Acute Pelvic Pain Causes in Women

Aka: Acute Pelvic Pain Causes in Women, Acute Pelvic Pain Causes, Differential Diagnosis of Acute Pelvic Pain

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II. Causes: Pregnancy Related Acute Pelvic Pain

  1. Early Pregnancy
    1. Ectopic Pregnancy
    2. Miscarriage
      1. Threatened Abortion
      2. Incomplete Abortion
      3. Septic Abortion
    3. Ruptured corpus luteum cyst
    4. Round ligament pain
  2. Later Pregnancy
    1. Preterm Labor
    2. Abruptio Placentae (Placental Abruption)
    3. Uterine Rupture
    4. Ovarian vein thrombosis
    5. Pubic Symphysis separation
  3. Throughout Pregnancy
    1. Ovarian Torsion
  4. Fertility treatment specific conditions (with or without current pregnancy)
    1. Ovarian Hyperstimulation Syndrome
    2. Heterotopic Pregnancy (rare)
  5. Postpartum Pelvic Pain
    1. Postpartum Endometritis
    2. Perineal Trauma (esp. Assisted Delivery)
    3. Urinary Tract Infection

III. Causes: Gynecologic Causes of Acute Pelvic Pain

  1. Mittelschmerz
  2. Ovarian Cyst (Hemorrhage or rupture)
  3. Ovarian Torsion
  4. Acute Pelvic Inflammatory Disease or Tubo-Ovarian Abscess
  5. Endometriosis
  6. Degenerating Uterine Fibroids
  7. Primary Dysmenorrhea
  8. Pelvic Neoplasm (especially post-menopausal)
  9. Intrauterine Device migration, retention or perforation
  10. Imperforate Hymen (adolescent)
  11. Transverse vaginal septum (adolescent)
  12. Pelvic Floor Dysfunction
  13. Vaginismus
  14. Vaginal Atrophy (Postmenopause)

IV. Causes: Urinary

  1. Urinary Tract Infection
  2. Pyelonephritis
  3. Urolithiasis or Nephrolithiasis

V. Causes: Gastrointestinal

  1. Acute Appendicitis
  2. Bowel Obstruction
  3. Inguinal Hernia
  4. Irritable Bowel Syndrome
  5. Inflammatory Bowel Disease
  6. Diverticulitis
  7. Volvulus
  8. Epiploic Appendagitis
  9. Mesenteric adenitis
  10. Perirectal Abscess
  11. Ischemic Colitis

VI. Causes: Miscellaneous Causes of Acute Pelvic Pain

  1. Abdominal Muscle Wall Pain
    1. See Abdominal Muscle Wall Pain Causes
  2. Sexual abuse or Intimate Partner Violence
  3. Trauma
    1. Bowel perforation
    2. Bladder perforation
  4. Vascular Abnormalities
    1. Iliac Artery Dissection
    2. Pelvic Vein Thrombophlebitis

VII. Causes: Margins of Reproductive Age

  1. Adolescent
    1. Imperforate Hymen
    2. Ovarian Torsion
    3. Ectopic Pregnancy
    4. Sexually Transmitted Infection (Pelvic Inflammatory Disease, Tubo-Ovarian Abscess)
    5. Sexual Abuse
    6. Primary Dysmenorrhea
  2. Postmenopause (15% of Acute Pelvic Pain patients)
    1. Vaginal Atrophy
    2. Complex Ovarian Cysts
    3. Uterine Fibroids
    4. Ovarian Cancer
    5. Endometrial Cancer
    6. Pelvic Inflammatory Disease (STIs occur in all ages)

VIII. References

  1. Smith (1997, Feb) Consultant 404-12
  2. Bhavsar (2016) Am Fam Physician 93(1): 41-8 [PubMed]
  3. Cartwright (2008) Am Fam Physician 77(7): 971-8 [PubMed]
  4. Frasca (2023) Am Fam Physician 108(2): 175-80 [PubMed]
  5. Kruszka (2010) Am Fam Physician 82(2): 141-7 [PubMed]

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