Question of the Week

For November 25, 2014

A 33-year-old woman reports a 2-year history of chronic pelvic pain. She describes the pain as intermittent, throbbing, and more intense at the time of her menses. It radiates to her back on both sides. She has dyspareunia on deep penetration but no dysuria or dyschezia. She has had one pregnancy culminating in a full-term vaginal delivery.

On bimanual examination, she has diffuse tenderness, particularly on the left side. She has no palpable pelvic masses. A cervical smear is normal, and cervical cultures are negative. Urinalysis is within normal limits, and a pregnancy test is negative.

Which one of the following next steps is most appropriate for this patient?

Cystoscopy
A trial of oral contraceptive pills and ibuprofen
Trigger-point injection
Laparoscopy
Transvaginal ultrasonography