when there is pain during intercourse, what is this called?
deep dyspareunia (not position dependent)
what happens to endometriosis over time?
what age group and parity are patients with endometriosis likely to be in?
what is this a typical description of: A 31-year-old nulliparous lady who complains of progressive pain during intercourse which may continue for some time afterwards, occurring at each intercourse and worsening over time.
what is Fitz-Hugh-Curtis syndrome?
rare complication of PID
gonorrhoea or chlamydia cause infection and inflammation in pelvis
can cause scar tissue to form on Glisson's capsule around the liver
so get RUQ pain worse on coughing or movement and referred to R shoulder
what is definition of chronic pelvic pain?
intermittent or constant pain in the lower abdomen or pelvis
NOT occurring exclusively with menstruation or sex
what % of women does CPP affect?
what 3 Ix could you do for CPP?
what are 2 causes of ongoing cyclical pelvic pain?
they are both hormonally driven gynae conditions
suppression of ovarian activity cures 2/3
what are features of torsion of ovary?
acute onset pain
unilateral - worse on one side
assoc with N&V
radiates to upper thighs
if suspect mittelschmerz, what do you need to ask?
LMP as its related to ovulation
what are features of pain relating to endometriosis?
can start up to 2 weeks before period
relieved when bleeding starts
also get deep dyspareunia
what are features of CPP that point to PID?
pain across whole of lower abdomen
fever in the hx
which 2 bowel conditions can cause pelvic pain and need to be excluded? how distinguish the 2?
appendicitis: central then right sided, N&V
diverticulitis: older people, constipation
what is differential for CHRONIC pelvic pain?
GI: diverticulitis, IBS
what is differential for ACUTE pelvic pain?
tubo-ovarian abscess: post TOP, IUCD insertion, hysteroscopy
EPAU: miscarriage, ectoptic
ovarian cyst: torsion, rupture, bleed
abscess: bartholin's abscess
why do you need to ask about LMP?
pregnancy, ectopic, miscarriage
if perimenopausal: atrophic vaginitis leading to superficial dyspareunia
why do you need to ask about recent gynae procedures - give eg
as risk of PID
if a pt had previous PID, what could now be causing their CPP?
what are risk factors for adhesions causing CPP?
previous pelvic surgery
what 2 things need to be asked in sexual hx?
contraception - if new partner and no barrier method - PID