Role of USG and MDCT in the Evaluation of Pelvic Pain in Women of Reproductive Age Group

Acute pelvic and/or lower abdominal pain in nonpregnant women of reproductive age is an extremely common presentation to emergency departments, urgent care centers and outpatient office practices. Approximately 1.4 million gynecologic visits were made to emergency departments annually, for an average annual rate of 24.3 visits per 100 women between the ages 15 to 44 years. Acute pelvic pain generally implies pain that is of less than 3 months duration in a toxic, ill appearing and unstable patient, or chronic pain that is worsening. When a female in the reproductive age presents with acute pelvic and/or lower abdominal pain, the first diagnoses to consider are those that are life threatening and would require urgent and/or emergent surgical intervention. Because the differential diagnosis of acute pelvic pain in the nonpregnant female of reproductive age includes many different organ systems (i.e. gastrointestinal, gynecological, urological, vascular, etc.) a cost-effective and efficient strategy, such a ultrasound need to be employed. It is essential in the assessment of pelvic pain in women of reproductive age to initially exclude pregnancy via urine and/or serum hCG. The diagnosis of pelvic pain is a composite picture (history, physical examination and investigations). No single fact or observation elicits the diagnosis. When evaluating pelvic pain, as with any clinical presentation, it is important to ask about the onset, location, quality, severity, radiation, duration, aggravating and alleviating factors and any temporal changes of the pain overtime. In addition, one must ask about associated symptoms, such as nausea, vomiting, diarrhea, fever, flank pain, dysuria, hematuria, pyuria, frequency, urgency, vaginal bleeding and vaginal discharge. The medical history should focus on the patient’s last menstrual period, age of onset of menarche, sexual history, history of sexually transmitted diseases and a complete obstetric history. The physical examination shou