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Asian J Neurosurg 2019 Jan-Mar;14(1):1-4

Department of Neurosurgery, Super Speciality Hospital and Government Medical College, Nagpur, Maharashtra, India.

A human tail is a rare congenital anomaly which mostly presents immediately after birth or in early childhood. Here, we are presenting a case of 17-year-old male who presented with 18-cm long tail, which was hidden till this age because of social stigma and shame. This is longest human tail reported of our knowledge. Read More

Enferm Clin 2019 Mar 9. Epub 2019 Mar 9.

UGC Medicina Maternofetal, Genética y Reproducción, Hospital Universitario Virgen del Rocío, Sevilla, España.

The coccyx is a bone with its own morphology and mobility and pain can occur due to trauma such as a difficult or instrumental delivery. Coccydynia can make it impossible to carry out the activities of daily life, its affects can be both physical and psychosocial, and causes great maternal morbidity. This article highlights the factors that predispose women to coccydynia and actions to relieve and improve it. Read More

Orthopade 2019 Jan;48(1):92-95

Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Deutschland.

Background: Coccygodynia is still often considered a mystery, and many patients are not taken seriously with their problems and pain.

Case: A 51-year-old thin lady presented at our clinic with lifelong, persistent low back pain. The clinical examination indicated suspicion of coccygodynia. Read More

Int J Surg Case Rep 2019 24;54:63-65. Epub 2018 Nov 24.

Department of Neurosurgery, Baylor Scott and White Health, Temple, TX, USA.

Background And Importance: Coccydynia is a rare pain syndrome due to trauma to the coccyx that is diagnosed through history, physical, and sitting/standing lateral plain film radiographs. Coccydynia is typically managed conservatively with specialized cushions, NSAIDS, and physical therapy. In cases refractory to nonsurgical management, coccygectomy has a high success rate for pain reduction. Read More

J Palliat Med 2019 Mar 1;22(3):343-347. Epub 2018 Dec 1.

3 Spectrum Health Medical Group , Palliative Care Medicine, Grand Rapids, Michigan.

Introduction: Intravenous lidocaine is an option for intractable pain caused by advancing cancer and wound care. We report a case of intractable cancer pain and wound care pain managed with concurrent use of lidocaine administered as a twice daily intravenous bolus in addition to continuous intravenous infusion.

Case Description: A 31-year-old male with rapidly progressing locally advanced squamous cell cancer affecting the gluteal area developed extensive painful and purulent ulcerating wounds affecting the coccyx, superior gluteal cleft, and buttocks. Read More

Med Hypotheses 2018 Dec 14;121:70-73. Epub 2018 Sep 14.

Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

The aim of this study is to develop an alternative way to locate the sacral hiatus for blind caudal block from the anthropometrical data measured on 3D pelvic CT. The intersection of the line connecting two sacral cornua and the midline is considered the ideal point (IP) for caudal block. The mean length from the coccyx tip to the IP was measured using 3D pelvic CT images in 30 men and 30 women and was 6. Read More

Neurol Neurochir Pol 2018 Sep - Oct;52(5):612-617. Epub 2018 Aug 28.

Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.

Aim Of The Study: To define the effectiveness of ganglion Impar block in improving neuropathic pain.

Materials And Methods: Patients who had pain around the coccyx for more than three months and did not respond to conservative treatment were included in this study. All the patients underwent fluoroscopy guided transsacrococcygeal ganglion Impar block with injecting 3 mL of 0. Read More

Adv Biomed Res 2018 20;7:112. Epub 2018 Jul 20.

Department of Emergency Medicine, Emergency Medicine Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Pelvic fracture (PF) is the second-most prevalent cause of mortality after brain trauma among multiple trauma patients. Our aim was to examine the reliability of suggestive criteria for having no PF (NPF) according to the common reported clinical signs and symptoms (CSSs).

Materials And Methods: In the current prospective study, 3527 patients with multiple trauma were recruited according to the guideline of emergency medicine. Read More

J Med Ultrasound 2017 Oct-Dec;25(4):208-214. Epub 2017 May 3.

Department of Radiology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.

Introduction: Anal pain is defined as pain originating from the anal canal or the perianal area that can be attributed to a variety of medical problems. The current study's aim was to evaluate the role of combined endoanal, transperineal, and in married women, transvaginal ultrasound in clarifying the etiology of anal pain among our patient study group.

Methodology: A total of 180 patients presented to our radiology department complaining of anal pain and were examined using transperineal, endoanal, and in women, transvaginal ultrasound aided with three-dimensional capability. Read More

BMJ Case Rep 2018 Jul 30;2018. Epub 2018 Jul 30.

