We group these according to location of clinical symptoms: pain localized to the deep or internal pelvis, with potential etiologies and associated conditions, including pelvic venous disorders (commonly termed pelvic congestion syndrome), intraperitoneal adhesions, hydrosalpinx, chronic inflammatory disease, or cervical stenosis versus chronic pain localized to the perineum, vulva, or vagina that arises from suspected vaginal atrophy, vaginismus, vaginal or vulvar cysts, vulvodynia, or pelvic myofascial pain. Special Imaging Considerations When there is suspected local pathology in the vulva, perineum, or vaginal wall, translabial/transperineal ultrasound (US) or side-firing transvaginal probes may provide better visualization than end-firing transvaginal The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Postmenopausal Subacute or Chronic Pelvic Pain US probes [8]. There is scant evidence for imaging recommendations at this level of specificity, and it is assumed that the performing sonographer and sonologist will make appropriate technical adjustments to optimize imaging in these relatively uncommon clinical scenarios. Discussion of Procedures by Variant Variant 1: Postmenopausal subacute or chronic pelvic pain, localized to the deep pelvis. Initial imaging. Radiography Abdomen and Pelvis To our knowledge, there is currently no evidence to support the use of radiography to evaluate postmenopausal subacute or chronic pelvic pain localized to the deep pelvis.
Postmenopausal Subacute or Chronic Pelvic Pain. We group these according to location of clinical symptoms: pain localized to the deep or internal pelvis, with potential etiologies and associated conditions, including pelvic venous disorders (commonly termed pelvic congestion syndrome), intraperitoneal adhesions, hydrosalpinx, chronic inflammatory disease, or cervical stenosis versus chronic pain localized to the perineum, vulva, or vagina that arises from suspected vaginal atrophy, vaginismus, vaginal or vulvar cysts, vulvodynia, or pelvic myofascial pain. Special Imaging Considerations When there is suspected local pathology in the vulva, perineum, or vaginal wall, translabial/transperineal ultrasound (US) or side-firing transvaginal probes may provide better visualization than end-firing transvaginal The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Postmenopausal Subacute or Chronic Pelvic Pain US probes [8]. There is scant evidence for imaging recommendations at this level of specificity, and it is assumed that the performing sonographer and sonologist will make appropriate technical adjustments to optimize imaging in these relatively uncommon clinical scenarios. Discussion of Procedures by Variant Variant 1: Postmenopausal subacute or chronic pelvic pain, localized to the deep pelvis. Initial imaging. Radiography Abdomen and Pelvis To our knowledge, there is currently no evidence to support the use of radiography to evaluate postmenopausal subacute or chronic pelvic pain localized to the deep pelvis.