History and Physical Form

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Dear Healthcare Professional:

The Board of the International Pelvic Pain Society is proud to present the 2008 version of the Pelvic Pain Assessment Form. We would like to acknowledge the hard work that was put into the original version by Dr. Metzger and The Research Committee. The original version will continue to be available through the IPPS website. The 2008 version is a result of a broad-based collaborative process with members of the Board of Directors as well as members of the IPPS. The main changes include:

• Flow: More comprehensive history, review of systems, and physical findings sections
  
• Pain maps for abdominal, vulvar, and vaginal findings (patients and providers)
  
• Additional space for the patient’s description of the problem
  
• Additional space for health care provider’s comments
  
• Space for additional treating health care providers
  
• Updated surgical history section to allow space for surgical findings
  
• Updated medication section to distinguish current and previous medications
  
• Expanded obstetrical history section
  
• Added section for medical / allergy / contraceptive history
  
• Addition of the PUF questionnaire (Thank you Dr. Lowell Parsons)
  
• Added Pelvic Congestion Syndrome (Pelvic Varicosity Pain Syndrome) questions
  
• Updated Rome III criteria for IBS
  
• Deleted SF-36

Though this version has been tested in several clinical sites, future updates will be easier and quicker due to the current format. You will notice that the SF-36 has been omitted. This was a result of input from several members as well as the Board of Directors. It was felt that this section was rarely scored and added significantly to the length. It will still be present in the original form. There is still no depression screening tool on this questionnaire. This is largely a result of difficulty obtaining permission to use published validated depression screening tools. We will continue to work on obtaining a validated tool. We wish to thank Dr. Lowell Parsons for giving permission to the IPPS to use his PUF questionnaire.

We hope you find the 2008 Pelvic Pain Assessment Form helpful in adding clarity to your history taking and recording of physical findings. Your feedback is welcome. Enjoy!

Sincerely,
Howard T. Sharp, MD
Vice President, IPPS

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