Chronic Pelvic Pain Workup

  • Author: Manish K Singh, MD; Chief Editor: Michel E Rivlin, MD   more...
 
Updated: Sep 13, 2010
 

Laboratory Studies

The decision to perform laboratory or imaging evaluations in patients with chronic pelvic pain (CPP) is based on the need for confirmation of the diagnosis and to help rule out other potentially life-threatening illnesses. Certain investigations sometimes are needed to provide appropriate and safe medical or surgical treatment.

  • CBC count and sedimentation rate: These tests provide nonspecific findings, but the results can be sensitive indicators of inflammation or infection and, occasionally, malignancy.
  • Serum drug screen: Perform this if any suggestion of prescription or street drug abuse is present.
  • Urine test
    • Urinalysis and urine culture are relatively inexpensive and noninvasive and should be performed when necessary.
    • If hematuria is present, carefully evaluate the condition with a history, physical examination, urine culture, urine cytology, cystourethroscopy, and intravenous pyelography or CT scan.
    • If malignancy is suggested, perform urine cytology in addition to urinalysis and culture, especially if the patient smokes.
  • Sexually transmitted disease testing
    • Testing for sexually transmitted diseases in women with chronic pelvic pain includes cervical cultures or smears, syphilis serology (rapid plasma reagent, microhemagglutination-Treponema pallidum), hepatitis B screening, chlamydial polymerase chain reaction, and HIV testing.
    • Other tests used to help rule out specific infections may include vaginal cultures, vaginal wet preparations, vaginal pH, and urine analysis and culture.
  • Hormone assays: Follicle-stimulating hormone level, estradiol level, and gonadotropin-releasing hormone agonist stimulation testing can be helpful in cases of ovarian remnant syndrome.
  • Thyroid-stimulating hormone testing
    • This is used for evaluation of hypothyroidism, especially in a patient with depression.
    • Perform stool guaiac testing in patients with gastrointestinal symptoms and in patients older than 50 years. Testing stool specimens for ova and parasites also may be helpful in selected cases.
Next

Imaging Studies

  • MRI
    • MRI is a noninvasive tool that can provide excellent structural information without any radiation harm.
    • Intravenous contrast can be used when inflammation, infection, or malignancy is suggested.
  • CT scan: This is useful in patients with pelvic masses and sometimes is helpful in differentiating an ovarian mass from a uterine mass, but it is more expensive than sonography.
  • Ultrasonography
    • This is a noninvasive diagnostic tool and could be helpful in many patients with chronic pelvic pain.
    • It is commonly used to help identify pelvic masses or cysts and their origin, pelvic varicosities, and hernias (spigelian hernias).
    • Transabdominal longitudinal and transverse views of the female pelvis using ultrasonography are shown in the images below.Transabdominal longitudinal view of the female pelTransabdominal longitudinal view of the female pelvis. Transabdominal transverse view of the female pelviTransabdominal transverse view of the female pelvis: The bladder is rectangular. The ovaries are seen bilaterally in the adnexa.
  • Plain film radiography
    • Obtaining chest and spine radiographs may be useful in fractures, infections, tumors, and other structural abnormalities.
    • Flat and upright abdominal radiographs may be obtained to help rule out intestinal obstruction and pelvic infection (eg, tuberculosis).
  • Herniography (perineal hernia herniography)
  • Bone scan
  • Hysterosalpingography
    • Hysterosalpingography (HSG) is not a first-choice diagnostic tool for endometriosis; however, it may be useful in patients with infiltrative endometriosis of the uterosacral ligaments. Adolescents with endometriosis also can be evaluated for obstructive anomalies.
    • HSG may be useful in cases suggestive of endometrial polyps, Asherman syndrome, and adenomyosis.
  • Barium enema radiography, colonoscopy, sigmoidoscopy, upper gastrointestinal series, and anorectal manometry
    • These can be used to evaluate a GI etiology of chronic pain.
    • Anorectal balloon manometry can be used to assess colonic transit time.
  • Vaginal sonography
    • This is useful in patients with possible pelvic congestion syndrome.
    • Transuterine venography commonly is recommended.
  • Voiding cystourethrography: When interstitial cystitis is suggested, consider cystoscopy with hydrodistention.
  • Double-balloon cystourethrography: This is a more sensitive diagnostic test than voiding cystourethrography for diagnosing urethral diverticula in women.[9]
Previous
Next

