4: Which Cause of Pelvic Pain?

Question 1

Which cause of pelvic pain? Signs include:

• May elicit abdominal pain with light palpation
• Decreased motility of pelvic organs
• Adnexal enlargement

Answer 1

Adhesions

Question 2

Which cause of pelvic pain? Diagnosis includes:

Laparoscopy is the diagnostic tool of choice if somatic causes are ruled out and the psychosocial evaluation is negative

Answer 2

Adhesions

Question 3

Which non-cyclic cause of pelvic pain? Diagnosis includes:

• US
• Note: US may be improved by treating the woman with clomiphene citrate (Clomid) 100 mg for 5–10 days prior to the US to stimulate follicular development

Answer 3

Ovarian remnant/retention syndrome

Question 4

Which non-cyclic cause of pelvic pain? Management:

• Initial treatment with danazol or high-dose progestins may be helpful in some cases
• GnRH agonist may help but cannot be used for long-term therapy
• Surgical excision is often required

Answer 4

Ovarian remnant/retention syndrome

Question 5

Which non-cyclic cause of pelvic pain? Signs include:

• Bulky feeling to uterus when palpated during the bimanual examination
• Ovaries may be enlarged and there may be many functional cysts on the ovaries
• Uterus, parametria, and uterosacral ligaments are tender to touch

Answer 5

Pelvic congestion syndrome

Question 6

Which non-cyclic cause of pelvic pain? Symptoms include:

• Bilateral lower abdominal and back pain
• Dysmenorrhea
• Dyspareunia
• Abnormal uterine bleeding
• Chronic fatigue
• Irritable bowel syndrome

Answer 6

Pelvic congestion syndrome

Question 7

Which cause of pelvic pain? Symptoms include:

• Lateral pelvic pain described as sharp and stabbing or dull and not radiating
• May have dyspareunia, constipation, or flank pain
• May have genitourinary and/or gastrointestinal symptoms that accompany the pelvic pain

Answer 7

Ovarian remnant/retention syndrome

Question 8

Which non-cyclic cause of pelvic pain? Diagnosis includes:

• Transuterine venography is the primary method used for diagnosis
• Other methods include the following:
  
  • Ultrasound
  • Magnetic resonance imaging
  • Laparoscopy

Answer 8

Pelvic congestion syndrome

Question 9

Which cause of pelvic pain? Symptoms include:

• Lower abdominal or pelvic pain that occurs or increases when the peritoneum or organ serosa is stretched
• Dyspareunia

Answer 9

Adhesions

Question 10

Which cause of pelvic pain? Signs include:

• Pelvic mass identified during bimanual examination
• May observe that the vulva and vagina remain in a persistent estrogenized state

Answer 10

Ovarian remnant/retention syndrome

Question 11

Which non-cyclic cause of pelvic pain? Management:

• Begin with the least invasive measures
• Hormonal measures include progestin or GnRH agonist administration
• Ovarian vein embolization or ligation
• Hysterectomy with bilateral salpingo-oophorectomy should be the last resort

Answer 11

Pelvic congestion syndrome

Question 12

Which cause of pelvic pain? Management includes:

Surgical lysis of adhesions only after a thorough evaluation and failed medical therapy

Answer 12

Adhesions