Exams and Tests

Although your condition may be diagnosed during your first exam, don't be surprised if you need to have a series of medical appointments and tests. For many women with pelvic pain, diagnosing the cause is a process of elimination that takes a while.

Even if tests don't find any problems, it doesn't mean that there's no physical cause for your chronic pain. Tests aren't yet able to detect all causes.

Initial tests

It's a good idea to make a calendar or diary of your symptoms, menstrual cycle, sexual activity, and physical exertion. And keep track of any other things that you think are important, such as stressful events or illnesses. Bring it with you when you see your doctor.

To begin narrowing down the list of possible causes of your pain, your doctor will review your symptom diary and:

• Ask about your health history. This includes the history of your menstrual cycle as well as any pelvic surgery, radiation treatment, sexually transmitted infection, pregnancy, or childbirth.
• Do a pelvic exam to look for signs of abnormalities. You may also have a digital rectal exam. Your doctor may conduct these exams in a slower, more thorough manner than a routine pelvic exam, carefully checking for tender areas.

You may also have tests, such as:

• A pregnancy test. If your test is positive, you'll also have an ultrasound to check for signs of a tubal pregnancy.
• Blood tests, to look for infection, anemia, and other problems.
  • Complete blood count.
  • Sedimentation rate.
• Tests for sexually transmitted infections.
• Urine tests, to look for infection and kidney stones.
  • Urinalysis.
  • Urine culture.
• Stool tests, to check for signs of blood.

Further testing

Sometimes more tests are needed. Your doctor may recommend one or more of the following:

• Imaging tests (tests that take pictures of the pelvic area), such as:
  • Abdominal ultrasound and/or transvaginal ultrasound of the pelvic area using a small ultrasound device inserted into the vagina.
  • Intravenous pyelogram, which uses an injected dye combined with X-rays to create pictures of the kidneys, bladder, ureters, and urethra.
  • CT scan, which uses X-rays to create pictures of organs and bones.
  • MRI, which uses a magnetic field and pulses of radio wave energy to create pictures of organs and bones.
• Laparoscopy. This surgical procedure uses a thin, lighted viewing instrument inserted through a small cut in the belly. If needed, scar tissue or a growth can also be removed during the procedure.
• Cystoscopy, which uses a viewing instrument inserted through the urethra into the bladder.
• Urodynamic studies. In these tests, a catheter is inserted through the urethra into the bladder to check for bladder problems.
• Other evaluations:
  • For irritable bowel syndrome.
  • For abdominal wall "trigger points." These are specific places on your abdomen that cause pain when pressed.

Your mental health

Chronic pain can have a wearing effect on the mind and emotions, which can in turn make harder to manage pain.

Your doctor may recommend a mental health assessment. You'll be asked questions to find out whether such conditions as depression, insomnia, or stress are adding to or being caused by your chronic pain.

For the best chance of recovering from pain, you will need treatment for emotional problems like these, plus treatment for any known physical causes of pain.