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Andrea J. Rapkin Leena Nathan
Acute pelvic pain is rapid in onset, often associated with unstable vital signs and obvious abnormalities on physical examination and laboratory assessment. Improper diagnosis can result in significant morbidity and even mortality.
Timely and thorough assessment, guided by organ system (reproductive, gastrointestinal, urinary) and category of pathology will ensure effective diagnosis and management of infection, obstruction, ischemia (torsion), leakage of irritating substance (viscus or cyst rupture), neoplasia, or pregnancy-related pain.
Chronic pelvic pain is a multifaceted disorder characterized by changes in the processing of afferent signaling in the pelvic organs, the surrounding somatic tissues, and the spinal cord and brain. The shared thoracolumbar and sacral innervations of the pelvic structures and the up-regulation processing of neural input in the central nervous system account for the multiplicity of somatic and psychological symptoms experienced by women with chronic pelvic pain.
A thorough history and physical examination are important for successful management of both chronic and acute pain. The ancillary laboratory and diagnostic procedures performed to assess acute, life-threatening processes differ from those focused on chronic pain conditions. Chronic pelvic pain requires a multidisciplinary approach for both diagnosis and management.