components of an evaluation of pelvic disorders

by Diane K. Newman, RNC, MSN, CRNP, FAAN

A proper evaluation of pelvic disorders includes several types of examinations including a complete history, a physical examination (abdominal, genitalia and pelvic, rectal exams) and other tests.

 See also Patient Tip Sheets:

• Understanding Chronic Pelvic Pain And Vulvodynia
• Oxalate Diet for Pelvic Pain and Vulvodynia
• Self Care Practices For Pelvic Pain And Vulvodynia

Patient History as Part of an Evaluation of Pelvic Disorders

• Assess charac- teristics of symptoms
• Location/site of pain /discomfort
  • Duration, time, association with other activities
  • Aggravating or alleviating factors
• Associated urinary symptoms such as urgency, frequency, dysuria
• History of recurrent UTI
• Menstrual history
  • cycle length
  • regularity
  • duration of bleeding
  • cyclic pain symptoms
• Changes in symptoms in relation to gastrointestinal and urinary functions
• Past surgery and its relationship to onset of symptoms
• Impact of symptoms on daily activities
• History of bowel disorders such as constipation, IBS
• History of depression or anxiety
• History of low back trauma
• Previous sexual abuse
• Previous treatments and outcomes: e.g. surgery, acupuncture, medications (common ones are antidepressants, narcotics), physical therapy, chiropractic

Physical Examination as Part of an Evaluation of Pelvic Disorders

• Abdominal
  • Note any abdominal guarding (pain)
  • Use gentle pressure to determine areas of tenderness, especially in lower abdominal quadrants
  • Explore scars for hernias and nerve entrapment
• Genitalia & Pelvic
  • Assess vulva, labia, Bartholin's and Skene's glands, clitoral hood and perineal region for lesions, excoriated areas, or erythema
  • Sensory assessment of vulvar mucosa and entire introitus with cotton-tipped swab to locate areas of tenderness or hypersensitivity
  • Pelvic muscle assessment
  • Using a single finger, palpate muscular attachments along the pubic arch and the insertion of the levator ani and coccygeus muscles
  • Palpate the levators at the 4 and 8 clock position to determine if that reproduces any discomfort or tenderness
  • Assess area of episiotomy scar for tenderness
  • Have woman contract and relax pelvic muscle to assess muscle tone, strength and ability to isolate levators
• Rectal
  • Assess reflexes such as anal wink to determine an intact pudendal nerve and functional levator ani
  • Assess for itching and burning

Other Tests Included in an Evaluation of Pelvic Disorders

• Urinalysis
• Urine culture
• Urinary oxalate assay
• Fungal and bacterial vaginal culture
• Vaginal pH
• If indicated referral for colposcopy/vulvoscopy

Adapted from Newman, DK. (2000) "Pelvic Disorders in Women: Chronic Pelvic Pain and Vulvodynia". OstomyWound Management: December 46(12): 48-54.

See Also: Vulvar/vaginal Disease, Women's Sexuality

References

Baker, PK. (1993) Musculoskeletal Origins of Chronic Pelvic Pain. Contemporary Management of Chronic Pelvic Pain, 20(4) December:719-742.05-227.

Duleba, A.J., Keltz, M.D., Olive, D.L. (1996) Evaluation and Management of Chronic Pelvic Pain. Journal American Association Gynecologic Laparoscopists, February 1996, 3 (2), 205-227.

Glazer,H.I.,Rodke,G.,Swencionis,C., Hertz,R.,Young,A.W.(2000) "Treatment of Vulvar Vestibulitis Syndrome with Electromyographic Biofeedback of Pelvic Floor Musculature". Journal of Reproductive Medicine, 40(4),11 pp.

Metts, J.F. (1999) Vulvodynia and Vulvar Vestibulitis: Challenges in Diagnosis and Management. American Family Physician, 59(6),1547-1556.

Newman, DK. (2000) "Pelvic Disorders in Women: Chronic Pelvic Pain and Vulvodynia". OstomyWound Management: December 46(12): 48-54.

Paavonen, J. (1995) "Vulvodynia - a complex syndrome of vulvar pain". Acta Obstet Gynecol Scand. 74,243-247.

Steege,J.F. (1997) Office Assessment of Chronic Pelvic Pain. Clinical Obstetrics and Gynecology, Vol.40(3),554-563.

Steege,J.F.,Metzger,D.A.,Levy, B.S. (1998) Chronic Pelvic Pain: An Integrated Approach. W.B.Saunders,Philadelphia, PA.

Yount,J.J., Solomons, C.C.,Willems, J.J., St. Amand, R.P. (1997) "Effective Nonsurgical Treatments for Vulvar Pain". Women's Health Digest, 3(2),88-93.

Posted October 2007
Updated August 2009

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