History of symptoms described above
Exam with tenderness when palpating posterior fornix
Labs are not generally useful
Pelvic ultrasound is the first-line study
Laparoscopy for definitive diagnosis
Endometriosis
Ectopic pregnancy
Pelvic inflammatory disease
Tubo-ovarian abscess
Interstitial cystitis
Adenomyosis
Ovarian neoplasms
Ovarian cyst