A 27 year old waitress has pelvic pain, dysmenorrhea and increasingly heavy periods. She also complains of dyspareunia. There is generalized pelvic tenderness without peritonism. Pelvic US is normal. What is the most likely diagnosis?

The key is C. Pelvic congestion syndrome. [In pelvic congestion syndrome there develops varicose

veins in the lower abdomen from prolonged standing (as occurred here in a waitress who remains

standing for long) with some pain syndromes like pelvic pain, dysmenorrea, dyspareunia and generalized

pelvic tenderness without peritonism. Also there may be associated menorrhagia].