Adnexal Tenderness Causes:
The most common cause of adnexal tenderness is abnormal uterine position. This condition occurs when the lower part of the cervix is not aligned with the upper part of it.
For example, if a woman’s uterus is positioned like a pear shaped cake, then her cervix will be tilted towards the bottom side. If she has a normal-shaped uterus, her cervix will look like an apple shape.
In some cases, the cervix may tilt up or down due to hormonal changes. Women with endometriosis are prone to having their cervices tilt upwards because they have no natural support around them.
Other women have their cervices tilt downwards due to pelvic floor dysfunction. These women experience pain during sexual activity, which makes them feel uncomfortable.
Another possible cause of adnexal tenderness is pregnancy. Pregnancy can affect the normal anatomy of the uterus causing it to tilt.
Also, in some cases, there is a change in the size of the cervix caused by a growth or scar tissue. In these cases, the cervix might appear larger than usual. Furthermore, during pregnancy the size of endometrial cups can increase causing more blood to pool inside.
Adnexal Tenderness Exam:
The adnexa are the ovaries and fallopian tubes. It is normal for women to experience adnexal tenderness at some point in their lives.
The condition is so common that it has been given a medical term called “PID”, which stands for Pelvic Inflammatory Disease. This condition occurs when the fallopian tubes and ovaries become infected. PID is a common complication that can occur after a woman has a sexually transmitted infection (STD) such as Chlamydia or Gonorrhea. It can also occur after a woman has an abortion or miscarriage.
PID is very serious because it can lead to permanent damage of the fallopian tubes and ovaries. In some cases, the woman’s body cannot fight off the infection causing permanent adnexal damage.
In other cases, the infection can become chronic causing long-term problems such as infertility. PID can be treated with a variety of antibiotics. Surgery is sometimes required if the infection is severe.
Adnexal tenderness exam is a test that your doctor may perform in order to check the size and shape of your fallopian tubes and ovaries. The test is also known as a pelvic exam or “Pap smear”.
The test involves gently pressing on the patient’s abdomen with two fingers while feeling the size, shape and consistency of the patient’s ovaries and fallopian tubes.
Other Causes:
Adnexal tenderness can also be caused by a number of other medical conditions. Some of these conditions include:
Pregnancy: The most common condition that causes adnexal tenderness is pregnancy. During pregnancy, the size of the endometrial cups increases, which causes more blood to pool inside.
This increases the amount of pressure on the fallopian tubes and ovaries.
Tumors: Tumors in the region can cause adnexal tenderness. The most common types of tumors that cause adnexal tenderness are ovarian cysts and fibroids.
In some cases, ovarian cancer can also cause adnexal tenderness.
Endometriosis: Endometriosis is a condition in which the tissue that lines the uterus (endometrium) grows outside of it. This can cause adhesions and scarring which can cause adnexal pain.
Adhesion: Adhesions are strands of scar tissue that bind organs together. They can cause adnexal pain as well.
Interstitial Cystitis: This condition involves the inflammation of the bladder. This can cause a painful pressure on the fallopian tubes and ovaries.
Appendicitis: Appendicitis is an inflammation of the appendix. In some cases, the appendix can extend out of the abdomen and into the pelvic region.
Infection can occur in these cases causing adnexal tenderness.
Pelvic Tuberculosis: This rare condition occurs when a patient is suffering from untreated tuberculosis in other parts of the body. The tuberculosis spreads to the pelvic region causing adnexal pain.
Ectopic Pregnancy: Ectopic pregnancies occur when the pregnancy develops in one of the fallopian tubes. The growing embryo cannot survive and will eventually cause the fallopian tube to burst.
Adnexal pain can sometimes be experienced without a noticeable pregnancy.
Prolapsed Uterus: A prolapsed uterus occurs when the uterus protrudes out of the vaginal canal. The fallopian tubes and ovaries are pulled with it causing adnexal pain.
Vaginal or Cervical Polyp: A vaginal or cervix polyp is a growth that protrudes from the vaginal canal or cervix. These are noncancerous and cause adnexal pain upon contact.
Ovarian Hyperstimulation: This condition occurs when patients undergoing fertility treatments such as ovulation induction or in vitro fertilization experience too much stimulation of the ovaries. The increased hormones can cause ovarian enlargement and adnexal pain.
Appendix Rupture: There have been rare cases in which the appendix has ruptured and protruded into the pelvic region. This condition can cause adnexal tenderness.
Uterine Cancer: Uterine cancer can sometimes cause adnexal pain. It is very important to seek medical attention for any vaginal bleeding that lasts for more than a few days.
Uterine Fibroids: Uterine fibroids are noncancerous tumors that grow in or on the uterus. These can sometimes cause adnexal pain.
Cervical Dysplasia: Cervical dysplasia is a condition in which abnormal cells grow in or on the cervix. These abnormal cells can sometimes transform into cancer over time.
Cervical dysplasia can sometimes cause adnexal pain.
PID: Pelvic Inflammatory Disease is an infection in the female reproductive system. The uterus, fallopian tubes and ovaries can all be affected by this disease.
PID can cause adnexal pain.
Blood Clot: A blood clot can sometimes form in the fallopian tubes or ovaries. The clot is caused by an injury or surgery in the pelvic region.
The clot can then break loose and travel to the lungs causing adnexal pain.
Tumor: Any type of tumor that develops in the ovary, fallopian tubes, uterus or cervix can cause adnexal pain. Benign and cancerous tumors can both cause this condition.
Endometriosis: Endometriosis is when the uterine lining grows outside of the uterus. These deposits can cause adnexal pain and can sometimes lead to infertility.
Lyme Disease: Lyme disease is an infection caused by the bacteria Borrelia burgdorferi. In very rare cases, this disease can spread to the reproductive system causing adnexal pain.
Adnexal Pain Treatment
If you are experiencing adnexal pain, it is important to seek medical attention immediately. Depending on the underlying cause of your condition, your doctor may run a series of tests.
These can include urine samples, blood tests or imaging studies. After a diagnosis is made, your doctor will suggest a treatment plan. Depending on the nature of the condition, this can include rest, over-the-counter medication, surgery or even fertility treatments.
Adnexal Pain Prevention
There are several steps you can take to help prevent adnexal pain. First and foremost, it is important to practice safe sexual practices.
This includes using condoms and being in mutually monogamous relationships. If you have a new sexual partner, it is best to get tested beforehand. You should also avoid intimate contact with people who have suspicious looking sores on their genitals or groin area.
It is also important to practice good hygiene in the pelvic region. This includes showering or bathing daily, trimming pubic hair and washing underwear in a manner that avoids fabric to skin contact.
Adnexal pain can be an alarming condition that requires medical attention. If you are experiencing this condition, it is important to seek medical attention right away.
Sources & references used in this article:
Diagnosis and management of adnexal masses by V Givens, G Mitchell, C Harraway-Smith, A Reddy… – American family …, 2009 – aafp.org
Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea by R Platt, PA Rice, WM McCormack – Jama, 1983 – jamanetwork.com
Diagnosis and management of adnexal masses by WS Biggs, ST Marks – American Family Physician, 2016 – aafp.org
Adnexal torsion—a multimodality imaging review by C Wilkinson, A Sanderson – Clinical radiology, 2012 – Elsevier