Other Tests

  • Endoscopic procedures used commonly in the evaluation and treatment of patients with chronic pelvic pain include laparoscopy, cystourethroscopy, hysteroscopy, sigmoidoscopy, and colonoscopy.
  • Laparoscopy can be used as a diagnostic tool in patients with chronic pelvic pain, as follows:
    • More than 40% of laparoscopies are performed for the diagnosis of chronic pelvic pain.
    • More then 60% of women with chronic pelvic pain have at least one condition detectable by laparoscopy.
    • Most commonly, diagnoses made via laparoscopy include endometriosis, pelvic adhesions, and chronic pelvic inflammatory disease. Other diagnoses include ovarian cysts, hernias, pelvic congestion syndrome, ovarian remnant syndrome, ovarian retention syndrome, postoperative peritoneal cysts, and endosalpingiosis.
  • Urodynamic testing can be performed if chronic urethral syndrome or interstitial cystitis is suggested in a patient with chronic pelvic pain.
  • Nerve-conducting velocities and needle-electromyographic studies are used to help evaluate compression or entrapment neuropathy and pelvic floor function.
  • Cancer antigen 125 (CA-125), used as a diagnostic test, has low sensitivity and specificity.
    • CA-125 may be elevated with diseases associated with pelvic pain, such as endometriosis or leiomyomata.
    • CA-125 levels also are elevated with malignancy (eg, ovarian, endometrial, colon, or breast cancer), pelvic inflammatory disease, pregnancy, and menses.[10]
    • Perform electroencephalography if the rare disorder of abdominal epilepsy is suggested.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Manish K Singh, MD  Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience

Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Association of Physicians of Indian Origin, American Headache Society, American Medical Association, and American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Elizabeth E Puscheck, MD  Professor, Department of Obstetrics and Gynecology, Wayne State University School of Medicine; In Vitro Fertilization Director, Gynecologic Ultrasound Director, Clinical Endocrine Laboratory Consultant, Department of Obstetrics and Gynecology, University Women's Care

Elizabeth E Puscheck, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Endocrine Society, International Society for Clinical Densitometry, Society for Assisted Reproductive Technologies, Society for Reproductive Endocrinology and Infertility, and Society of Reproductive Surgeons

Disclosure: Wyeth Grant/research funds Other

Jashvant Patel, MD  Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University

Jashvant Patel, MD is a member of the following medical societies: Alberta Medical Association, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Specialty Editor Board

Suzanne R Trupin, MD  Clinical Professor of Obstetrics and Gynecology, University of Illinois College of Medicine-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center

Suzanne R Trupin, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Reproductive Health Professionals, International Society for Clinical Densitometry, and North American Menopause Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

A David Barnes, MD, PhD, MPH, FACOG  Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)

A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association

Disclosure: Nothing to disclose.

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD  Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh

Disclosure: Nothing to disclose.

References

  1. Mathias SD, Kuppermann M, Liberman RF, et al. Chronic pelvic pain: prevalence, health-related quality of life, and economic correlates. Obstet Gynecol. Mar 1996;87(3):321-7. [Medline].

  2. Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. Jan 1996;87(1):55-8. [Medline].

  3. Reiter RC. A profile of women with chronic pelvic pain. Clin Obstet Gynecol. Mar 1990;33(1):130-6. [Medline].

  4. Zondervan KT, Yudkin PL, Vessey MP, et al. Prevalence and incidence of chronic pelvic pain in primary care: evidence from a national general practice database. Br J Obstet Gynaecol. Nov 1999;106(11):1149-55. [Medline].

  5. Neis KJ, Neis F. Chronic pelvic pain: cause, diagnosis and therapy from a gynaecologist's and an endoscopist's point of view. Gynecol Endocrinol. Nov 2009;25(11):757-61. [Medline].

  6. Taran FA, Weaver AL, Coddington CC, Stewart EA. Understanding adenomyosis: a case control study. Fertil Steril. Sep 2010;94(4):1223-8. [Medline].

  7. Weijenborg PT, Ter Kuile MM, Stones W. A cognitive behavioural based assessment of women with chronic pelvic pain. J Psychosom Obstet Gynaecol. Dec 2009;30(4):262-8. [Medline].

  8. Lampe A, Solder E, Ennemoser A, et al. Chronic pelvic pain and previous sexual abuse. Obstet Gynecol. Dec 2000;96(6):929-33. [Medline].

