Pelvic pain

This page is for adult patients. For pediatric patients, see: Prepubertal pelvic pain.

Background

Pelvic anatomy.

Clinical Features

• Post-pubertal pelvic pain

Differential Diagnosis

Acute Pelvic Pain

Differential diagnosis of acute pelvic pain

Gynecologic/Obstetric

• Normal variants may be noted on exam but generally do not cause pain or other symptoms
  • Nabothian cysts: Epithelial cells within mucous glans that appear as yellow inclusions on the cervix
  • Cervical Ectropion: Edothelial cells on the exterior of the cervix
  • Parous cervix: The is no longer round but may have multiple shapes after birth
• Pregnancy-related
  • Ectopic pregnancy
  • Spontaneous abortion, threatened or incomplete
  • Septic abortion
• Pelvic organ prolapse
• Acute Infections
  • Herpes
  • Cervicitis
  • Endometritis
  • Bartholin gland abscess
  • Pelvic inflammatory disease (PID)
  • Tubo-ovarian abscess
• Vulvovaginitis
  • Bacterial Vaginosis
  • Candida Vaginitis
  • Trichomonas
  • Contact Vulvovaginitis
  • Atrophic vaginitis
• Adnexal Disorders
  • Hemorrhage/rupture of ovarian cyst
  • Ovarian torsion
  • Twisted paraovarian cyst
• Other
  • Myoma (degenerating)
  • Genitourinary trauma
  • Ovarian hyperstimulation syndrome
  • Sexual assault
• Recurrent
  • Mittelschmerz
  • Primary/Secondary Dysmenorrhea
  • Pelvic Congestion Syndrome
  • Endometriosis

Genitourinary

• Cystitis
• Pyelonephritis
• Urethritis (e.g. N. gonorrhoeae/Chlamydia)
• Urolithiasis

Gastrointestinal

• Gastroenteritis
• Appendicitis
• Bowel obstruction
• Perirectal abscess
• Diverticulitis
• Inflammatory bowel disease
• Irritable bowel syndrome
• Mesenteric adenitis

Musculoskeletal

• Abdominal wall hematoma
• Psoas hematoma, psoas abscess
• Hernia

Vascular

• Pelvic thrombophlebitis
• Abdominal aortic aneurysm
• Ischemic bowel (Mesenteric Ischemia)

Postmenopausal Pelvic Pain

Gynecologic

• Vulvovaginitis
  • Atrophic vaginitis
  • Infectious (STI)
  • Allergic
• Uterine prolapse
  • Cystocele
  • Rectocele
  • Enterocele
  • Uterine/Vaginal Vault Prolapse
• Cervical polyps
• Uterine fibroids
• Endometrial hyperplasia
• Neoplasm
  • Uterine
  • Ovarian

Gastrointestinal

• Rectocele
• Diverticulitis
• Neoplasm
• Appendicitis
• Ischemic Bowel (Mesenteric Ischemia)

Urologic

• Infection
  • Cystitis
  • Urethritis
  • Pyelonephritis
• Cystourethrocele

Prepubescent-Urethral prolapse

Urologic

• Sarcoma botryoides

See Also

• Prepubertal pelvic pain
• Abdominal Pain

External Links

• DDxOf: Differential Diagnosis of Acute Pelvic Pain