.5339\/qmj.2021.50","type":"journal-article","created":{"date-parts":[[2021,11,26]],"date-time":"2021-11-26T10:30:49Z","timestamp":1637922649000},"source":"Crossref","is-referenced-by-count":3,"title":["Association of endometriosis with interstitial cystitis in chronic pelvic pain syndrome: Short narrative on prevalence, diagnostic limitations, and clinical implications"],"prefix":"10.5339","volume":"2021","author":[{"given":"Tariq F.","family":"Al-Shaiji","sequence":"first","affiliation":[{"name":"Urology Unit, Department of Surgery, Amiri Hospital, Kuwait City, Kuwait E-mail: tshaiji@gmail.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalal H.","family":"Alshammaa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternity Hospital, Kuwait City, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam M.","family":"Al-Mansouri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternity Hospital, Kuwait City, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdullatif E.","family":"Al-Terki","sequence":"additional","affiliation":[{"name":"Urology Unit, Department of Surgery, Amiri Hospital, Kuwait City, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"key":"CIT0001","series-title":"Obstet Gynecol","article-title":"(1999)\u00a0Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates"},{"issue":"6:","key":"CIT0002","series-title":"BMC Public Health","first-page":"177","article-title":"(2006) WHO systematic review of prevalence of chronic pelvic pain: Neglected reproductive health morbidity"},{"issue":"(4):","key":"CIT0003","series-title":"JSLS","first-page":"311\u20134","article-title":"(2002) The evil twins of chronic pelvic pain syndrome: endometriosis and interstitial cystitis","volume":"6"},{"issue":"(1):","key":"CIT0004","series-title":"JSLS","first-page":"6\u20139","article-title":"(2011) Anterior\u00a0vaginal\u00a0wall\u00a0tenderness\u00a0(AVWT) as a\u00a0physical\u00a0symptom\u00a0in\u00a0chronic\u00a0pelvic\u00a0pain","volume":"15"},{"issue":"(4):","key":"CIT0005","series-title":"Urology","first-page":"53\u20139","article-title":"(2007) The emerging presence of interstitial\u00a0cystitis\u00a0in gynecologic patients\u00a0with\u00a0chronic\u00a0pelvic\u00a0pain","volume":"69"},{"issue":"17:","key":"CIT0006","series-title":"Pain Physician","first-page":"E141\u2013E147","article-title":"(2014) Prevalence of chronic pelvic pain among women: An updated review"},{"issue":"(3):","key":"CIT0007","series-title":"J Obstet Gynaecol Can","first-page":"174\u2013180","article-title":"(2017) Hospital-associated costs of chronic pelvic pain in Canada: A population-based descriptive study","volume":"39"},{"issue":"(1):","key":"CIT0008","series-title":"J Minim Invasive Gynecol","first-page":"43\u20139","article-title":"(2005) The prevalence of interstitial cystitis, endometriosis, adhesions, and vulvar pain in women with chronic pelvic pain","volume":"12"},{"issue":"(2):","key":"CIT0009","series-title":"J Urol","first-page":"450\u20136","article-title":"(2007) Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: A systematic review","volume":"177"},{"issue":"(10):","key":"CIT0010","series-title":"Int Urogynecol J","first-page":"1361\u20136","article-title":"(2012) Diagnosis of interstitial cystitis\/ bladder pain syndrome in women with chronic pelvic pain: A prospective observational study","volume":"23"},{"issue":"(3):","key":"CIT0011","series-title":"Urology","first-page":"576\u201380","article-title":"(2011) Prevalence and correlates of sexual dysfunction among women with bladder pain syndrome\/ interstitial cystitis","volume":"77"},{"issue":"(4):","key":"CIT0012","series-title":"Clin Obstet