  9. Jacoby K, Rowbotham RK. Double balloon positive pressure urethrography is a more sensitive test than voiding cystourethrography for diagnosing urethral diverticulum in women. J Urol. Dec 1999;162(6):2066-9. [Medline].

  10. Howard FM, Perry PC, Carter JE, eds. Pelvic Pain: Diagnosis and Management. Baltimore, Md: Lippincott Williams & Wilkins; 2000.

  11. [Guideline] American College of Obstetricians and Gynecologists (ACOG). Chronic pelvic pain. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2004 Mar. 17 p. (ACOG practice bulletin; no. 51). [Full Text].

  12. [Guideline] Chronic pelvic pain. In: Fall M, Baranowski AP, Elneil S, Engeler D, Hughes J, Messelink EJ, Oberpenning F, Williams AC. Guidelines on chronic pelvic pain. Arnhem, The Netherlands: European Association of Urology (EAU); 2008 Mar. p. 8-62. [Full Text].

  13. Everaert K, Devulder J, De Muynck M, et al. The pain cycle: implications for the diagnosis and treatment of pelvic pain syndromes. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(1):9-14. [Medline].

  14. Baker PK. Musculoskeletal origins of chronic pelvic pain. Diagnosis and treatment. Obstet Gynecol Clin North Am. Dec 1993;20(4):719-42. [Medline].

  15. Ben-David B, Friedman M. Gabapentin therapy for vulvodynia. Anesth Analg. Dec 1999;89(6):1459-60. [Medline].

  16. Benes J, Nadvornik P, Dolezel J. Abdominoinguinal pain syndrome treated by centrocentral anastomosis. Acta Neurochir (Wien). 2000;142(8):887-91. [Medline].

  17. Bergqvist A. Current drug therapy recommendations for the treatment of endometriosis. Drugs. Jul 1999;58(1):39-50. [Medline].

  18. Bodden-Heidrich R, Küppers V, Beckmann MW, Rechenberger I, Bender HG. Chronic pelvic pain syndrome (CPPS) and chronic vulvar pain syndrome (CVPS): evaluation of psychosomatic aspects. J Psychosom Obstet Gynaecol. Sep 1999;20(3):145-51. [Medline].

  19. Bost BW. Deflecting sigmoid adhesions: an anatomic cause of chronic pelvic pain and irritable bowel syndrome. Obstet Gynecol. Apr 2001;97(4 Suppl 1):S27.

  20. Braverman PK. Sexually transmitted diseases in adolescents. Med Clin North Am. Jul 2000;84(4):869-89, vi-vii. [Medline].

  21. Carter JE. A systematic history for the patient with chronic pelvic pain. JSLS. Oct-Dec 1999;3(4):245-52. [Medline].

  22. Carter JE. Surgical treatment for chronic pelvic pain. J Soc Laparoendosc Surg. Apr-Jun 1998;2(2):129-39. [Medline].

  23. Clemons JL, Arya LA, Myers DL. Diagnosing interstitial cystitis in women with chronic pelvic pain. Obstet Gynecol. Aug 2002;100(2):337-41. [Medline].

  24. Cody RF Jr, Ascher SM. Diagnostic value of radiological tests in chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. Jun 2000;14(3):433-66. [Medline].

  25. Demco LA. Pain referral patterns in the pelvis. J Am Assoc Gynecol Laparosc. May 2000;7(2):181-3. [Medline].

  26. Dwarakanath LS, Persad PS, Khan KS. Role of laparoscopy in the management of chronic pelvic pain. Hosp Med. Aug 1998;59(8):627-31. [Medline].

  27. Economy KE, Laufer MR. Pelvic pain. Adolesc Med. Jun 1999;10(2):291-304. [Medline].

  28. Ehlert U, Heim C, Hellhammer DH. Chronic pelvic pain as a somatoform disorder. Psychother Psychosom. Mar-Apr 1999;68(2):87-94. [Medline].

  29. [Best Evidence] Finnerup NB, Otto M, McQuay HJ, et al. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain. Dec 5 2005;118(3):289-305. [Medline].

  30. Ghaly AF, Chien PF. Chronic pelvic pain: clinical dilemma or clinician's nightmare. Sex Transm Infect. Dec 2000;76(6):419-25. [Medline].

  31. Grace VM. Pitfalls of the medical paradigm in chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. Jun 2000;14(3):525-39. [Medline].

