Approach to dysmenorrhea Quiz: Ace Your Exams
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A 20-year-old nulligravid woman presents for evaluation of cyclic pelvic pain that has been worsening over the past year. The pain fluctuates between 2 and 5 on a 10-point scale for most of the month but increases to 8 just before and during the first few days of menstruation. Her menstrual cycles are regular with average flow. She is sexually active with a single male partner and avoids penetration in the week leading up to her cycle due to deep dyspareunia. On review of systems, she notes discomfort with voiding around the time of menses. She is otherwise healthy and takes no medication. Family history is notable for infertility and chronic pelvic pain in her mother. Vital signs are within normal limits. The examination reveals rectovaginal nodularity and widespread pelvic tenderness that is especially prominent in the posterior vaginal fornix. The uterus is normal in size and contour but exhibits reduced mobility. Urine pregnancy test is negative. Which of the following is most likely to be found upon further evaluation?
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