Relating pelvic pain location to surgical findings of endometriosis

Abstract

Objective: To study whether pain location is related to lesion location in women with chronic pelvic pain and biopsy-proven endometriosis.

Methods: A secondary analysis was performed to compare self-reported pain location with recorded laparoscopy findings for location and characteristics of all visible lesions. All lesions were excised. Endometriosis was diagnosed using histopathology criteria. The pelvic area was divided into three anterior and two posterior regions. Lesion depth, number of lesions or endometriomas, and disease burden (defined as sum of lesion sizes, or single compared with multiple lesions) were determined for each region. Data were analyzed using t tests, Fisher exact tests, and logistic regression modeling, with P values corrected for multiple comparisons using the step-down Bonferroni method.

Results: Women with endometriosis (n = 96) had lower body mass indexes, were more likely to be white, had more previous surgeries, and had more frequent menstrual pain and incapacitation than did chronic pain patients without endometriosis (n = 37). Overall, few patients had deeply infiltrating lesions (n = 38). Dysuria was associated with superficial bladder peritoneal lesions. Other lesions or endometriomas were not associated with pain in the same anatomic locations. Lesion depth, disease burden, and number of lesions or endometriomas were not associated with pain.

Conclusion: In this group of women with biopsy-proven endometriosis, few had deeply infiltrating lesions or endometriomas. Dysuria and midline anterior pain were the only symptoms associated with the location of superficial endometriosis lesions. The lack of relationship between pain and superficial lesion location raises questions about how these lesions relate to pain.

Clinical trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00001848.

Level of evidence: : II.

Figure 1

Figure 1a. Computerized diagram of pain location regions for patient surveys. Upward right shading, anterior right and posterior right; cross-hatches, anterior middle; upward left shading, anterior and posterior left. Note that the posterior middle was included with both the posterior left and posterior right regions. Modified from: Management of endometriosis in the presence of pelvic pain. The American Fertility Society. Fertil Steril 1993 Dec;60(6):952–5, Copyright 1993, with permission from Elsevier. “Figure 1b. Diagram of anterior pain regions for surgically-scored lesions. Upward right shading, anterior right; cross-hatches, anterior middle; upward left shading, anterior left. Figure 1c. Diagram of posterior pain regions for surgically-scored lesions. Upward right shading, posterior right; upward left shading, posterior left. Note that the posterior middle was included with both the posterior left and posterior right regions. Figures 1b and 1c modified from: Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997 May;67(5):817–21, Copyright 1997, with permission from Elsevier.

Figure 1

Figure 1a. Computerized diagram of pain location regions for patient surveys. Upward right shading, anterior right and posterior right; cross-hatches, anterior middle; upward left shading, anterior and posterior left. Note that the posterior middle was included with both the posterior left and posterior right regions. Modified from: Management of endometriosis in the presence of pelvic pain. The American Fertility Society. Fertil Steril 1993 Dec;60(6):952–5, Copyright 1993, with permission from Elsevier. “Figure 1b. Diagram of anterior pain regions for surgically-scored lesions. Upward right shading, anterior right; cross-hatches, anterior middle; upward left shading, anterior left. Figure 1c. Diagram of posterior pain regions for surgically-scored lesions. Upward right shading, posterior right; upward left shading, posterior left. Note that the posterior middle was included with both the posterior left and posterior right regions. Figures 1b and 1c modified from: Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997 May;67(5):817–21, Copyright 1997, with permission from Elsevier.

Figure 1

Figure 1a. Computerized diagram of pain location regions for patient surveys. Upward right shading, anterior right and posterior right; cross-hatches, anterior middle; upward left shading, anterior and posterior left. Note that the posterior middle was included with both the posterior left and posterior right regions. Modified from: Management of endometriosis in the presence of pelvic pain. The American Fertility Society. Fertil Steril 1993 Dec;60(6):952–5, Copyright 1993, with permission from Elsevier. “Figure 1b. Diagram of anterior pain regions for surgically-scored lesions. Upward right shading, anterior right; cross-hatches, anterior middle; upward left shading, anterior left. Figure 1c. Diagram of posterior pain regions for surgically-scored lesions. Upward right shading, posterior right; upward left shading, posterior left. Note that the posterior middle was included with both the posterior left and posterior right regions. Figures 1b and 1c modified from: Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997 May;67(5):817–21, Copyright 1997, with permission from Elsevier.