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ACP MKSAP Interdisciplinary Medicine
A 24-year-old woman is evaluated for 6 months of pelvic and back pain that is worse around the time of menses. She also has pain with sexual intercourse. She has tried ibuprofen, with minimal relief. Her menstrual periods are regular and have not changed. She is sexually active with one male partner and uses condoms for contraception. She has no other medical problems and takes no medications.
On physical examination, vital signs are normal. External gynecologic examination is normal. Speculum examination shows a normal-appearing cervix and no discharge. Bimanual examination is notable for pain in the posterior vaginal fornix but otherwise reveals a uterus of normal size and shape with no cervical motion or uterine tenderness.
A pregnancy test result is negative.
Which of the following is the most likely diagnosis?
A: Endometriosis
B: Ovarian cyst
C: Pelvic inflammatory disease
D: Uterine fibroid
Back to the March 2025 issue of ACP Global