DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20192442

Comparing the degree of pelvic pain with the macroscopic features of endometriosis

Tarini Sonwani, Ratna Biswas

Abstract


Background: Endometriosis is considered as the chronic benign gynecologic disease which can cause chronic pelvic pain (CPP) and infertility. Endometriosis has affected almost 10% of the women of reproductive age.

Methods: Thirty women diagnosed with endometriosis were studied. Pain intensity was assessed by visual analogue scale (VAS) and categorized as mild, moderate or severe accordingly. This was followed by laparoscopy/ laparotomy and staging of endometriosis which was done as per the American Society for Reproductive Medicine (ASRM) classification system. Corrective procedures were done simultaneously.

Results: Mean age of women with endometriosis was 30±5.75 years. Majority had superficial implants (30%), 6.66% had deep implants and 6.66% had combination of superficial and deep implants. There was no significant difference between implants and severity of pain (p=0.069). There was a significant association between severity of pain with obliteration of POD. Significant association was seen between deeply infiltrating endometriosis (DIE) represented by the pouch of Douglas (POD) obliteration and severity of pain.

Conclusions: Severity of pain was significantly associated with deeply infiltrating endometriosis (DIE) represented by the pouch of Douglas (POD) obliteration. However, no association was obtained between severities of pain with superficial implants.


Keywords


Deeply infiltrating endometriosis, Macroscopic features, Pouch of douglas

Full Text:

PDF

References


Walter AJ, Hentz JG, Magtibay PM, Cornella JL, Magrina JF. Endometriosis: correlation between histologic and visual findings at laparoscopy. American J Obstet Gynecol. 2001;184 (7): 1407-13.

Giudice LC, Kao LC. Endometriosis. The Lancet 2004;364 (9447):1789-99.

ESHRE Guideline for the diagnosis and treatment of endometriosis, 2007. Available at: http://guidelines.endometriosis.org/concise-pain.html. Accessed on 28 March 2019.

Missmer SA, Cramer DW. The epidemiology of endometriosis. Obstet Gynecol Clinics North America. 2003;30(1):1-19.

Forman RG, Robinson JN, Mehta Z, Barlow DH. Patient history as a simple predictor of pelvic pathology in subfertile women. Hum Reprod. 1993;8:53-5.

Balasch J, Creus M, Fabregues F, Carmona F, Ordi J, Martinez-Roman S, et al. Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and in patients with chronic pelvic pain: a prospective study. Hum Reprod. 1996;11:387-91.

Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Crosignani PG. Endometriosis and pelvic pain: relation to disease stage and localization. Fertil Steril. 1996;65:299-304.

Chapron C, Barakat H, Fritel X, Dubuisson JB, Bréart G, Fauconnier A. Presurgical diagnosis of posterior deep infiltrating endometriosis based on a standardized questionnaire. Hum Reprod. 2005;20:507-13.

Howard FM. The role of laparoscopy in chronic pelvic pain: promise and pitfalls. Obstet Gynecol Surv 4. 1993;8:357-87.

Redwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril. 1999;72:310-5.

Clement PB. Pathology of endometriosis. Pathol Annu. 1990;25:245-95.

Koninckx PR, Martin D. Treatment of deeply infiltrating endometriosis. Curr Opin Obstet Gynecol. 1994;6:231-41.

Brosens IA, Vasquez G, Deprest J, Puttemans P. Pathogenesis of endometriosis. In Nezhat CR, Berger GS, Nezhat FR, Buttram VC and Nezhat CH (eds) Endometriosis: Advanced Management and Surgical Techniques, Vol. 1. Springer-Verlag, New York; 1995:9-17.

Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997;8:585-96.

Somigliana E, Viganò P, Candiani M, Felicetta I, Di Blasio AM, Vignali M. Use of serum-soluble intercellular adhesion molecule-1 as a new marker of endometriosis. 2002;77(5):1028-31.

Holland TK, Cutner A, Saridogan E, Mavrelos D, Pateman K, Jurkovic D. Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multi centre diagnostic accuracy study. BMC Womens Health. 2013;13:43.

Dai Y, Leng JH, Lang JH, Liu ZF, Li XY, Wang YY. Clinico-pathologic characteristics of posterior deeply infiltrating endometriosis lesions, pain symptoms and its treatment using laparoscopic surgery. Zhonghua Fu Chan Ke Za Zhi. 2010;45(2):93-8.

Vercellini P, Buggio L, Somigliana E, Barbara G, Viganò P, Fedele L. Attractiveness of women with rectovaginal endometriosis: a case-control study. Fertil Steril. 2013;99(1):212-8.

Muzii L, Marana R, Pedulla S, Catalano GF, Mancuso S. Correlation between endometriosis-associated dysmenorrhea and the presence of typical or atypical lesions. Fertility and Sterilit. 1997;68(1):19-22.

Reid S, Lu C, Casikar I, Reid G, Abbott J, Cario G, et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol. 2013;41(6):685-91.