Components of an Evaluation of Pelvic Disorders
by Diane K. Newman, RNC, MSN, CRNP, FAANHistory
- Assess characteristics 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
- mpact 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
- 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
- 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.
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.
February 2003