Objective: To measure the ability of transvaginal ultrasonography to diagnose the possible causes of pelvic pain. ,Study design and procedure:It is a prospective study, where 50 cases of pelvic pain were recruited, thorough clinical examination of these cases failed to find an expaination for their pain and each case underwent a transvaginal ultrasonic examination (TV/US) using a 90 degrees 5 MHz probe and a high resolution machine (Aloka SDD 500, Japan). A diagnostic laparoscopy was then done for each case under general anesthesia using a complete set rom Storz including endovisual capability. Histopathology was done in certain cases. Findings of the two techniques were recorded and compared.
Outcome measures: The sensitivity, specificity and positive predective values of TV/US to diagnose different causes of pelvic pain as confirmed by laparoscopy and histopathology if neede.
Results: The study indicated that as much as 22% of pelvic pain do not have any organic background even after dignostic laparoscopy. TV/US has a specificity of 100%, positive predective value of 100% but a sensitivity of 51.3% in diagnosing clinically undetectable problems. It could detect clinically undetectable ovarian cyst (14%), and ectopic pregnancy (6%) with a sensitivity, specificity and positive predective values of 100%. The corresponding values were 85.7%, 100% and 100% for pelvic inflammatory disease (12%) and 100%, 97.6% and 66.6% for cases of prolapsed ovary in Douglas pouch (4%). However, it could not diagnose pelvic adhesions (20%), endometriosis(10%), pelvic T.B.(4%) and pelvic congestion(8%) which are common causes of pelvic pain.
Conclusion: Although TV/US is a sensitive tool for diagnosis of many causes of pelvic pain, it can not replace laparoscopy in diagnosing cases like endometriosis, T.B., PELVIC ADHESIONS AND CONGESTION. tHE TWO TECHNIQUES COMPLETE RATHER THAN COMPETE WITH EACH OTHER.