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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, or pelvic pain. (UGAP).
It is a great masquerader and mimics several different groin, lower abdominal and pelvic conditions.
It is not an uncommon condition, and unfortunate patients with severe disabling pain are often shuttled from one specialist to another, hoping to find some relief.
Because the condition is widespread, physicians in several specialties encounter patients with this presentation.
The volume of UGAP pain and its economic impact are staggering. Nearly 15 million women in the USA have chronic pelvic pain, and in this subset, 46% have dyspareunia (painful sex). The annual medical cost of diagnosis 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 diverticulitis, incarcerated groin hernias, etc.
b. In male patients with chronic groin and pelvic pain, it can mimic sportsman's hernia, prostatitis, and epididymorchitis.
c. In females with chronic pelvic pain, it can mimic commonly seen pelvic and groin conditions such as endometriosis, pelvic congestion, ovarian cyst, diverticulitis, and groin pain, including hernias.
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