Investigations

Depending on the clinical impression and previous investigations, patients with chronic pelvic pain usually need the following: 

  • Detailed medical history and thorough clinical examination
  • Filling a pain questionnaire and pain calendar
  • Different microbiological and haematological tests as indicated by presentation mode
  • Abdominal and pelvic ultrasound scan examination of the pelvis
  • Site specific pelvic tenderness during menstrual pelvic ultrasound examination will avoid missing clinical diagnosis of 40% of cases of endometriosis
  • MRI in suspected cases of deep endometriosis of the rectovaginal septum and bladder bed may be helpful, but not for superficial peritoneal endometriosis
  • Psychological assessment especially in patients with history of depression, sexual or physical abuse, drug misuse and vague symptoms suggestive of somatization
  • Laparoscopy if the pain had affected the quality of life, or an organic cause is suspected clinically or by imaging techniques.
  • Chronic pelvic pain associated with infertility is a good indication for laparoscopy as a primary procedure
  • Cystoscopy may help with the diagnosis of interstitial cystitis

 


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