Adnexal Tenderness: Causes & Reasons

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Possible Causes for Adnexal Tenderness

Female Pelvic Inflammatory Disease

Seventeen days later, she presented with severe bilateral lower abdominal pain, cervical motion tenderness, uterine tenderness, and bilateral adnexal tenderness. [ncbi.nlm.nih.gov]

The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. [cdemcurriculum.com]

[…] has the highest specificity (93%).16,17 Bimanual exam findings suggestive of PID include cervical motion tenderness, uterine tenderness, and/or adnexal tenderness. [mdedge.com]

Tubo-Ovarian Abscess

Upon palpation, patients affected by a TOA usually report adnexal tenderness, that is unilateral. [symptoma.com]

uterine tenderness, or adnexal tenderness. [emdocs.net]

On pelvic exam, you note purulent discharge from the cervix and severe bilateral adnexal tenderness to palpation. [saem.org]

Tubal Pregnancy

[…] of cervical motion tenderness (LR+ 4.9; 95% CI, 1.7-14; n = 1435), an adnexal mass (LR+ 2.4; 95% CI, 1.6-3.7; n = 1378), and adnexal tenderness (LR+ 1.9; 95% CI, 1.0-3.5; [doi.org]

The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. [saem.org]

uterine tenderness, or adnexal tenderness. [emdocs.net]

Ovarian Torsion

Physical examination may reveal lower abdominal tenderness. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. [cdemcurriculum.com]

Pelvic inflammatory disease Sexually active female with lower abdominal pain, cervical motion tenderness, and adnexal tenderness. [online.epocrates.com]

There is adnexal tenderness. A raised white cell count is common. [radiopaedia.org]

Chlamydial Pelvic Inflammatory Disease

The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. [cdemcurriculum.com]

tenderness, or both. [annals.org]

tenderness and pelvic masses), as well as microscopic evaluation of a cervicovaginal discharge sample. [news-medical.net]

Chronic Pelvic Inflammatory Disease

The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. [saem.org]

Uterine Tenderness Adnexal Tenderness The following add support for the diagnosis: Fever (>101°F / >38.3°C) Mucopurulent cervical discharge or friability Wet prep with abundant [pedemmorsels.com]

[…] or uterine tenderness or adnexal tenderness. [mshc.org.au]

Acute Pelvic Inflammatory Disease

An optimal set of PID indicators consisted of adnexal tenderness, lower abdominal pain of < one week's duration and an elevated white blood cell count. [ncbi.nlm.nih.gov]

The most frequent signs and symptoms were abnormal vaginal discharge (100%), adnexal tenderness (97.1%), cervical motion tenderness (94.3%) and fever ≥ 38.3 degrees C (82.9% [ncbi.nlm.nih.gov]

Adnexal tenderness Thickening or definite mass Minimum clinical criteria for diagnosis Cervical motion tenderness Uterine tenderness Adnexal tenderness The presence of temperature [medchrome.com]

Ovarian Cyst Torsion

Physical examination may reveal lower abdominal tenderness. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. [cdemcurriculum.com]

One study of emergency department physicians found an inter-examiner reliability of only 23% for detection of pelvic masses, and only 32% for the presence of adnexal tenderness [emlyceum.com]

The abdomen may feel tender. Doctors usually suspect adnexal torsion based on symptoms and results of a physical examination. [merckmanuals.com]

Ectopic Pregnancy

[…] of cervical motion tenderness (LR+ 4.9; 95% CI, 1.7-14; n = 1435), an adnexal mass (LR+ 2.4; 95% CI, 1.6-3.7; n = 1378), and adnexal tenderness (LR+ 1.9; 95% CI, 1.0-3.5; [ncbi.nlm.nih.gov]

A lack of adnexal abnormalities on transvaginal sonography (negative LR [LR−] 0.12; 95% CI, 0.03-0.55; n = 6885) decreases the likelihood of ectopic pregnancy. [doi.org]

tenderness and masses state of cervix and material passing through it fetal heart (almost never heard in ectopic) INVESTIGATIONS beta-HCG (should almost double every 2 days [lifeinthefastlane.com]

Fallopian Tube Carcinoma

A urine pregnancy test should be performed in any woman of reproductive age with adnexal tenderness. [cancertherapyadvisor.com]

On the pelvic examination, she had cervical motion and adnexal tenderness. [e-crt.org]

