Docteur Kadoch

Gynécologue Accoucheur à Paris.

Chirurgien, Obstétricien.


Pelvic pain in women

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There are different types and degrees of pelvic pain in women :

-the acute pelvic pain

-the cyclical pelvic pain

-the chronic pelvic pain (> 6months)

EXTREMELY ACUTE pelvic pain:

We musn't forget that any pelvic pain in women of childbearing age may be an ectopic pregnancy. It is a diagnosis to eliminate as a priority given the dramatic consequences that this disease can have

-Ectopic pregnancy (EP) (see File USG)

-Early spontaneous abortion (see briefing hemorrhage Q1)

-Acute salpingitis disease (PID see details)

-Adnexal torsion (see briefing ovarian tumors)

-Ruptured ovarian cyst (see ovarian tumors)

-Intra Cystic hemorrhage (see ovarian tumors)

-intermenstrual syndrome

Intermenstrual syndrome happens at the same time as ovulation. It is related to the rupture of the mature follicle The result is pelvic pain that occurs rapidly in mid-cycle. It may be associated with generally light metrorrhagia. The ßHCG will of course be negative.

-Torsion of a subserosal fibroid in position (see briefing fibroma)>

-Aseptic necrobiosis of a leiomyoma (fibroid see details)

CYCLIC pelvic pain:

-Dysmenorrhoea : It's painful.periods Symptoms can sometimes be very debilitating. The most frequent is the functional dysmenorrhea, that is to say without associated pathology. We distinguish:

-Primary dysmenorrhea in the adolescent (from the first periods) that are functional, less often of malformation

-Secondary dysmenorrheain women (onset at any time of the sexual life) where we must seek the underlying pathology (endometriosis, polyps, removal of an IUD, adenomyosis ...) before asserting that they are functional.

-Early dysmenorrhea : from the 1st day

-Late dysmenorrhea : in the second part of the periods

-Intermenstrual syndrome (see above)

-Premenstrual syndrome : It is a common syndrome (35-40% of women). All the signs occur in the days preceding the periods and disappear at the beginning of the periods The signs are varied: abdominal bloating, breast tenderness, breast pain, mood disorders, headaches, fatigue .... The treatment of this syndrome based on the administration of progestin in the second part of the cycle.

CHRONIC pelvic pain:

These are difficult diagnoses because the only symptom is often pain. We must distinguish between what is functional (not disease associated) and what is organic (associated with a disease).

-Endometriosis (endometriosis see details)


It is an internal endometriosis It occurs in multiparous women in pre menopause. It involves menorrhagia and secondary late dysmenorrhea (see Dysmenorrhea). On physical examination, we find a uterus of hard consistency and increased in volume. The diagnosis is usually done using a hysteroscopy.

-Sequelae of pelvic inflammatory disease :

This is the subacute or chronic salpingitis. The germ which is most often the cause is Chlamydia trachomatis The diagnosis is by laparoscopy: annexes are inflamed with adhesions and fluid in the peritoneal cavity. Often it involves multiple ovarian cysts. The medical treatment is based on antibiotics and anti-inflammatory.drugs

-Masters and Allen syndrome:

Pain is associated with a severe deficiency of the means of fixation of the uterus associated with obstetric trauma. The examination shows an abnormal mobility of the neck relative to the uterine body. The treatment is discussed case by case and consists of surgical repair.

-Retroverted uterus:

uterine malposition is common but often can be linked to endometriosis. In fact in the, anatomical position, the uterus is tipped forward. The result is a gravity with effort, anal and pelvic pain, pain during intercourse (dyspareunia).

-Pelvic congestion :

pelvic congestion is a venous insufficiency of the veins of the pelvis causing circulatory problems with varicose veins.

-Extragenital causes :

You must also consider the proximity of other organs from non-gynecological causes such as musculoskeletal pain, digestive problems or urinary tract.