Pelvic Pain

Question 1

Ectopic pregnancy

Answer 1

6-8 weeks amenorrhoea.
Presents with lower abdominal pain.
Later develops vaginal bleeding.
Shoulder tip pain and cervical excitation may be seen.

Question 2

UTI

Answer 2

Dysuria
Frequency
Suprapubic burning may occur secondary to cystitis

Question 3

Appendicitis

Answer 3

Pain initially in the centre of the abdomen before localising to RIF.
Anorexia common
Tachycardia, low-grade pyrexia, tenderness in RIF

Rousing’s sign - when palpating LIF, pain is felt more in the RIF than LIF

Question 4

Pelvic inflammatory disease

Answer 4

Pelvic pain
Fever
Deep dyspareunia 
Vaginal discharge 
Dysuria 
Menstrual irregularities 
Cervical excitation may be found on examination

Question 5

Ovarian torsion

Answer 5

Sudden onset unilateral lower abdominal pain.
Onset may coincide with exercise.
Nausea and vomiting.
Unilateral, tender adnexal mass on examination

Question 6

Miscarriage

Answer 6

Vaginal bleeding and crampy lower abdominal pain.

Follows a period of amenorrhoea

Question 7

Endometriosis

Answer 7

Chronic pelvic pain.
Dysmenorrhoea - pain often starts days before bleeding
Deep dyspareunia
Subfertility

Question 8

Irritable bowel syndrome

Answer 8

Extremely common chronic pain. Most consistent features are; abdominal pain, bloating, change in bowel habit.
May also have; lethargy, nausea, backache, bladder symptoms

Question 9

Ovarian cyst

Answer 9

Unilateral dull ache - may be intermittent or occur during intercourse.
Larger cysts may cause abdominal swelling or pressure effects on the bladder.

Torsion or rupture —> severe abdominal pain

Question 10

Urogenital prolapse

Answer 10

Seen in older women
Sensation of pressure, heaviness, ‘bearing down’.
Urinary symptoms: incontinence, frequency, urgency