Because there is such a wide range of causes of pelvic pain, the particular tests performed should be carefully determined based on the features of the individual woman’s condition.
- Infection screening: Testing for sexually transmitted infections such as Chlamydia and Gonorrhoea in sexually active women
- Transvaginal ultrasound: This is helpful in diagnosing adenomyosis and fibroids as well as identifying endometriotic and other cysts. Ultrasound scanning will also help to determine whether there is restricted movement of pelvic structures such as ovaries and bowel, which could indicate the presence of adhesions.
- Magnetic resonance imaging (MRI): This could be particularly helpful when endometriosis is suspected to involve the bowel and for diagnosing adenomyosis.
- Laparoscopic surgery: Laparoscopy allows the pelvis to be thoroughly inspected. Chronic pelvic pain accounts for up to 40% of gynaecological laparoscopies. Laparoscopy can identify deposits of endometriosis that would otherwise remain undetected by tests such as ultrasound scans. Laparoscopy may also reveal adhesions and tethering of structures such as bowel or ovaries. 85% of abnormalities identified with laparoscopy involve endometriosis and adhesions. It is important to note, however, that laparoscopy does not guarantee that a problem will be found.
- Cystoscopy: This is helpful in diagnosing interstitial cystitis and can be performed at the same time as a laparoscopy. The distension brought about by instilling liquid into the bladder while performing cystoscopy produces symptom relief in 20-30% of patients.