Pelvic Pain: When to Seek Further Evaluation in Gynecology

Is it pelvic inflammatory disease?

Hello Doctor: I have been experiencing occasional mild sharp pain in my right pelvic area for the past three months, especially during uterine contractions at orgasm, where the pain becomes quite intense.
However, the sharp pain stops after orgasm.
I have visited several major hospitals for a transvaginal ultrasound, and both my uterus and ovaries appear normal, but the cause of the sharp pain in my right pelvis remains uncertain.
I suspect it might be pelvic inflammatory disease, but I have very little discharge, and sometimes I experience frequent urination, while other times I do not.
The sharp pain in my right pelvis is persistent.
Should I continue to see a gynecologist, or what other tests should I consider? P.S.
The doctors I have seen previously mentioned that I do not exhibit typical symptoms of pelvic inflammatory disease (such as increased discharge and frequent urination), so no further diagnostic tests (like blood tests) were conducted.
Should I request a blood test from my doctor?

Mijiang, 20~29 year old female. Ask Date: 2017/11/08

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In the past three months, I have occasionally experienced a mild stabbing pain in the right pelvic area, especially during uterine contractions at orgasm, where the pain becomes quite intense in a rhythmic manner.
However, the stabbing sensation stops after orgasm.
I have visited several large hospitals for transvaginal ultrasound examinations, and both my uterus and ovaries appear normal, but the cause of the right pelvic pain remains undetermined.
I suspect it might be pelvic inflammatory disease, although I have very little discharge and sometimes experience frequent urination, while other times I do not.
The stabbing pain in the right pelvic area is persistent.
Should I continue to see a gynecologist, or what other tests should I consider?
Answer: The intense stabbing pain in the right pelvic area during uterine contractions at orgasm is not indicative of pelvic inflammatory disease; it is more likely a condition known as ligamentous syndrome.
The doctors I previously consulted mentioned that my symptoms were not typical for pelvic inflammatory disease (such as excessive discharge and frequent urination), so they did not proceed with further diagnostics (like blood tests).
Should I request a blood test from my doctor?

Reply Date: 2017/11/08

More Info

Pelvic pain, especially when it occurs in conjunction with menstrual cycles or sexual activity, can be a complex issue that requires careful evaluation. Your description of experiencing sharp pain on the right side of your pelvis, particularly during uterine contractions at orgasm, is noteworthy and warrants further investigation. While you have undergone vaginal ultrasound examinations that returned normal results for your uterus and ovaries, the persistence of your symptoms suggests that a more comprehensive approach may be necessary.

Pelvic pain can arise from various causes, including but not limited to gynecological conditions such as endometriosis, pelvic inflammatory disease (PID), ovarian cysts, or even fibroids. However, it can also stem from non-gynecological issues, such as gastrointestinal disorders (like irritable bowel syndrome or appendicitis), urinary tract issues, or musculoskeletal problems. Given that your pain is localized to the right side, it is essential to consider these differential diagnoses.

The fact that your pain intensifies during orgasm could indicate a connection to the pelvic floor muscles or the surrounding structures. In some cases, pelvic floor dysfunction can lead to pain during sexual activity or orgasm, which may not be directly related to the reproductive organs. This dysfunction can result from various factors, including stress, trauma, or even prolonged muscle tension.

Regarding your concerns about pelvic inflammatory disease, it is true that typical symptoms include abnormal discharge, fever, and pain during intercourse. However, not all cases present with the classic symptoms, and the absence of discharge does not rule out the possibility of an underlying infection or inflammation. If your healthcare provider has ruled out PID based on your symptoms and examination, it may be worthwhile to seek a second opinion or request further testing, such as blood tests or cultures, to explore other potential causes.

In your case, it may be beneficial to continue consulting with a gynecologist, especially if your symptoms persist or worsen. A thorough evaluation may include:
1. Detailed History and Physical Examination: A comprehensive review of your medical history, including any previous surgeries, infections, or chronic conditions, along with a focused physical examination, can provide valuable insights.

2. Imaging Studies: While you have had ultrasounds, other imaging modalities like MRI can offer a more detailed view of the pelvic structures and may help identify conditions like endometriosis or other abnormalities that ultrasound might miss.

3. Laparoscopy: If non-invasive imaging does not yield conclusive results, a diagnostic laparoscopy may be considered. This minimally invasive procedure allows direct visualization of the pelvic organs and can help diagnose conditions like endometriosis or adhesions.

4. Pelvic Floor Assessment: If pelvic floor dysfunction is suspected, a referral to a physical therapist specializing in pelvic health may be beneficial. They can assess muscle function and provide targeted exercises to alleviate pain.

5. Blood Tests: While your previous doctor may not have deemed blood tests necessary, certain markers can help identify inflammation or infection. Tests for sexually transmitted infections (STIs) may also be warranted, given their potential to cause pelvic pain.

In conclusion, while your initial evaluations have not revealed any significant gynecological issues, the persistence of your symptoms suggests that further investigation is warranted. It is essential to advocate for your health and seek additional opinions or tests if you feel that your concerns are not being adequately addressed. Pelvic pain can be multifactorial, and a thorough, multidisciplinary approach is often the best way to achieve a diagnosis and effective treatment.

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