Guest Author - Denise Howard, M.D., M.P.H.

Pelvic Pain is a common complaint in women. A gynecologic cause is often assumed but it is important to remember that there are other organs that reside in the pelvis. It is perfectly acceptable to start the evaluation process with a Primary Care Physician or a Gynecologist but if the problem persist further evaluation by other specialist may be required.

When communicating with your provider it is important to be clear and concise. They will be interested in the timing of the pain. How long has the pain been present? Is it constant or intermittent? Note the location of the pain and if it radiates. Describe the pain. Is it sharp, dull, cramping or burning? Grade the severity of the pain. Is it mild, moderate or severe? What brings on the pain and what appears to ease it? What is the relationship of the pain to menstruation?

The health care provider may also ask questions about urinary symptoms, gastrointestinal symptoms, vaginal irritation or discharge and sexual habits. Urinary frequency, pain with urination and urinary urgency suggest a urinary source for the pain such as a urinary tract infection. Nausea, vomiting and poor appetite suggest a gastrointestinal source such as appendicitis. Vaginal discharge and a new sexual partner are suggestive of a gynecologic infection as the source.

A physical examination, including a pelvic examination will be performed. A rectal examination may also be necessary. Cervical cultures, urine cultures and blood work may be taken. Other diagnostic test might include a CT scan, pelvic ultrasound or other imaging test. Finally, a colonoscopy or a diagnostic laparoscopy might be recommended.

Possible causes of the pain are gynecologic, urologic, or gastrointestinal. It is important to know that physicians are anxious to eliminate a cancer as the possible source of the pain but this is a rare cause. Urologic causes include urinary tract infections, kidney stones, and interstitial cystitis. Gastrointestinal causes may include appendicitis, constipation, irritable bowel syndrome, diverticulitis and colon cancer. Gynecologic causes include pelvic inflammatory disease, ovarian cyst, ovulation, fibroids, endometriosis, ovarian torsion, ectopic pregnancy and malignancy.

Management of the pain is dependent on the presenting symptoms and the test results. In addition if the pain is chronic in nature, resolution may take some time. It is important to be cooperative and patient in the evaluation. Following up as scheduled to review test results, consultation reports and treatment response are an important part of partnering with your physician and hopefully taking the first step to treating the pelvic pain.