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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
defined chronic pelvic pain as non
cyclic pain that persists for six or
more months pain that localizes 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 50% of reproductive age women
report that they have chronic pelvic
pain chronic pelvic pain falls within a
broad spectrum of causes however in
Demetrios Asst symptomatic fibroids or
lay of myomas and 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
for it occurs moreover a patient is
reassured if she knows that she can hope
the examination at any time let's now
talk about how to do a physical exam on
a patient any patient that's a 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 underneath
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 a sturgeon 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 progestins
certain androgens thank you for
listening and good luck on your exam
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you