Acute pelvic pain is commonly defined as pain in the pelvis or lower abdomen lasting less than 3 months [1]. Pelvic pain is a common complaint, and it is estimated that approximately one in seven women of reproductive age will be evaluated for pelvic pain [2]. The workup and diagnosis of acute pelvic pain can be challenging, because signs and symptoms are often nonspecific and insensitive. Also, the clinical presentation of each cause of pelvic pain may vary from patient to patient. Therefore, an effort must be made to keep a broad differential diagnosis when assessing patients with acute pelvic pain in order to consider both common causes, such as urinary tract infections and cervicitis, and also uncommon causes, such as heterotopic pregnancy and mesenteric adenitis. It is critical to quickly identify emergent conditions of acute pelvic pain such as ectopic pregnancy, ovarian torsion, and appendiceal perforation. The consequences of missing these diagnoses are high and may result in infertility or death.

The differential diagnosis of acute pelvic pain is vast and includes pathology from a wide variety of organ systems. The differential diagnosis of pelvic pain also varies with respect to the patient’s age. Therefore, when constructing a differential diagnosis for acute pelvic pain, it can be helpful to categorize conditions based on pregnancy status, organ systems, and the patient’s age.

A thorough history and physical examination is essential to the diagnosis of acute pelvic pain in the emergency department. Eliciting specific information about the patient’s clinical situation and correlating that information with the patient’s physical examination allow a physician to choose the appropriate laboratory testing and imaging modalities in order to identify the cause of that patient’s pain.

Important historical features to elicit include: