1. Pelvic pain Dr Felicia Molokoane

2.  Chronic pelvic pain is a complex disorder associated with multiple and often overlapping conditions.  Accounts for 10% of outpatient referrals to gynaecologist.  Important to distinguish gynaecological causes from non-gynaecological causes. Introduction

3.  Many women present because they want an explanation of their pain.  Often they have a theory or concern about the origin of the pain.  Allow time for initial assessment. Introduction

4. Causes Gynaecological  Endometriosis  Gynaecological malignancies  Ovarian remnant syndrome  PID  Pelvic congestion syndrome Gastrointestinal  Irritable bowel syndrome  Inflammatory bowel syndrome  Constipation  Colon cancer

5. Causes Urological  Interstitial cystitis  Urethral syndrome  Bladder malignancy Musculoskeletal  Fibromyalgia  Poor posture  Chronic coccygeal pain  Neuralgia  Pelvic floor dysfunction pain

6. Causes Other  Depression  Physical or sexual abuse  Somatization disorder

7.  Ask questions about the pattern of pain  Associated factors  Psychological  Bladder  Bowel symptoms  Effects of movements or posture on pain History

8.  General examination  Abdominal examination  Bimanual examination  Screen for infections, particularly chlamydia or gonorrhoea if suspect PID Examination

9.  Diagnostic laparoscopy: Gold standard  Diagnose and treat peritoneal endometriosis and adhesions  TVS: Screen and assess for adnexal masses  MRI scan: Adenomyosis Investigations

10.  Cyclical pain  Therapeutic trial of COCs for 3 – 6 months before diagnostic laparoscopic  Mirena  Irritable bowel syndrome  Antispasmodics  Diet control Treatment

11.  Analgesia  NSAIDs Treatment

12.  Pelvic pain is common  Affect 1 in 6 adult female population  Majority are unclear of the aetiology  Pain diary may be helpful in tracking symptoms and activities associated with pain Summary