Pain Localization and Control

The female pelvis contains diverse, multiple, and intricately innervated structures that are potential sources of pain. As an example, when the etiologic process is gynecologic cancer, which tends to spread locally either by direct invasion or by spread of metastases to regional lymph notes, pain can be present at multiple sites simultaneously.

Pelvic pain is particularly difficult to manage because it is often vague, poorly localized, and tends to be bilateral or to cross the midline. Thus, a systematic approach to pelvic pain is the best approach. A careful review of history and physical examination may give a clue about the source and type of pain. Cooperation with a specialist in gynecology, urology, or colorectal surgery is helpful in identifying the most likely location of the painful stimulus during a directed pelvic examination.