Ovarian Cysts and Tumors
Ovarian cysts and tumors may be detected as adnexal masses on one or both sides. Later, they may extend out of the pelvis. Cysts tend to be smooth and compressible, tumors more solid and often nodular. Uncomplicated cysts and tumors are not usually tender.
Small (<6 cm in diameter), mobile, cystic masses in a young woman are usually benign and often disappear after the next menstrual period.
A ruptured tubal pregnancy spills blood into the peritoneal cavity, causing severe abdominal pain and tenderness. Guarding and rebound tenderness are sometimes associated. A unilateral adnexal mass may be palpable, but tenderness often prevents its detection. Faintness, syncope, nausea, vomiting, tachycardia, and shock may be present, reflecting the hemorrhage. There may be a prior history of amenorrhea or other symptoms of a pregnancy.
Pelvic inflammatory disease (PID) is most often a result of sexually transmitted infection of the fallopian tubes (salpingitis) or of the tubes and ovaries (salpingo-oophoritis). It is caused by Neisseria gonorrhoeae, Chlamydia trachomatis, and other organisms. Acute disease is associated with very tender, bilateral adnexal masses, although pain and muscle spasm usually make it impossible to delineate them. Movement of the cervix produces pain. If not treated, a tuboovarian abscess or infertility may ensue.
Infection of the fallopian tubes and ovaries may also follow delivery of a baby or gynecologic surgery.
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