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Pelvic Pain and Dyspareunia

Acute

Causes:

  • UTI

  • Miscarriage

  • Ectopic pregnancy

  • Ovarian cysts – Torsion, Rupture

  • Acute PID

  • Endometriosis

  • Appendicitis


Investigations:

  • Pregnancy test!

  • Swabs

  • MSU and Urinalysis – check nitrites and leukocytes

  • CRP and ESR

  • TVUS if miscarriage or ectopic suspected


Red flags:

  • Severe unilateral pain and tenderness around 6 weeks after LMP suggests ectopic pregnancy, even w/o bleeding – Admit urgently for TVUS

  • If PID doesn’t resolve with 48 hrs of abx treatment, consider abscess formation


Chronic

Called this if present for 3+ cycles.


Causes:

  • Endometriosis

  • Adhesions

  • Chronic PID

  • IBD

  • IBS

  • Recurrent UTI


Investigations:

  • Pregnancy test!

  • MSU and Urinalysis

  • Swabs

  • CRP and ESR

  • US if palpable mass felt o/e


Red flags:

  • A ‘forgotten’ coil can cause cyclical pelvic pain

  • If pain is linked to periods, find out if primary or secondary dysmenorrhoea



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