PELVIC PAIN
P
PROCEDURE FOR PELVIC EXAMINATION
The examination is usually
performed with the woman lying
on her back with her knees bent.
If the examination is carried out
because of uterine prolapse or
incontinence, the woman may
be asked to lie on her side.
The doctor usually begins by
inspecting the external genitals
for ulceration or swelling and then
does an internal examination.
Use of speculum
A speculum is inserted into the vagina to hold
the vaginal walls apart; this gives the doctor
a clear view of both the vagina and cervix. A
c e r v i c a l s m e a r t e s t ,
in which cells are removed
with a spatula, may also be performed.
U te r u s
V a g in a
Manual examination
The doctor inserts two fingers into the vagina
and palpates (feels) the abdomen with the other
hand to evaluate the size and position of the
uterus and ovaries, and to detect any abnormal
pelvic swelling or tenderness.
T h e r e m a y a l s o b e a p r o f u s e v a g i n a l d i s -
c h a r g e c o n s i s t i n g o f b l o o d a n d / o r p u s .
P a i n o f t e n o c c u r s a f t e r
m e n s tru a tio n
a n d
m a y b e w o r s e d u r i n g s e x u a l i n t e r c o u r s e
( s e e
in te rc o u rs e , p a in f u l).
T h e r e m a y a l s o
b e m a l a i s e , v o m i t i n g ,
o r b a c k a c h e . P I D
m a y b e a c u t e o r c h r o n i c .
DIAGNOSIS AND TREATMENT
A
d i a g n o s i s
i s
u s u a l l y
m a d e
b y
a n
i n t e r n a l
p e lv ic e x a m in a tio n
a n d
e x a m
i -
n a t i o n
o f s w a b s
f r o m
t h e
v a g i n a
o r
c e r v i x t o l o o k f o r i n f e c t i o u s o r g a n i s m s .
L a p a ro s c o p y
( e x a m
i n a t i o n o f t h e a b d o -
m
i n a l
c a v i t y
u s i n g
a v i e w i n g
i n s t r u -
m e n t ) c a n c o n f i r m
t h e d i a g n o s i s .
A n t ib io t ic d r u g s
a r e p r e s c r i b e d t o c l e a r
t h e i n f e c t i o n , a n d s o m e t i m e s
a n a lg e s ic
d ru g s
( p a i n k i l l e r s )
m a y b e g i v e n . I f a n
I U D i s t h e s u s p e c t e d c a u s e o f P I D , t h e
d e v i c e m a y n e e d t o b e r e m o v e d .
OUTLOOK
I f P I D i s d e t e c t e d a n d t r e a t e d e a r l y , t h e
p a t i e n t
s h o u l d
r e c o v e r
f u l l y .
S o m e
a f f e c t e d w o m e n , h o w e v e r , h a v e r e p e a t e d
a t t a c k s w i t h o r w i t h o u t r e i n f e c t i o n . A
p e lv ic a b s c e s s
m a y d e v e l o p a s a c o m
p l i -
c a t i o n o f t h e c o n d i t i o n . P I D m a y c a u s e
in fe rt ilit y
o r i n c r e a s e t h e r i s k o f
e c to p ic
p r e g n a n c y
; t h i s i s p r i m a r i l y d u e t o s c a r -
r i n g
o f
t h e
f a l l o p i a n
t u b e s ,
w h i c h
p r e v e n t s e g g s f r o m t r a v e l l i n g d o w n t h e
t u b e s t o t h e u t e r u s .
p e lv ic p a in
S e e
a b d o m in a l p a in
.
p e lv im e try
A s s e s s m e n t o f t h e s h a p e a n d d i m e n s i o n s
o f a w o m a n ’s p e l v i s . P e l v i m e t r y m a y b e
c a r r i e d o u t a c o u p l e o f w e e k s b e f o r e
c h ild -
b irth ,
t o d e t e r m i n e w h e t h e r a w o m a n i s
l i k e l y t o
h a v e
d i f f i c u l t y i n
d e l i v e r i n g
a
b a b y v a g i n a l l y . T h e p r o c e d u r e m a y a l s o b e
p e r f o r m e d
a f t e r
a
v a g i n a l
d e l i v e r y
h a s
b e e n u n s u c c e s s f u l a n d a
c a e s a re a n se c tio n
h a s b e e n c a r r i e d o u t , t o a s s i s t i n p l a n n i n g
a f u t u r e p r e g n a n c y a n d d e l i v e r y .
