Amenorrhea Quiz: Ace Your Exams

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A 14-year-old girl was brought to the clinic by her mother due to abdominal and back pain over the past few months. The pain started approximately 6 months ago and since then has progressively worsened. Each month, the patient experiences a few days of severe pain that cause her to miss school. She also discloses pain with defecation and difficulty urinating. The patient had not yet had a menstrual period and is not sexually active. In the office, the patient’s temperature is 37.6°C (99.7°F), pulse is 65/min, and blood pressure is 121/73 mmHg. On physical examination, the patient is Tanner stage 5 with fully developed female secondary sex characteristics. Suprapubic fullness and tenderness are noted. β-hCG is negative. Which of the following is most likely the cause of this condition? 

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