women s health issues
Pelvic Pain in Women
Evaluation of Pelvic Pain
Usually, pelvic pain is not an emergency, but when a woman has new, sudden, very severe pain in the lower abdomen or pelvis, medical attention should be sought as soon as possible. Sometimes, emergency surgery is required. Disorders that usually require emergency surgery include Appendicitis None A ruptured Ectopic Pregnancy (an abnormally located pregnancy—not in its usual place in the uterus) Twisting of an ovary ( Adnexal Torsion ) A ruptured abscess in the pelvis A tear in the intestine An Abdominal Aortic Aneurysms None Doctors check for pregnancy in all girls and women of childbearing age. In women with pelvic pain, certain symptoms are cause for concern: Light-headedness or sudden loss of consciousness (fainting, or syncope), however brief Dangerously low blood pressure ( Shock ) Sudden, severe pain, especially when accompanied by nausea, vomiting, excessive sweating, or agitation Fever or chills Vaginal bleeding after menopause Women with most warning signs should see a doctor immediately. Women may need to be seen the same day or within a few days if they have Vaginal bleeding after menopause Pain that is constant or steadily worsening If women have new pain that is not constant and is not worsening or if they have pain that is recurring or chronic, they should schedule a visit when practical, but a delay of several days is usually not harmful. Mild menstrual cramps are normal. Menstrual cramps do not require evaluation unless they are very painful. The doctor does a quick evaluation to see if emergency treatment is needed. Doctors ask the woman questions about her symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Some Causes of Pelvic Pain in Women* ). Doctors ask about the pain: Whether it begins suddenly or gradually Whether it is sharp or dull How severe it is When it occurs in relation to the menstrual cycle, eating, sleeping, sexual intercourse, physical activity, urination, and bowel movements Whether any other factors worsen or ease the pain The woman is asked about other symptoms, such as vaginal bleeding, a discharge, and light-headedness. The woman is asked to describe past pregnancies and menstrual periods. Doctors also ask whether she has had any disorders that can cause pelvic pain and whether she has had abdominal or pelvic surgery. Doctors may ask about stress, depression, and other psychologic factors to determine whether these factors may be contributing to the pain, especially if the pain is chronic. Certain groups of symptoms that accompany pelvic pain suggest a type of medical condition. For example, Fever and chills suggest an infection. A vaginal discharge suggests an infection, such as Pelvic Inflammatory Disease (PID) . Abdominal pain, a change in bowel movements, or rectal bleeding suggests a digestive tract disorder. Vaginal bleeding during pregnancy suggests an Ectopic Pregnancy or a possible The physical examination starts with checking vital signs, such as temperature, blood pressure, and pulse. Then doctors focus on the abdomen and pelvis. Doctors gently feel the abdomen and do a Gynecologic Examination . During an examination, the abdomen or other areas may feel tender if touched. This evaluation helps doctors determine which organs are affected and whether an infection is present. Often, doctors also check the rectum for abnormalities. The following tests are routinely done: Urine tests A pregnancy test if women are of childbearing age Urinalysis and Urine Culture is a simple, fast urine test that is a first step to check for many common causes of pelvic disorders such as a bladder infection or most kidney stones. A urine culture is done if a A pregnancy test is done if a woman is in her reproductive years. A urine pregnancy test is usually done first. If a very early pregnancy is possible and the urine test is negative, a blood test for pregnancy is done. The blood test is more accurate than the urine test when a pregnancy is less than 5 weeks. If a woman is pregnant and has pain or vaginal bleeding, ultrasonography is done to rule out an Ectopic Pregnancy . For ultrasonography, doctors use a handheld ultrasound device that is placed on the abdomen or inside the vagina. Ultrasonography of the pelvis is done for many reasons. It is done whenever doctors think a gynecologic disorder may be the cause of the symptoms and the symptoms have begun suddenly, recur, or are severe. If results of ultrasonography are unclear, other tests, such as a series of blood tests or laparoscopy, are done to rule out ectopic pregnancy. For the blood tests, doctors measure levels of a hormone produced by the placenta called human chorionic gonadotropin (hCG). If hCG levels are low, the pregnancy may be too early for ultrasonography to detect. If levels are high and ultrasonography does not detect a pregnancy, ectopic pregnancy is possible. For laparoscopy, doctors make a small incision just below the navel and insert a viewing tube (laparoscope) to directly look for an ectopic pregnancy or other causes of pelvic pain. Tests depend on which disorders are suspected. Tests may include Urine tests or testing of samples from the vagina or cervix to check for infections that can cause pelvic pain Ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) of the abdomen and pelvis to check for Introduction to Miscellaneous Gynecologic Abnormalities and tumors If other tests do not identify the cause of severe or persistent pain and a serious cause (such as a ruptured ectopic pregnancy) is suspected, sometimes laparoscopy or laparotomy 