30-year-old Nasima, wife of Asif, resident of Korangi town, housewife by profession, married for eight

years, non-cousin marriage, she has two kids with one year gap(G2P2), her last menstrual period (LMP)
was on 14th March. She has no comorbidities. He came to OPD on 15th April with complaint of mass
coming out of her vagina.

HOPC: The patient has complained of pelvic pain and a mass coming out of her vagina. The symptoms
have increased over time. They began after the patient delivered her first baby. And kept on
progressively increasing when the patient goes to the washroom. There is protrusion of the mass, which
returns manually with fingers. Patient has no urinary or fecal symptoms. The symptoms are more
pronounced when the patient coughs and sneezes or sits. The pelvic pain is constant and dull, but it is
more pronounced when the patient is menstruating. The patient has no history of weightlifting.

Post obstetric history:

Antepartum: No anemia, no PIH, no gestational diabetes, no other complications.

Intrapartum: Normal vaginal deliveries with no complications.

Postpartum: No transfusion and no postpartum depression.

Gynecological history: The patient had menarche when she was 14 years old. There is a 20-day
cycle which lasts for five days. Normal flow, no dysmenorrhea, no dyspareunia, no dyschezia, no
intermenstrual bleeding, no post coital bleeding, no vaginal discharge, no Pap smear was performed.

Personal history: sleep and appetite normal, patient has had some weight loss, patient has normal
bowel and bladder movements. Menstrual cycle is also normal and regular, she has no addictions.

Family history: no significant family history with any co-morbidities. She has two kids aged seven
and six, respectively.

Socioeconomic history: Lives in a rented house with 2 rooms and 4 people, the house is well lit
and well ventilated, clean neighborhood, have gas and light facility, drinks tanker water.