Pelvic pain

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

Background

• This page outlines the general approach to pelvic pain

Classification by Abdominal pain location

Side-by-side comparison of quadrants and regions.

Chart of commonly reported referred pain sites.

RUQ pain	Epigastric pain	LUQ pain
Flank pain	Diffuse abdominal pain	Flank pain
RLQ pain	Pelvic pain	LLQ pain

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

Evaluation

Workup

• Pregnancy test

See Also

• Prepubertal pelvic pain
• Abdominal Pain

External Links

• DDxOf: Differential Diagnosis of Acute Pelvic Pain