Module 12: Pelvic Pain, Pelvic Organ Prolapse, And Urinary Incontinence

Question 1

Dysmenorrhea

Answer 1

1. Primary Vs Secondary

Primary - Peaks in 20’s and 30’s then decreases

• Occurs shortly after menarche
• Occurs with Ovulatory cycles
• Crampy pelvic pain
• Surrounding menstruation

Secondary

• Develops later in life
• “New onset”
• Pathologic association — Think PALM COEIN

Question 2

Dysmenorrhea - Diagnosis and Treatment

Answer 2

1. Crampy or spasmodic pain that may radiate to the back sacrum or thighs
2. NO pelvic exam with younger women with primary dysmenorrhea
3. Pelvic exam is helpful with secondary dysmenorrhea
   - Follow up with Pelvic Ultrasound
4. Treatment with Ibuprofen or Naproxen is FIRST LINE — decreases prostaglandins
   - If NSAIDS fail, move to contraceptives

Question 3

Pelvic Pain

Answer 3

Role of Primary care is Rule out acute causes

1. Abdominal pain, CVA tenderness, MSK, Pelvic examination**
2. Testing includes - STI screen, UA/culture, HCG, and Transvaginal US

Question 4

Pelvic Organ Prolase

Answer 4

1. Greatest risk factor is childbirth

Question 5

Types of Incontinence

Answer 5

1. Stress — on effort or physical exertion (Sneeze/cough)
2. Urgency — “gotta go”
3. Mixed — Combination of urgency and physical exertion

ASK ABOUT URINARY LEAKAGE**
-Get UA/Culture to rule out UTI