Gynecol","first-page":"811\u201323","article-title":"(2003) Interstitial cystitis and chronic pelvic pain: New insights in neuropathology, diagnosis, and treatment","volume":"46"},{"issue":"(3):","key":"CIT0013","series-title":"J Pediatr Adolesc Gynecol","first-page":"181\u20135","article-title":"(2009) Interstitial cystitis is an etiology of chronic pelvic pain in young women","volume":"22"},{"issue":"(2):","key":"CIT0014","series-title":"Eur J Obstet Gynecol Reprod Biol","first-page":"105\u20139","article-title":"(2009) Differentiating Interstitial Cystitis from similar conditions commonly seen in gynecologic practice","volume":"144"},{"issue":"(1):","key":"CIT0015","series-title":"JSLS","first-page":"25\u201329","article-title":"(2005) Interstitial Cystitis and Endometriosis in patients with chronic pelvic pain: The \u201cEvil Twins\u201d Syndrome","volume":"9"},{"issue":"(5):","key":"CIT0016","series-title":"Reprod Sci","first-page":"551\u20135","article-title":"(2015) Diagnostic accuracy of urinary cytokeratin 19 fragment for endometriosis","volume":"22"},{"issue":"(3):","key":"CIT0017","series-title":"J Fam Plann Reprod Health Care","first-page":"189\u201393","article-title":"(2007) Endometriosis-associated dyspareunia: The impact on women's lives","volume":"33"},{"issue":"(1):","key":"CIT0018","series-title":"J Sex Med","first-page":"219\u201327","article-title":"(2015) Concurrent deep-superficial dyspareunia: Prevalence, associations, and outcomes in a multidisciplinary vulvodynia program","volume":"12"},{"issue":"(2):","key":"CIT0019","series-title":"JSLS","first-page":"182\u20139","article-title":"(2007) Patients\u00a0with\u00a0chronic\u00a0pelvic pain:\u00a0endometriosis\u00a0or\u00a0interstitial cystitis\/painful bladder syndrome","volume":"11"},{"issue":"(3):","key":"CIT0020","series-title":"J Pediatr Adolesc Gynecol","first-page":"171\u20135","article-title":"(2013) Prevalence of pain syndromes, mood conditions, and asthma in adolescents and young women with endometriosis","volume":"26"},{"issue":"(2):","key":"CIT0021","series-title":"JSLS","first-page":"175\u201381","article-title":"(2007) The relationship between interstitial cystitis and endometriosis in patients with chronic pelvic pain","volume":"11"},{"issue":"(4):","key":"CIT0022","series-title":"JSLS","first-page":"329\u201333","article-title":"(2004) Interstitial cystitis in persistent posthysterectomy chronic pelvic pain","volume":"8"},{"issue":"(3):","key":"CIT0023","series-title":"Am J Obstet Gynecol","first-page":"286.e1\u20136","article-title":"(2010) Pelvic pain\u00a0and\u00a0surgeries\u00a0in\u00a0women\u00a0before\u00a0interstitial cystitis\/painful bladder syndrome","volume":"202"},{"issue":"(2):","key":"CIT0024","series-title":"Urology","first-page":"313\u20139","article-title":"(2011) Numbers\u00a0and\u00a0types\u00a0of\u00a0nonbladder\u00a0syndromes\u00a0as\u00a0risk\u00a0factors\u00a0for\u00a0interstitial\u00a0cystits\/painful bladder syndrome","volume":"77"},{"issue":"(1):","key":"CIT0025","series-title":"Urology","first-page":"52\u20137","article-title":"(2009) Antecedent\u00a0nonbladder\u00a0syndromes\u00a0in\u00a0case-control study\u00a0of\u00a0interstitial cystitis\/painful bladder\u00a0syndrome","volume":"73"},{"issue":"(3):","key":"CIT0026","series-title":"Int Urogynecol J\u00a0Pelvic\u00a0Floor Dysfunct","first-page":"341\u20135","article-title":"(2008) Dilemmas in diagnosing pelvic pain: multiple pelvic surgeries in women with interstitial cystitis","volume":"19"},{"issue":"(5):","key":"CIT0027","series-title":"J Urol","first-page":"1832\u20136","article-title":"(2005) Menstrual cycle affects bladder pain sensation