A 25-year-old woman comes to the emergency department with a sudden fever of 38.3$\degree$ C and abdominal pain. Upon examination, the nurse notices that she has rigid, boardlike lower abdominal musculature. When the nurse tries to perform a vaginal examination, the patient has severe pain when the uterus and cervix are moved. What do these findings suggest?

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These signs and symptoms are suggestive of acute pelvic inflammatory disease, also known as acute salpingitis. Endometriosis may have masses (in various locations in the pelvic area) that are small, firm, nodular, and tender to palpation, with enlarged ovaries. Uterine fibroids often are asymptomatic. Symptoms that may occur included vague discomfort, bloating, heaviness, pelvic pressure, dyspareunia, urinary frequency backache or excessive uterine bleeding. The uterus may be irregularly enlarged, firm, mobile and nodular with hard, painless nodules in the uterine wall. An ectopic pregnancy presents with sharp, stabbing abdominal or pelvic pain, vaginal spotting or new-onset bleeding, and positive pregnancy test. There will likely be a softening of the cervix and fundus; movement of cervix and uterus causes pain; and palpable tender, round mobile swelling, lateral to uterus.

A 25-Year-Old Woman Comes to the Emergency Department with a Sudden