Pain is one of the most common symptoms, including in gynecology. By itself, it is too subjective a symptom, since the feeling of pain is individual. The same painful stimulus can cause a significantly different response in different people. The strength of the pain is not always in harmony with the seriousness of the health condition. According to its nature, the pain can be described as sharp, dull, colicky, girdling, burning, throbbing, spastic, etc. Acute unremitting pelvic pain is a critical condition that requires immediate medical attention. It is observed most often in a process that led to inflammation of the peritoneum (abdomen), tearing (rupture) of an organ or its twisting (torsion), in inflammation of the adnexa (adnexa – a term uniting the ovary and the adjacent fallopian tube), tubal pregnancy (here the pain can also have a colic character in addition), parametritis (inflammation of the structures around the uterus), etc. The pain is usually localized in the lower abdomen, waist, tailbone. When inflammation of a given structure is the cause of the symptom, the spread of this inflammation will also cause the acute pain to spread. In some more sensitive women, sudden sharp pains can be observed when ovulation occurs, but unlike the above conditions, here the symptom relatively quickly changes its character and subsides. Dull pain in gynecology is observed when the vagina or uterus is “pulled down”, with a volume-occupying process that presses nerve endings in the small pelvis, as well as with most chronic inflammatory conditions and adhesions. The presence of benign or malignant formations or their torsion should be excluded as a cause of sharp and dull pain symptoms. NEWS_MORE_BOX Pulsating is characteristic of purulent processes affecting the external genitalia (vulva) such as acute bartholinitis, carbuncle or furuncle. In the first case, we have inflammation of the Bartholin’s glands, and in the other two – of the hair follicles. Burning pain mainly accompanies inflammatory diseases of the vulva and/or vagina. Spastic pain is characteristic of dysmenorrhea, although symptoms in this condition vary from person to person and may be accompanied by headache, fatigue, diarrhea, nausea, and vomiting. Primary dysmenorrhea is considered functional, i.e. is not a condition that needs medical attention. According to some sources, it is due to hypoplasia of the uterus, and according to others, to a high concentration of prostaglandins released by the endometrium, which intensify contractions. Unlike primary, secondary dysmenorrhea is a pathological condition – it usually occurs in women in their 30s, the pain is not necessarily synchronized with the days of genital bleeding, and it is difficult to respond to banal painkillers. In the presence of secondary dysmenorrhea or new-onset dysmenorrhea, in women,who have normal, painless menstruation, it is important to carry out a control gynecological examination to exclude inflammatory changes in the small pelvis and endometriosis. Despite the development of modern medicine, determining the cause of the pain syndrome in gynecology, and not only, is sometimes difficult, even impossible. In these cases, the term “idiopathic pelviopathy” is used. Behind this concept lie poorly diagnosed cases, various rare syndromes, and probably also psychosomatic disorders.
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