Scope of the problem

Pelvic pain is a common emergency department (ED) condition, and is the second most common gynecologic complaint. The pain may be acute or chronic, vague or defined, and occasionally referred to other parts of the body. Etiologies of pelvic pain may be reproductive, gastrointestinal (GI), vascular or urinary. Though specific causes of pelvic pain often do not require emergent diagnosis or treatment, other diagnoses may pose a threat to life (e.g., ectopic pregnancy) or may have serious reproductive sequelae, such as infertility (e.g., salpingitis).

Anatomic essentials

Pelvic pain may originate from the reproductive organs (uterus, fallopian tubes, ovaries) or local organs, such as the appendix, ureters, bladder, sigmoid colon or rectum (Figure 29.1).

Visceral pelvic pain is usually caused by distention of hollow organs by fluid or gas, or capsular stretching of solid organs secondary to edema, blood, cysts or abscesses. Less commonly it is caused by ischemia or inflammation. It is often the earliest manifestation of a particular disease process. The discomfort is often poorly characterized and hard to localize, varying from a steady ache or vague discomfort to excruciating or colicky pain. Examples include distention of the fallopian tube in ectopic pregnancy, uterine contractions in dysmenorrhea, or stretch of the round ligament with advancing stages of pregnancy.

Parietal (somatic) pelvic pain is caused by irritation of the parietal peritoneum. This is usually caused by infection, chemical irritation, or other inflammatory processes. This type of pain is typically sharp, knife-like and constant.