My 16 year old daughter was awakened yesterday with severe abdominal pain on her left side and nausea. She rated it a "10" and she is usually pretty pain tolerant. She continued to report pain levels at about an "8" or "9" despite being administered pain meds through her IV at the ER. The pain was worse when she coughed or if pressure was applied to the area. However if pressure was applied then released it was more painful after the release. The pain was constant at first then less frequent but still as intense. Her blood tests, CT scan and ultrasound were normal. She had not previously had a pelvic exam and is not sexually active. The doctor did a manual exam. The ultrasound was confined mainly to an external look. Her period started today and she was still experiencing pain. She has had cramps before but not this kind of intense sharp pain. What are we looking at?