Pelvic pain

Overview
Pain in the pelvis can be described as acute or chronic. Urologic, gastrointestinal and gynocologic problems can all be possible.

Differential diagnosis of causes of pelvic pain
In alphabetical order:

Acute (<6 months)

 * Abdominal Aortic Aneurysm
 * Cervicitis
 * Diverticulitis
 * Ectopic pregnancy
 * Endometriosis
 * Incomplete abortion
 * Intra-uterine device
 * Irritable Bowel Syndrome
 * Midcycle ovulation
 * Mesenteric ischemia/infarction
 * Nephrolithiasis
 * Ovarian cyst
 * Ovarian torsion
 * Pelvic Inflammatory Disease
 * Pelvic neoplasm
 * Pelvic floor prolapse
 * Primary dysmenorrhea
 * Ruptured corpus lutenal cyst
 * Septic abortion
 * Sexual abuse/trauma
 * Threatened abortion
 * Tubo-ovarian abscess
 * Urinary Tract Infection
 * Uterine fibroids
 * Vaginitis

Chronic (>6 months)

 * Adenomyosis
 * Depression
 * Diverticulosis
 * Diverticular abscess
 * Hernia
 * IBD
 * IBS
 * Interstitial Cystitis
 * Leiomyoma
 * Lymphoma
 * Pelvic adhesions

History and Symptoms

 * Nature
 * Sensitivity
 * Onset
 * Pain occurrence
 * intercourse
 * menstrual
 * chronic vs. acute


 * Risk of pregnancy
 * Associated symptoms:
 * fever
 * nausea
 * vomiting
 * dysuria
 * vaginal bleeding
 * vaginal discharge
 * abdominal pain or back pain

Abdomen

 * Full abdominal & pelvic exam - speculum, bimanual, rectal

Other

 * Examine for signs of physical abuse

Laboratory Findings

 * Labs include:
 * Urine pregnancy test
 * urinalysis
 * gram stain & culture
 * STD tests
 * vaginal smear wet mount

Echocardiography or Ultrasound

 * Ultrasound for ovarian cyst, mass, ectopic pregnancy vs. intrauterine pregnancy

Treatment

 * Positive pregnancy test
 * Determine LMP
 * confirm intrauterine pregnancy

Acute Pharmacotherapies

 * Endometriosis
 * Oral contraceptives 3-4 months
 * Provera 39mg QD/2 months
 * Danazol 200-800mg QD/6 month
 * GnRH agonist


 * Primary dysmennorhea
 * Oral contraceptives


 * Treat STD's accordingly