Mucopurulent (green or yellow) discharge on speculum examination and acute cervical motion tenderness, uterine or adnexal tenderness are indicative for PID and TOA. [cancertherapyadvisor.com]

Chlamydia Infection

PID was defined by the presence of lower abdominal tenderness, adnexal tenderness and cervical motion tenderness in a patient with complaint of pelvic pain. [guttmacher.org]

and uterine or adnexal tenderness on examination. [cdc.gov]

or cervical motion tenderness with no other identifiable cause. 2 Culture techniques are the preferred method for detecting C. trachomatis infection, but they have been [web.archive.org]

Endometriosis

However, there may be: Posterior fornix or adnexal tenderness. [patient.info]

The physician should palpate for a fixed, retroverted uterus, adnexal and uterine tenderness, pelvic masses or nodularity along the uterosacral ligaments. [web.archive.org]

Palpable nodules in the posterior fornix or adnexal masses (endometriosis can cause cystic lesions on the ovaries, known as 'chocolate cysts'). [patient.info]

Gonorrhea

Adnexal tenderness (usually bilateral) or adnexal mass Intermenstrual bleeding Fever, chills, nausea, and vomiting (less common) In males, the major genitourinary symptoms [emedicine.medscape.com]

[…] abdominal pain: Most consistent symptom of PID Increased vaginal discharge or mucopurulent urethral discharge Dysuria: Usually without urgency or frequency Cervical motion tenderness [emedicine.medscape.com]

Salpingitis

ESSENTIALS OF DIAGNOSIS Uterine, adnexal, or cervical motion tenderness. Abnormal discharge from the vagina or cervix. Absence of a competing diagnosis. [accessmedicine.mhmedical.com]

Cervicitis, adnexal tenderness and salpingitis were not associated with any specific serovar. [ncbi.nlm.nih.gov]

Findings of bilateral adnexal tenderness and signs of a lower genital tract infection (mucopus, or leukorrhea, or both) should prompt clinicians to consider the diagnosis [ncbi.nlm.nih.gov]

Metastatic Ovarian Carcinoma

A rare case of metastatic ovarian carcinoma arising from intrahepatic cholangiocarcinoma is reported and the literature reviewed. A 49-year-old woman presented with ascites and a left pelvic mass. Optimal debulking surgery was carried out including a segmental resection of segment 5/6 of the liver. Histopathology[…] [ncbi.nlm.nih.gov]

Adenocarcinoma of the Ovary

OBJECTIVE: The aim of this study was to assess the importance of appendectomy during surgery for mucinous ovarian cancer. It can be difficult to distinguish between primary ovarian and primary appendiceal cancers clinically, histologically, and immunohistochemically. Removal of the appendix may facilitate differential[…] [ncbi.nlm.nih.gov]

Fitz-Hugh-Curtis Syndrome

The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. [cdemcurriculum.com]

During a pelvic exam, uterine or adnexal tenderness and cervical motion tenderness may be noted. Evidence of cervicitis may be present as well. [www2a.cdc.gov]

Pleuritic RUQ pain and tenderness may occur with or after the onset of acute PID. Some degree of cervicitis or adnexal tenderness is also usually present. [adhesions.org]

Mucopurulent Cervicitis

All had a history of mild-to-moderate pelvic discomfort for 30 days or less, uterine or adnexal tenderness, and leukorrhea, mucopurulent cervicitis, or untreated gonococcal [acronymfinder.com]

uterine tenderness or adnexal tenderness. [clinicaltrials.gov]

adnexal tenderness, or cervical motion tenderness on pelvic exam. [stiplus.com.au]

Adnexitis

tenderness are an indication for treatment for pelvic inflammatory disease, see section on PID) OR ▪ the patient is from a high-risk group (see section on Screening) The [glosbe.com]

PID should be suspected in young, sexually active women who present with lower abdominal pain and adnexal/cervical motion tenderness! [amboss.com]

Clinical manifestations Adnexitis: acute or slowly progressive lower abdominal pain, often bilateral; frequently begins after menses; fever; palpable tender mass. [ultrasound-cases.blogspot.com]

Abdominal Visceral Abscess

Physical examination may reveal lower abdominal tenderness. On pelvic exam, the patient may have adnexal tenderness or an adnexal mass. [cdemcurriculum.com]

Bimanual examination revealed no adnexal mass or tenderness, no cervical excitation. Larger amounts of pussy fluid exuded from the vagina. [ommegaonline.org]

