Management of pelvic pain

Pelvic pain is a common complaint of women which is frequently poorly managed. Diagnosis of pelvic pain in women can be challenging because many symptoms and signs are insensitive and nonspecific. The complex innervation of the pelvis and the anatomical proximity of pelvic viscera mean this symptom frequently overlaps traditional medical specialties, leading to diagnostic delay and frequently inadequate treatment. As the first priority, urgent life-threatening conditions (e.g., ectopic pregnancy, appendicitis, ruptured ovarian cyst) and fertility-threatening conditions (e.g., pelvic inflammatory disease, ovarian torsion) must be considered. Careful history taking and examination can in itself be therapeutic and will likely identify a number of causal and perpetuating factors which should be managed within the context of a multidisciplinary clinic. This review will provide a comprehensive summary of pelvic pain management in women for the generalist in order to facilitate appropriate investigation and management.