Diagnosing Pelvic Pain

Pelvic pain occurs in the lowest part of the abdomen, below your navel. The pain can be mild, moderate, or severe; localized or radiating to other areas of the body, such as the legs; and dull or sharp.

Acute pelvic pain comes on suddenly. It’s typically sharp and intermittent—meaning it comes and goes—but may become chronic, lasting for weeks, months, or longer, as either continual or intermittent pain.

One or more conditions may cause pelvic pain. The most common are endometriosis, in which the lining of the uterus grows on other pelvic organs; adenomyosis, when the lining of the uterus grows into the muscular wall of the uterus itself; and fibroids, uterine growths.

After conducting physical and pelvic exams and taking a medical history, your NYU Langone doctor may order one or more tests to help determine the cause of your pelvic pain.

Laboratory Tests

Laboratory tests allow your doctor to check for certain conditions that can lead to pelvic pain, such as pelvic inflammatory disease (PID), which often results from a sexually transmitted infection. Laboratory tests may include swabbing vaginal secretions to check for sexually transmitted infection, and taking blood and urine to test for signs of inflammation or infection.

Your doctor may also conduct a pregnancy test, because an ectopic pregnancy—in which a fertilized egg implants in the fallopian tube instead of the uterus—may cause pelvic pain.

Cystoscopy

Doctors may perform a cystoscopy to check inside the bladder for conditions that can lead to pain. In this test, which is performed in a physician’s office or at the hospital, your doctor inserts a thin, lighted device called a cystoscope into the opening of the urethra—the tube that carries urine from the bladder out of the body. This allows your doctor to look inside the bladder for inflammation—which could signal interstitial cystitis—or for signs of a bladder prolapse.

This procedure is performed using local anesthesia and takes about 20 minutes. If your doctor suspects that interstitial cystitis or pelvic organ prolapse are causing your pelvic pain, he or she may refer you to an NYU Langone urogynecologist—a doctor who specializes in urinary tract and pelvic conditions.

Laparoscopy

Laparoscopy is a minimally invasive surgical procedure that can help your doctor diagnose endometriosis or adenomyosis. During the procedure, your doctor inserts a thin instrument with a light at the tip into a small incision in the abdomen.

If your doctor finds endometrial growths or internal scar tissue called adhesions, he or she removes them during surgery. This procedure is performed using general anesthesia in the hospital. You may go home the day of the surgery and rest at home. Recovery typically takes 10 to 14 days.

MRI Scans

If your pain is severe and accompanied by heavy menstruation and bleeding between periods, your doctor may order an MRI scan to check for adenomyosis, endometriosis, or fibroids. The MRI scan uses a magnetic field and radio waves to create computerized, three-dimensional images of the uterus and surrounding tissues.

Ultrasound

Ultrasound, which uses sound waves to create images of the pelvic organs on a computer monitor, may be useful in identifying growths such as fibroids or ovarian cysts, pelvic organ prolapse, or scar tissue caused by pelvic inflammatory disease.

Sometimes your doctor may recommend a transvaginal ultrasound, in which a wand called a transducer is inserted into the vagina, which produces more detailed images of the pelvic organs.

Urinalysis

Your doctor may ask you to provide a urine sample that may reveal a bladder or urinary tract infection, which can cause pelvic pain.