He relates that he has no feeling when he defecates and rectal sensation is diminished. 25 year old female college student presents with increased menstrual bleeding and mild dyspareunia. She is otherwise in good health. On physical examination the patient's vital signs are normal. There is bilateral lower abdominal tenderness.
Pelvic examination reveals that cervical motion causes mild left adnexal tenderness.
The cervix is friable, and a mucopurulent exudate is present. A bacterial culture is obtained, as well as chlamydial screening test. A 12 year old girl with a congenital urologic defect admitted for her fifth corrective surgical repair has been participating at a birthday celebration at which balloons, party favors, and ice cream with cookies had been distributed. Ten minutes later she develops rapidly progressive swelling of her lips, stridor, wheezing and cyanosis. The lesions last 1 to 3 hours and then disappear.