Characteristics/Clinical Presentation & Differential Diagnosis

Chronic pelvic pain has numerous presentations, and women with the same problem may exhibit different characteristics. Common symptoms include:

  • constant severe pelvic pain
  • intermittent pain
  • sharp or cramping pain
  • dull aching
  • pressure

Many women miss work, have difficulty doing non-strenuous exercises, and have difficulty sleeping. The level of pain can vary greatly and can contrast from mild to disabling.

Differential Diagnoses of Chronic Pelvic Pain by Organ System

  • Gastrointestinal - Celiac disease, colitis, colon cancer, inflammatory bowel disease, irritable bowel syndrome

  • Gynecologic - Adhesions, adenomyosis, adnexal cysts, chronic endometritis, dysmenorrhea, endometriosis, gynecologic malignancies, leiomyomata pelvic congestion syndrome, pelvic inflammatory disease

  • Musculoskeletal - Degenerative disk disease, fibromyalgia, levator ani syndrome, myofascial pain, peripartum pelvic pain syndrome, stress fractures

  • Psychiatric/neurologic - Abdominal epilepsy, abdominal migraines, depression, nerve entrapment, neurologic dysfunction, sleep disturbances, somatization

  • Urologic - Bladder malignancy, chronic urinary tract infection, interstitial cystitis, radiation cystitis, urolithiasis

  • Other - Familial Mediterranean fever, herpes zoster, porphyria

Diagnostic Procedures

  • Pelvic exam - This can reveal signs of infection, abnormal growths or tense pelvic floor muscles. Your doctor checks for areas of tenderness and changes in sensation. Let your doctor know if you feel any pain during this exam, especially if the pain is similar to the discomfort you’ve been experiencing.

  • Cultures - Lab analysis of cell samples from your cervix or vagina can detect infections, such as chlamydia or gonorrhea.

  • Ultrasound - This test uses high-frequency sound waves to produce precise images of structures within your body.

  • Other imaging tests - Your doctor may recommend abdominal X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI) to help detect abnormal structures or growths.

  • Laparoscopy - During laparoscopy, your doctor makes a small incision in your abdomen and inserts a thin tube attached to a small camera (laparoscope). The laparoscope allows your doctor to view your pelvic organs and check for abnormal tissues or signs of infection in your pelvis. This procedure is especially useful in detecting endometriosis and chronic pelvic inflammatory disease.Laparoscopy is an invaluable tool in the diagnosis of CPP in adolescents and should be performed before starting a psychiatric evaluation or prescribing long-term medical treatment.