Dear Dr Mitchell,
I am a 24-year-old lady who has had sex once in my life. I have never been pregnant and I am not sexually active, but I have this deep pain in my womb even when I am not on my period.
The pain is unbearable. What can I do?
The pain that you experience deep in your womb may be due to one of several factors.
This pain may be due to an ovarian cyst that has suddenly increased in size or a cyst in the ovary that has had some bleeding into it. In some cases, an ovarian cyst can leak or rupture and this can cause quite a disabling or unbearable pelvic pain.
In the case of a ruptured ovarian cyst, there can be significant internal bleeding which can cause dizziness, fainting spells or shock in some severe cases, warranting emergency surgery because of the blood loss.
Torsion of an ovarian cyst is a condition where the ovary twists on its pedicle and this interferes with the blood flow. This is associated with severe pain, and is an emergency that warrants surgical correction to preserve the ovary.
Endometriosis in the ovaries, uterine muscles, or in the lining of the pelvis can also present with severe pelvic pain.
Endometriosis is a condition where tissues similar to that lining the inside of the uterus is present outside of the cavity of the uterus, and these deposits bleed in a similar manner to the lining of the uterus at the time of the menstrual period. This results in adhesions (sticking together of the pelvic organs) and severe pelvic pain that usually starts before the menstrual flow, continues throughout the period, with pain even after the period is finished. This can sometimes cause difficulty becoming pregnant and severe debilitating pelvic pain. It can be confirmed on doing a minor procedure called a diagnostic laparoscopy, and treated using hormonal medications or by surgery in severe cases.
Uterine fibroids may also cause severe pelvic pain, in addition to heavy menstrual periods.
In sexually active women, pelvic infection, which is detected late or not treated completely, can result in severe pelvic pain. This, too, can result in damage to the fallopian tubes, and infertility.
In some cases the pain may be due to an infection in the bladder, stones in the bladder or kidneys, or even problems in the bowel.
It is important for you to get a complete physical examination and an ultrasound of the abdomen and pelvis to determine the underlying cause of the pelvic pain so that appropriate treatment can be started. You should also do a pap smear to screen for cervical cancer and get the HPV vaccine for prevention of cervical cancer.
Consult your doctor, who will advise you further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to firstname.lastname@example.org ; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.