Gynaecological Causes of Pelvic Pain

Abstract

Pelvic pain in girls is a common clinical complaint in childhood and throughout adolescence and an important cause of morbidity particularly in the postmenarchal female. Clinical evaluation in these patients is challenging. Abdominopelvic pain in the absence of a history of cyclical pain related to the menstrual cycle is a very non-specific symptom, with a range of gynaecological and non-gynaecological causes. Non-gynaecological aetiologies of pain include gastrointestinal, urological, musculoskeletal and psychosomatic disorders. Gynaecological causes of pelvic pain include complications related to ovarian cysts (cyst rupture, haemorrhage or torsion), torsion of adnexal masses or normal ovaries, and fallopian tube pathology including torsion and pelvic inflammatory disease. Other causes of pain more specific to reproductively mature adolescents include ovulatory Mittelschmerz (mid-cycle) pain, endometriosis and complications of pregnancy. Exclusion of pregnancy in this age group is an important initial step in clinical management. This chapter concentrates on the imaging of the common and important causes of acute abdominal or pelvic pain with a gynaecologic aetiology. A brief discussion of the ultrasound imaging of pregnancy is included. The role of imaging in gynaecologic conditions resulting in chronic pelvic pain syndromes is also considered.