  32. Gurel H, Atar Gurel S. Dyspareunia, back pain and chronic pelvic pain: the importance of this pain complex in gynecological practice and its relation with grand multiparity and pelvic relaxation. Gynecol Obstet Invest. 1999;48(2):119-22. [Medline].

  33. Hewitt GD, Brown RT. Acute and chronic pelvic pain in female adolescents. Med Clin North Am. Jul 2000;84(4):1009-25. [Medline].

  34. Holley RL, Richter HE, Wang L. Neurologic disease presenting as chronic pelvic pain. South Med J. Nov 1999;92(11):1105-7. [Medline].

  35. Howard FM. Abuse history and chronic pain in women: I. Prevalences of sexual abuse and physical abuse. Obstet Gynecol. Jan 1995;85(1):158-9. [Medline].

  36. Howard FM. An evidence-based medicine approach to the treatment of endometriosis- associated chronic pelvic pain: placebo-controlled studies. J Am Assoc Gynecol Laparosc. Nov 2000;7(4):477-88. [Medline].

  37. Howard FM. Laparoscopic evaluation and treatment of women with chronic pelvic pain. J Am Assoc Gynecol Laparosc. Aug 1994;1(4 Pt 1):325-31. [Medline].

  38. Howard FM. The role of laparoscopy as a diagnostic tool in chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. Jun 2000;14(3):467-94. [Medline].

  39. Howard FM. The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynecol Surv. Jun 1993;48(6):357-87. [Medline].

  40. Howard FM. The role of laparoscopy in the evaluation of chronic pelvic pain: pitfalls with a negative laparoscopy. J Am Assoc Gynecol Laparosc. Nov 1996;4(1):85-94. [Medline].

  41. Howard FM, El-Minawi AM, Sanchez RA. Conscious pain mapping by laparoscopy in women with chronic pelvic pain. Obstet Gynecol. Dec 2000;96(6):934-9. [Medline].

  42. Jarrell JF. The weight of chronic pelvic pain. J Obstet Gynaecol Can. May 2004;26(5):453-4. [Medline].

  43. Justins DM. Management strategies for chronic pain. Ann Rheum Dis. Sep 1996;55(9):588-96. [Medline].

  44. Kanazi GE, Perkins FM, Thakur R, Dotson E. New technique for superior hypogastric plexus block. Reg Anesth Pain Med. Sep-Oct 1999;24(5):473-6. [Medline].

  45. Kontoravdis A, Hassan E, Hassiakos D, et al. Laparoscopic evaluation and management of chronic pelvic pain during adolescence. Clin Exp Obstet Gynecol. 1999;26(2):76-7. [Medline].

  46. Large RG. Psychological aspects of pain. Ann Rheum Dis. Jun 1996;55(6):340-5. [Medline].

  47. Luzzi G, O'Leary M. Chronic pelvic pain syndrome. BMJ. May 8 1999;318(7193):1227-8. [Medline].

  48. Malik E, Berg C, Meyhofer-Malik A, et al. Subjective evaluation of the therapeutic value of laparoscopic adhesiolysis: a retrospective analysis. Surg Endosc. Jan 2000;14(1):79-81. [Medline].

  49. McCrory P, Bell S. Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Med. Apr 1999;27(4):261-74. [Medline].

  50. McDonald JS. Management of chronic pelvic pain. Obstet Gynecol Clin North Am. Dec 1993;20(4):817-38. [Medline].

  51. Moore J, Kennedy S. Causes of chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. Jun 2000;14(3):389-402. [Medline].

  52. Morikawa JH. Laparoscopy for chronic pelvic pain. Hawaii Med J. Jan 1999;58(1):22-3. [Medline].

  53. Negre E, Chaptal PA, Grolleau-Raoux D, Caporiccio A. [Systemic embolism after closure of an ostium secundum (author's transl)]. Ann Chir Thorac Cardiovasc. Jan 1975;14(1):21-4. [Medline].

  54. Nezhat FR, Crystal RA, Nezhat CH, Nezhat CR. Laparoscopic adhesiolysis and relief of chronic pelvic pain. JSLS. Oct-Dec 2000;4(4):281-5. [Medline].

  55. Olive DL, Schwartz LB. Endometriosis. N Engl J Med. Jun 17 1993;328(24):1759-69. [Medline].

  56. Papathanasiou K, Papageorgiou C, Panidis D, Mantalenakis S. Our experience in laparoscopic diagnosis and management in women with chronic pelvic pain. Clin Exp Obstet Gynecol. 1999;26(3-4):190-2. [Medline].

