Pelvic pain may be acute or chronic and usually indicates a problem with tissues in the pelvic area which can range from the gynaecological organs to the bowel or urinary tract. One of the most common causes of pelvic pain is endometriosis but other causes include adhesions, pelvic infection, fibroids, ovarian cysts and polyps.

History and examination

To determine the cause of pelvic pain it is very important to take a careful history and perform an examination. Specific types of pain or findings on examination can usually suggest the cause fairly accurately. For example, endometriosis can cause specific symptoms such as pain at the time of the period, deep pain with intercourse, aching after intercourse, pain or looseness of the bowels at the time of the period or even urinary frequency at the time of the period. With endometriosis, examination may show tenderness, thickening, tethering and nodule or cyst development in the pelvis. Careful pelvic examination can also indicate adhesions, fibroids and ovarian cysts.

Investigations

Various investigations may be needed to further delineate the causes of pelvic pain. A pap smear is usually taken and if there is a history of infection, vaginal swabs will be taken. Blood tests may be necessary, particularly if there is a significant ovarian cyst. Ultrasound can be very useful and should be performed by an experienced gynaecological ultrasonographer. Ulltrasound, however, usually cannot diagnosis endometriosis or adhesions unless the disease is significant. Ultimately, the most accurate investigation is ‘looking’ with endoscopic (key hole) surgery – laparoscopy, hysteroscopy, cystoscopy. Treatment can then be performed at the same time.