Validation of the Fremantle Perineal Awareness Questionnaire (FrePAQ) in women with Chronic Pelvic Pain
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Background
Chronic pelvic pain (CPP) affects up to 26% of women worldwide. While its pathophysiology is poorly understood, disturbances in body perception have been identified in various similar chronic musculoskeletal disorders. The Fremantle Perineal Awareness Questionnaire (FrePAQ) is a novel tool designed to specifically assess disturbed body perception in the pelvic region, but its structural validity and reliability require formal evaluation.
Methods
Patient partners with lived experience contributed to study design. Participants with (n=417 and without (n=277) chronic pelvic pain completed the FrePAQ at baseline, as well as one week later. We assessed the validity and reliability of the FrePAQ following COSMIN guidelines for Classical Test Theory.
Results
The validated FrePAQ comprises a two-factor model, with a six-item Distress & Disconnection (D&D) subscale and a two-item Size & Shape (S&S) subscale. Confirmatory analysis showed excellent fit (CFI = .988; RMSEA = .048) and measurement invariance between diagnostic groups. Internal consistency was high (α = .838 CPP; .819 controls). Test–retest reliability was high for D&D (ICC = .863) and acceptable for S&S (ICC = .695). FrePAQ scores showed a weak-moderate correlation with pain scores (r = .234–.255), psychological distress (r = .226–.443), and functional impact (r = .172–.295), particularly for the D&D subscale.
Conclusion
The FrePAQ is a reliable and valid instrument to measure perineal perceptual disturbances in CPP. Future research will evaluate the tool’s potential to support phenotyping and guide individualised interventions. Improved understanding of body perception disturbance in CPP can enhance diagnosis and treatment precision.
Perspective
This article validates the Fremantle Perineal Awareness Questionnaire (FrePAQ), the first measure of perineal body perception disturbance in chronic pelvic pain. The findings support body perception disturbance as a clinically relevant feature of chronic pelvic pain and provide a foundation for future research exploring its role in phenotyping, treatment selection, and treatment response.
