Pelvic painBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h5637 (Published 12 November 2015) Cite this as: BMJ 2015;351:h5637
- Rachel Brown, GPSI gynaecology, NICE fellow1,
- Sanjay Vyas, consultant gynaecologist2
- 1Montpelier Health Centre, Bristol BS6 5PT, UK
- 2Southmead Hospital, Bristol BS10 5NB
- Correspondence to: R Brown
- Accepted 15 September 2015
What you need to know
Refer immediately to gynaecology all patients with a pelvic mass, abnormal cervix, or persistent bleeding
Consider endometriosis and therefore referral in patients presenting with chronic dyspareunia and rectal pain who fail to respond to medical treatment
A 28 year old woman presents with six months of pelvic pain associated with painful periods and painful sex.
What you should cover
With any woman with pelvic pain, ask the following questions, taking care to screen for red flag symptoms (see box):
Can she describe exactly where she feels the pain? How long are her periods, are the cycles regular, how heavy is the bleeding?
Does she have painful periods or pain with sex? If so, are these new symptoms? Primary dysmenorrhoea (since menarche) is less likely to be due to pathology1 and therefore often doesn’t need a referral.
Is she worried about sexually transmitted infection? Does she have any vaginal discharge that is abnormal for her which might suggest infection?
Explore her family history of cancer. It is also often useful to know how other family members cope with pain and periods.
Is she getting any post-coital or intermenstrual bleeding suggestive …