Pelvic Pain

Pelvic pain presents perhaps the greatest diagnostic challenge to the pain practitioner. A multitude of clinicians in various disciplines may be consulted due to the difficulty in precisely identifying the cause or localizing the etiology of the pain. The proximity and social constraints associated with the reproductive organs add another dimension inhibiting the patient to openly discuss symptoms or personal behavior. A detailed history and problem-oriented physical examination often fail to disclose the appropriate differential diagnosis for the problem. Pelvic pain may originate in the pelvis or be referred from another organ of the body. The history and physical findings suggest a pelvic source, but a high index of suspicion must be maintained for extra pelvic disorders that are referred to the pelvis. The chronological sequence of events in the patient’s history is very important. In the case of an acute event, a diagnosis is readily established in most instances; however, in chronic pain syndromes, the detailed history is far more valuable than a laboratory or roentgenographic examination. Lower abdominal pain and pelvic pain appear to be especially common in women, with many reporting both forms of distress. Although pelvic pain is primarily a process that affects women, it should not be forgotten that men might present with discreet syndromes associated with pelvic pathology. While organic causes have been implicated in chronic pelvic pain, laparoscopic investigations have shown variable rates of observable pathology. 1,2,3 Therefore, a number of researchers have turned to examining the psychological characteristics of this patient population and have found high prevalence rates of psychological disturbances in chronic pelvic pain patients. 4,5