Acute Pelvic Pain in the Reproductive Age Group

Acute pelvic pain is a common problem in women who are of childbearing age (premenopausal). The pain can be caused by gynecologic conditions (eg, hemorrhagic ovarian cysts, pelvic inflammatory disease, ovarian torsion, ectopic pregnancy) or by nongynecologic conditions (eg, appendicitis, inflammatory bowel disease, diverticulitis). Before imaging tests are done, a pregnancy test is performed to select tests that minimize radiation exposure to the fetus for women who are pregnant.

If the patient is pregnant and the cause of pain is likely gynecologically related, ultrasound duplex Doppler (visualizes blood flow) adnexa (regarding the fallopian tube/ovary), ultrasound pelvis transabdominal (ultrasound transducer placed on the outside of abdomen), or transvaginal (transducer inserted into the vagina) is usually appropriate. For pregnant patients, MRI and CT are usually not appropriate.

In nonpregnant patients in whom the cause of pain is likely gynecologically related, ultrasound duplex Doppler pelvis or ultrasound pelvis transabdominal or transvaginal is usually appropriate. MRI pelvis without and/or with intravenous (IV) contrast or CT abdomen and pelvis with IV contrast may be appropriate.

In pregnant patients in whom the cause of pain is likely nongynecologic, ultrasound abdomen and pelvis transabdominal, ultrasound duplex Doppler adnexa, or ultrasound pelvis transvaginal are usually appropriate.

In nonpregnant patients in whom the cause of pain is likely nongynecologic, ultrasound abdomen and pelvis transabdominal, ultrasound duplex Doppler pelvis, ultrasound pelvis transvaginal, and CT abdomen pelvis with or without IV contrast are usually appropriate.

For more information, see the Pelvic Pain page.

— By Caitlin Coughlin and Aya Kamaya, MD. This information originally appeared in the Journal of the American College of Radiology.