- Fibroid with degeneration
- Bicornuate uterus
- Rupture of follicular cyst
- Pelvic inflammatory disease (PID)
- Ectopic pregnancy
- Torsion of hydrosalpinx
Non gynaecological causes
- Irritable bowel syndrome
- Stone in ureter
- Abdominal wall haematoma
- Femoral and inguinal hernia
- Sexual abuse
Acute pelvic pain
- Ectopic pregnancy
- Twisted ovarian cyst
- Acute gastroenteritis
- Intestinal obstruction
American college of obstetrics and gynecologists describes it as a
non cyclical pain of 3 months duration or cyclical pain of 6 months duration, either of which interfere with normal routine activities.
- Pain which is refractory to the medical treatment.
- When there is significant impairement of physical and sexual function.
Diagnosis is based on
- Nature of pain
- Relation to menstrual cycles
- Aggravating and relieving factors
- Bowel movement
- Urinary history
- Menstrual history
- Gait of the patient
- Color and general appearance is noted.
- Alteration in the posture
- facial expressions of the patient
- Tender points on the abdomen
- Hymen whether ruptured or not (haematocolpos can also cause pain )
- Urethra , any discharge or lesion
- Discharge from vagina
- Cervical erosion on per speculum examination
- Tenderness in the fornices or adenexal masses
- Uterine size
- Smear is taken for gonorrhoea and chlamydia infection.
Differential diagnosis (D/D)
1 Functional cysts
CBC , USG , culdocentesis , diagnostic laparoscopy confirm the diagnosis.
3 Ectopic pregnancy
- Acute pain
- Usually history of amenorrhoea with spotting or bleeding per vaginum
- Pregnancy test is positive.
- USG confirms the diagnosis.
- or methotrexate are the line of treatment.
4 Twisted ovarian cyst
If there is ischaemia due to twist it will cause unbearable pain.A benign cystic teratoma is the most common to undergo torsion.
- Acute pain
- Large tender adenexal mass
- Mild rise in temperature
- Laparoscopic or laparotomy
- If necrosed then oopherectomy is required.
- If not infarcted then just untwist the cyst.
Hymen is persistent and there is accumulation of blood in vagina.
on usg , solid mass in vagina is found.Hymen is bluish in colour.
give a cruciate incision in the hymen and drain out the blood.
6 Acute salpingo-oopheritis
there is fever, purulent discharge , nausea, vomiting , bilateral fornices tendreness.
ESR is raised and there is leukocytosis.
Cervical smear will show gram negative intracellular diplococci.
for chlamydia there will be positive chlamydia Ag test.
- Broad spectrum antibiotics
- Hospitalization if TO abscess is there.
7 IUCD can also cause pelvic discharge with pain.
Give antibiotics , if doesn’t subside then remove it.
When ovarian follicle ruptures there is small amount of blood leakege in the peritoneal cavity causing mid cyclic pain.
- Low dose OCPs
- Ovarian cyst
- Prostaglandin inhibitors
- Is diagnosed with history
- Usg is normal
- Subsides with prostaglandins and low dose ओच्प्स
If does not subside,then it can be secondary dysmenorrhoea
- Adhesions, TO masses , endometriomas or bicornuate uterus are the findings.
Surgical fulgration and excision of the lesion
and biopsy is done.
If adhesions are found (they are usually post operative) , then perform adhesiolysis.
Pelvic congestion syndrome
- Ovarian and Internal iliac varices cause this syndrome.
- History is significant
- Premenstrual exacerbation of the pain which is unilateral and increases in standing posture and is relieved in supine position.
- Laparoscopy / imaging / selective ovarian and internal iliac venography are done to diagnose it.
- Embolization is the treatment.
- Sucess rate is 50 to 80 %.
- GnRh agonists like goserlin acetate and medroxyprogesterone acetate are also given.
- Mini sood, pubertal menstrual anomalies;Jaypee Publication;125-135;
- Joseph S, adolescent pelvic pain, best practice and research clinic obs and gyne,vol 7;93-101;2003
- AOGD october 2008 ,Dr Chandra Mansukhani.
- Common Causes of Vaginal Pain (everydayhealth.com)
- MCQs-Gynaec-2 (bhagia.wordpress.com)
- Can my pelvic pain be endometriosis? (zocdoc.com)
- I have had pelvic pain for 3 months now, I am not sure what it is! (zocdoc.com)
- How can I lessen the frequency of chronic pelvic pain? (zocdoc.com)