in subjects with interstitial cystitis","volume":"174"},{"issue":"(4):","key":"CIT0028","series-title":"Curr Opin Obstet Gynecol","first-page":"394\u20139","article-title":"(2008) Deep dyspareunia: causes, treatments, and results","volume":"20"},{"issue":"(2 Pt 2):","key":"CIT0029","series-title":"J Sex Med","first-page":"996\u20131002","article-title":"(2010) Prevalence of interstitial cystitis in vulvodynia patients detected by bladder potassium sensitivity","volume":"7"},{"issue":"(6):","key":"CIT0030","series-title":"J Sex Med","first-page":"1726\u201334","article-title":"(2011) Interstitial cystitis is associated with vulvodynia and sexual dysfunction- a case-control study","volume":"8"},{"issue":"(3):","key":"CIT0031","series-title":"BJU Int","first-page":"370\u20135","article-title":"(2011) The\u00a0role\u00a0of a\u00a0leaky\u00a0epithelium\u00a0and potassium in the generation of bladder symptoms in interstitial cystitis\/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain","volume":"107"},{"issue":"(4):","key":"CIT0032","series-title":"Urology","first-page":"573\u20138","article-title":"(2002) Increased\u00a0prevalence\u00a0of interstitial cystitis:\u00a0previously unrecognized\u00a0urologic\u00a0and\u00a0gynecologic\u00a0cases\u00a0identified using a new symptom questionnaire and intravesical potassium sensitivity","volume":"60"},{"issue":"(5):","key":"CIT0033","series-title":"Eur Urol","first-page":"1145\u201351","article-title":"(2008) Insight into urogynecologic features of women with interstitial cystitis\/ painful Bladder syndrome","volume":"54"},{"issue":"(6):","key":"CIT0034","series-title":"Obstet Gynecol","first-page":"1029\u201332","article-title":"(1998) Criteria that indicate endometriosis is the cause of chronic pelvic pain","volume":"92"},{"issue":"(1):","key":"CIT0035","first-page":"203\u20136","volume":"140","year":"1988"},{"issue":"(5):","key":"CIT0036","series-title":"Eur Urol","first-page":"662\u20139","article-title":"(2004) Primary evaluation of patients suspected of having Interstitial Cystitis","volume":"45"},{"issue":"(1):","key":"CIT0037","series-title":"Eur Urol","first-page":"60\u20137. Epub 2007 Sep 20","article-title":"(2008) Diagnostic criteria, classification, and nomenclature for Painful Bladder Syndrome\/ Interstitial Cystitis: An ESSIC proposal","volume":"53"},{"issue":"(5):","key":"CIT0038","series-title":"J Urol","first-page":"1848\u201352","article-title":"(2010) Development, validation, and testing of an epidemiological case definition of interstitial cystitis\/ painful bladder syndrome","volume":"183"},{"key":"CIT0001","series-title":"Obstet Gynecol","article-title":"(1999)\u00a0Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates"},{"issue":"6:","key":"CIT0002","series-title":"BMC Public Health","first-page":"177","article-title":"(2006) WHO systematic review of prevalence of chronic pelvic pain: Neglected reproductive health morbidity"},{"issue":"(4):","key":"CIT0003","series-title":"JSLS","first-page":"311\u20134","article-title":"(2002) The evil twins of chronic pelvic pain syndrome: endometriosis and interstitial cystitis","volume":"6"},{"issue":"(1):","key":"CIT0004","series-title":"JSLS","first-page":"6\u20139","article-title":"(2011) Anterior\u00a0vaginal\u00a0wall\u00a0tenderness\u00a0(AVWT) as a\u00a0physical\u00a0symptom\u00a0in\u00a0chronic\u00a0pelvic\u00a0pain","volume":"15"},{"issue":"(4):","key":"CIT0005","series-title":"Urology","first-page":"53\u20139","article-title":"(2007) The emerging presence of interstitial\u00a0cystitis\u00a0in gynecologic patients\u00a0with\u00a0chronic\u00a0pelvic\u00a0pain","volume":"69"},{"issue":"17:","key":"CIT0006","series-title":"Pain