When approaching the patient with acute pelvic pain, it is imperative to keep in mind the subtle differences each diagnosis can present with. Narrowing down pelvic pain to a specific location in the body while maintaining a high index of suspicion for acute pelvic pain emergencies will aid in a more rapid and accurate diagnosis. Bear in mind that acute pelvic pain is a clinical challenge, and although an exact diagnosis maybe elusive, emergency treatment should always be provided first and foremost despite an exact diagnosis.