Introduction
Pelvic pain is a common problem, seen more in women that in men. Patients with acute pelvic pain are frequently seen in the Emergency Room of a hospital. Ref.22 lists 24 various conditions that can cause pelvic pain in women. Some of the life threatening conditions are a ruptured tubal pregnancy or a pelvic abscess that may have opened up causing acute peritonitis.
Causes of pelvic pain
Ovarian cyst pain can be caused from bleeding into it, from rupture or from a rapidly enlarging tumor or cancer. On the other hand infections inside the uterus (endometritis) or from PID /STD (PID caused by STD) can cause pelvic pain as well. In an early pregnancy a spontaneous abortion can cause excruciating pelvic pain and is often associated with profuse vaginal bleeding. In later pregnancy pelvic pain can be associated with placental problems (infarct, placenta abruptio), with premature labor or with severe preeclampsia. Pelvic adhesions from prior pelvic surgery, appendectomy or perforated diverticulitis can cause pelvic pain as well.Endometriosis and ovarian cancer as well as primary dysmenorrhea can also cause pelvic pain.
Diagnostic tests for investigating pelvic pain
Obviously the treating physician will want to refer many of these patients to a gynecologist for a pelvic pain diagnosis and to pinpoint the cause of pelvic pain.
Several tests are available, from pelvic examination to ultrasound and MRI scan. Several other X-ray methods are also available. Often, even with these methods, the gynecologist comes to a point where only a laparoscopic procedure will show the pathology that underlies the pelvic pain.
Treatment of pelvic pain
The gynecologist will offer the specific treatment for the condition identified. This may involve some hormones, a surgical procedure or reassurance. Sometimes no cause can be found and only pain relieving medication can be offered.
References:
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 235.
2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby, Inc.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 245.
5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.
6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.
7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B. Saunders Company
8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B. Saunders Company
9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.
10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B. Saunders Company
11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.
12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B. Saunders Company
13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.
14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.
15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc.
16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams & Wilkins
17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC
18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.
19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.
20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.
21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.
22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.
23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.
24. Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. On page 256 and 257 Dr. Lee describes how progesterone can be used as a cream to treat PMS.
25. Dr. John R. Lee: “Natural Progesterone- The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.