Associated with bilateral lower abdominal pain and cervical motion, uterine, or adnexal tenderness. [medical-institution.com]

Pelvic Actinomycosis

A case of actinomycosis involving the pelvic cavity is reported. The patient had a pelvic mass clinically and radiographically. Barium enema examination showed a mass with extrinsic compression and fixed narrowing of the rectum with mucosal irregularity. A computed tomographic scan showed a pelvic mass displacing the[…] [ncbi.nlm.nih.gov]

Gonococcal Vulvovaginitis

TABLE 1 Diagnostic Criteria for PID Minimal criteria Cervical motion tenderness Uterine or adnexal tenderness Additional criteria* Abnormal cervical or vaginal mucopurulent [aafp.org]

Pelvic exam demonstrates an absence of cervical motion tenderness and no adnexal tenderness. Which of the following is the most likely diagnosis? [medbullets.com]

Cervicitis

uterine tenderness or adnexal tenderness. [clinicaltrials.gov]

tenderness. [ww2.health.wa.gov.au]

adnexal tenderness, or cervical motion tenderness on pelvic exam. [sti.guidelines.org.au]

Cornual Pregnancy

Clinical acumen and suspicion of ectopic pregnancy in a woman presenting with acute abdominal pain, amenorrhea, adnexal tenderness or mass and hemodynamic collapse form the [symptoma.com]

Vaginal examination showed mild blood stained and minimal adnexal tenderness. There was no adnexal mass or cervical excitation tenderness. [omicsonline.org]

Examination Common signs: Pelvic or abdominal tenderness. Adnexal tenderness. Other possible signs: Rebound tenderness. Cervical tenderness. Pallor. [patient.info]

Ruptured Ectopic Pregnancy

Right adnexal tenderness was noted on physical examination. [nejm.org]

(most frequent sign) adnexal tenderness or mass abdominal tenderness, rebounding, or guarding Cullen sign: blue discoloration around umbilicus suggesting retroperitoneal [sharinginhealth.com]

On examination, the patient may have localised abdominal tenderness, with vaginal examination revealing cervical excitation and/or adnexal tenderness. [teachmeobgyn.com]

Pelvic Abscess

The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. [saem.org]

Cervical motion and adnexal tenderness are often elicited on physical examination. [emedicine.medscape.com]

Bimanual examination revealed no adnexal mass or tenderness, no cervical excitation. Larger amounts of pussy fluid exuded from the vagina. [ommegaonline.org]

Pyosalpinx

Cervical motion tenderness or uterine or adnexal tenderness with lower abdominal or pelvic pain are the minimum diagnostic criteria. [lumen.luc.edu]

elevated ESR, paralytic iléus, and shock from peritonitis. 3 criteria should be present : * Lower abdominal tenderness * Adnexal tenderness * Tenderness with cervical motion [medicalechography.com]

and bilateral adnexal tenderness and at least one of the following minor diagnostic criteria were observed in sexually active women: documentation of a cervical infection [docksci.com]

Pelvic Examination

Abnormal bimanual findings included adnexal tenderness (6 [12%]) and uterine tenderness (4 [8%]). [ncbi.nlm.nih.gov]

Is there tenderness in the uterus, ovaries, or fallopian tubes (adnexal tenderness)? NO YES Possible PID. 4. Is there a purulent cervical discharge? [fphandbook.org]

(0.7%) tenderness. [ncbi.nlm.nih.gov]

Tuberous Sclerosis Type 2

The most common physical exam findings are bilateral adnexal tenderness and purulent cervical discharge. [saem.org]

A urine pregnancy test should be performed in any woman of reproductive age with adnexal tenderness. [cancertherapyadvisor.com]

[…] of PID, and concomitant uterine or adnexal tenderness should raise concern for a TOA. [5] A detailed abdominal examination and careful attention to vital signs will help [ncbi.nlm.nih.gov]

Gonococcal Pharyngitis

Adnexal tenderness (usually bilateral) or adnexal mass Intermenstrual bleeding Fever, chills, nausea, and vomiting (less common) Acute perihepatitis (Fitz-Hugh-Curtis syndrome [emedicine.medscape.com]

tenderness, and tested for gonorrhea, chlamydia, bacterial vaginosis, and trichomoniasis with endocervical swabs for light microscopy and nucleic acid amplification testing [aafp.org]

Presumptive treatment for PID should be considered if one or more of the following minimum criteria are present on pelvic examination—uterine or adnexal tenderness or cervical [std.uw.edu]