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9. Genito-urinary diseases

Lower abdominal pain in women

U pper g enital tract infection (see pag e 240) sh ould be suspected in wom en with low er
abd om inal pain.
Gynaecolog ical exam ination sh ould be routinely perform ed :
– Inspection of th e v ulv a, speculum exam ination: ch eck for purulent d isch arg e or

inflam m ation,
and
– Abd om inal exam and bim anual pelv ic exam : ch eck for pain on m obilising th e cerv ix.

Case management

P atient com plains of lower
abd om inal pain

Following d eliv ery or YE S S ee Post-partum/abortum UGTI, pag e 240
abortion?

NO

T ake h istory and
exam ine

Any of th e following

present? NO Is th ere cerv ical m otion N O Any oth er
– Am enorrh oea tend erness or abnorm al illness found *?
– Abnorm al v ag inal v ag inal d isch arg e?

bleed ing YE S YE S
– Abd om inal g uard ing or

rebound tend erness

9

YE S S ee Sexually transmitted M anag e
UGTI, pag e 240. appropriately
Request Rev iew in 3 d ays.
g ynaecolog ical/surg ical
P atient h as im prov ed ? NO Refer patient
consultation**

YE S

Continue treatm ent
until com pleted

* Look for anoth er cause (in particular, g astrointestinal or urinary path olog y).
**Look for a preg nancy related path olog y (th reatened abortion, extra-uterine preg nancy) or a

com plication (peritonitis, pelv ic abscess).

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