<prompt> A 25-year-old female states that she and her husband have been trying to have a baby for the last two years. The patients medical history included cyclical pelvic pain, dysmenorrhea, dyspareunia, and, not uncommonly, infeility. The physical exam reveals the following: diffuse abdominal or pelvic pain of variable location, nodular thickening and tenderness along the uterosacral ligaments, on the posterior surface of the uterus, and in the posterior cul-de-sac, scarring and narrowing of the posterior vaginal fornix, and adnexal enlargement and tenderness. What is your diagnosis?EndometriosisEctopic pregnancyAdnexal massPelvic relaxation  <response>: Endometriosis is the growth of tissue outside the uterus. The ectopic endometrial tissue can proliferate, and infiltrate, and spread to remote sites elsewhere in the body. Sites that endometriosis is most often found are, ovarian, pelvic peritoneum, anterior and posterior cul-de-sac, uterosacral, round, and broad ligaments, and fallopian tubes. An ectopic pregnancy is one that develops at any site other than the endometrium. Symptoms of an ectopic pregnancy are abdominal pain possible a missed period, abnormal bleeding at the time of presentation is not uncommon. Physical characteristics of an adnexal mass that may give a presumptive diagnosis: consistency cystic, solid or both, size in centimeters morphology and surface contour smooth, nodular, vague or sharp borders, location around the uterus, mobility free or fixed to adjacent structures tenderness, unilateral or bilateral. Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. 2010. Chapter 40. Reproductive Tract Abnormalities. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong Eds, Williams Obstetrics, 23e. 