Pelvic Inflammatory Disease
Acute pelvic inflammatory disease is associated with very tender bilateral adnexal masses ( adnexa, refers to the region of the ovaries, fallopian tubes and supporting ligaments) although pain and muscle spasm usually make it impossible to delineate them. Movement of the cervix produces pain. Chronic pelvic inflammatory disease is manifested by tender, usually irregular and fairly fixed adnexal masses.
Bates, Barbara. 1974. A Guide to Physical Examination. J.B. Lippincott Company, Toronto.