The patient is a female who is 32 years old. Having had painful periods for three years coupled with painful intercourse, a retroverted uterus, with nodules along the cul de sac, she could be experiencing a case of endometriosis, pelvic inflammatory disease, or pelvic adhesions (Signorile & Baldi, 2015). The conditions often lead to irregularities in menstrual periods, severe pain around the pelvic or abdominal area, and infertility or irregular ovulation (Vercellini, Viganò, & Somigliana, 2014). It could have been a case of PID but this is ruled out by the fact that she has only had one sexual partner for years (Greydanus & Dodich, 2015). Pelvic adhesions often occur in women and cause lots of pain but given that she has not had any surgery recently. The case for endometriosis is confirmed by the following symptoms observed in the patient:
She has tried to have children with her partner with no success making a case for infertility that is often associated with endometriosis.
Her uterus is retroverted.
She has had painful periods for a long time.

Diagnosis can be confirmed by performing a laparoscopy. Treatment can be done during the procedure, but medicinal treatment can include painkillers to deal with some of the symptoms (Signorile & Baldi, 2015). Dietary changes can also help for some women. Chiropractic treatment may also apply. Her retroverted uterus needs to be treated if it causes her a lot of pain (Vercellini, Viganò, & Somigliana, 2014). This can be achieved by surgery (laparoscopic surgery as pointed out above), using pessaries, and even exercises.

Given the fact that the condition can be misdiagnosed for a mere menstrual pain, and that the symptoms may pass for certain kinds of cancer, a proper diagnosis has to consider the risk factors. These include instances of STDs, and a patient’s medical history as observed in this patient’s case. One of them is the painful menstruation and the attempts to be pregnant with no success (Ross, 2014). Patients are encouraged to go for medical check-up regularly and to offer their doctors as much information as they can remember to avoid misdiagnosis.

References
• Greydanus, D. E., & Dodich, C. (2015). Pelvic inflammatory disease in the adolescent: a poignant, perplexing, potentially preventable problem for patients and physicians. Current opinion in pediatrics, 27(1), 92-99.
• Ross, J. D. (2014). Pelvic inflammatory disease. Medicine, 42(6), 333-337.
• Signorile, P. G., & Baldi, A. (2015). New evidence in endometriosis. The international journal of biochemistry & cell biology, 60, 19-22.
• Vercellini, P., Viganò, P., Somigliana, E., & Fedele, L. (2014). Endometriosis: pathogenesis and treatment. Nature Reviews Endocrinology, 10(5), 261.