Which of the following is a key diagnostic features of adenomyosis during a pelvic exam?

Adenomyosis is characterized by the presence of endometrial tissue within the myometrium of the uterus, leading to specific physical findings during a pelvic examination. One of the key diagnostic features of adenomyosis is a globular, boggy uterus. This finding is due to the enlargement of the uterine muscle from the abnormal endometrial tissue infiltration, which causes the uterus to have a softer and somewhat irregular contour rather than a firm, well-defined border.

The bogginess of the uterus can be palpated during an examination, distinguishing adenomyosis from other conditions that may cause uterine enlargement. In contrast, a thickened cervix is not a typical feature of adenomyosis but may be seen in other cervical conditions. Tender adnexa suggests other pelvic issues, potentially involving the ovaries or fallopian tubes, and a fixed and immobile uterus can indicate a broader set of possible pathologies, including adhesions or malignancy, rather than specifically adenomyosis.

Hence, the globular, boggy aspect of the uterus during a pelvic exam stands out as the key diagnostic feature for adenomyosis, guiding clinicians in identifying and confirming this condition.