Physician","first-page":"E141\u2013E147","article-title":"(2014) Prevalence of chronic pelvic pain among women: An updated review"},{"issue":"(3):","key":"CIT0007","series-title":"J Obstet Gynaecol Can","first-page":"174\u2013180","article-title":"(2017) Hospital-associated costs of chronic pelvic pain in Canada: A population-based descriptive study","volume":"39"},{"issue":"(1):","key":"CIT0008","series-title":"J Minim Invasive Gynecol","first-page":"43\u20139","article-title":"(2005) The prevalence of interstitial cystitis, endometriosis, adhesions, and vulvar pain in women with chronic pelvic pain","volume":"12"},{"issue":"(2):","key":"CIT0009","series-title":"J Urol","first-page":"450\u20136","article-title":"(2007) Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: A systematic review","volume":"177"},{"issue":"(10):","key":"CIT0010","series-title":"Int Urogynecol J","first-page":"1361\u20136","article-title":"(2012) Diagnosis of interstitial cystitis\/ bladder pain syndrome in women with chronic pelvic pain: A prospective observational study","volume":"23"},{"issue":"(3):","key":"CIT0011","series-title":"Urology","first-page":"576\u201380","article-title":"(2011) Prevalence and correlates of sexual dysfunction among women with bladder pain syndrome\/ interstitial cystitis","volume":"77"},{"issue":"(4):","key":"CIT0012","series-title":"Clin Obstet Gynecol","first-page":"811\u201323","article-title":"(2003) Interstitial cystitis and chronic pelvic pain: New insights in neuropathology, diagnosis, and treatment","volume":"46"},{"issue":"(3):","key":"CIT0013","series-title":"J Pediatr Adolesc Gynecol","first-page":"181\u20135","article-title":"(2009) Interstitial cystitis is an etiology of chronic pelvic pain in young women","volume":"22"},{"issue":"(2):","key":"CIT0014","series-title":"Eur J Obstet Gynecol Reprod Biol","first-page":"105\u20139","article-title":"(2009) Differentiating Interstitial Cystitis from similar conditions commonly seen in gynecologic practice","volume":"144"},{"issue":"(1):","key":"CIT0015","series-title":"JSLS","first-page":"25\u201329","article-title":"(2005) Interstitial Cystitis and Endometriosis in patients with chronic pelvic pain: The \u201cEvil Twins\u201d Syndrome","volume":"9"},{"issue":"(5):","key":"CIT0016","series-title":"Reprod Sci","first-page":"551\u20135","article-title":"(2015) Diagnostic accuracy of urinary cytokeratin 19 fragment for endometriosis","volume":"22"},{"issue":"(3):","key":"CIT0017","series-title":"J Fam Plann Reprod Health Care","first-page":"189\u201393","article-title":"(2007) Endometriosis-associated dyspareunia: The impact on women's lives","volume":"33"},{"issue":"(1):","key":"CIT0018","series-title":"J Sex Med","first-page":"219\u201327","article-title":"(2015) Concurrent deep-superficial dyspareunia: Prevalence, associations, and outcomes in a multidisciplinary vulvodynia program","volume":"12"},{"issue":"(2):","key":"CIT0019","series-title":"JSLS","first-page":"182\u20139","article-title":"(2007) Patients\u00a0with\u00a0chronic\u00a0pelvic pain:\u00a0endometriosis\u00a0or\u00a0interstitial cystitis\/painful bladder syndrome","volume":"11"},{"issue":"(3):","key":"CIT0020","series-title":"J Pediatr Adolesc Gynecol","first-page":"171\u20135","article-title":"(2013) Prevalence of pain syndromes, mood conditions, and asthma in adolescents and young women with endometriosis","volume":"26"},{"issue":"(2):","key":"CIT0021","series-title":"JSLS","first-page":"175\u201381","article-title":"(2007) The relationship between interstitial cystitis and endometriosis in patients with chronic pelvic