What tests (if any) would be able to identify the source of extreme pelvic pain not associated with period?

I have been to the dr. numerous times for the pelvic pain that I have been having -- it is quite extreme at times, and is accompanied by nausea, dizziness, chills, and rarely a fever. The dr. just keeps saying it's probably nothing, but she never runs any tests or does more than the yearly pap exam.

The pain is not associated with my period, because I have it throughout the month.

I would like to know *why* I am having these issues; are there tests or such that I can insist on having?

I do have to get a referral from our primary care physician to see anyone else, so I am 'stuck' with this physician for the time being (ie: until the paperwork goes through the insurance company to select a new primary care physician -- for some reason it is taking longer than I had thought).

Any insight would be greatly appreciated.

Pain in the pelvis could be related to numerous different organ systems. There are gynecological causes, urinary system causes, and gastrointestinal causes. Figuring out what is the root cause should occur in a stepwise process that starts with the most common causes to the least common.

In order to come to a diagnosis you may need to see one or more specialists and to have an imaging study or invasive procedure.

A gynecologist can give you a pelvic exam. This can allow her to visualize any lesions on your cervix, visualize a discharge, take swabs and cultures for the presence of infection, and do scrapings for abnormal cells.

An ultrasound can image the ovaries to check for cysts or adjacent masses and also can image the uterus for fibroids.

A urologist can do cystography, place a camera into your bladder to see the mucosal surface. Also they can help evaluate your ureters, also with ultrasound.

A gastroenterologist can help determine if you have colitis, which can sometimes cause vague pelvic discomfort, or other rare conditions, like chronic appendicitis or abscess, fistulas etc...He/she can do a colonoscopy to look at your colon.

Other tests include an abdominal/pelvic CAT scan, which can image your kidneys, ureters, intrabdominal organs, bladder etc. It is not as good as ultrasound for the ovaries. CT also uses a lot of radiation (the new asbestos) and about 1 in 2500 people will develop malignant transformation from a single CAT scan. The chance of developing malignancy is greater the younger you are when you get the CT and also rises with the number of CT's you get.

MRI images just as well as CT scan without any radiation but is more expensive.

If you exhaust a full/complete work up and still have pain, many people opt to see a surgeon for what is called an exploratory laparotomy. The surgeon basically takes you to the O.R. and opens you up to look around and see what can be seen.

Going to the ER may not be the best next step. You will be evaluated for an acute process: ectopic pregnancy, urinary infection, acute appendicitis etc. The tests ordered (if they are ordered) are very focused to answer one specific question: ectopic pregnancy yes or no, kidney stone yes or no.... MRI is not utilized through the emergency dept except in exceptional circumstances (usually for spinal cord disease). If you are not pregnant you may not have an ultrasound ordered. You may convince the doctor to order you a CT scan, but is this the best first test? Consider the radiation.

At this point I recommend you speak with your doctor about your concerns and express your desire to either be referred to someone or have a specific test ordered. Unfettered communication with your physician is the best way to get the work up started. He/she may not realize the depth of your concern.

Good luck.

When I had pelvic pain, they did a sonogram on me as well as look at me internally with this probe that has a camera on it. I would change dr. asap. What insurance do you have? Most of them are getting rid of the need for a referral.

Do you have pelvic pain during intercourse?

It sounds like also that you could either a) have endometris or b) have a retroverted (flipped) uterus. So anytime something is inserted (i.e. a penis) into your vagina, it is hitting your uterus causing you to have pelvic pain.

Thats very stupid that your doctor wont do anything, its like they are waiting to be sued for malpractice. I'm thinking its probably an inflammation of your pelvis or endometriosis. I would go to the outpatient ER and get it checked out before its too late. :)

Some tests:
-Pap Smear
-Pelvic Exam
-Ultrasound