Department of Ob/Gyn, Texas Tech University Health Science Center School of Medicine, Amarillo, Texas, USA.

An 18-year-old virginal woman was referred to the reproductive endocrinology clinic with primary amenorrhoea and secondary sexual development in the absence of pelvic pain. Additionally, she had significant congenital sensorineural hearing loss, autism, bipolar disorder and class III obesity. On physical examination, secondary sexual development was confirmed (Tanner 5 breasts and Tanner 4 pubic hair). Read More

Ann Surg Oncol 2018 Sep 6;25(9):2641. Epub 2018 Jul 6.

Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA.

Introduction: The management of perirectal tumors often requires rectal wall resection, and sometimes a complete proctectomy is required. Access to posterior perirectal masses via a posterior, transcoccygeal approach (Kraske procedure) avoids dissection of the intraperitoneal rectum.

Patient: The patient was a 63-year-old male who presented to his primary care physician with debilitating perirectal pain of several months' duration. Read More

Interv Neuroradiol 2018 Oct 3;24(5):580-585. Epub 2018 Jul 3.

6 Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey.

Objective Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB. Materials and methods We retrospectively analyzed the data for patients diagnosed with chronic coccygodynia who underwent GIB only once by a transsacrococcygeal method under fluoroscopy guidance in our Pain Medicine Clinic. Read More

Int J Surg Case Rep 2018 28;49:74-77. Epub 2018 Jun 28.

Department of Surgery, Kure City Medical Association Hospital, Japan; Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Japan.

Introduction: Spinal tuberculosis (TB) is the most common manifestation of extra-pulmonary TB. TB of the lumbosacral junction is rare and occurs in only 1 to 2% of all cases of spinal TB. Moreover, isolated sacrococcygeal TB is extremely rare. Read More

Cureus 2018 Apr 2;10(4):e2407. Epub 2018 Apr 2.

Surgery, Max Hospital Vaishali.

Coccydynia in adult patients is not uncommon and is frequently neglected. Coccydynia is mostly associated with fall on buttocks. In long-standing cases, coccydynia can be debilitating. Read More

J Bodyw Mov Ther 2018 Apr 19;22(2):261-265. Epub 2017 Jun 19.

S.O.M.A. Istituto Osteopatia Milano, Milan (MI), Italy; Manima Non-Profit Organization Social Assistance and Healthcare, Via Franchetti 4, 20124 Milan (MI), Italy. Electronic address:

Background: Coccydynia is a disorder associated with pain/discomfort at the base of the spine. The role of osteopathic manipulative treatment (OMT) in chronic coccydynia as well as for low back pain (LBP) and radicular pain (RP) associated with coccydynia, has not previously been investigated. This study seeks to analyse the effects of OMT on chronic coccydynia compared to physical therapy and pharmacological treatment (PTPT). Read More

Case Rep Anesthesiol 2018 29;2018:5832401. Epub 2018 Apr 29.

Spine & Pain Institute of New York, New York City, NY, USA.

Coccydynia can be difficult to resolve with conventional treatment options. Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for chronic pain, but its application has not been described in the context of coccydynia. We used DRG stimulation treatment in a patient suffering from intractable coccyx pain. Read More

J Emerg Med 2018 08 18;55(2):e33-e35. Epub 2018 May 18.

Department of Physical Medicine and Rehabilitation, Newark, New Jersey.

Background: Water slides and rides are increasingly popular attractions at amusement parks. There has been some documentation of various patterns of injury associated with these rides, most notably vaginal injuries caused by water jets. But we find no previous medical publications reporting the association between water slides/rides with coccydynia (coccyx pain) and tailbone injuries. Read More

Asian J Neurosurg 2018 Apr-Jun;13(2):277-282

Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.

Introduction: Coccygodynia refers to a pathological condition in which pain occurs in the coccyx or its immediate vicinity. The pain is usually provoked by sitting or rising from sitting. Several studies have reported good or excellent results after coccygectomy especially in patients who are refractory to conservative treatment. Read More

Trauma Case Rep 2017 Dec 14;12:11-15. Epub 2017 Nov 14.

Carilion Clinic Department of Orthopedics, Roanoke, VA, USA.

Dislocation of the sacrococcygeal joint is a rare injury from trauma to the buttocks, most often from falling backwards. Standard of care for this injury has not been determined because it is rare. Left untreated this can cause coccydynia in the long-term. Read More

Pediatr Surg Int 2018 08 3;34(8):905. Epub 2018 Apr 3.

