Common causes of chronic pelvic pain and associated findings
| Differential diagnosis | Associated historical feature | Physical examination |
|---|---|---|
| Musculoskeletal | ||
| Pelvic floor dysfunction | Complicated delivery, dyspareunia | Vaginismus, point tenderness, or high tone of pelvic floor |
| Myofascial pain or fibromyalgia | Tender points, chronic somatic pain | Tender points |
| Stress fractures | Pain with repetitive movements, improved with rest | |
| Degenerative disk disease | Burning, paresthesias | Radicular signs, muscle weakness |
| Gastrointestinal | ||
| Constipation | ||
| Inflammatory bowel disease | Bowel urgency, hematochezia | |
| Irritable bowel syndrome | Bowel symptoms; may increase premenstrually | |
| Gynecologic (often cyclic with menses) | ||
| Adhesions | Surgical history | Immobile uterus, nodularity |
| Adenomyosis | Menorrhagia, dysmenorrhea | Enlarged, irregular tender uterus on bimanual examination |
| Adnexal mass | Localized to 1 area | Localized adnexal mass |
| Chronic pelvic inflammatory disease | ||
| Dysmenorrhea | Uterine cramping with menses | |
| Endometrial or cervical polyp | Intermenstrual or postcoital bleeding | Visual inspection |
| Endometritis | Uterine tenderness on bimanual examination | |
| Endometriosis | Diffuse pelvic pain with menses, deep dyspareunia | Fixed or immobile uterus, nodularity |
| Leiomyomata | Menorrhagia, pressure or heaviness | Uterine nodularity, enlargement |
| Pelvic congestion syndrome | Multigravid patient; deep dyspareunia, post-coital pain, worse after prolonged standing | Varicosity of labia, uterine tenderness on bimanual examination |
| Vulvar vestibulitis | Vulvodynia, dyspareunia | Exquisite localized tenderness |
| Urologic | ||
| Interstitial cystitis | Urgency, increased frequency of urination | |
| Urinary tract infection | Dysuria | |
| Urolithiasis | Localized sharp pain | |
| Radiation cystitis | History of radiation | |
| Other | ||
| Psychiatric (depression, somatization) | Concurrent mood disorder | |
| Neurologic (herpes zoster, nerve entrapment) | Hot, burning, electric shock-like pain; shingles | |