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
Cyclic pelvic pain 




Noncyclic pelvic pain

Pelvic inflammatory disease

Ruptured or hemorrhagic ovarian cyst, endometrioma, or ovarian torsion

Ectopic pregnancy


Acute growth or degeneration of uterine myoma

Threatened abortion

Pelvic congestion syndrome

Adhesions and retroversion of the uterus

Pelvic malignancy


Chronic pelvic inflammatory disease

Tuberculous salpingitis

History of sexual abuse

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