A 20 year old woman gives a history of sharp pain in the lower abdomen for 2-3 days every month approximately 2 weeks before the menses. The most probable etiology for her pain is:
1. Endometriosis.
2. Dysmenorrhea.
3. Pelvic tuberculosis.
4. Mittelschmerz.
Answer
4. Mittelschmerz.

Discussion
Mittleschmerz is Painful Ovulation
· Pain associated with rupture of Ovarian Follicle at the Time of Ovulation
· Pain occurs at regular time in succeeding or intermittent cycles
· Usually at the time of cvulation
· Short Duration < 12 hours
· Slight Vaginal Bleeding may be present
· Treated with Analgesics and Assurance

Explanation
1. In Endometriosis pain is at the time of Menstraution.
2. In Dysmenorrhea. pain is at the time of Menstraution
3. In Pelvic tuberculosis pain is not cyclical.
4. Mittelschmerz classically presents as described above.

Comments
The only factor that created concern in this question is that OUR PATIENT experiences pain for 2 to 3 days, where as Shaw says that Mittelschmerz is usually of shorter duration