The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.

Pelvic pain is one of the more common presenting symptoms that cause a woman to seek gyn care. Diagnosis of pelvic pain may be simple and straightforward, or it may be difficult. The treatment of pelvic pain depends on an accurate diagnosis. The source of the pain may be the female organs, or it may come from an unrelated organ system.

Evaluation of pelvic pain involves:

• History and physical examination.

Providing your physician with a precise history improves the likelihood of an accurate diagnosis. A pain scale is frequently used to describe the intensity of the pain (see Pain Scale at the end of this brochure). The nature of the pain is also important. Is the pain dull, sharp, burning, or pulling? Is the pain continuous or intermittent? Is the pain related to your menstrual cycle, physical activity, or eating? Does the pain stay in one spot, or does it radiate to your back or leg? Are there any associated symptoms such as nausea, vomiting, constipation, diarrhea, fever, or burning on urination?

• Physical examination will include the abdomen and pelvis. If the history suggests a non-gyn source for the pain, other physical examination made be needed.

• Laboratory studies may be appropriate. These might include blood tests, urinalysis, or cultures

• Ultrasound evaluation may be helpful in certain cases as may CT scan, MRI, or other radiology tests.

If the above assessment does not pinpoint the source of the pain, video laparoscopy may be needed (see Laparoscopy in Surgery).

The causes of pelvic pain are many and varied. The following are some of the causes of pelvic pain.

Gynecologic causes

• adhesions or scar tissue
• pelvic infection
• endometriosis (see Endometriosis in Patient Health Information)
• ectopic (tubal) pregnancy
• ovarian cyst
• pelvic congestion syndrome (varicose veins in the pelvis)
• uterine fibroids (see Uterine Fibroids in Patient Health Information)
• pelvic prolapse (see Pelvic Prolapse in Patient Health Information)

Urologic causes

• urinary tract infection
• kidney stone
• interstitial cystitis (irritation and inflammation of the bladder without infection)

Gastrointestinal causes

• irritable bowel syndrome
• constipation
• appendicitis
• diverticulitis
• inflammatory bowel disease
• cancer

Musculoskeletal and Neurological causes

• disk problems
• degenerative joint disease
• fibromyalgia
• hernias
• osteoporosis
• shingles

Other causes

• abuse – physical or sexual, current or prior
• heavy metal poisoning
• porphyria
• sickle cell disease
• substance use, especially cocaine

Pain Scale

0-  No Pain

1-  Mild pain, not requiring medication

2-  Moderate pain, completely relieved with non-narcotic medication (such as aspirin, Motrin, ibuprofen, Tylenol, naproxen, Anaprox, BC powder, Darvocet, and/or in the case of menstrual cramps birth control pills

3-  Mild pain while on non-narcotic medication

4-  Moderate pain while on non-narcotic medication, but can function at work, home, and/or school

5-  Severe pain while on non-narcotic medication; pain relieved by narcotics (such as Tylenol with codeine, Tylenol 3, Lorcet, Percocet, or Demerol); can function at work, home, and/or school most of the time

6-  Severe pain while on non-narcotic medication; mild to moderate relief with narcotics; the patient has missed work/school/housework/recreation because of pain, but can function most of the time

7-  Severe pain while on non-narcotic medication; minimal relief with narcotics; the patient frequently misses work/school/housework/recreation because of pain (but misses work less than 50% of the time when she has pain)

8-  Severe pain while on non-narcotic medication; minimal relief with narcotics; the patient frequently misses work/school/housework/recreation because of pain (but misses work more than 50% of the time when she has pain)

9-  Severe pain even with narcotic medication and is severely limited in her activity including work/school/housework/recreation

10- Severe pain even on narcotic medication which prevents most activity