M e d i c a l s t a f f c a n o b t a i n a r o u g h i n d i c a -
t i o n o f t h e s i z e
o f t h e p e l v i c o u t l e t b y
m a n u a l l y c h e c k i n g t h e d i s t a n c e b e t w e e n
t h e
i s c h i a l
t u b e r o s i t i e s
( t h e
p r o m i n e n t
b o n e s i n t h e l o w e r p e l v i s ) d u r i n g a p e l v i c
e x a m i n a t i o n .
M o r e
p r e c i s e
i n f o r m a t i o n
m a y b e o b t a i n e d b y t a k i n g a n
X -ra y
o f t h e
p e l v i s a n d t h e n m a k i n g m e a s u r e m e n t s
f r o m t h e r e s u l t i n g i m a g e . H o w e v e r , e x c e s -
s i v e e x p o s u r e t o X - r a y s i n p r e g n a n c y m a y
i n c r e a s e t h e r i s k o f s u b s e q u e n t
le u k a e m ia
o r o t h e r c a n c e r s i n t h e u n b o r n c h i l d , a n d
t h e r e f o r e
t h i s
p r o c e d u r e
i s
c a r r i e d
o u t
o n l y i n r a r e c i r c u m s t a n c e s .
p e lv is
T h e r i n g o f b o n e s i n t h e l o w e r t r u n k
t h a t
s u p p o r t s
t h e
t r u n k ,
p r o t e c t s
t h e
l o w e r a b d o m i n a l o r g a n s , a n d f o r m s p a r t
o f t h e h i p j o i n t s . A t t a c h e d t o t h e p e l v i s
a r e t h e m u s c l e s o f t h e a b d o m i n a l w a l l ,
t h e b u t t o c k s ,
t h e l o w e r b a c k ,
a n d t h e
i n s i d e s a n d b a c k s o f t h e t h i g h s .
STRUCTURE
T h e p e l v i s c o n s i s t s o f t w o i n n o m i n a t e
b o n e s ( h i p - b o n e s ) . A t t h e b a c k , t h e h i p -
b o n e s
a r e
j o i n e d b y
r i g i d
j o i n t s
( t h e
s a c r o ilia c jo in t s )
t o t h e
s a c ru m
( t h e t r i a n -
g u l a r
s p i n a l
b o n e
b e l o w
t h e
l u m b a r
v e r t e b r a e ) . A t t h e f r o n t , t h e y c u r v e f o r -
w a r d s t o j o i n a t a c e n t r a l p o i n t k n o w n
a s t h e p u b i c s y m p h y s i s .
E a c h
i n n o m i n a t e
b o n e
c o n s i s t s
o f
t h r e e f u s e d b o n e s : t h e i l i u m , i s c h i u m ,
a n d p u b i s . T h e
i l i u m ,
t h e
l a r g e s t
a n d
u p p e r m o s t o f t h e s e b o n e s , c o n s i s t s o f a
w i d e ,
f l a t t e n e d
p l a t e
w i t h
a
l o n g ,
c u r v e d r i d g e
( t h e i l i a c c r e s t )
a l o n g i t s
u p p e r b o r d e r . T h e i s c h i u m i s t h e b o n e
t h a t
b e a r s
m
u c h
o f t h e
b o d y
w e i g h t
w h e n s i t t i n g . T h e p u b i s i s t h e s m a l l e s t
o f t h e p e l v i c b o n e s ; f r o m t h e i s c h i u m i t
e x t e n d s
f o r w a r d s
a n d
r o u n d
t o
t h e
p u b i c s y m p h y s i s , w h e r e i t i s j o i n e d t o
t h e o t h e r p u b i s b o n e b y t o u g h f i b r o u s
t i s s u e .
A l l
t h r e e
b o n e s
m e e t
i n
t h e
a c e t a b u l u m , t h e c u p - s h a p e d c a v i t y t h a t
f o r m s t h e s o c k e t o f t h e h i p j o i n t .
I n
w o m
e n ,
t h e
p e l v i s
i s
g e n e r a l l y
s h a l l o w
a n d
b r o a d ,
a n d
t h e
p u b i c
s y m p h y s i s
j o i n t
i s
l e s s
r i g i d
t h a n
a
m
a n ’s . T h e s e d i f f e r e n c e s f a c i l i t a t e c h i l d -
b i r t h . I n m e n , t h e g r e a t e r b o d y w e i g h t
n e e d s a l a r g e r
a n d m
o r e
h e a v i l y b u i l t
p e l v i s f o r s u p p o r t .
594
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