Pelvic Pain

Abstract

The differential diagnosis for acute pelvic pain is long and varied. Common gynecologic causes include infection, ovarian cysts, endometriosis, ectopic pregnancy, or adnexal torsion. Non-gynecologic sources include gastrointestinal, urinary, musculoskeletal, neurologic, and psychologic pathology. Patients may have more than one diagnosis and one may potentiate pain from another. External visual inspection of genitalia, including assessment of vulva, perineum, urethra, clitoris, hymen, and lower third of vagina, consider cotton swab to look for hymenal and vaginal anomalies and to ensure vaginal patency. For cases where abuse is suspected, social services and local law enforcement must be involved, as well as providers with special training to evaluate victims of abuse. Pelvic ultrasound is preferred for evaluation of pelvic pathology and is first-line imaging for evaluation of possible appendicitis.