Photo from http://steptohealth.com/symptoms-of-pelvic-inflammatory-disease-pid/
Differential Diagnosis #1: Pelvic Inflammatory Disease (PID)
Rationale
The patient’s description of pelvic pain during menstruation, dysuria, and dyspareunia are often symptoms of Pelvic Inflammatory Disease (PID).
PID is an infection caused by bacteria that travels from the vagina or cervix to your womb, fallopian tubes, or ovaries and causes an infection. PID is often caused by bacteria from chlamydia and gonorrhea. (“Pelvic Inflammatory Disease”, n.d.)
PID would be ruled out with a vaginal swab to test for any organisms that might have caused the infection (especially chlamydia or gonorrhea), a transvaginal ultrasound, or with laparoscopy.
Photo from http://womensvoicesforchange.org/ovarian-cysts-in-post-menopausal-women-what-to-look-for-and-what-to-ask.htm
Differential Diagnosis #2: Ovarian Cysts
Rationale
Again, the presentation of pelvic pain during menstruation, dysuria, dyspareunia and also dyschezia are common symptoms of ovarian cysts.
Ovarian cysts are fluid-filled sacs in the ovary. They are common and generally have no symptoms and resolve themselves with no intervention. When cysts grow large or multiply is when they can cause painful symptoms and/or further problems.
There are several different types of ovarian cysts including dermoid cysts, cystadenomas, endometriomas, and the most common form, functional cysts (which are further subdivided into follicle cysts and corpus luteum cysts).
To rule out an ovarian cyst, a pelvic exam can be performed to palpate for swollen masses on the ovaries. An ultrasound can also be performed to visually verify or nullify. (Higuera, 2015)
Photo from https://en.wikipedia.org/wiki/Endometriosis
Differential Diagnosis #3: Endometriosis
Rationale
The patient’s presenting symptoms of dull and cramping pelvic pain longer than 6 months, dyschezia, dysuria, dyspareunia, and history of inability to conceive would provide rationale for endometriosis. It would be necessary to rule out the above two possibilities, as the clinical manifestations of endometriosis can often look like other disease processes (McCance & Huether, 2014). We would start with an exam and palpate for pain. A transvaginal ultrasound would be used to attempt to visualize an endometrial growth outside of the uterus but the gold standard for confirmation of endometriosis is laparoscopy (Hsu, Khachikyan and Stratton, 2010).