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  • • Lower abdominal pain in women is a common presenting complaint; pain characteristics (duration, location, quality, and severity) may be helpful in determining the diagnosis.
  • • Pain may be caused by gynecologic disorders, but also by disorders of the gastrointestinal, urinary, and musculoskeletal systems.
  • • Pain on abdominal or pelvic examination may signal peritoneal irritation.
  • • History, physical examination, and laboratory tests should be used to arrive at a diagnosis.
  • • Ultrasound may aid in the diagnosis; diagnostic laparoscopy can provide a definitive diagnosis and may be considered when the diagnosis is uncertain.

Lower abdominal pain is a common presenting complaint and one of the most difficult problems to evaluate in women. Arriving at the correct diagnosis when a woman of reproductive age presents with acute pelvic pain remains a challenge in clinical medicine—a fact that has been confirmed by numerous studies. A comprehensive evaluation leading to a timely diagnosis will reduce the morbidity associated with delayed diagnosis.

Pelvic pain is a common presenting symptom of many gynecologic disorders. However, it also may occur with disorders of the gastrointestinal, urinary, and musculoskeletal systems. To determine the etiology of the pain, the clinician must use the history, physical examination, and diagnostic tests as tools.

Symptoms and Signs

Pain Characteristics

Characteristics of the pain may aid in determining the diagnosis. Important characteristics include timing of onset, location, quality, and severity.


Pain of sudden onset suggests an acute event such as hemorrhage, rupture, or torsion of an ovarian cyst, whereas pain that is more gradual may be present in subacute or progressive conditions. The differential diagnosis of lower abdominal pain grouped by time of onset is presented in Table 5–1.

Table 5–1. Differential Diagnosis of Lower Abdominal Pain by Time of Onset.


The location of the pain may also be helpful, although different disease processes can lead to pain in the same region. The uterus, cervix, and adnexae share visceral innervation with the lower ileum, sigmoid, and rectum (T10–L1), and pain from any of these structures may be felt in the same place. This is one of the dilemmas when trying to distinguish acute appendicitis ...

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