When a woman complains of lower abdominal pain, the provider
uses the lower abdominal pain algorithm. If she complains of
both lower abdominal pain and vaginal discharge, the provider
still uses the lower abdominal pain algorithm since it can determine
if a potentially life-threatening condition is present. This
slide shows one possible algorithm to use with this syndrome.
Before deciding if a woman should be treated for PID, a provider
must first determine if the abdominal pain indicates another
condition that requires immediate surgical attention. The provider
takes a history and does a physical exam, checking specifically
for abdominal tenderness. The provider should see if there is
increased tenderness when pressing and quickly releasing muscles
in the abdominal area, called rebound tenderness.
This rebound tenderness may be a sharp pain, more distinctive
than the general pain of the presenting symptom. Rebound tenderness
may indicate a serious, life-threatening complication, such
as ectopic pregnancy; complications from delivery, miscarriage
or abortion; appendicitis; or some other acute condition.
If the woman has rebound tenderness, the provider should refer
her immediately for evaluation to a facility with surgical capabilities
and trained specialists. Referral may be difficult in some areas.
If the woman does not appear to need immediate surgical evaluation,
the provider moves to the next step in the algorithm, to identify
whether she has PID.