A 39-Year-Old, Nulliparous Woman Comes to the Office Due to Pelvic

A 39-year-old, nulliparous woman comes to the office due to pelvic pressure and constipation that have worsened over the past year.  She frequently has an uncomfortable sensation of incomplete evacuation following defecation.  Menses occur every 28 days without heavy bleeding or severe pain.  The patient has no pain with intercourse and routinely uses condoms for contraception.  BMI is 24 kg/m².  Examination shows an irregularly enlarged uterus and normal rectal tone.  Which of the following is the most likely etiology of the patient's constipation?

A) Adenomyosis
B) Cervical carcinoma
C) Posterior subserosal uterine leiomyoma
D) Posterior vaginal wall prolapse
E) Rectovaginal endometriosis

Correct Answer:

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