- As pain arising from the pelvis is a subjective perception rather than an objective sensation, accurately determining the etiology is often difficult.
- Dysmenorrhea (uterine pain associated with menses) is the most common gynecologic pain complaint.
Evaluation strategies
- The history provides a description of the nature, intensity, and distribution of the pain. However, imprecise localization is typical with intra-abdominal processes.
- Physical examination includes a comprehensive gynecologic examination. Specific attention should be paid to trying to reproduce the pain symptoms.
- Chlamydia/gonorrhea cervical cultures and urinalysis with culture are frequently helpful.
- Ultrasonography and other imaging studies may be indicated.
- Specialized diagnostic studies based on the presumptive diagnosis may require consultation with other specialists in anesthesiology, orthopedics, neurology, or gastroenterology.
Acute pelvic pain
Potentially catastrophic causes (ruptured appendix) require timely intervention to quickly diagnose and treat.
Gynecologic causes
Three main categories: rupture, infection, and torsion.
- Ectopic pregnancy (Figure 6.1; see Chapter 5). In all women of reproductive age, the first priority in evaluating acute pelvic pain is to rule out the possibility of a ruptured ectopic pregnancy.
- Acute pelvic inflammatory disease (PID) (Figure 6.1; see Chapter 8) is an ascending bacterial infection that often presents with high fever, severe pelvic pain, nausea, and evidence of cervical motion tenderness in sexually active women.
- Rupture of an ovarian cyst. Intra-abdominal rupture of a follicular cyst, corpus luteum, or endometrioma is a common cause of acute pelvic pain. The pain may be severe enough to cause syncope. The condition is usually self-limiting with limited intraperitoneal bleeding.
- Adnexal torsion (Figure 6.1
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