A careful and detailed history of the pain is the most useful tool we have in diagnosis of pelvic pain. When was the onset of the pain? Can you remember a time without pelvic pain? If so, what was going on when the pain began? What makes the pain better? What makes it worse? There is an entire questionnaire designed by the International Pelvic Pain Society to help health care providers sort out the various causes of pelvic pain. Completing such a questionnaire is extremely useful for both you and your health care provider. It helps to focus the medical evaluation on those areas most likely to be causing the pain. Diagnosis of pelvic pain also requires a detailed physical examination including examination of the back and its muscles, the abdominal wall and all of its structures, the pelvic floor (separately from the pelvic organs), and finally a careful assessment of the female reproductive organs, the bladder, and the bowel. Rarely is any other test or study required. Small ovarian cysts or fibroid tumors which are not appreciated on a careful physical examination are NEVER the source of pelvic pain. Both women and their physicians must avoid the temptation to intervene and treat a minor abnormality with the assumption that it must be the cause of the pain since nothing obvious was found on physical examination. These small lesions are actually almost always present if we look hard enough. They are innervated by the visceral nervous system, and are therefore incapable of "feeling" most of the kinds of pain women experience. When the physical examination is normal, it is important to search for musculoskeletal or functional problems that may be causing the pain. A functional problem does NOT mean that the pain is imagined. It means that the pain originates with the function rather than the structure of an organ. For example, teenagers who suffer with terrible menstrual cramping often have nothing structurally wrong with the uterus, rather the uterus contracts so hard during a period that it does not have enough blood supply. The ischemia, or lack of oxygen to the contracting muscle causes the severe pain. Similarly, people with irritable bowel syndrome do not have a structural problem with the intestines. Their bowels contract haphazardly rather than in the normal sequential fashion. This causes distention of isolated segments of the bowel and rapid onset of sharp, severe pain.

A complete and careful history coupled with a skillful and focused physical examination are the most important tools for the diagnosis of pelvic pain. Finding a physician or health care provider who will take the time and energy to hear your story and carefully evaluate all of the possible sources of pain is the key to successful partnership in dealing with pelvic pain.