My first year of college, when I played softball for the University of Tennessee, I had an episode of osteitis pubis. It was the worst experience that I ever had; unfortunately, it occurred during one of the most important softball tournaments of my career. We were playing against one of the best teams in the country, Arizona University, and I was having major debilitating pain in my vaginal area that radiated to my abdomen. It felt like I had been kicked between the legs, so walking, let alone jogging, was extremely difficult. I was too embarrassed to tell my coaches and teammates why I was unable to play. The sporadic pain lasted for several days during this episode. My only relief was resting, icing, and consistently stretching.

Causes

● Osteitis pubis is the inflammation of the pubic symphysis and the surrounding muscle insertions.
Osteitis pubis is identified by sclerosis and bony changes of the pubic symphysis.
● First observed in patients undergoing urologic procedures, osteitis pubis results from abnormal shearing forces across the pubic symphysis caused by muscle imbalance and poor flexibility. The effects of muscle imbalance and poor flexibility cause microtrauma to the pubic symphysis. The consequences are inflammation and muscle spasms.

Examples of this include

❖ Pregnancy
❖ Childbirth
❖ Gynecologic surgery
❖ Urologic surgery
❖ Major trauma
❖ Repeated minor trauma
❖ Rheumatologic disorders
❖ Sacroiliac (SI) joint dysfunction
❖ Running
❖ Kicking
❖ Rapid lateral movements that occur in soccer, sprinting, ice hockey, and football

● The prevalence of osteitis pubis is unknown; however, this condition has been reported to commonly occur in men aged 30 to 50 years old.
● Women are affected in their mid-30s.

Symptoms

Patients will often complain of vague symptoms such as

● Groin or lower abdomen pain localized over the symphysis that may radiate to the groin, scrotum, perineum, mid-thigh, hip, or abdomen.
● Complaints of adductor pain to lower abdominal pain that radiates to the pubic area.
● Pain is described as unilateral and present for a few days to weeks, exacerbated by activities like running, pivoting on one leg, kicking, or pushing off to change one direction, and lying on the side.
● Pain while walking, climbing stairs, coughing, or sneezing.

Treatment

● If you or anyone you know have these symptoms, please contact your primary care physician or general practitioner for a physical assessment and work-up.
● The treatment plan may consist of

o Rest and time (2 weeks to 3 months for non-athletes; 3 months to 6 months for athletes with a gradual return to sports)
o Ice
o Heat
o NSAIDs (ibuprofen)
o Physical therapy
● If pain persists, a consultation with a gynecologist, urologist, infectious disease physician, podiatrist (poor foot mechanics), or physical therapist may be necessary.
Osteitis pubis has a good prognosis.

Figure 1: Human pelvic bone with highlighting of the area of pain in the symphysis pubis.

References

Goitz, H. (2018). Osteitis Pubis. https://emedicine.medscape.com/article/87420-overview

Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology,
19(3), 156–163. https://doi.org/10.3909/riu0767

Vipman. (2020). [Illustration]. Human pelvic bone with highlighting of the area of pain in the symphysis
pubis. https://www.shutterstock.com/image-vector/human-pelvic-bone-highlighting-area-symphysis-18550709
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