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INTRODUCTION:
 POPSS (Pain Over Pubis and Surrounding Structures) syndrome is not an uncommon
condition. It is an enthesopathy (tendonitis) and/or periosteitis (inflammation of the
lining of the bones). This article will provide background information and share lessons
learned during 23 years of practice treating these patients.
POPSS syndrome is a fascinating and enigmatic condition and presents as undiagnosed groin,
lower abdominal and pelvioc pain. (UGAP).
It is a great masquerader and mimics several different groin, lower abdominal and pelvic
conditions.
It is not an uncommon condition and several of these unfortunate patients with severe
disabling pain are shuttled from one specialist to another hoping to get some relief.
It is widespread and several different specialists come across patients with this presentation (Fig.1)
The volume of UGAP pain and the economic impact is staggering. Nearly 15 million women in
the USA have chronic pelvioc pain and in this subset 46% have dyspareunia (painful sex).
The annual medical cost of diagmosis and treatment is 1.2 billion dollars. The cost of loss of
productivity is estimated to be 15 billion dollars annually.
Tens of millions of adult males suffer from abacterial prostatitis causing UGAP pain. Nearly
half to one million patients with interstitial cystitis have UGAP pain. Also 0.5% to 6.2% of
professional athletes have groin pain also known as "sportsman's hernia".
"POPSS syndrome" can be mistaken for the following commonly seen conditions;
a. In patients with acute pain (only 8% of the patients in our series) it can mimic acute appendicitis, acute diverticultis, incarcerated groin hernias, ets.
b. In male ptients with chronic groin and pelvic pain it can mimic sportsman's hernia, prostatitis, and epididymorchitis.
c. In female with chronic pelvic pain it can mimic commonly seen pelvic and groin
conditions like endometriosis, plevic congestion, ovarian cyst, diverticulities,
groin pain including hernias.
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