This case study illustrates how the same clinical encounter can be used to produce evidence for multiple CiPs. Please read the scenario below and answer the two reflective tasks.
A 29-year-old woman attends the gynaecology outpatient department with pelvic pain mainly in the left iliac fossa, which has been increasing over the last 6 months. Her pain is worst on the day before her period and during her period, but now she has some pain present throughout the month. It is associated with dyspareunia but she denies any dyschesia.
She has regular periods with LMP 2 weeks ago and cycles 5/28. She is nulliparous but fertility is desired. She has been in a stable heterosexual relationship with the same partner for the last 4 years and they have been having regular intercourse. The couple have not been using any contraception for 10 months, but no conceptions as yet. Recently she has been limiting intercourse due to pain and she volunteers that this is placing the relationship under some strain. Cervical screening is overdue but has previously been normal.
She is otherwise fit and well with no previous operations. She takes no regular medications and has no allergies. She has tried simple analgesia but this has not been particularly helpful.
She is a smoker of 10 cigarettes/day and is overweight, with a BMI of 34. She works as a teacher and has missed 3 days of work over the last 6 months due to pelvic pain.
On examination, her abdomen is soft and non-tender to palpation. Vaginal speculum examination reveals a normal vulva, vagina and cervix. With her permission you take a smear and triple swabs for infection. On bimanual examination there is reduced mobility of the uterus with marked tenderness in the posterior fornix, but you are unable to feel any nodules or masses.
You request an ultrasound of her pelvis to look for ovarian cysts, hydrosalpinx or endometrioma. The USS is normal. Her infection screen was also negative, and her smear was normal.
Due to her ongoing pain, which is affecting daily life and her relationship, and her desire for fertility, you add her to the waiting list to come in for a laparoscopy +/- treatment to adhesions, endometriosis or ovarian cysts. You complete written consent with the patient, and provide written information about endometriosis and laparoscopy. You also direct the patient to relevant reliable online resources for further information.
N.B. Model answers to these tasks are provided if you are signed-in to the eLearning platform.