Diagnosing Pelvic pain and Abnormal bleeding dynamically
A major complaint of women coming to a gynecologist’s office is pelvic pain or abnormal bleeding or both. Physicians rely on an ultrasound “examination” to help diagnose the cause of the pain and bleeding. These ultrasounds will produce “still” images. Gynecologists are trained as to what images to obtain, where to look and how to measure.
However, a patient’s pelvic pain cannot be evaluated with just an anatomical image. To fully evaluate a patient’s pelvic pain and abnormal bleeding, it must be done by dynamic assessment.
DoctorStevenR.GoldsteinMD,anobgyninManhattan, isapioneeringynecologic ultrasound and is one of the most highly recognized and regarded individuals in the fieldofvaginalprobeultrasounds. According to DrGoldstein, apatient’s pelvicpain cannot be properly diagnosed with just an anatomical image.
Evaluating pain requires dynamic assessment which involves the transvaginal ultrasound operator using their hands. During the transvaginal ultrasound, the operator must place one hand on the abdomen and liberally move it over the
abdomen. The tip of the vaginal probe can elicit where the patient’s pain exists and whether the pain can be recreated.
For instance, pelvic adhesions can be a significant source of pelvic pain, and, also sometimes infertility. Here again, the transducer tip is pointed at the uterus, ovaries or any pelvic finding and a gentle push/pull movement of a few centimeters started. If no adhesions are present, the organs will move freely in the pelvis.
Dr Goldstein, an obgyn in Manhattan and ultrasound expert, put forward this thesis of dynamic ultrasonography in one of his articles and coined the phrase “the ultrasound enhancedbimanual exam”. In it, thegynecologistdoesn’tjust relyon still images, but actually performs the ultrasonography instead of relying on a report or just viewing still images.
Dynamic ultrasonography is an important and emerging topic in gynecologic imaging. Static imaging and cine clips will give information only on anatomy. Increasingly, whoever holds the transducer - whether it be the gynecologist, radiologist, or sonographer, needs to examine the patient with the probe and include liberal use of the hand on the abdomen. The “ultrasound enhanced bimanual exam” can also be used in cases of endometriosis, pelvic organ prolapse and incontinence, or abnormal bleeding.
Women who are suffering from pelvic pain or abnormal bleeding, or have been told they have endometriosis or pelvic organ prolapse can schedule an appointment with Dr Steven R. Goldstein, a gynecologist in Manhattan, for dynamic ultrasonography to diagnose the cause of their condition and listen to possible treatment options.