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hello in this lecture series we'll be
going over chronic pelvic pain
what is chronic pelvic pain how long do
you have to have pelvic pain before it's
considered chronic I'll give you a
second to answer that
well if you said I don't know then you'd
be right it's yet to be defined no
definition is universally accepted
however many investigators define
chronic pelvic pain as non cyclic pain
that persists for six or more months
pain that localized us to the anatomic
pelvis and pain sufficiently severe to
cause functional disability or lead to
medical intervention chronic pelvic pain
is a very common GYN problem and about
15% of reproductive age women report
that they have chronic pelvic pain
chronic pelvic pain falls within a broad
spectrum of causes
however in Demetrios asymptomatic
fibroids or leiomyomas & IBS are very
often diagnosed endometriosis is a
frequent cause but typically is also
associated with cyclical symptoms that
means symptoms that occur with their
menses chronic pelvic pain and sexual
abuse are strongly associated and don't
forget to screen for history of sexual
abuse chronic pelvic pain unfortunately
can change the posture of a patient an
oral posture looks like this however a
patient who might have some pain may
have some market lordosis they can also
have kyphosis as well concurrent
lordosis and kyphosis are common
postural changes associated with chronic
pelvic pain let's now review what you
might find on history and physical exam
more than with any other gynecologic
problem a detail in history and physical
exam are extremely important to
determine the diagnosis a pelvic pain
questionnaire can be used initially to
obtain information in a woman with
chronic pain even a routine examination
can be extremely painful and distressing
therefore the examination should be slow
and relaxed environment with you
explaining each step to her before it
occurs
moreover a patient is reassured if she
knows that she can halt the examination
at any time let's now talk about how to
do a physical exam on a patient any
patient at the GYN patient but
specifically a patient who has chronic
pelvic pain for a bimanual exam you're
going to need two hands just remember
that pain elicited under the urethra may
indicate a urethral diverticulum and
that can be a cause of chronic pelvic
pain also you can have pain with the
anterior vagina this can reflect pain in
the bladder may be from interstitial
cystitis a large uterus may suggest
fibroids but a globular uterus may also
be consistent with adenomyosis
for more information about fibroids and
adenomyosis
check out the AUB lecture in mobility
may actually be a result of scarring or
adhesion formation tenderness may
reflect in Demetrios as' diverticular
disease of the bowel or pelvic
congestion again in the diagnosis of
chronic pelvic pain you should have a
urinalysis to rule out any type of
infection in the bladder
you should also obtain a TSH or thyroid
stimulating hormone to make sure that
that's not a cause transvaginal
ultrasound with Doppler is also
important in the diagnostic evaluation
consider a fasting glucose to rule out
any diabetic neuropathic pain the
management of chronic pain is based on
the cause if you identify a pathology
then treatment is dictated by the
diagnosis if no pathology is identified
then treatment is directed toward the
dominant symptom endometriosis is also a
common cause of chronic pelvic pain the
endometrium plants are actually
supported by estrogen so if you can
suppress sex steroid hormones then you
can actually help improve the symptoms
associated with estrogen supporting the
endometrial implants this can be done
with oral contraceptives gene RH
agonists projections and certain Andrews
thank you for listening and good luck on
your exam
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