Chronic pelvic pain

Question 1

Definition of chronic pelvic pain

Answer 1

• Pelvic pain that lasts for 6 months or longer
• Cyclical (constant vs intermittent)

Question 2

Differentials of chronic pelvic pain

Answer 2

Endometriosis
PID
Cervical stenosis

Non-gynae causes:
- Intestinal obstruction
- IBD
- Functional

Question 3

Physical examination for chronic pelvic pain

Answer 3

1. General: Vital signs
2. Abdominal examination
   - Palpable masses: enlarged uterus (adenomyosis), endometriomas,
   tubo-ovarian abscesses
3. Speculum examination
   - Vaginal discharge (perform swab tests)
   - Opportunistic pap smear if not done
4. Vaginal examination
   - Uterine size, anteverted/retroverted, mobility
   - Cervical excitation, adnexal tenderness
   - Adnexal masses
   - Thickened uterosacrals

+/- PR examination

Question 4

Cervical stenosis

Answer 4

Due to cervical instrumentation e.g. hysteroscopy with
dilatation and curettage, terminal of pregnancy, evacuation of
uterus
- Present with chronic pain that worsens cyclically
- Ultrasound: fluid seen within uterus

Treatment:
- Medical: Misoprostol
- Surgical: Dilatation of cervix