HOW TO EVALUATE PELVIC PAIN

1.Stabilization: Airway, respiratory, and cardiovascular status should be assessed, and shock should be treated immediately before making a diagnosis.

2. Patient history: It is imperative to obtain a menstrual history in all women of childbearing age.

3. Physical examination: Take into account the kind of pain and tenderness the patient is feeling. Does vaginal discharge, stomach bloating, or fever have an association? Asking the patient to cough, gently moving the bed, or using percussion is the best way to demonstrate peritonitis.

4. Laboratory studies

a) Pregnancy test: Pregnancy tests should be administered to all women of childbearing age. This can aid in excluding ectopic pregnancy or miscarriage but cannot do so entirely.

b) Blood work: A blood type and screen and a complete blood count (CBC) should be obtained.

c) Urinalysis should be performed on a sample obtained by catheterization.

d) Culture: Swabs from the cervical and vaginal areas are submitted for potassium hydroxide, wet prep, and culture as necessary. Patients who have a fever may want to explore blood and urine cultures.

5. Other diagnostic tools

a) Abdominal and pelvic ultrasonography may be indicated to search for free fluid in the cul-de-sac, ectopic pregnancy, ovarian cyst, ovarian torsion, uterine fibroids, tubal-ovarian abscess, or an inflamed appendix.

b) Computed tomography scanning can be considered in the non-pregnant patient where ultrasound is unable to definitively identify the cause.

c) Laparoscopy and biopsy may be necessary to definitively diagnose endometriosis, dysfunctional uterine bleeding, uterine or ovarian cancer, and complicated PID.