Acute and Chronic Pelvic Pain in Women

Bernard Karnath, Daniel M. Breitkopf
2007 · W2318853537
article OA: closed CC0 ⤵ 7 in-corpus citations Metadata only
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This article discusses the evaluation of acute and chronic pelvic pain in women, emphasizing how a thorough history and physical examination help differentiate gynecologic and nongynecologic causes.

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Abstract

Pain located in the pelvis or lower abdomen is a common presenting symptom in both outpatient and acute care settings. Pelvic pain is associated with a wide range of conditions involving the reproductive, gastrointestinal, genitourinary, and musculoskeletal systems. Given the diverse etiology of pelvic pain, an accurate and efficient diagnosis of the underlying cause(s) can present a clinical challenge. A thorough history and physical examination are essential to characterize the pain and any accompanying symptoms and corroborate the patient’s description of the pain. The findings on initial clinical evaluation help to discriminate among potential causes and guide further evaluation or therapy. This article discusses the evaluation of gynecologic and nongynecologic causes of acute and chronic pelvic pain with an emphasis on the history and physical examination. DEFINITIONS Pelvic pain can be characterized as acute, chronic, or recurrent. Acute pelvic pain is defined as pain lasting for less than 3 months, while chronic pelvic pain generally lasts longer than 3 to 6 months. This timeline is arbitrary, and patients with cyclic episodic pain may be best classified as having recurrent pelvic pain rather than acute or chronic pain. 1 Pain with an identifiable specific cause is termed organic pain, while pain without a clearly identifiable cause that is exacerbated by psychosocial factors is termed functional pain. 2 EVALUATION History and Physical Examination The initial approach to the patient with pelvic pain should include a detailed and thorough history and physical examination. The history should be used to characterize the pain and should include questions about location, duration (constant or intermittent), onset, radiation, associated symptoms, severity, quality (eg, sharp pains, cramping, dull aching pain), and alleviating and aggravating factors. Relevant organ system symptoms (eg, urinary, gastrointestinal, and musculoskeletal) should be reviewed as there are many nongynecologic causes of pelvic pain. The physical examination serves to confirm the history. Pelvic Examination Performance of a pelvic examination is the standard of care for women with lower abdominal and pelvic symptoms. Following a thorough abdominal examination, a pelvic examination should be performed to assess for potential causes of the patient’s symptoms. The external genitalia should be visually inspected for lesions first. The vagina and cervix should be visualized by speculum examination. The bladder, vaginal walls,

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chronic_pelvic_pain

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