Approach to chronic pelvic pain (GYN) Quiz: Ace Your Exams

A 41-year-old woman presents to the clinic with a 9-month history of anterior pelvic pain. The pain is dull and aching. She reports a constant sensation of pressure in the same area and that sexual intercourse with her husband has become painful. The pain is more noticeable when her bladder is full and is relieved with urination. She also has urinary frequency, urgency and nocturia. She does not have dysuria, gross hematuria, bowel habit changes, abnormal vaginal bleeding or discharge. Her past medical history is unremarkable. She had one normal spontaneous vaginal delivery 2 years ago after an uncomplicated pregnancy. Vital signs are within normal limits. Abdominal examination reveals suprapubic tenderness. Pelvic examination shows a 7 cm mobile uterus. There is no uterine, adnexal or costovertebral angle tenderness or masses. hCG is and urinalysis is negative. Which of the following additional physical examination findings would support the likely diagnosis?