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Pelvic Pain

Pelvic pain is a common gynaecological problem and has many potential causes.

It can be debilitating and can have a major effect on people’s lives.

A cause needs to be identified and an effective treatment given.

Causes of pelvic pain

A systematic approach needs to be followed to identify a cause for pelvic pain.

It is important to try and avoid an unnecessary cycle of ongoing investigations and ineffective treatments.

Causes of pelvic pain include:

  • Ovarian cysts
  • Endometriosis
  • Sexually transmitted disease
  • Pelvic inflammatory disease

Timing of pain

Gynaecological pain can occur at the same time in the menstrual month (cyclical).

It can be mid cycle, “ovulation pain” or menstrual, “dysmenorrhoea”.

Some gynaecologic pains may have no cyclical pattern and can be caused by inflammatory conditions such as ovarian cysts and STD.

Investigations

Investigations, which are commonly performed, include vaginal swabs to screen for STD and blood tests, which can be used as markers for inflammation.

Pelvic ultrasound scans are often performed to check on the presence of:

  • Pelvic collections (endometriomas, abscess).
  • Ovarian cysts.
  • Degenerating fibroids.
  • Adenomyosis.
  • Pelvic adhesions.

Pelvic adhesions cannot be directly seen on ultrasound scan. They can be assumed to exist if when pushing pelvic organs with the ultrasound probe results in surrounding structures moving in the same direction at the same time. This would suggest that they are attached with adhesions. Often it is necessary to perform a diagnostic laparoscopy to finally make a diagnosis.

Treatment

There are many causes for pelvic pain and there are many potential treatments. The essence of care once having made a diagnosis is to commence targeted treatment.

Medical treatments may include:

  • Commencing the oral contraceptive pill.
  • Stopping periods by inducing amenorrhoea.
  • Commencing antibiotics.

Surgical treatments may occasionally be required including:

  • Operative laparoscopies.
  • Open procedures.
  • Surgery may include definitive treatments such as hysterectomy.