Rationale

Painful menstruation is a very common symptom, and this pain can be incapacitating for some patients. Dysmenorrhea is a significant cause of absence from work, school, or other responsibilities.

Causal Conditions

(list not exhaustive)

1. Primary/idiopathic (no demonstrable pelvic abnormality recognized on available investigations or examination)

2. Secondary to identified acquired or congenital conditions (e.g., infections, endometriosis, adnexal abnormalities)

Key Objectives

Given a patient with dysmenorrhea, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. Specifically, the candidate will differentiate primary from secondary dysmenorrhea.

Enabling Objectives

Given a patient with dysmenorrhea, the candidate will

1. list and interpret critical clinical findings, including those based on

   1. a focused history of the quality and timing of pain, as related to bleeding;

   2. the differentiation between primary and secondary dysmenorrhea; and

   3. the results of a pelvic examination aimed at excluding possible causes of secondary dysmenorrhea;

2. list and interpret critical investigations, including

   1. Papanicolaou test, if indicated;

   2. screening test for infection (e.g., vaginal and cervical cultures); and

   3. determination of indications for imaging studies (e.g., ultrasonography); and

3. construct an effective initial management plan, including

   1. outlining treatment options including symptomatic control;

   2. determining whether the patient needs to be referred for investigation (examination under anesthesia, laparoscopy); and

   3. determining whether the patient requires specialized care.