  57. Pashley DH. Dentin permeability and dentin sensitivity. Proc Finn Dent Soc. 1992;88 Suppl 1:31-7. [Medline].

  58. Prentice A. Medical management of chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. Jun 2000;14(3):495-9. [Medline].

  59. Reiter RC. Evidence-based management of chronic pelvic pain. Clin Obstet Gynecol. Jun 1998;41(2):422-35. [Medline].

  60. Richter HE, Holley RL, Chandraiah S, Varner RE. Laparoscopic and psychologic evaluation of women with chronic pelvic pain. Int J Psychiatry Med. 1998;28(2):243-53. [Medline].

  61. Rickert VI, Kozlowski KJ. Pelvic pain. A SAFE approach. Obstet Gynecol Clin North Am. Mar 2000;27(1):181-93. [Medline].

  62. Robert R, Prat-Pradal D, Labat JJ. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat. 1998;20(2):93-8. [Medline].

  63. Sand PK. Chronic pain syndromes of gynecologic origin. J Reprod Med. Mar 2004;49(3 Suppl):230-4. [Medline].

  64. Scialli AR. Evaluating chronic pelvic pain. A consensus recommendation. Pelvic Pain Expert Working Group. J Reprod Med. Nov 1999;44(11):945-52. [Medline].

  65. Selfe SA, Matthews Z, Stones RW. Factors influencing outcome in consultations for chronic pelvic pain. J Womens Health. Oct 1998;7(8):1041-8. [Medline].

  66. Selfe SA, Van Vugt M, Stones RW. Chronic gynaecological pain: an exploration of medical attitudes. Pain. Aug 1998;77(2):215-25. [Medline].

  67. Steege JF. Office assessment of chronic pelvic pain. Clin Obstet Gynecol. Sep 1997;40(3):554-63. [Medline].

  68. Stewart P, Slade P. Comparative study of pelvic and non-pelvic pain/the prevalence of chronic pelvic pain. Br J Obstet Gynaecol. Dec 1998;105(12):1338-9. [Medline].

  69. Stone AR, Kim JH. Pelvic, perineal, and genital pain. In: Gershwin ME, Hamilton ME eds. The Pain Management Handbook: A Concise Guide to Diagnosis and Treatment. Totowa, NJ: Humana Press; 1998:147-63.

  70. Stones RW, Mountfield J. Interventions for treating chronic pelvic pain in women. Cochrane Database Syst Rev. 2000;CD000387. [Medline].

  71. Stones RW, Selfe SA, Fransman S, Horn SA. Psychosocial and economic impact of chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. Jun 2000;14(3):415-31. [Medline].

  72. Stovall DW. Transvaginal ultrasound findings in women with chronic pelvic pain. Obstet Gynecol. Apr 1 2000;95(4 Suppl 1):S57.

  73. Summitt RL Jr. Urogynecologic causes of chronic pelvic pain. Obstet Gynecol Clin North Am. Dec 1993;20(4):685-98. [Medline].

  74. Toozs-Hobson P, Bidmead J, Cardozo L. Chronic pelvic pain. Br J Obstet Gynaecol. Nov 1998;105(11):1238. [Medline].

  75. Vercellini P, De Giorgi O, Pisacreta A, et al. Surgical management of endometriosis. Baillieres Best Pract Res Clin Obstet Gynaecol. Jun 2000;14(3):501-23. [Medline].

  76. Walker JJ, Irvine G. How should we approach the management of pelvic pain?. Gynecol Obstet Invest. 1998;45 Suppl 1:6-10; discussion 10-1, 35. [Medline].

  77. Winkel CA, Scialli AR. Safety of medical and surgical management of chronic pelvic pain and endometriosis. Obstet Gynecol. Apr 2001;97(4 Suppl 1):S28.

  78. Wise TN, Arnold LM, Maletic V. Management of painful physical symptoms associated with depression and mood disorders. CNS Spectr. Dec 2005;10(12 Suppl 19):1-13. [Medline].

  79. Zondervan K, Barlow DH. Epidemiology of chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol. Jun 2000;14(3):403-14. [Medline].

 
Previous
Next
 
Transabdominal longitudinal view of the female pelvis.
Transabdominal transverse view of the female pelvis: The bladder is rectangular. The ovaries are seen bilaterally in the adnexa.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.