QuestionSBA
QuestionChoice
An infection of the female reproductive organs is pelvic inflammatory disease (PID). Although it can present with pelvic pain, it is often associated with symptoms like fever, abnormal vaginal discharge, and a history of sexually transmitted infections. The absence of these characteristic features in the patient's history makes PID less likely in this case.
10025408
d
An infection of the female reproductive organs
QuestionChoice
Benign uterine growths, called fibroids can cause pelvic pain and other symptoms. However, the key feature in this case is the progressive nature of the pain and its association with dysmenorrhea, which is more indicative of endometriosis rather than fibroids. Fibroids tend to cause more chronic, non-cyclical pain and may lead to heavy menstrual bleeding.
10025406
b
Benign uterine growths
QuestionChoice
This is the correct answer. The vignette describes endometriosis, which is characterised by endometrial tissue outside the uterus. Endometriosis is known for causing severe pelvic pain, which is often cyclical and can worsen over time. This aligns with the patient's complaint of progressively worsening pain. The symptoms of dysmenorrhea, dyspareunia, subfertility and bleeding between periods fit the clinical picture of endometriosis. Examination findings of tenderness upon palpation of the pelvic area indicate endometriotic lesions causing localised inflammation and sensitivity in this region.
10025405
a
Endometrial tissue outside the uterus
QuestionChoice
Idiopathic or primary dysmenorrhea is characterised by crampy pelvic pain at the onset of menses with no identifiable pelvic pathology. However, in this vignette, the clinical picture points to endometriosis, with dysmenorrhoea, dyspareunia, bleeding between periods and subfertility.
10025409
e
Idiopathic, no pelvic pathology
QuestionChoice
Ovarian cysts are fluid-filled sacs that can form in the ovaries. They can cause discomfort and pain, but the patient's symptoms, including severe pelvic pain and painful intercourse, are more strongly associated with endometriosis. This is characterised by endometrial tissue outside the uterus.
10025407
c
Fluid-filled sacs in the ovaries
Concept
Chapter
2693
5838
Dysmenorrhoea
Topic
176
Gynaecology
17479
A 32 year old woman presents to her gynaecologist with a history of severe pelvic pain and dysmenorrhea. She describes the pain as progressively worsening over the past few years and is particularly noticeable during sexual intercourse. The pain is not relieved by over-the-counter pain relievers. Sometimes, she observes vaginal bleeding between her periods.

She has a single sexual partner and denies any abnormal vaginal discharge. She and her partner are currently awaiting an appointment with a fertility specialist, as they have not been able to conceive despite trying for over a year.

On physical examination, there is tenderness upon palpation of the pelvic area. All observations are within normal limits.

Which of the following is the most likely cause of this patient's symptoms?
a