214. Clueless

I can usually come up with a presumptive diagnosis, or at least some testing (imaging or blood work) that would work towards either a diagnosis or a tentative treatment plan.

But with Caroline, I am clueless:

This 29 year old describes severe pelvic cramps lasting for about 45 minutes upon awakening, usually from a "sexual dream." Happened rarely until last year when they started occurring every few weeks; not associated with mens. She states they do not feel like orgasms which anyway are not painful to her. The symptoms are relieved within 10 minutes of having a bowel movement although she does not necessary feel like she needs to have a BM. She denies any problems with her bowel--in general is very regular. Her only significant history is migraine HA.