pain","volume":"11"},{"issue":"(4):","key":"CIT0022","series-title":"JSLS","first-page":"329\u201333","article-title":"(2004) Interstitial cystitis in persistent posthysterectomy chronic pelvic pain","volume":"8"},{"issue":"(3):","key":"CIT0023","series-title":"Am J Obstet Gynecol","first-page":"286.e1\u20136","article-title":"(2010) Pelvic pain\u00a0and\u00a0surgeries\u00a0in\u00a0women\u00a0before\u00a0interstitial cystitis\/painful bladder syndrome","volume":"202"},{"issue":"(2):","key":"CIT0024","series-title":"Urology","first-page":"313\u20139","article-title":"(2011) Numbers\u00a0and\u00a0types\u00a0of\u00a0nonbladder\u00a0syndromes\u00a0as\u00a0risk\u00a0factors\u00a0for\u00a0interstitial\u00a0cystits\/painful bladder syndrome","volume":"77"},{"issue":"(1):","key":"CIT0025","series-title":"Urology","first-page":"52\u20137","article-title":"(2009) Antecedent\u00a0nonbladder\u00a0syndromes\u00a0in\u00a0case-control study\u00a0of\u00a0interstitial cystitis\/painful bladder\u00a0syndrome","volume":"73"},{"issue":"(3):","key":"CIT0026","series-title":"Int Urogynecol J\u00a0Pelvic\u00a0Floor Dysfunct","first-page":"341\u20135","article-title":"(2008) Dilemmas in diagnosing pelvic pain: multiple pelvic surgeries in women with interstitial cystitis","volume":"19"},{"issue":"(5):","key":"CIT0027","series-title":"J Urol","first-page":"1832\u20136","article-title":"(2005) Menstrual cycle affects bladder pain sensation in subjects with interstitial cystitis","volume":"174"},{"issue":"(4):","key":"CIT0028","series-title":"Curr Opin Obstet Gynecol","first-page":"394\u20139","article-title":"(2008) Deep dyspareunia: causes, treatments, and results","volume":"20"},{"issue":"(2 Pt 2):","key":"CIT0029","series-title":"J Sex Med","first-page":"996\u20131002","article-title":"(2010) Prevalence of interstitial cystitis in vulvodynia patients detected by bladder potassium sensitivity","volume":"7"},{"issue":"(6):","key":"CIT0030","series-title":"J Sex Med","first-page":"1726\u201334","article-title":"(2011) Interstitial cystitis is associated with vulvodynia and sexual dysfunction- a case-control study","volume":"8"},{"issue":"(3):","key":"CIT0031","series-title":"BJU Int","first-page":"370\u20135","article-title":"(2011) The\u00a0role\u00a0of a\u00a0leaky\u00a0epithelium\u00a0and potassium in the generation of bladder symptoms in interstitial cystitis\/overactive bladder, urethral syndrome, prostatitis and gynaecological chronic pelvic pain","volume":"107"},{"issue":"(4):","key":"CIT0032","series-title":"Urology","first-page":"573\u20138","article-title":"(2002) Increased\u00a0prevalence\u00a0of interstitial cystitis:\u00a0previously unrecognized\u00a0urologic\u00a0and\u00a0gynecologic\u00a0cases\u00a0identified using a new symptom questionnaire and intravesical potassium sensitivity","volume":"60"},{"issue":"(5):","key":"CIT0033","series-title":"Eur Urol","first-page":"1145\u201351","article-title":"(2008) Insight into urogynecologic features of women with interstitial cystitis\/ painful Bladder syndrome","volume":"54"},{"issue":"(6):","key":"CIT0034","series-title":"Obstet Gynecol","first-page":"1029\u201332","article-title":"(1998) Criteria that indicate endometriosis is the cause of chronic pelvic pain","volume":"92"},{"issue":"(1):","key":"CIT0035","first-page":"203\u20136","volume":"140","year":"1988"},{"issue":"(5):","key":"CIT0036","series-title":"Eur Urol","first-page":"662\u20139","article-title":"(2004) Primary evaluation of patients suspected of having Interstitial Cystitis","volume":"45"},{"issue":"(1):","key":"CIT0037","series-title":"Eur Urol","first-page":"60\u20137. 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