Detailed history (focusing on above etiologies):

■ Temporal pattern

■ Associated symptoms

■ Past surgeries

■ Last menstrual period (LMP) Physical exam:

Look for:

■ Cervical motion tenderness

■ Gastrointestinal (GI) complaints

■ Neurological testing

Relation of pain to basal body temperature elevation (to rule out mittelschmerz pain associated with ovulation) Blood work:

■ Complete blood count (CBC)

■ Pregnancy test

Pelvic pain accounts for 12% of hysterectomies, 40% of diagnostic laparoscopies, and 40% of 2° and 3° office visits.

Chronic pelvic pain: Think of "leapin' " pain. Leiomyoma Endometriosis Adhesions, adenomyosis Pelvic inflammatory disease (PID) Infections other than PID Neoplasia

PID is the most common cause of chronic pelvic pain.

Mittelschmerz is pelvic pain associated with ovulation.

Laparoscopy is the final, conclusive step in diagnosing pelvic pain, but it should only be done once psychogenic causes are considered carefully.

Differential of acute pelvic pain:


■ Appendicitis

■ Ruptured ovarian cyst

■ Ovarian torsion/abscess

■ Ectopic pregnancy

■ STS (serotest for syphilis)

■ Blood culture

5. Radiographic studies:

■ Abdominal and vaginal sonogram

■ Computed tomography (CT)

■ Magnetic resonance imaging (MRI)

■ Renal sonogram/intravenous pyelogram (IVP)

6. Colonoscopy and/or cystoscopy (should be perfomed if all above are inconclusive)

7. Rule out psychosomatic pain.

8. Diagnostic laparoscopy


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