Case of a Girl with Painful Periods, Pain with Bowel Movements, and Dyspareunia

A 16-year-old girl presents to office with complaint of persistent abdominal and pelvic pain. She reports cramping and sharp pain that initially started prior to her menstrual cycle and lasted through the first 2–3 days of her menses, but now pain occurs daily. Her pain is most severe before and during her menses, which are regular. She has intermittent constipation and pain with bowel movements but no dysuria or increased frequency of urination. She is currently sexually active. She has missed multiple days of school due to her pain. Family history is significant for endometriosis and diabetes. Ibuprofen and an oral contraceptive pill provide no relief. Physical exam, as well as pelvic ultrasound, is normal. She undergoes a diagnostic laparoscopy, which reveals clear vesicular and red-flame-like lesions scattered along with posterior cul-de-sac and the bilateral uterosacral ligaments. Final pathology reveals endometrial stroma and glands confirming diagnosis of endometriosis.