Using transvaginal ultrasound to determine the cause of chronic pelvic pain

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Mrs. C, 29, tells her NP that she has had intermittent left lower abdominal pain, particularly midway through her menstrual cycle, for the last 3 months. She also describes pain with intercourse over the last 3 months. Mrs. C feels generally well and has no other complaints. However, she is concerned because the pain seems to be getting worse every month.
During her history, Mrs. C states that the pain is not interfering with her work or home life. She has taken ibuprofen with relief. Her last menstrual period was 2 weeks earlier, and she describes her periods as regular, lasting approximately 4 days each month. Mrs. C's last Pap test was 6 months ago, and the results were normal. She is happily married and has two young children. Mrs. C denies sexual partners other than her husband of 10 years and does not believe he has had other partners since their marriage.
Upon exam, Mrs. C is a well-groomed and pleasant historian. Her abdominal exam is normal; her genitalia exam revealed pink vaginal walls with rugae. A small amount of thin, white vaginal discharge was noted on exam. The bimanual exam revealed pain with deep palpation of the left adnexal area. After completing Mrs. C's history and physical exam, the NP told Mrs. C that she was going to order a test to assist in the differential diagnosis. A transvaginal ultrasound (TVU) was ordered to check for uterine or ovarian abnormalities.

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