Question

A 27-year-old G0 woman presents due to a one-year history of dysmenorrhea and dyspareunia. Pain, when present, is 7/10 in strength and requires that she miss work. She now avoids intercourse and no longer finds it pleasurable. She is otherwise in good health. Her last menstrual period was 17 days ago and her menses are typically 28 days apart. She had chlamydia once, at age 19. Physical examination is notable for some tenderness on abdominal and pelvic exams in the lower quadrants. Uterus is normal in size and there is uterosacral ligament nodularity. What is the most likely diagnosis in this patient?

A. Adenomyosis
B. Chronic pelvic inflammatory disease
C. Endometriosis
D. Endometritis
E. Premenstrual dysphoric disorder

Answer 1

The woman's symptoms and physical examination findings are most consistent with Endometriosis, which is characterized by endometrial tissue growing outside the uterus, leading to severe pelvic pain, inflammation, and scarring.

Step-by-step explanation:

The most likely diagnosis for a 27-year-old woman with a one-year history of dysmenorrhea and dyspareunia, along with uterosacral ligament nodularity and normal-sized uterus, is C. Endometriosis. Endometriosis is a condition characterized by the growth of endometrial tissue outside the uterus, which can lead to inflammation, pain, and scarring, especially during menstruation. This explains the patient's symptoms of pelvic pain, which is the main symptom of endometriosis. The past history of chlamydia could be relevant, as pelvic inflammatory disease (PID) is also in the differential diagnosis, but PID often has additional symptoms such as fever, irregular bleeding and discharge, which are not present in this case. Endometriosis is commonly associated with pain during intercourse (dyspareunia) and menstrual cramps (dysmenorrhea), both of which are prominent in this patient's presentation.