Last reviewed: 28 Oct 2020
Last updated: 21 May 2020

Summary

Definition

History and exam

Key diagnostic factors

  • dysuria
  • dyspareunia
  • dysmenorrhea
  • abdominal trigger points
  • levator ani tenderness
  • cervical motion tenderness
  • uterine tenderness
  • abdominal tenderness
  • vestibular tenderness
  • rectal tenderness
  • adnexal tenderness
  • bladder tenderness
  • urethral tenderness

Other diagnostic factors

  • abdominal pain
  • nocturia
  • incomplete voiding
  • headache
  • dyschezia
  • low back pain

Risk factors

  • sexual abuse
  • pelvic inflammatory disease
  • anxiety or depression
  • drug or alcohol abuse
  • pregnancy
  • polymenorrhea
  • previous cesarean section
  • endometriosis
  • adhesions

Diagnostic investigations

1st investigations to order

  • urinalysis
  • urine culture
  • cervical swab
  • pelvic ultrasound
  • alkalinized lidocaine instillation into bladder
More 1st investigations to order

Investigations to consider

  • pelvic CT
  • pelvic MRI
  • laparoscopic biopsy
  • cystoscopy with hydrodistension
More investigations to consider

Treatment algorithm

Contributors

Bradford W. Fenton

Consultant

Obstetrics and Gynecology

Independence Park Medical Services

Anchorage

AK

Disclosures

BWF is the author of an article cited in this topic.

Dr Bradford W. Fenton would like to gratefully acknowledge the assistance of Dr Jennifer J. Schmitt in producing this topic. JJS declares that she has no competing interests.

Peer reviewersVIEW ALL

Associate Professor and Chief

General Division of Obstetrics and Gynecology

University of Utah School of Medicine

Salt Lake City

UT

Disclosures

HS has been reimbursed for attending and participating in conferences on pelvic varicosity pain syndrome by Cook Inc.

Consultant Obstetrics

Obstetrics and Gynaecology

Middlesex Hospital

London

UK

Disclosures

CS declares that he has no competing interests.

Consultant Obstetrician and Gynaecologist

Barnet and Chase Farm Hospitals NHS Trust

Urogynaecology Services

Chase Farm Hospital

Enfield

UK

Disclosures

DS-O declares that he has no competing interests.

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