Interrogatoire et examen clinique d’un patient ayant des douleurs pelvipérinéales chroniques

Abstract

Patients with chronic pelvic and perineal pain sometimes report major complaints with no objective value that help to "validate" this pain other than by the patient's own interpretation of the pain. The purpose of this article is to describe the essential elements of the clinical interview and clinical examination in the diagnostic approach to patients with chronic pelvic and perineal pain. A review of the literature and a description of our experience was performed to describe the clinical interview and clinical examination of patients with chronic pelvic and perineal pain. Clinical interview of the patient is designed to define the characteristics of the pain: mode of installation, topography, irradiation, type, remission, nocturnal waking, and aggravating or limiting factors. It must also look for associated clinical signs: urinary, gastrointestinal, gynaecological, sexual, cutaneous and neurological. The intensity of the pain is evaluated on an analogue scale. A complete clinical examination of the pelvis and perineum must be performed looking for an organic cause: neurological, dermatological, urogenital, spinal, myofascial and sympathetic nervous system. Digital rectal and vaginal (pelvic) examinations play an important role in the detection of trigger points. A well-conducted clinical interview and clinical examination can help to elucidate a large proportion of cases of chronic pelvic and perineal pain and are an essential in part of the diagnostic approach.