Exams and Test to Diagnose Pelvic Pain

Since pelvic pain may be related to the reproductive system, the urinary tract or the digestive system, patients may need to see more than one doctor to have it properly diagnosed.

Diagnosing Pelvic Pain

To diagnose the cause of your pelvic pain, the doctor will ask you about the pain and your health history. Questions may include when you started having the symptoms; whether the pain is better or worse at certain times; if the pain is related to your menstrual cycle or sexual activity; and whether you have had any injuries, illnesses, or surgery.

The doctor or nurse practitioner will perform a physical exam of the pelvis and abdomen, and assess the muscles, tissues, and organs in the pelvic region for tenderness or abnormalities.

Additional tests and procedures may include:

  • Blood or urine tests, including testing for pregnancy, sexually transmitted diseases, or a urinary tract infection
  • Vaginal culture test, which involves growing cells that have been taken from a woman's vagina to identify the microorganisms present in them
  • Colposcopy, a procedure to examine the cervix
  • Vulvoscopy, a procedure to inspect the vulva (the skin around the vagina and anus)
  • Pelvic ultrasound—test that uses sound waves to view organs and structures inside the pelvic region
  • Pelvic MRI—imaging test that creates pictures of the pelvis
  • Pelvic laparoscopy—surgical procedure in which the doctor makes a small cut in the skin below the belly button and uses an instrument called a laparoscope to view inside the pelvis or take tissue samples
  • Cytoscopy—a procedure in which a thin tube with a camera, called a cystoscope, is inserted into the urethra and bladder
  • Colonoscopy—a test that allows the doctor to look at the inner lining of the large intestine using a thin, flexible tube called a colonoscope

Some women need to see more than one doctor to have their pelvic pain diagnosed. Often a woman starts with her gynecologist, since pelvic pain is often related to a problem with the reproductive system.

(Source: 123RF)

If your pain could be due to interstitial cystitis or other problems related to the urinary tract, you may be referred to a urologist. If the pain could be due to irritable bowel syndrome (IBS), you may be referred to a gastroenterologist. IBS is generally diagnosed based on symptoms, and on tests that rule out other possible causes.

To diagnose endometriosis, your doctor will perform a pelvic exam, and may use ultrasound and possibly laparoscopy to look for signs of the condition. A study found that biomarkers, or measurable indicators of the severity or presence of some disease state, can predict whether women will respond to first-line treatment for endometriosis. In this case, progesterone receptor levels (progestin-based therapies such as oral contraceptives) were an important predictor of responsiveness.

To diagnose vulvodynia, your doctor will ask about your medical history and symptoms, and will conduct a pelvic exam to look for signs of infection. Your doctor may use a moistened cotton swab to check for specific areas of pain in your vulvar region.

To diagnose interstitial cystitis, your doctor will ask about your medical history and ask you to keep a bladder diary, which keeps track of how much fluid you drink and the volume of urine you pass. Tests include a pelvic exam, urine test, cystoscopy, and in some cases a biopsy of the bladder and urethra.

Your doctor may also order a potassium sensitivity test, in which the doctor places two solutions—water and potassium chloride—inside your bladder, one at a time. You will be asked to rate your pain and urgency you feel. If you feel much more pain or urgency with the potassium chloride, that may be a sign of interstitial cystitis.

The diagnosis of pudendal neuralgia is generally made based on a patient’s symptoms and medical history, and ruling out other illnesses that could be causing symptoms such as urinary tract infections, prostate infections, vaginal infections, or sexually transmitted diseases. The doctor will conduct a physical exam, and ask whether you exercise heavily, if you've been involved in an accident, if you've had pelvic surgery, vaginal delivery or sit for long periods during the day. The doctor may use the following tests and procedures to help diagnose pudendal neuralgia:

  • Pudendal nerve motor latency test. The pudendal nerve is stimulated with electrodes on the tip of a special glove, and the speed of electrical impulses through the nerve is recorded. If the nerve responds more slowly than normal, it may be a sign that it is damaged.
  • Electromyography, a diagnostic procedure used to assess the health of muscles and the nerve cells that control them.
  • Diagnostic nerve block. This is an injection with a local anesthetic into the buttock. If the pain diminishes immediately, it can indicate the pudendal nerve is the cause of the pain.
  • MRI or CT scan to rule out tumors or spinal abnormalities.
Updated on: 10/26/18
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Pelvic Pain Treatments
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