9.4 Pelvic Pain

Question 1

Chronic pelvic pain definition and characteristic

Answer 1

Def
- pelvic pain
- min duration of 6 months

Characteristic
- Duration of 6months or longer;
- Incomplete relief with most treatments;
- Significantly impaired function at home or work;
- Signs of mental/emotional affectation

Question 2

Chronic pelvic pain gynaecologic aetiology

Answer 2

• endometriosis
• endosalpingiosis
• adenomyosis
• pelvic adhesions
• chronic pelvic infections
• ovarian cysts
• residual ovary syn
• ovarian remnant syn
• post-hysterectomy pain
• pelvic congestion
• fibroids
• vulvodynia

Question 3

Dysmenorrhoea
Definition
Classification

Answer 3

• pain during menstruation

Primary = pain without organic cause

Secondary = pain associated with identifiable disease
Causes of sec:
- endometriosis
- fibroids (myomas)
- adenomyosis
- endometrial polyps
- pelvic inflam disease

Question 4

Dysmenorrhoea signs & symptoms
Primary
Secondary

Answer 4

Primary
- shortly after menarche
- lower abdominal or pelvic pain with onset of menstrual flow (lasts 8-72hrs)
- back and thigh pain
- headache
- diarrhoea
- nausea and vomiting
- no adnorm findings on examination

Secondary
- at any time after menarch (>25yrs of age)
- change in time of pain onset during menstrual cycle or intensity of pain
- dyspareunia
- menorrhagia
- pelvic abnormality on physical examination

Question 5

Endometriosis
Definition

Answer 5

• unknown aetiology
• presence of endometrium outside endometrial cavity
• both endometrial glands and stroma have to be present for histological diagnosis

Question 6

Endometriosis
3 different types
Clinical presentation

Answer 6

1. Peritoneal disease
2. Ovarian disease
3. Rectovaginal disease (DIE)

Clinical presentation of all:
- pain
- infertility

HANDBOOK

Question 7

Define Adenomyosis

Answer 7

• It is defined histologically as the presence of endometrial glands and stroma deep within the myometrium.
• unknown aetiology and pathogenesis

Question 8

Main presenting forms of adnomyosis

Answer 8

• diffuse form
• focal forms: pseudowidening, adenomyoma, hemorrhagic cyst

Question 9

Define pre-menstural tension syndrome (PMS)

Answer 9

• the cyclic recurrence in the luteal phase of the menstrual cycle ‐ a combination of distressing physical, psychological, and/or behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and/or interference with normal activities

Question 10

PMS aetiology

Answer 10

• uncertain
• symptoms are triggered by hormonal fluctuations of the menstrual cycle, hormonal disproportion like oestrogen surplus and progesterone deficiency have been proposed.
• The two best‐studied and relevant neurotransmitter systems implicated in the genesis of the symptoms are the GABAergic and the serotonergic systems.