Women's Health

Pelvic Pain & Vulvar Disease Center

Chronic Pelvic Pain

Diagnostic Tests

The need for diagnostic tests in women with chronic pelvic pain varies greatly, and depends largely on findings at the time of the history and physical examination. Thus, the more thorough you can be relating your history, the better the chance of appropriately performing diagnostic tests.

Certain commonly performed diagnostic studies, such as ultrasound and plain x-rays, are frequently not very helpful, but are still done in most women with chronic pelvic pain as part of the initial evaluation. If there is suspected disease of the urinary tract, a CT-IVP (intravenous pyelogram) may be ordered, and if intestinal disease is suspected, a barium enema may be needed. More expensive radiologic tests, such as a CAT scan or MRI, may be done to look for suspected pelvic mass, nerve compressions, hernias, or spinal problems that might contribute to the pelvic pain.

Cystoscopy, a minor surgical procedure done by inserting a lighted optical tube (cystoscope) into the urethra and bladder, is often performed if the history and physical exam suggest problems with the urethra or bladder. Often this must be done under anesthesia to allow over-distention of the bladder. Urodynamic testing, a way of testing the pressure and flow functions of the bladder and urethra, can sometimes be needed. A potassium chloride test is another test of the bladder that is sometimes necessary. This test involves instilling water and potassium chloride solution into the bladder to see if either causes urgency or pain.

One of the most important diagnostic test for chronic pain is laparoscopy, a surgical procedure done by inserting a lighted optical tube (laparoscope) into the abdominal cavity. Laparoscopy is the most reliable way to endometriosis and adhesions. This is done either under local anesthesia with a small needle-like laparoscope to allow an accurate localization of pain to specific internal organs or structures (called conscious pain mapping when it is performed this way) or under general anesthesia to permit surgical treatment as well as diagnosis.