The Approach to Chronic Pelvic Pain in the Adolescent

Dysmenorrhea, Endometriosis and Chronic Pelvic Pain in Adolescents

“…Myofascial pain is assessed by asking the patient to contract their abdominal wall muscles while palpating an area of tenderness (Carnett's test). Increased pain indicates a myofascial trigger point as the intraperitoneal organs are protected (10).…”

“…A cotton swab can be used to gently apply pressure to the vaginal introitus to map out points of increased pain, indicating provoked vestibulodynia (17). Internal pelvic examination should be limited to sexually active patients, and may not be feasible due to anxiety, patient expectations, or pain (10). In adolescents that can tolerate a single digit vaginal exam, the bladder neck, levator ani, cervix, adnexa and uterosacral ligaments should be palpated for tenderness.…”

“…CHC improve dysmenorrhea by reducing endometrial growth, menstrual fluid volume, and prostaglandin and leukotriene production through inhibition of ovulation and decidualization of the endometrial lining (3,21,27). CHC improve dysmenorrhea and reduce missed activities, and can safely be taken cyclically or continuously (10,28). Multiple studies have demonstrated improvement in dysmenorrhea with extended or continuous compared to cyclic regimens (11,15).…”

“…Chronic abdominal pain can precipitate hypertonicity/spasm in the abdominal wall. Attention should also be given to aggravating factors including biomechanical stressors (poor posture, footwear, heavy bags) and acute muscle strain (10). Mobilization of multi-disciplinary teams is important to address comorbidities (17).…”

“…Mobilization of multi-disciplinary teams is important to address comorbidities (17). Treatment includes assessment and improvement in biomechanical stressors, heat, rest, NSAIDs, and trigger point injections (10). The adolescent may require referral to physiotherapist specially trained in pelvic floor physiotherapy.…”