A previously healthy 30-year-old woman comes to the physician for the evaluation of pain during sexual intercourse for 6 months. She also reports frequent episodes of crampy pelvic pain that starts one day before menses and lasts for 7 days. Her symptoms are not relieved with pain medication. Menses occur at regular 28-day intervals and last 5 days. Her last menstrual period was 2 weeks ago. She is sexually active with her husband. She uses a combined oral contraceptive pill. Her vital signs are within normal limits. Physical examination shows rectovaginal tenderness and nodularity in the posterior cul-de-sac. Cervical and urethral swabs are negative. Surgical biopsy of the pelvic nodules would most likely show which of the following?

Question

Quizplus · Accepted Answer

Eductional Objective: Endometriosis causes chronic pelvic pain due to ectopic implantation of endometrial glands and stroma in the abdominopelvic cavity.  Bladder implants may also result in dysuria while rectovaginal implants may cause dyschezia, rectovaginal nodularity, and pelvic fibrosis (eg, immobile uterus).

A Previously Healthy 30-Year-Old Woman Comes to the Physician for the Evaluation