Acute Pelvic Pain | Dr. Pixel

Educational and clinical decision support tool. Does not replace a complete medical evaluation.

Clinical assessment

Hemodynamic stability

Signs of shock or acute clinical deterioration.

Does the patient show signs of instability?

Pregnancy / β-hCG

Current pregnancy, suspicion, or unknown status.

Positive β-hCG or suspected pregnancy?

Fever

Fever or suspected infectious process.

Does the patient have fever?

Cervical motion pain

Pain with cervical motion on examination.

Cervical motion tenderness?

Adnexal / pelvic mass

Palpable mass or suggestive finding on exam.

Adnexal or pelvic mass on examination?

Right lower quadrant pain

Peritoneal signs and maneuvers suggestive of appendicitis.

Signs suggestive of appendicitis?

Carnett sign

Differentiates abdominal wall from visceral pain.

Positive Carnett sign?

Suspected endometriosis

Uterosacral nodularity or compatible history.

Uterosacral nodularity or history suggestive of endometriosis?

Summary of physical examination findings in women with acute pelvic pain

Finding	Suggested diagnosis	Considerations for further testing
Adnexal mass and/or unilateral adnexal tenderness	Ovarian cyst or torsion	Transvaginal ultrasonography; gynecology consultation if ovarian torsion is suspected
Carnett sign (increased pain to palpation when the abdominal wall is voluntarily contracted)	Musculoskeletal or abdominal wall pain	No further testing needed
Cervical motion tenderness	Sexually transmitted infection or pelvic inflammatory disease	Testing for sexually transmitted infections; if fever or leukocytosis is present: transvaginal ultrasonography to evaluate for tubo-ovarian abscess; gynecology consultation if tubo-ovarian abscess is suspected
Fever	Appendicitis	Transabdominal ultrasonography (especially if pregnant); computed tomography of the abdomen and pelvis if non-pregnant or ultrasonography is inconclusive
	Pelvic inflammatory disease	Testing for sexually transmitted infection
	Complicated urinary tract infection / pyelonephritis	Urinalysis, urine culture, complete blood count
	Tubo-ovarian abscess	Transvaginal ultrasonography; pelvic magnetic resonance imaging if pelvic ultrasonography is inconclusive; complete blood count
Pelvic mass	Ectopic pregnancy	Beta human chorionic gonadotropin test, pelvic ultrasonography
	Uterine fibroids	Pelvic ultrasonography
	Ovarian cancer	Pelvic ultrasonography; computed tomography of chest, abdomen, and/or pelvis if concern for metastasis
	Ovarian cyst	Pelvic ultrasonography
	Tubo-ovarian abscess	Pelvic ultrasonography
Right lower quadrant pain, McBurney point tenderness, Rovsing sign (palpation of the left lower quadrant causes pain in the right lower quadrant), psoas sign, or obturator sign	Appendicitis	Transabdominal ultrasonography; if it cannot be performed or is inconclusive, computed tomography of abdomen and pelvis with oral and intravenous contrast; complete blood count, infectious disease workup; surgery consultation for appendicitis management
Tachycardia or hypotension	Ruptured ectopic pregnancy or ruptured hemorrhagic cyst	Urgent surgical consultation; complete blood count; beta human chorionic gonadotropin test
Uterosacral ligament tenderness or nodularity	Endometriosis	Ultrasonography; consider laparoscopy if findings are unremarkable

This tool provides educational clinical decision support for the initial evaluation of acute pelvic pain in women. Suggestions are produced by coded clinical rules based on Frasca et al. (American Family Physician, 2023), not by artificial intelligence or statistical models.

What you enter

The questionnaire has eight steps: hemodynamic stability, pregnancy/β-hCG, fever, cervical motion pain, adnexal mass, appendicitis signs, Carnett sign, and suspected endometriosis.

Hypotheses (Recommendation panel)

Each finding adds points to one or more possible diagnoses. Points accumulate across steps — for example, fever and cervical motion pain strengthen pelvic inflammatory disease and tubo-ovarian abscess.

