Pelvic Pain: the True Emergencies

Pelvic pain in this category indicates a problem that if not treated urgently will cause serious harm or death. One serious cause of acute pelvic pain is a ruptured tubal (ectopic) pregnancy. Many women with a tubal pregnancy will continue to have menstrual-like bleeding, so they do not consider this possibility. One of the most serious mistakes made in evaluation of pelvic pain in women is to delay the diagnosis of ectopic pregnancy. The only way to be sure not to miss this diagnosis is to presume everyone to be pregnant until proven otherwise! Since tubal pregnancies can sometimes be present for months, be sure to have a pregnancy test if you have had intercourse within the last 6 months!!! Is this overreacting? Pregnancy tests are so easy to do. The failure to diagnose tubal pregnancy is serious. Having seen enough women who "couldn't possibly be pregnant" with a positive pregnancy test, just do the test!

What else could require urgent treatment? Most ovarian cysts do not need to be (and should not be) treated urgently. Occasionally, an ovarian cyst will twist (undergo torsion) and cut off the blood supply to the ovary. If this is not operated on quickly the ovary will die and need to be removed. Ovarian cysts can rupture, and cause internal bleeding that is serious if allowed to continue. Most of the time, however, if a cyst ruptures, no harm is done. (More about this in "ovarian cysts".) The exception to the rule is that certain types of cysts (dermoids) contain material that is very irritating, and will cause peritonitis if not treated urgently. Fortunately, only a very small percentage of ruptured cysts need any treatment at all. 

Pelvic infection (Pelvic inflammatory disease, or PID) caused by chlamydia or gonorrhea need to be treated without delay. These infections often cause diffuse lower abdominal pain, and may or may not cause a fever. If an infection is suspected, treatment is usually begun without waiting for laboratory confirmation, since delay could result in serious damage to the pelvic organs. Unfortunately, the diagnosis of PID is is used to explain any pain whose cause is not obvious. Some studies have shown that up to 50% of women given this diagnosis do not have PID but instead have other conditions. Laparoscopy, a procedure in which a little telescope actually examines the tubes and ovaries, may be necessary for an accurate diagnosis.

Non-gynecologic emergencies should also be considered. Pain from appendicitis often starts out near the belly button, and then moves to the right lower side. Inflammation of the colon can cause severe pain, as can kidney stones.

If you suspect any above emergencies, you should call your physician without delay. If you don't have your own physician then you should go to an emergency room. It is a good idea to have your own gynecologist, so that that if a problem develops you can call someone who knows you, and who you know and trust.

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