Investigations

1st investigations to order

urinalysis

Test
Result
Test

Useful to rule out the possibility of infective cystitis or urethritis.[3][26]​​

Result

positive/negative

urine culture

Test
Result
Test

Useful to rule out the possibility of infective cystitis or urethritis.[3]

Result

positive/negative

nucleic acid amplification test

Test
Result
Test

Useful to screen for chronic sexually transmitted infections: for example, chlamydia, gonorrhoea, mycoplasma, trichomonas.[1]

Result

positive/negative

pelvic ultrasound

Test
Result
Test

Pelvic ultrasound may be useful to find fibroids, adenomyosis, or large ovarian cysts.[1][30]

Result

may identify fibroids, adenomyosis, or large ovarian cysts

alkalinised lidocaine instillation into bladder

Test
Result
Test

Relief of bladder pain symptoms at the time of alkalinised lidocaine instillation is diagnostic for pain of bladder origin.

Result

relief of bladder pain symptoms

Investigations to consider

pelvic CT

Test
Result
Test

Pelvic CT can be considered to characterise any pelvic masses found on ultrasound. It can also characterise the extent of large fibroid uterus and adnexal mass, or detect a hernia.

Result

further characterisation of pelvic mass previously seen on ultrasound

pelvic MRI

Test
Result
Test

A more sensitive diagnostic test than ultrasound for the identification of adenomyosis and endometriosis.[31][32]​ MRI does not have a routine place in the diagnosis of most chronic pelvic pain.[33][34]​ 

Result

may identify adenomyosis

laparoscopic biopsy

Test
Result
Test

Definitive test for confirming diagnosis of endometriosis and adenomyosis.

Result

histological characteristics of endometriosis or adenomyosis

cystoscopy with hydrodistension

Test
Result
Test

For patients with interstitial cystitis, distension may be diagnostic and therapeutic.

Result

visualisation of features of interstitial cystitis; possible reduction in pain and discomfort

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