Lower abdominal pain in women

Upper genital tract infection should be suspected in women with lower abdominal pain (see Upper genital tract infections).
Gynaecological examination should be routinely performed:
– Inspection of the vulva, speculum examination: check for purulent discharge or inflammation.
– Abdominal exam and bimanual pelvic exam: check for pain on mobilising the cervix. 

If available, POCUS1 : perform FAST views to evaluate for free fluid and urological abnormalities. Perform pelvic views to evaluate for uterine and adnexal pathologies. Consult a gynaecologist (local or via telemedicine services). 

Case management

* Look for another cause (in particular, gastrointestinal or urinary pathology).
** Look for a pregnancy related pathology (threatened abortion, extra-uterine pregnancy) or a complication (peritonitis, pelvic abscess).

Ref Notes
1 POCUS should only be performed and interpreted by trained clinicians.