Pelvic Pain

Pelvic pain is one of the most frequent reasons for gynecological consultation. In order to guide the diagnosis, it is important to know the characteristics of the pain and if it is associated with any other symptoms. There are many diseases that manifest themselves with pelvic pain, some in the genitourinary area and others in the gastrointestinal system. In men, pelvic pain is not a challenge since, anatomically, the male pelvis contains only the bladder and the colon. In women, the entire internal genital system must be taken into account, which includes the uterus, uterine tubes, and ovaries in addition to the colon and bladder.

Particularly, the first thing I notice in a patient with pelvic pain is whether she is of reproductive age or not. A woman who has regular periods and has had sex may be pregnant without knowing it. I then look at her general condition and if her face reflects pain or discomfort. In the questioning, I focus on whether it is the first time she has the symptoms and her medical history highlighting STDs. It is important to know if the pain is accompanied by other symptoms, such as discharge through the vagina, pain when urinating, or menstruation.

CFCF, Own work, CC BY-SA 3.0

As you begin palpation, remember to touch the site of the pain last so that the patient feels more comfortable and relaxed. With those simple questions, it can be ruled out that the pain is caused by some abdominal organ. Watery appendicitis in female patients is more difficult to diagnose than in male patients. However, the most important thing is to identify the signs of peritoneal irritation that indicate that the patient requires surgery. A patient who is agitated and pale, with pelvic pain and increased heart and breathing rates, may be experiencing a ruptured ectopic pregnancy, which is a major cause of acute pelvic pain. An ectopic pregnancy is one that grows in a place other than the uterus, usually in the fallopian tubes. When it is not diagnosed in time, the embryo continues to grow until the tube can no longer hold it and breaks, causing a lot of bleeding in the abdominal cavity.

I have had the opportunity to operate on some patients with ruptured ectopic pregnancies because an inexperienced physician was confused with some abdominal pathology. It is a surgery that I enjoy very much because of the fast and satisfactory results for the patients. Burst or twisted ovarian cysts are also causes of acute pelvic pain, but they are not the most frequent since this type of pathology is usually operated on before it becomes complicated. A large percentage of chronic pelvic pain is caused by pelvic inflammatory disease (PID), which is an inflammatory process that forms in the pelvis due to repeated infection with sexually transmitted diseases.

Bruce Blaus, Own work, CC BY-SA 4.0

These cases usually get better with painkillers and anti-inflammatory drugs, but sometimes the pain is so intense that the patient needs surgery. PID may extend to the entire pelvis, including part of the small intestine and bladder, or remain in only one organ, especially if it is the first episode of pain that occurs.

When pelvic pain is chronic and associated with menstruation, it is usually a case of endometriosis. Endometriosis is the presence of endometrial tissue anywhere other than in the uterus. This tissue can be found anywhere in the abdominal cavity. During menstruation, this tissue is stimulated just like the uterus, and it has a scaling similar to menstruation. This process causes a lot of abdominal pain during the days of menstruation and is repeated each time.

Bruce Blaus, Own work, CC BY 3.0

Vega Asensio, Own work, CC BY-SA 4.0

The most important thing is to know if the pelvic pain requires immediate attention or not, and the way to do this is with the medical interview and physical evaluation that will guide you toward the probable diagnosis of that patient. REMEMBER, A PATIENT OF REPRODUCTIVE AGE WHO IS PALE, WITH INCREASED HEART AND RESPIRATORY RATE AND LOW BLOOD PRESSURE, HAS A RUPTURED ECTOPIC PREGNANCY UNTIL PROVEN OTHERWISE. THIS IS AN ABSOLUTE EMERGENCY AS IT REQUIRES SURGERY. THINK OF IT LIKE A GUNSHOT WOUND.