Department of Physical Medicine and Rehabilitation, Coccyx Pain Center, Rutgers New Jersey Medical School, 90 Bergen St, D.O.C. Suite 3100, Newark, NJ, 07103-2425, USA.

Radiography (Lond) 2018 May 1;24(2):e48-e50. Epub 2017 Nov 1.

Department of Medicine, University of Otago, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand.

Magnetic susceptibility artefacts, caused by metallic objects, present a challenge in magnetic resonance imaging (MRI). In this case, MRI showed metal-induced artefact in the rectum of a 14-year-old girl who presented with pain in the coccyx after a snowboarding accident. Previous radiographs showed no evidence of metal in the area. Read More

Curr Pain Headache Rep 2018 Mar 19;22(4):28. Epub 2018 Mar 19.

Department of Anesthesiology, Jefferson Pain Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite T-150, Philadelphia, PA, 19107, USA.

Purpose Of Review: Coccygodynia is pain within the coccyx area. The diagnosis is made clinically with symptoms of pain in the coccyx region and worsening pain in sitting position. The initial treatment is conservative therapy. Read More

Ann R Coll Surg Engl 2018 Jan 15;100(1):12-15. Epub 2017 Sep 15.

Royal Derby Hospital , Derby , UK.

Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63-90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. Read More

Eur Spine J 2018 05 12;27(5):1166-1171. Epub 2017 Dec 12.

Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey.

Objective: We compared the results of manual therapy combined with steroid injection with single steroid injection in the treatment of persistent coccydynia.

Patients And Methods: Combined therapy was performed in 21 patients (Group 1) and steroid injection in 23 patients (Group 2). We compared two groups and investigated the combined therapy group in details. Read More

Surg Neurol Int 2017 24;8:260. Epub 2017 Oct 24.

Department of Neurosurgery, Kaiser Permanente Medical Center, Los Angeles, California, USA.

Background: Saccrococcygeal teratomas (SCT) are derived from embryonic germ cell layers. They frequently present at the base of the coccyx within the pelvis. While these tumors are common in children, they are exceedingly rare in adults. Read More

Neurourol Urodyn 2018 Mar 26;37(3):971-977. Epub 2017 Oct 26.

Department of Surgical, Hospital Brugmann, Université libre de Bruxelles, Brussels, Belgium.

Aim: To describe a new minimal invasive approach of the gluteal region which will permit to perform neurolysis of the pudendal and cluneal nerves in case of perineal neuralgia due to an entrapment of these nerve trunks.

Method: Ten transgluteal approaches were performed on five cadavers. Relevant anatomic structures were dissected and further described. Read More

Folia Morphol (Warsz) 2018 21;77(2):397-399. Epub 2017 Sep 21.

Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece..

Sacrum is a triangular bone placed in the base of the spine and formed by the synostosis of five sacral vertebrae (S1-S5). Its upper part is connected with the inferior surface of the body of L5 vertebra forming the lumbosacral joint, while its lower part is connected with the base of the coccyx forming the sacrococcygeal symphysis, an amphiarthrodial joint. The existence of four pairs of sacral fora-mina in both anterior and posterior surface of the sacrum is the most common anatomy. Read More

Pol Przegl Chir 2017 Aug;89(4):33-40

Centrum Terapii Manualnej, Sierosław, Tarnowo Podgórne, Polska.

Coccygodynia is a problem with a small percentage (1%) of the population suffering from musculoskeletal disorders. This pain is often associated with trauma, falling on the tailbone, long cycling, or by women after childbirth. The reason for the described problem can be the actual morphological changes. Read More

J Bodyw Mov Ther 2017 Jul 29;21(3):743-746. Epub 2017 Mar 29.

Swami Vivekanand National Institute of Rehabilitation Training & Research, Olatpur, Cuttack 754010, Odisha, India.

Pain in the coccyx is referred as coccydynia. The pain aggravates in weight bearing i.e. Read More

Phys Med Rehabil Clin N Am 2017 08 27;28(3):539-549. Epub 2017 May 27.

Physical Medicine and Rehabilitation, Coccyx Pain Center, Rutgers New Jersey Medical School, 90 Bergen Street, DOC Suite 3100, Newark, NJ 07103-2425, USA. Electronic address:

Coccyx (tailbone) pain substantially decreases the quality of life for patients who suffer with this condition. Classic symptoms include midline pain located below the sacrum and above the anus. Symptoms are worse while sitting or during transitions from sitting to standing. Read More

J Pain Res 2017 12;10:881-886. Epub 2017 Apr 12.

