Management of Pelvic Pain, Dyspareunia, and Endometriosis

Abstract

Pelvic pain is an enigmatic diagnosis which often brings frustrations to both patient and practitioner. Within this chapter an introduction to the changing categorization of pain, a review of pain pathophysiology, and clinical approaches to three presentations of pelvic pain (general pelvic pain, dyspareunia, and endometriosis) are highlighted. Dives into the clinical approach for general pelvic pain, dyspareunia, and endometriosis stress the need for thorough interview, history documentation, and detailed physical exam findings. If these parameters fail to give a clear explanation of the etiology, other techniques may be useful to elicit other common findings associated with pelvic pain, dyspareunia, or endometriosis. Despite the trend toward algorithmic clinical practice for many disease assessments, the diversity of diagnoses related to pelvic pain limits the effectiveness of an algorithmic approach. A focus on the reproductive status of the patient impact may help to guide both diagnosis and therapeutic options.