Evaluating the Accuracy of Gynecological Ultrasound for Left Lower Abdominal Pain

Accuracy of General Gynecological Ultrasound - Left Lower Abdominal Discomfort

Hello, Doctor! I occasionally experience a pressure sensation and intermittent dull pain in my lower left abdomen, sometimes accompanied by the urge to have a bowel movement.
Although I have had occasional bowel issues, there are no significant bowel problems during the abdominal pain episodes, which is why I consulted a general gynecologist.
I visited two gynecological clinics consecutively, and both performed ultrasound examinations, with the initial findings indicating that my ovaries were normal (one doctor even mentioned that both ovaries were normal).
However, I had my right ovary removed four years ago in the United States due to a large ovarian cyst.
Neither doctor raised the question of having only one ovary during the initial ultrasound and both directly stated that the ovaries were normal, only later asking about the large scar on my abdomen.
This has led me to question the accuracy of gynecological ultrasounds.
I would like to ask the doctor, in this situation, is my abdominal pain related to gynecological issues?

huihui, 30~39 year old female. Ask Date: 2004/12/02

Dr. Lin Zhaopei reply Obstetrics and Gynecology

Oophorectomy can be classified into total and partial removal.
If it is a partial removal, ultrasound can still detect the remaining normal tissue.
Left lower abdominal pain accompanied by bowel changes may still be related to gastrointestinal issues.
Since the ultrasound has ruled out a left ovarian tumor, it is likely unrelated to the ovary.
However, if the uterus is tilted to the left and there is inflammation, it can also cause left lower abdominal pain.

Reply Date: 2004/12/02

More Info

When evaluating left lower abdominal pain, particularly in the context of gynecological issues, it's essential to consider a variety of potential causes and the limitations of diagnostic tools like ultrasound. Your experience highlights a common concern among patients regarding the accuracy of ultrasound examinations, especially when previous surgeries, such as the removal of an ovary, are involved.

Firstly, it's important to understand that abdominal pain can arise from multiple sources, including gynecological, gastrointestinal, urinary, and musculoskeletal systems. In your case, the left lower abdominal pain could indeed be related to gynecological issues, but it may also stem from other non-gynecological causes.
Gynecological ultrasound is a valuable tool for assessing conditions related to the reproductive organs, such as ovarian cysts, fibroids, and other abnormalities. However, its accuracy can be influenced by several factors, including the operator's skill, the patient's body habitus, and the specific characteristics of the structures being examined. In your situation, where you have a history of ovarian surgery, the ultrasound may not have adequately visualized the remaining ovary or any potential complications related to the previous surgery.

The fact that both physicians reported normal findings in the ovaries could suggest that there are no immediate gynecological concerns, but it does not entirely rule out the possibility of issues such as adhesions, endometriosis, or other pelvic conditions that may not be easily detected via ultrasound. For instance, endometriosis can cause significant pain and may not always be visible on an ultrasound, especially if it involves deeper structures or is associated with adhesions.

Given your symptoms of pressure and intermittent pain, along with the sensation of needing to have a bowel movement, it is also prudent to consider gastrointestinal causes. Conditions such as irritable bowel syndrome (IBS), diverticulitis, or even constipation could contribute to similar symptoms.
To further evaluate your condition, you might consider the following steps:
1. Comprehensive Evaluation: A thorough history and physical examination by a healthcare provider can help differentiate between potential causes of your pain. This may include a detailed discussion of your bowel habits, menstrual history, and any other associated symptoms.

2. Advanced Imaging: If ultrasound results are inconclusive, further imaging studies such as a pelvic MRI or CT scan may provide additional insights, particularly for conditions like endometriosis or adhesions that are not easily visible on ultrasound.

3. Laparoscopy: In some cases, a diagnostic laparoscopy may be warranted. This minimally invasive surgical procedure allows direct visualization of the pelvic organs and can help diagnose conditions like endometriosis or adhesions that may be causing your symptoms.

4. Referral to a Specialist: If your symptoms persist, consider seeking a referral to a specialist in pelvic pain or a gastroenterologist who can provide a more comprehensive evaluation of both gynecological and gastrointestinal issues.

5. Pain Management: Discussing pain management options with your healthcare provider can also be beneficial. This may include medications, physical therapy, or other interventions aimed at alleviating your discomfort.

In conclusion, while gynecological ultrasound is a useful tool, it is not infallible. Your symptoms warrant a comprehensive approach that considers both gynecological and non-gynecological causes. Engaging in open communication with your healthcare providers and exploring further diagnostic options will be crucial in identifying the underlying cause of your left lower abdominal pain and determining the appropriate treatment.

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