Common gynae histories - Pelvic pain

Question 1

What would you want to ask about pelvic pain?

Answer 1

SOCRATES

Question 2

What systems would you want to ask about in someone with pelvic pain?

Answer 2

• General
• Gynaecological
• Urological
• Gostrointestinal

Question 3

What gynaecological symptoms would you want to ask about on systemic enquiry for pelvic pain?

Answer 3

• PV bleeding - menorrhagia, intermenstrual, post-coital, post-menopausal
• PV discharge
• Pain - dysmennorhoea, dyspareunia
• Pregnancy risk

Question 4

What general symptoms would you want to ask about on systemic enquiry for pelvic pain?

Answer 4

• Fever
• Sweats

Question 5

What urological symptoms would you want to ask about on systemic enquiry for symptoms of pelvic pain?

Answer 5

• Storage - frequency, volume, urgency, nocturia, incontinence
• Infection - dysuria, haematuria, odour

Question 6

What gastrointestinal symptoms would you ask about on systemic enquiry in someone with pelvic pain?

Answer 6

• Weight loss
• Appetitie change
• Nausea/vomtiing
• Bowel habits
• Tenesmus
• Blood/mucus in stool

Question 7

What features associated with pelvic pain would suggest PID/acute salpingitis as a cause?

Answer 7

• Bilateral pelvic pain
• Vaginal discharge
• Dyspareunia
• Dysmennorhoea
• Fever
• Post coital/intermenstrual bleeding

Question 8

What features assocaited with pelvic pain would suggest ectopic pregnancy?

Answer 8

• Recent period of amenorrhoea
• Trying to get pregnant or unprotected sex
• May have vaginal spotting
• Collapse + shoulder tip pain - rupture

Question 9

What features associated with pelvic pain suggest ovarian cyst torsion/rupture/haemorrhage?

Answer 9

• Sudden unilateral pelvic pain
• Fever/vomting

Question 10

What features assocaited with pelvic pain would suggest endometriosis?

Answer 10

• Cyclical pelvic pain
• Dysmenorrhoea
• Deep dyspareunia
• Menstrual disturbance

Question 11

What features of pelvic pain would suggest pyelonephritis as the cause?

Answer 11

• FEver/chills/rigors
• Loin pain
• Urinary frequency
• Dysuria

Question 12

What features of pelvic painw ould suggest appendicitis?

Answer 12

• YOung patient
• Periumbilical pain
• Moves to RIF
• Anorexia

Question 13

What features associated with pelvic pain would suggest diverticulitis as a cause?

Answer 13

• Elderly
• LIF pain
• Pyrexia

Question 14

What features assocaited with pelvic pain suggest IBS/IBD?

Answer 14

• Lower abdominal pain
• Bowel habit change
• May pass blood/mucus in IBD

Question 15

What are causes of pelvic pain?

Answer 15

• PID/acute salpingitis
• Ectopic pregnancy
• Ovarian cyst torsion/rupture/haemorrhage
• Endometriosis
• Pyelonephritis
• Appendicitis
• Diverticulitis
• IBS/IBD
• Mittelschmerz
• Fibroid degeneration
• Renal colic
• Bowel obstruction