Term
| Ask about pelvic or lower abdominal pain. |
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Definition
"Have you had recent pelvic or lower abdominal pain? Is it on one or both sides?"
Key Points: Recent-onset, often bilateral (but can be unilateral). |
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Term
| Assess for deep dyspareunia. |
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Definition
A: "Have you experienced pain during deep intercourse recently?"
Key Points: Recent-onset pain suggests PID. |
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Term
| Inquire about menstrual pain changes. |
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Definition
"Has your period pain worsened or started after previously painless cycles?"
Key Points: Secondary dysmenorrhea (new/worsening menstrual pain). |
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Term
| Ask about abnormal bleeding patterns. |
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Definition
Have you noticed bleeding between periods, after sex, or heavier periods?"
Key Points: Intermenstrual, postcoital, or heavy bleeding (cervicitis/endometritis). |
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Term
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Definition
A: "Do you have unusual vaginal discharge? What color or consistency?"
Key Points: Mucopurulent discharge (linked to cervicitis/vaginal infection). Ask for vaginal itching. |
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Term
| Screen for RUQ/shoulder pain. |
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Definition
| "Any pain in your upper right abdomen or shoulder?"ey Points: Perihepatitis (Fitz-Hugh-Curtis syndrome). |
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Term
| Check for systemic signs. |
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Definition
"Have you had fever, nausea, vomiting, or fatigue?"
Key Points: Present in 50% of cases; fever may be absent. |
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Term
| Consider asymptomatic cases. |
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Definition
"PID can sometimes cause no symptoms. Maintain suspicion in high-risk patients."
Key Points: Asymptomatic PID is possible. |
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Term
| Explore contraception and pregnancy. |
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Definition
"Are you using contraception (e.g., IUD)? Could you be pregnant?"
Key Points: IUD insertion increases risk; rule out pregnancy. |
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Term
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Definition
"How many partners have you had recently? Any symptoms in your partner(s)?"
Key Points: Multiple partners, partner symptoms, STI risks. |
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Term
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Definition
"When was your last cervical smear? Were there any concerns?"
Key Points: Recent smears may inform STI risk. |
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Term
| Why should you Low Threshold for PID? |
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Definition
| Suspect PID in sexually active women, even if monogamous. Start treatment promptly without waiting for lab results. |
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Term
| Rule out Ectopic Pregnancy/Rupture |
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Definition
"Have you had a positive pregnancy test or missed period? Any sudden pelvic pain or shoulder tip pain?"
Key Points: Sudden-onset unilateral pain, vaginal bleeding, syncope. Rule out with pregnancy test. |
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Term
| Rule out Threatened Miscarriage |
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Definition
"Are you pregnant? Any vaginal bleeding or cramping?"
Key Points: Confirmed pregnancy, cramping, and bleeding. Assess for retained products. |
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Term
| Rule out Acute Appendicitis |
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Definition
"Is the pain in your lower right abdomen? Does it worsen with movement or coughing?"
Key Points: Migratory pain (umbilical → RLQ), rebound tenderness, nausea/vomiting. |
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Term
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Definition
"Do you have chronic pelvic pain, especially around your periods? Pain during intercourse? "Deep dyspareunia is commonly
associated with this condition.
Key Points: Cyclical pain, dysmenorrhea, infertility history.typically starting up to 2 weeks
before the period and usually being relieved when
the bleeding starts. |
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Term
| Rule out Gastrointestinal Disorders |
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Definition
"Any nausea, vomiting, diarrhea, constipation, or blood in stool? Does eating or passing stool affect pain?"
Key Points: IBS (bloating, relief after defecation), diverticulitis (LLQ pain), gastroenteritis (vomiting). |
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Term
| Rule out Ovarian Cyst Complications |
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Definition
"Did the pain start suddenly on one side? Any nausea/vomiting with movement?"
Key Points: Unilateral pain, sudden onset (rupture/torsion), radiating to the upper thighs. aggravated by movement. |
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Term
| Rule out UTI/Pyelonephritis/Renal Stones |
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Definition
"Any burning during urination, frequent urination, or flank pain?"
Key Points: Dysuria, hematuria (stones), fever (pyelonephritis). |
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Term
| Rule out Mittelschmerz Pain |
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Definition
"Is the pain mid-cycle (ovulation time)? Does it resolve within hours?"
Key Points: Brief, unilateral, correlates with menstrual cycle. |
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Term
| Ruptured Corpus Luteal Cyst |
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Definition
"Did the pain occur around your period? Any dizziness or spotting?"
Key Points: Sudden onset post-ovulation, mild bleeding. |
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Term
| Rule out Functional Pelvic Pain |
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Definition
"Have you had chronic pain unrelated to your cycle? Any history of anxiety/depression?"
Key Points: Non-cyclical, psychological stressors, no organic cause. |
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Term
Examination of Patients with
Pelvic Pain |
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Definition
General examination.
Abdominal palpation.
Vulval/vaginal/cervical inspection.(with a chaperone):
Bimanual pelvic examination."Next, I’ll perform a pelvic exam. This involves using a speculum to look at your cervix and vagina for any unusual discharge or bleeding. After that, I’ll gently feel for tenderness in your uterus, ovaries, or cervix using my fingers. You might feel some discomfort, but I’ll be as gentle as possible. A chaperone will be present for your comfort and privacy." |
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Term
| Examination findings in PID |
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Definition
Cervical motion tenderness
● Adnexal tenderness
● Lower abdominal tenderness
● Pyrexia. |
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Term
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Definition
vaginal swabs for Chlamydia and gonorrhoea test
● Pregnancy test, if indicated
● MSU sample
● WBC, ESR, CRP
● Pelvic ultrasound
HIV, hepatitis, and syphilis |
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Term
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Definition
Antibiotics:
"We’ll start antibiotics today to treat the infection. It’s critical to finish the full course, even if you feel better sooner."
Pain Relief:
"I’ll recommend painkillers like ibuprofen or paracetamol to manage discomfort."
Advice for Partners:
"Any sexual partners from the last 6 months should be tested and treated for STIs to prevent reinfection. Avoid sex until both you and your partner(s) have completed treatment." |
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Term
| Admit immediately if any of the following |
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Definition
Pregnancy or suspected ectopic pregnancy.
- Severe systemic symptoms (e.g., fever >38°C, vomiting) or adnexal mass (suggesting abscess/pelvic peritonitis).
- Systemically unwell with uncertain diagnosis.
- Inability to tolerate primary care management. |
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Term
| How should I follow up a woman with PID? |
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Definition
If a woman has a suspected diagnosis of pelvic inflammatory disease (PID) and has started empirical antibiotic drug treatment as part of initial management:
Review the woman within 72 hours, depending on clinical judgement.
Consider arranging a further review 2–4 weeks after completion of antibiotic treatment. Advise on the future use of a barrier method of contraception. Ensure a 'test of cure' is arranged by the local specialist sexual health service or in primary care if the woman has:Ensure a 'test of cure' is arranged by the local specialist sexual health service or in primary care if the woman has:A positive initial test result for gonorrhoea and chlamydia |
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Term
| How should I manage sexual partners? |
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Definition
Advise the woman that any current and recent sexual partners (within the last 6 months) should attend a local specialist sexual health service for sexually transmitted infection (STI) screening, treatment, and contact tracing. If a sexual partner is unable or unwilling to attend a specialist clinic:
Offer screening for chlamydia and gonorrhoea. Advise to abstain from all sexual activity until both the woman and sexual partner(s) have completed a course of antibiotic treatment, are symptom-free, and have had a 'test of cure' if needed, depending on clinical judgement. |
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