Post-Coital Abdominal Pain in Young Woman with Copper IUD

Case at a Glance

A 20-year-old female presents with severe lower and upper abdominal cramping pain following sexual intercourse, sometimes accompanied by nausea and vomiting. Patient has a copper intrauterine device (IUD) in place and has tested negative for sexually transmitted infections.

Patient's Story

The patient experiences significant abdominal pain after sexual intercourse, described as cramping in both lower and upper abdomen regions. The pain intensity varies but can be severe enough to cause nausea, vomiting, and bring the patient to tears. The symptoms have negatively impacted the couple's intimate relationship, leading to decreased frequency of intercourse. The patient currently uses a copper IUD for contraception.

Initial Assessment

Patient presented to Accident & Emergency department with post-coital pain. Initial workup included STI screening via swab tests, which returned negative results. Physical examination findings were not documented. No imaging studies were performed during the initial emergency department visit. Healthcare providers initially attributed symptoms to normal cramping and did not pursue further investigation.

The Diagnostic Journey

Following the initial emergency department visit, the patient sought care from her General Practitioner (GP). The GP also minimized the symptoms without performing detailed examination or ordering additional tests. Patient expressed frustration with healthcare dismissal and felt discouraged from seeking further medical attention. Discussion of cervical cancer screening was mentioned but deferred due to patient's age being under 25 years (UK screening guidelines).

Final Diagnosis

Diagnosis remains unclear and requires further investigation. Differential diagnoses to consider include: IUD malposition or displacement, endometriosis, adenomyosis, ovarian cysts, pelvic inflammatory disease, or other gynecological pathology.

Treatment Plan

Patient plans to have copper IUD removed to rule out device-related complications. Recommended follow-up includes: comprehensive blood work and urinalysis with culture and sensitivity, pelvic and abdominal ultrasound imaging, thorough gynecological examination, and consideration of referral to gynecology specialist if symptoms persist after IUD removal.

Outcome and Follow-up

Case ongoing. Patient requires advocacy for proper diagnostic workup including imaging studies and laboratory tests. Second opinion from different healthcare provider recommended if initial providers continue to dismiss symptoms. Private imaging consultation may be considered if NHS services remain inadequate. Long-term follow-up needed to monitor symptom resolution after IUD removal and ensure appropriate diagnosis and treatment.