Women's Health

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

If 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:

• A Pap test, which detects cervical cancer and cervical precancer (dysplasia).
• A 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.
• A complete blood count (CBC), which can detect signs of infection, anemia, and blood cell abnormalities.
• An erythrocyte sedimentation rate (ESR), which can indicate infection if ESR is elevated.
• Tests for sexually transmitted infections, such as chlamydia, gonorrhea, and genital herpes.
• Urinalysis and urine culture, which can detect signs of infection and kidney stones.
• 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 include:

• 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 endometrial hyperplasia; 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, and urethra.
• Computed tomography (CT) urogram, which uses X-rays to create pictures of the kidneys and urinary tract.
• 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 and bones.
• 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 bladder.
• 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