Score ≥ 6: high probability
Score ≥ 3: intermediate probability
Score ≥ 1: possible hypothesis
Coded priorities: instability favors hemorrhagic/ruptured ectopic causes; pregnancy strengthens ectopic pregnancy and abortion; fever and cervical pain point to infectious focus; mass traits (sudden pain, reduced Doppler, etc.) adjust torsion, cyst, and neoplasm; appendicitis signs raise appendicitis; positive Carnett favors abdominal wall pain; suspected endometriosis strengthens deep endometriosis

Recommended studies

The study list uses fixed triggers (e.g., β-hCG with pregnancy or instability, transvaginal ultrasound with mass, CT with suspected appendicitis). There is no Bayesian probability — only finding → suggested test mapping.

Alerts and badges

Emergency, attention, or low-risk messages appear when predefined combinations occur (instability, infectious picture, appendicitis, positive Carnett). They are guidance text, not derived from hypothesis scores.

Table at the bottom of the page

The physical examination summary table translates the reference article table and complements the interactive flow; it does not change app calculations.

Limitations

Educational tool: does not replace a full clinical history, focused examination, or individualized management.
Finding weights and score thresholds were set manually from the published algorithm.
When in doubt or if the patient is unstable, prioritize in-person evaluation and institutional protocols.

Understand the evaluation

How to evaluate acute pelvic pain

Evaluation follows a priority order: first rule out hemodynamic instability (emergency), then assess pregnancy, fever, cervical motion pain, adnexal mass, and appendicitis signs — each finding points to specific differentials (Frasca et al., AFP 2023).

Hemodynamic instability — assess first

Sudden severe pain, hypotension, or syncope raise suspicion of a gynecologic or hemorrhagic emergency: ruptured ectopic pregnancy, ruptured hemorrhagic cyst, or hemoperitoneum. Management: urgent β-hCG, CBC, immediate surgical evaluation, and pelvic ultrasound.

Clinical finding → main differentials

Achado	Diferenciais
Positive pregnancy test	Ectopic pregnancy, miscarriage, hemorrhagic corpus luteum
Fever	Pelvic inflammatory disease, tubo-ovarian abscess, pyelonephritis, appendicitis
Cervical motion pain	Pelvic inflammatory disease, tubo-ovarian abscess
Adnexal mass with sudden severe pain, or reduced Doppler flow	Ovarian torsion
Complex or septated adnexal mass	Ovarian neoplasm, tubo-ovarian abscess
McBurney, Rovsing, psoas/obturator signs	Appendicitis
Positive Carnett sign	Musculoskeletal or abdominal wall cause (non-gynecologic)

Common questions

Frequently asked questions about acute pelvic pain

Why is hemodynamic stability assessed before anything else?+

Because sudden severe pain, hypotension, or syncope suggest a gynecologic or hemorrhagic emergency — ruptured ectopic pregnancy, ruptured hemorrhagic cyst, or hemoperitoneum — requiring urgent β-hCG, CBC, and immediate surgical evaluation before investigating other causes.

What differentials does an adnexal mass with sudden severe pain suggest?+

Ovarian torsion is the main concern, especially with reduced Doppler flow in the mass. Complex or septated masses raise suspicion for ovarian neoplasm or tubo-ovarian abscess.

What diagnoses does fever with acute pelvic pain suggest?+

Pelvic inflammatory disease, tubo-ovarian abscess, pyelonephritis, and appendicitis are the main differentials when fever is present.

What does cervical motion pain on exam mean?+

It is a sign of high infectious suspicion, mainly associated with pelvic inflammatory disease and tubo-ovarian abscess.

Which physical exam signs suggest appendicitis?+

McBurney's sign, Rovsing's sign, right lower quadrant pain, and psoas/obturator signs — especially combined with fever — should raise suspicion for appendicitis.

What does a positive Carnett sign indicate?+

It suggests a musculoskeletal or abdominal wall cause, making a gynecologic cause of the pain less likely.