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Pelvic Pain

Diagnosis/Definition

• Abdominal pain focused primarily in the pelvis or lower abdomen that is of a chronic nature (greater than six months).
• Pain may or may not be associated with menses, intercourse, or accompanied by vaginal discharge.

Initial Diagnosis and Management

• History of pain originating in or referred to the pelvis. Complete physical examination, cervical cultures for GC and Chlamydia, Pap Smear, serologic test for syphilis, urinalysis, and culture. Evaluation of GI and GU tracts and psychiatric evaluation (when appropriate).
• Rule out pregnancy: BHCG.
• Management: The primary care physician may consider a trial of NSAIDs and/or oral contraceptive pills (OCPs) prior to referral for specialty evaluation; however, the department of OB/GYN encourages early referral.

Ongoing Management and Objectives

Controlling symptoms and laparoscopic confirmation of diagnosis for failed medical management.

Indications for Specialty Care Referral

Patient request.

After appropriate diagnostic work-ups and persistent pain after a two-month trial of NSAIDs or OCPs.

Note patient’s age and duration and nature of pain on the consult.

Positive result on pregnancy testing (if the Primary Care Manager is not comfortable managing).

Criteria for Return to Primary Care

Completion of specialty care evaluation with treatment or resolution of symptoms.

Follow-up in OB/GYN may be required.