PELVIC PAIN

ETIOLOGY

Pelvic pain may be associated with normal or abnormal menstrual cycles and may originate in the pelvis or be referred from another region of the body. A high index of suspicion must be entertained for extrapelvic disorders that refer to the pelvis, such as appendicitis, diverticulitis, cholecystitis, intestinal obstruction, and urinary tract infections. A thorough history including the type, location, radiation, and status with respect to increasing or decreasing severity can help to identify the cause of acute pelvic pain. Associations with vaginal bleeding, sexual activity, defecation, urination, movement, or eating should be sought. Determination of whether the pain is acute versus chronic, constant versus spasmodic, and cyclic versus noncyclic will direct further investigation (Table 178-1).

TABLE 178-1: Causes of Pelvic Pain
	ACUTE	CHRONIC
Cyclic pelvic pain		Mittelschmerz Dysmenorrhea Endometriosis
Noncyclic pelvic pain	Pelvic inflammatory disease Ruptured or hemorrhagic ovarian cyst, endometrioma, or ovarian torsion Ectopic pregnancy Endometritis Acute growth or degeneration of uterine myoma Threatened abortion	Pelvic congestion syndrome Adhesions and retroversion of the uterus Pelvic malignancy Vulvodynia Chronic pelvic inflammatory disease Tuberculous salpingitis History of sexual abuse

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