This may or may not be related to the menstrual cycle. Premenstrual pain may represent endometriosis. Dysmenorrhoea refers to painful menses, usually of a crampy nature. This is usually central low abdominal cramp but can be referred to the thighs and lower back.
Primary dysmenorrhoea – periods have been painful since established menstruation has occurred.
Secondary dysmenorrhoea – periods have become painful. This is thought to be more likely to be associated with pelvic pathology.
Mittelshmertz – mid-cycle pain related to ovulation. There are a number of other organ systems that can be
responsible for pelvic pain. The most likely sources within the pelvis are the gastrointestinal and urinary tracts. It is
important to ask about these systems when assessing for a source of pain. For example, acute right iliac fossa pain could represent an ovarian cyst accident or appendicitis among other diagnoses. Classically, appendicitis will also present with anorexia.
Dyspareunia – Pain or exacerbation of underlying pain during sexual intercourse is an important symptom. Deep dyspareunia implies pathology of the upper genital tract. Patient will describe the pain as ‘deep inside’ during intercourse. Superficial dyspareunia is more likely to represent a vaginal cause. Superficial causes of dyspareunia include causes such as local infections, that is, Candida or scarring from episiotomy or vaginal tears during childbirth. Vaginismus is also a common cause of dyspareunia, where the vaginal muscles tense during attempted penetration. It can affect tampon insertion and smear taking and can usually be demonstrated with vaginal examination. It may be present in women with entirely healthy vaginal tissues, but understandably women who experience dyspareunia for any reason can tense up because of anticipation of pain so the presence of vaginismus does not exclude pelvic pathology. A careful one finger vaginal examination to identify if there are any specific areas of tenderness can be useful if the patient will not tolerate a speculum or two-finger bimanual.