Adnexal Mass Diagnosis

Other, less serious things can cause symptoms of adnexal masses. So you should discuss them with your doctor. To determine the cause of any symptoms, the doctor will perform a physical exam. The doctor will also ask about your personal and family medical history. The doctor may also perform one or more of the following tests:

  • Pelvic exam. The doctor usually finds adnexal masses during a pelvic exam. During a pelvic exam, the doctor feels the vagina, uterus, ovaries, bladder, and rectum. The doctor does this to check for lumps or anything unusual. An instrument called a speculum is used to make the vagina wider. That’s so the doctor can see the top part of the vagina and the cervix.
  • Ultrasonography. If the doctor feels an adnexal mass, the doctor will often order a pelvic sonogram (ultrasound). The doctor may also do this if you are having pelvic symptoms. In ultrasonography, sound waves are aimed at the ovaries. The echoes from the sound waves form a picture called a sonogram. A special computer transforms the echoes into images so that they can be viewed on a big screen. The echoes sound different for healthy tissues, fluid-filled cysts, and tumors. The uterus, tubes, and ovaries can generally be seen very well on a sonogram. A vaginal approach will give more accuracy. If an adnexal mass is present, its size, location, and appearance can be determined. If a woman has ovarian masses, the doctor will be very interested in whether the masses are cystic (fluid filled), solid, or both. If they are both cystic and solid they are called complex. Masses that are mostly composed of fluid—cysts—are less suspicious for cancer than are masses that contain solid areas.

When an adnexal mass is found, how it’s managed depends on the following:

  • the size and type of mass
  • your age
  • whether or not the mass causes any symptoms

For a woman of reproductive age with a small, non-suspicious, asymptomatic mass, the most likely cause is a functional cyst. It is also called a physiologic cyst. These cysts will almost always disappear on their own over four to six weeks. Usually, if you have this type of mass, the doctor will recommend that you have another sonogram in four to six weeks. Sometimes oral contraceptives will be prescribed. They may help the cysts go away more quickly or at least help prevent new cysts from growing. In about three out of every four cases, these masses will be gone by the second sonogram. The doctor can then be sure that the mass was a functional cyst that went away on its own. No further treatment is necessary. If the mass does not go away, sometimes surgery is recommended. In other cases, if the mass is purely cystic and does not grow, it can be followed by repeated sonograms and physical exams.

Women do not ovulate before their first menstrual period or after the menopause. So masses that occur in women in these age groups are not likely to be functional cysts. Generally, adnexal masses in young girls should be removed surgically. In postmenopausal women, small purely cystic adnexal masses may be watched for a period of time. These may also go away or remain stable over repeated evaluations