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).
|Cyclic pelvic pain|
|Noncyclic pelvic pain|
Pelvic inflammatory disease
Ruptured or hemorrhagic ovarian cyst, endometrioma, or ovarian torsion
Acute growth or degeneration of uterine myoma
Pelvic congestion syndrome
Adhesions and retroversion of the uterus
Chronic pelvic inflammatory disease
History of sexual abuse
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