Chronic Pelvic Pain – Gynecology | Lecturio


[Music] 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 [Music] you

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