Painful Gynaecological Conditions you Should Know About
The female reproductive organs uterus, cervix, vagina, and ovaries are innervated by the same nerves as the lower gastrointestinal tract (GI). So, sometimes it is difficult to differentiate pelvic pain from GI pain. Hence, here are the common causes of gynaecological pain along with their pain relief solutions. However, the most common recurrent cause of pelvic pain is dysmenorrhoea.
Most Common Causes Of Pelvic Pain
Primary Dysmenorrhoea
This is menstrual pain associated with normal ovulatory cycles in young girls, without any associated structural pathology. The pain usually starts 72 hours prior and may last one-two days after the start of periods. This pain usually responds very well to simple analgesics and prostaglandin synthetase inhibitors. Oral contraceptive pills also helps in some cases and can be prescribed if fertility control Is required as well.
Secondary Dysmenorrhoea
This pain ¡s menstrual pain associated with a structural pathology. Most common causes are adenomyosis, endometriosis and ovarian cysts. They need specific treatment and are less responsive to NSAIDS. It may need hormonal treatment like OCPS, progesterone, Mirena or a definitive surgical treatment. However, definitive treatment depends upon the patient’s age, her requirement for fertility and symptoms.
Mittleschmerz
It is a mid-cycle ovulatory pain which happens at the time of ovulation. It is usually self-limiting and also responds to NSAIDS, if required.
Causes Of Acute Pelvic Pain
Ectopic Pregnancy
If there is acute pelvic pain with a positive pregnancy test, ectopic pregnancy must be ruled out. An unruptured ectopic pregnancy usually causes localized pain, but a ruptured ectopic pregnancy causes generalized peritoneal pain and needs Immediate management.
An ectopic pregnancy patient, it stable and fulfilling the criteria for medical management, can be done, but if it Is ruptured or the patient is unstable, then she needs immediate surgical management either laparoscopy or laparotomy. This is a life-threatening situation and should be managed immediately.
Ovarian Cysts
Ovarian cysts like cystadenoma, dermoids, endometriosis or chocolate cyst, if ruptured, need immediate laparoscopic surgery, or if unruptured causing pelvic pain, needs cystectomy surgery via a laparoscopic route.
Ovarian Torsion
In few of the ovarian cyst cases, there may be axial rotation o? the adnexa and patients present with acute lower abdominal pain with vomiting and fever. Thus, an uttrasound should be done to see the vascularity of the pedicle followed by a laparoscopy. In case the ovarian pedicle maintains vascularity, detorsion can be done followed by cystectomy and the ovary can be saved, but it vascularity is jeopardized, the ovary has to be sacrificed.
Corpus Luteum Hematoma
This may develop for some patients in the second half of the cycle that is the luteal phase, where corpus luteum which forms after ovulation, may rupture causing hemoperitoneum and need laparoscopy, if the patient is stable or laparotomy, ¡t patient ¡s unstable.
Acute Pelvic Inflammatory Disease (PID)
This is a microbial infection of the pelvis and presents acutely, as lower abdominal pain and tenderness. On examination, lower abdominal tenderness, adnexal tenderness and cervical motion tenderness is present. Treatment may be on an outpatient basis, by oral antibiotics or inpatient basis, by intravenous antibiotics depending on the severity of the symptoms and infection.
Tubo-Ovarlan Abscess is a surgical emergency and usually presents with bilateral tender adnexal masses and needs surgical drainage under good antibiotic cover.
Fibroids
This is a benign tumour of the uterus and usually presents with heavy bleeding, pain and an abdomen mass.
Degenerating Fibroids
This condition usually occurs during pregnancy and causes acute pain, is managed conservatively.
Subserosal Pedunculated Fibroid
If affected by this condition, one may undergo torsion to remove the fibroid surgically.
Submucosal Fibroid
This condition may also present with pain and can be removed hysteroscopically.
Medical management of fibroid Is not very successful but in some cases to shrink the size of fibroids, GnRH analogues are used or a newer drug called ulipristal acetate Is used.
Treatment for PID may be on an outpatient basis by oral antibiotics or inpatient basis, by intravenous antibiotics, depending on the severity of the symptoms and infection
Other Painful Conditions
Endometriosis
This is a condition whereby, the endometrìal lining of the uterus gets implanted at other locations and it presents as painful periods. li sometimes involves rectum and other organs as well and may present as dyspareunia or dyschezia too. Management involves, NSAIDS, hormonal treatment, and surgical management by clearing the disease by laparoscopy.
Adenomyosis
It is endometriosis of the uterus that means the endometrial lining grows Into the myometrium of the uterus and presents as progressive painful periods and heavy bleeding. Treatment involves OCP, NSAIDS, Progesterones, GnRH analogues and definitive treatment involves hysterectomy.
Chronic Pelvic Pain Or CPP
This is defined as pelvic pain either cyclical or non-cyclical, which lasts for more than six months and is localized to the pelvis and abdominal wall, at or below the umbilicus, radiating to the buttocks, lumbosacral region and is of sufficient severity to debilitate a woman’s quality of life. It contributes to almost 20 per cent hysterectomies and 40-50 per cent of laparoscopies.
There are some non-gynaecologic causes such as irritable bowel syndrome, interstitial cystitis and my of ascitis which should always be considered in the differential diagnosis for pelvic pain.
Adhesions
These are due to previous surgeries or PID. it s also an important cause of gynaecologic pelvic pain and needs a multidisciplinary approach and adhesiolysis.
Vulvar Pain Or Vulvodynla
This kind of pain is caused due to infections or is related to neurological cause and needs specific treatment.
Health Tip
Any type of pelvic pain should be evaluated thoroughly and treated.