Chronic Female Pelvic Pain - Exams and Tests
There are many possible causes of
female pelvic pain, so it is important to see your
doctor for a thorough evaluation. Although your condition may be
easily diagnosed during your first exam, expect that you might have a series of
medical appointments and tests. For many women with pelvic pain, diagnosing the
cause is a process of elimination that takes a while to complete.
Initial exam for a cause of female pelvic pain
possible, bring with you a calendar or diary of your symptoms, menstrual cycle,
sexual activity, physical exertion, and any other factors that you consider
important, such as stressful events or illnesses. To begin narrowing down the
list of possible causes of your pain, your doctor will review your
symptom diary and:
- Ask about
your health history, including the history of your menstrual cycle as well as
any pelvic surgery, radiation treatment, sexually transmitted infection,
pregnancy, or childbirth.
- Perform a
pelvic exam to look for signs of abnormalities in your
reproductive tract. You may also have a
digital rectal exam. Your doctor may
conduct this exam in a slower, more thorough manner than a routine pelvic exam,
carefully checking for tender areas.
You may also have additional tests, depending on whether
you've recently had a Pap test or are sexually active. These may include:
Pap test, which detects
cervical cancer and cervical precancer (dysplasia).
pregnancy test (human chorionic gonadotropin, or hCG).
If you test positive for pregnancy, you will also have an
ultrasound to check for signs of a
tubal (ectopic) pregnancy.
complete blood count (CBC), which can detect signs of
anemia, and blood cell abnormalities.
erythrocyte sedimentation rate (ESR), which can
indicate infection if ESR is elevated.
- Tests for
sexually transmitted infections, such as
- Urinalysis and
urine culture, which can detect signs of infection and
- Stool analysis, to check for signs of blood.
Experts have noted a link between abuse and chronic
pelvic pain.1 If you have ever been physically or
sexually abused, your pelvic pain may be made worse by physical and
psychological trauma. For this reason, it's important that you choose a health
professional with whom you are comfortable discussing any past or current abuse
as well as your current symptoms.
Further testing for a cause of female pelvic pain
If your initial exam hasn't detected a cause of your pain, or if your
results suggest a specific condition, your doctor will recommend
further testing. Commonly used tests for further diagnosis of pelvic pain
- Abdominal ultrasound and/or
transvaginal ultrasound of the pelvic area using a
small ultrasound device (transducer) inserted into the vagina. Ultrasound plays
a major role in looking for causes of pelvic pain. It is useful for detecting
pelvic inflammatory disease; and cancerous or
noncancerous (benign) growths such as fibroids, cysts, and tumors on the
ovaries, uterus, cervix, or fallopian tubes.
- Intravenous pyelogram (IVP), which uses an injected
dye combined with X-rays to create pictures of the kidneys, bladder, ureters,
- Computed tomography (CT) urogram, which
uses X-rays to create pictures of the kidneys and urinary
- Laparoscopy, a surgical procedure that
uses a thin, lighted viewing instrument (laparoscope) inserted through a small
abdominal incision. This allows a doctor to look inside the pelvis for causes
of pain, including scar tissue (adhesions),
abnormal growths, cysts, tumors, and pelvic inflammatory disease. Laparoscopy
is the only way to confirm the presence of
endometriosis. If needed, a growth or adhesion can
also be removed during the procedure.
- Computed tomography (CT) scan of the pelvis, which uses X-rays to create pictures of organs
- Magnetic resonance imaging (MRI) of the
pelvis, which uses a magnetic field and pulses of radio wave energy to create
pictures of organs and bones.
- Cystoscopy, which uses a viewing
instrument inserted through the urethra into the bladder. This allows a doctor
to see signs of inflammation, growths, or kidney stones in the
- Urodynamic studies, which test bladder function and
whether bladder spasms are causing pelvic pain.
- Evaluation for
irritable bowel syndrome.
- Evaluation of
abdominal wall for "trigger points."
Chronic pain testing