As an OB/GYN, I have examined and treated thousands of women who complain of pelvic pain. Sometimes the diagnosis is easy — itís pelvic inflammatory disease, a ruptured ovarian cyst, a twisted ovary, or an ectopic pregnancy. But more often than not, the cause doesnít jump out and whack you on the white coat.
How We Evaluate Pelvic Pain
In most cases, we start with a pelvic exam, which may not reveal any helpful information. So we dig deeper, ordering a pelvic ultrasound, which will usually rule out ovarian cysts or fibroids, or we get a pregnancy test, meant to rule out ectopic pregnancy. These tests wonít pinpoint a diagnosis of endometriosis or scar tissue or interstitial cystitis (inflammation of the bladder wall).
So if we find nothing, we wind up scratching our heads, prescribing pain pills, and scheduling surgery so we can go hunting with various scopes and try to determine the cause.
Once we put a laparoscopic camera inside a womanís abdomen, we can get up close and personal with her ovaries, the outside of her uterus, the lining of her abdomen, the outside of her bowel. We can look for little lesions that resemble burn-marks or red blebs or clear blisters, which can signal endometriosis. Or we can track down and cut up scar tissue.
What If You Find . . . Nothing?
But way too often, we do all that, we invade a womanís body, we look inside and we findÖ.nothing. Which should be good news, right? Congratulations! You donít have cancer or any bad disease we can see with a laparoscope! But our patients donít usually celebrate. They cry, because many have suffered for years and we have failed to diagnose or fix the cause of their pain.
So what do we do? We ship them off to chronic pain clinics, shrinks, and pelvic physical therapists, who drug them up with painkillers and antidepressants and teach them exercises intended to help them change the experience of their pain. But so many of these women lose their mojo. They become despondent. They wind up cutting back on activities until many are stuck in bed, hooked on narcotics. As a doctor, itís frustrating and defeating — and as a patient, it must be a million times worse.