Department of Trauma and Orthopedics, Adana Numune Training and Research Hospital, Adana, Turkey.

Purpose: The aim of this study was to evaluate the results of partial and total coccyx excisions in patients with traumatic coccydynia resistant to conservative treatment.

Patients And Methods: The study included 22 patients (from a total of 27) who underwent partial or total coccygectomy because of persistent coccydynia between December 2007 and January 2014. There were 15 females and 7 males with a mean age of 33. Read More

Eur J Orthop Surg Traumatol 2017 Oct 6;27(7):961-965. Epub 2017 Apr 6.

Orthopedic Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Background: Coccygodynia is a pain of the coccyx that is typically exaggerated by pressure. Management includes anti-inflammatory medications, physiotherapy, and coccyx manipulation. Coccygectomy is the surgical approach for treating coccygodynia when the conservative management fails. Read More

Paediatr Anaesth 2017 Jun 3;27(6):643-647. Epub 2017 Apr 3.

Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.

Introduction: Sciatic nerve blocks provide intraoperative and prolonged postoperative pain management after lower limb surgery (posterior knee, foot, skin graft surgery). Accurate needle placement requires sound anatomical knowledge. Anatomical studies on children are uncommon; most have been performed on adult cadavers. Read More

Altern Ther Health Med 2017 Jan;23(1):14-19

Context • Five herbs-Urtica dioica (stinging nettle), Boswellia serrata, Equisetum arvense, Allium sativum, and Apium graveolens-have been demonstrated to have activity at several anti-inflammatory pathways and have analgesic properties that are effective in treating chronic musculoskeletal pain. Objectives • The study intended to evaluate the clinical efficacy of a proprietary blend of U dioica, B serrata, E arvense, A sativum, A graveolens, and thiamine (vitamin B1), or "the blend," in the treatment of chronic musculoskeletal pain. Methods • The research team performed a prospective case study. Read More

Lakartidningen 2017 01 5;114. Epub 2017 Jan 5.

Eur J Orthop Surg Traumatol 2017 Jul 2;27(5):591-598. Epub 2017 Jan 2.

Department of Orthopaedic Surgery, Al-Razi Orthopaedic Hospital, P.O. Box 24923, 13110, Safat, Kuwait City, Kuwait.

Background: Coccydynia can lead to significant functional disability and worsening of quality of life if not properly managed. In this study, we aim to assess the outcomes of extracorporeal shock wave therapy in patients with coccydynia.

Methods: A prospective case series study was carried out from January to December 2015. Read More

Pain Med 2017 06;18(6):1111-1130

Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.

Objectives: Coccydynia is a condition with a multitude of different causes, characterized by ill-defined management. There are multiple prospective studies, including several controlled trials, that have evaluated conservative therapies. Additionally, a plethora of observational studies have assessed coccygectomy, but few studies have reported results for nonsurgical interventional procedures. Read More

Anesth Pain Med 2016 Aug 1;6(4):e37428. Epub 2016 Jun 1.

Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Several nonsurgical and surgical treatment modalities are available for patients with chronic coccydynia, with controversial results. Extracorporeal shock wave therapy (ECSWT) is effective in the treatment of many musculoskeletal disorders; however, it has not been tested for chronic coccydynia.

Objectives: We performed the current study to determine the effects of ECSWT on pain in patients with chronic coccydynia. Read More

World Neurosurg 2017 Jan 13;97:758.e1-758.e5. Epub 2016 Oct 13.

Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital, Sulaymaniyah, Kurdistan, Iraq. Electronic address:

Background: Isolated lower segment sacral fracture is very rare. To the best of our knowledge, there is only one case report of S4 stable fracture that was treated conservatively.

Case Description: Here, we report a 12-year-old girl who sustained an isolated S5 fracture with anterior displacement of S5 and coccyx on S4. Read More

Medicine (Baltimore) 2016 Sep;95(39):e5010

Department of Anesthesiology and Pain Medicine, Inha University School of Medicine, Inha University Hospital, Incheon, South Korea.

Background: Coccygodynia is a pain in the region of the coccyx that radiates to the sacral, perineal area. The cause of the pain is often unknown. Coccygodynia is diagnosed through the patient's past history, a physical examination, and dynamic radiographic study, but the injection of local anesthetics or a diagnostic nerve blockade are needed to distinguish between somatic, neuropathic, and combined pain. Read More

Zhongguo Gu Shang 2016 Sep;29(9):831-835

The Second Department of Spinal, Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing 100102, China;

Objective: To study the clinical efficacy of sacral manual therapy in the treatment of coccygodynia.

