Chapter 23 - Ultrasonographic evaluation of chronic pelvic pain

Summary

Adenomyosis is a common disorder in the gynecologic population that consists of the presence of endometrial glands and stroma in the myometrium. Adenomyosis is associated with chronic pelvic pain, dysmenorrhea, dyspareunia, and feelings of pressure low in the pelvis due to uterine enlargement. Infection of the pelvis causes pain by several different mechanisms: pelvic inflammatory disease, puerperal infections, postoperative gynecologic surgery, and abortion-related infections. Pelvic congestion syndrome (PCS) is a pelvic pain syndrome caused by retrograde flow in an incompetent ovarian vein. Symptoms associated with PCS include a shifting location of pain, deep dyspareunia, and postcoital pain, with exacerbation of symptoms after prolonged standing. Ultrasound is a very useful tool for evaluating chronic pelvic pain sufferers. Patients have better satisfaction due to their understanding of their pain, with a goal of better productivity and return to normal function.