Chronic Pelvic Pain

Question 1

Endometriosis

Answer 1

Abdo pain
Dyspareunia
Secondary dysmenorrhoea 
Subfertility
Bimanual: fixed tender uterus
25-35 yrs
True diagnosis only on laparoscopy

Question 2

Ovarian cyst

Answer 2

Intermittent pelvic pain, not cyclical, no bleeding or discharge
Examine: abdo, spec and biman. Rule out PID with swabs. USS! Low risk: normal CA125, simple, unilateral, unilocular, conservative with follow up in 3-4months if asymptomatic
Symptomatic + simple -> consider cystectomy
High risk: elevated CA125, complex, bilat, multinodular, >5 cm
Surgical removal, !! Histology + appropriate follow up

Question 3

Functional pain

Answer 3

Diagnosis of exclusion once every other pathology has been ruled out
Sometimes no cause is found
Relationship issues, sexual abuse, fears about sexuality or infertility

Question 4

Constipation

Answer 4

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Question 5

IBS

Answer 5

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