Methods: From November 2013 to July 2015, 184 patients with sacrococcygeal pain were divided into treatment group and control group. There were 26 males and 65 females in the treatment group, with an average age of (39. Read More

PM R 2017 Apr 24;9(4):367-376. Epub 2016 Aug 24.

Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX(§).

Background: Coccydynia is a challenging disorder that often is refractory to treatments such as medications and injections. Physical therapy for coccydynia rarely has been studied.

Objective: To evaluate the efficacy of pelvic floor physical therapy for reducing pain levels in patients with coccydynia. Read More

Case Rep Orthop 2016 20;2016:7286806. Epub 2016 Jul 20.

Department of Orthopedics, MES Medical College, Sahloul University Hospital, 4051 Sousse, Tunisia.

Infection of the lumbosacral junction by tuberculosis is quite rare and occurs in only 1 to 2% of all cases of spinal tuberculosis; moreover, isolated sacrococcygeal or coccygeal tuberculosis is much rarer. Failure to identify and treat these areas of involvement at an early stage may lead to serious complications such as vertebral collapse, spinal compression, and spinal deformity. In the present paper, we report an uncommon case of spinal tuberculosis with sacrococcygeal location revealed by a chronic low back pain that was successfully managed. Read More

AJR Am J Roentgenol 2016 Oct 6;207(4):W77. Epub 2016 Jul 6.

1 Coccyx Pain Center, Rutgers New Jersey Medical School, Newark, NJ.

Surg Neurol Int 2016 17;7(Suppl 13):S370-4. Epub 2016 May 17.

Department of Neurosurgery, Arrowhead Regional Medical Center, Colton, CA, USA; Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, CA, USA.

Background: Chondromyxoid fibroma (CMF) is an extremely rare, benign cartilaginous tumor that makes up <0.5% of all bone tumors, typically presenting in the second or third decade of life. CMF of the sacrum is exceedingly rare, with only seven documented cases reported in the neurosurgical literature. Read More

Agri 2016 Apr;28(2):79-88

Department of Physical Medicine and Rehabilitation, İstanbul University Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

Objectives: Musculoskeletal injections (MIs) are frequently used in conservative treatment-resistant cases. Joint or soft tissue (ST) corticosteroid (CS) or local anesthetic (LA) injections can be used to relieve musculoskeletal pain. Assessed in the present study was the short-term efficacy of MIs for pain relief, as was the relative efficacy of injections in various joint and ST sites. Read More

Enferm Intensiva 2016 Oct - Dec;27(4):168-172. Epub 2016 May 21.

Hospital Universitari Joan XXIII de Tarragona, Unidad de Acogida Prequirúrgica, Tarragona, España.

A 69 year old man was admitted to the Intensive Care Unit (ICU) from the Emergency Department due to severe respiratory failure. Due to unsuccessful non-invasive mechanical ventilation, endotracheal intubation was performed. A category I ulcer in coccyx was detected 48h after admission. Read More

Bone Joint J 2016 Apr;98-B(4):526-33

Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300 Charlotte, NC 28204, USA.

Aims: The purpose of this prospective study was to evaluate the outcomes of coccygectomy for patients with chronic coccydynia.

Patients And Methods: Between 2007 and 2011, 98 patients underwent coccygectomy for chronic coccydynia. The patients were aged > 18 years, had coccygeal pain, local tenderness and a radiological abnormality, and had failed conservative management. Read More

Clin Orthop Relat Res 2016 Jul 25;474(7):1692-6. Epub 2016 Feb 25.

Congress Orthopedic Associates, 800 South Raymond Avenue, Pasadena, CA, 91105, USA.

Background: Pelvic tilt can affect the presence of the ischial spine sign and crossover sign. Numerous studies of pelvic tilt on radiographic measurements of pincer impingement have shown that increasing anterior tilt is associated with more radiographic signs of pincer impingement. However, to our knowledge, no study has directly compared supine and standing plain radiographs in patients with respect to lateral center-edge (LCE) angle, acetabular inclination, crossover sign, and ischial spine sign. Read More

Reumatol Clin 2017 Jan - Feb;13(1):42-43. Epub 2016 Jan 21.

Sección de Reumatología, Hospital Universitario General de Castellón, Castellón de la Plana, Castellón, España.

Coccydynia is a syndrome that rheumatologists encounter frequently in the form of tailbone pain, which is usually worse when sitting. Although the most common origin is trauma, there are several other possible causes of pain in the coccyx. We present an unusual case in which coccydynia developed shortly after the insertion of a contraceptive vaginal ring and remitted completely upon removal of this system. Read More