Author: Tanzeela Mariam Shuja, Shuja Ul Latif / Editor: Nick Tilbury / Codes: GP1, ObC12, ObP1, SLO1 / Published: 21/09/2022

A 27-year-old woman comes into the Emergency Department (ED) complaining of pain on urination with lower abdomen discomfort for the last 2 months. She visited the ED two weeks earlier and was discharged on antibiotics after a diagnosis of UTI was made.

The patient also complains of pain on defecation, especially during her period. She denies any change in her bowel movements and has had no fever or vaginal discharge.

Her periods are usually regular, occurring every 28 days and lasting for 5 days. Normally during menstruation, she experiences just slight lower abdominal pain and a mild flow.

Past Medical History: None of note

Sexual History: She has had one regular, male sexual partner for the last 3 years and always uses condoms during intercourse. She has no history of sexually transmitted infections (STIs).


  • Observations: RR 20, HR 80, BP 123/86 mmHg, apyrexial,
  • Abdomen: Mild suprapubic tenderness, no organomegaly
  • Pelvic: Normal-sized retroverted uterus with no irregularities
  • Rectal: Nodularity felt in the Posterior cul-de-sac (the space between the uterus and rectum) Urine dip: normal.

Module Content