Mystery gyno pain: strange twinges or dull aches down there? Find out how to stop those below-the-belt agonies

A persistent or recurring ache or pain that strikes between your navel and crotch can be more difficult to diagnose than most women would ever guess. While ovarian cancer may be the first thing to leap to your mind (and not entirely without reason; it ranks as the fourth-leading cause of cancer death among U.S. women), the more likely scenario is one of the more common, but still potentially dangerous, gyno woes that follow.

It can, however, be frustrating and difficult to pinpoint the specific source of gynecological pain, because so many organs--the uterus, the ovaries, the fallopian tubes, the bladder and the rectum--share a relatively compact space, notes Kathleen Fitzgerald, M.D., a clinical assistant professor of obstetrics and gynecology at Brown Medical School in Providence, R.I. "Separating them [as pain sources] isn't easy for patients or physicians."

If it's just a mild twinge, you might be tempted to shrug it off or pop an over-the-counter pain reliever. "Unfortunately, the level of pain does not necessarily correlate with the cause," Fitzgerald says. "Some people with a high pain threshold won't be doubled over." So if the discomfort becomes persistent, it's essential to learn how to name your pain, pinpoint the source and effectively communicate those details to your gynecologist.

Here's what you need to know about types of pain and what they might mean.

The pain: an intense ache in the lower pelvis

* If the pain is sharp or there's tenderness around the navel or on the right side of the abdomen, it could indicate appendicitis (in which case you'd probably have a slight fever too), but it may also be a sign of a ruptured ovarian cyst or ovarian torsion.

* Ovarian cysts, like cysts elsewhere, are closed sacs, usually filled with fluid or semisolid material. If the cyst ruptures, pain medication--a nonsteroidal anti-inflammatory drug (NSAID) for mild pain, codeine or oxycodone for more severe pain--may be necessary until the hurt subsides and the lesion heals, according to Gerson Weiss, M.D., a professor and the chair of the department of obstetrics, gynecology and women's health at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School in Newark.

* Ovarian torsions (twisting) are most common when the fallopian tube on the side that's painful has been removed or when the cyst present is a dermoid cyst. These result when cells in the ovary develop into mature tissues and structures such as hair, bone and teeth. A twisted ovary may have its blood supply blocked. If that doesn't cause the ovary to die, it can be untwisted surgically to save the organ.

The pain: a sharp ache in the abdomen with vaginal bleeding

* When experienced along with weakness or dizziness, such symptoms can signal an ectopic pregnancy, a potentially life-threatening condition in which a fertilized egg grows in the fallopian tube instead of in the uterus. Such a pregnancy must be terminated either with medication, with laparoscopic surgery (the insertion of a telescopic probing device into the abdomen) or with an open laparotomy (full abdominal surgery), according to David Foster, M.D., an associate professor of obstetrics and gynecology at the University of Rochester School of Medicine and Dentistry in Rochester, N.Y.

The pain: sharp cramps seemingly unrelated to your period

* More than 50 percent of women suffer from pain during their periods, something doctors call dysmenorrhea. But only about 20 percent experience Mittelschmerz, German for "middle pain," which occurs 14-16 days before menstruation begins, when an egg is released by the ovary. Depending on how pain-sensitive a woman is, she may feel this as mild to moderately severe discomfort that lasts a few hours or a day before fading.

* Premenstrual cramps, on the other hand, which typically occur five to 11 days before menstruation, can be severe enough to interfere with daily routines and activities for 30-40 percent of women. A common symptom of premenstrual syndrome (PMS), which affects 70-90 percent of women, the cramping is brought on by the release of prostaglandins, fatty acids made by the body that act as messengers and can stimulate muscle contractions, including that of the uterus. An NSAID such as ibuprofen or naproxen can relieve this type of cramping; so can applying a hot-water bottle to the lower abdomen, Fitzgerald says.

* Noncyclical cramping experienced for at least six months in the pelvis, lower back or buttocks may be diagnosed as chronic pelvic pain. (See "What Is Chronic Pelvic Pain?" on page 117 for more information about this condition, which affects nearly one-quarter of women ages 18-49.)

The pain: A burning or "cutting" sensation during sex

Sex is supposed to be one of the most pleasurable activities on the planet, so when penetration and thrusting hurt, it can be both physically and emotionally traumatic. Nearly two out of three women will experience painful sex, known as dyspareunia, at some point, according to the American College of Obstetricians and Gynecologists. If sex is only occasionally painful, the cause may be nothing more than inadequate lubrication. If it's more frequent, other conditions may be to blame: