Evaluation of acute pelvic pain in women
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
Acute pelvic pain is a common presenting complaint in women. The differential diagnosis includes gynecologic, urologic, musculoskeletal, gastrointestinal, vascular, and metabolic disorders (table 1). Gynecologists are frequently consulted to help determine whether the woman's pain is from a gynecological or nongynecological etiology. A thorough history and physical examination are usually necessary to narrow the possible diagnoses and focus the work-up. A critical component of this process is to quickly identify the presence of conditions that are life-threatening and thus demand immediate surgical intervention, such as severe hemorrhage from a ruptured ectopic pregnancy or impending appendiceal perforation.
This topic will discuss gynecologic causes of acute pelvic pain. The approaches to women with nongynecologic causes of acute abdominal pain or chronic pelvic pain are reviewed separately. (See "Evaluation of the adult with abdominal pain in the emergency department" and "Causes of abdominal pain in adults" and "Evaluation of chronic pelvic pain in women".)
Gynecologic — The most common gynecological causes of acute pelvic pain are:
●Pelvic inflammatory disease and tuboovarian abscess (see "Pelvic inflammatory disease: Clinical manifestations and diagnosis")
●Hemorrhage, rupture, or torsion of an ovarian neoplasm. Torsion of a normal ovary or fallopian tube (normal or abnormal) is also possible. (See "Evaluation and management of ruptured ovarian cyst" and "Ovarian and fallopian tube torsion".)
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