Pelvic Pain and Dyspareunia (1)

Question 1

Acute:
What are the causes?

Which investigations should be done?

What are the red flags here?

Answer 1

➊ • UTI
• Miscarriage
• Ectopic pregnancy
• Ovarian cysts – Torsion, Rupture
• Acute PID
• Endometriosis
• Appendicitis

➋ • Pregnancy test!
• Swabs
• MSU and Urinalysis – check nitrites and leukocytes
• CRP and ESR
• TVUS if miscarriage or ectopic suspected

➌ • Severe unilateral pain and tenderness around 6 wks after LMP suggest ectopic pregnancy, even w/o bleeding – Admit urgently for TVUS
• If PID doesn’t resolve with 48 hrs of abx treatment, consider abscess formation

Question 2

Chronic: (If present for 3+ cycles)
What are the causes?

Which investigations should be done?

What are the red flags here?

Answer 2

➊ • Endometriosis
• Adhesions
• Chronic PID
• IBD
• IBS
• Recurrent UTI

➋ • Pregnancy test!
• MSU and Urinalysis
• Swabs
• CRP and ESR
• US if palpable mass felt o/e

➌ • A ‘forgotten’ coil can cause cyclical pelvic pain
• If pain is linked to periods, find out if primary or secondary dysmenorrhoea