Relating Pelvic Pain Location to Surgical Findings of Endometriosis

George Washington University, Washington, Washington, D.C., United States
Obstetrics and Gynecology (Impact Factor: 5.18). 08/2011; 118(2 Pt 1):223-30. DOI: 10.1097/AOG.0b013e318223fed0
Source: PubMed


To study whether pain location is related to lesion location in women with chronic pelvic pain and biopsy-proven endometriosis.
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.
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.
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.,, NCT00001848.
: II.

Download full-text


Available from: James H Segars, Aug 21, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to assess the late effects of ovarian salvage or oophorectomy on gonadal function and fertility as measured by menstrual regularity. We performed a 10-year retrospective review of females aged 20 years or younger who required surgery to treat an ovarian disorder. A mail survey was distributed to these patients to evaluate the effects of ovarian surgery on menarche, menstrual regularity, and pregnancy. A total of 180 females had surgery to treat an ovarian disorder. Eighty-six of these underwent unilateral oophorectomy (48%), whereas 94 (52%) had an ovary sparing procedure. Eighty-one patients (45%) returned completed surveys. Of the respondents, 44 had oophorectomy, and 37 had ovarian salvage. Ages of menarche were similar between surgical groups. Symptoms of menstrual irregularity differed most significantly according to painful menses (oophorectomy, 27.3%; salvage, 59.5%; P < .04). Interestingly, continuation of regular menses after surgery was higher in the oophorectomy group (oophorectomy, 70%; salvage, 15%; P = .013). Unilateral oophorectomy does not appear to impair late gonadal function when compared with ovarian salvage. Surprisingly, oophorectomy appears to maintain more normal ovarian activity as estimated by menstrual regularity. Oophorectomy may be performed without apparent adverse effect on gonadal activity.
    Journal of Pediatric Surgery 06/2012; 47(6):1272-9. DOI:10.1016/j.jpedsurg.2012.03.038 · 1.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Endometriosis is a common and chronic inflammatory disorder affecting 10%-16% of women of reproductive age. Although endometriosis is a benign condition, it has negative effects on the quality of life and fertility of women affected. The annual cost in the United States from endometriosis is estimated at $65 billion, because of lost productivity and medical expenses. The socioeconomic impact of endometriosis is evident; however, effective treatment options elude clinicians. Medical management typically consists of nonsteroidal anti-inflammatory drugs and hormonal drugs that suppress ovarian function. Often, however, medical treatment regimens do not satisfactorily alleviate the intractable pelvic pain and are counterproductive for fertility. When medical treatment is suboptimal for managing endometriosis-related symptoms, complete excision of the deeply infiltrating lesions, endometriomas, and associated scar tissue can significantly alleviate pain and improve fertility. In this review, the current management of deeply infiltrating endometriosis, focusing on the surgical treatment of deeply infiltrating disease in the pelvis, urogenital tract, bowel, diaphragm, and chest, are discussed.
    Journal of Gynecologic Surgery 06/2013; 29(3):118-127. DOI:10.1089/gyn.2012.0119
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: How do fully-comprehensive patient-centred descriptions of the symptoms of endometriosis compare with the physicians' description of the symptoms? The description of the painful symptoms due to endometriosis is based on numerous distinct parameters. The way these are used to describe symptoms and the way they are interpreted varies significantly between patients and clinicians. The descriptions of severe pelvic pain and dysmenorrhoea and dyspareunia by the clinicians were incomplete compared with those of the patients. Painful symptoms due to endometriosis were found to be of little use to predict the location and severity of the disease. Currently there are few data on the patients' description of symptoms and no questionnaire is available to derive data from patients. Descriptions of painful symptoms by patients and by physicians were obtained by qualitative, interview-based study and analysed using Colaizzi's method. The patients planned to be operated on for painful endometriosis were volunteers for preoperative interview. They were recruited by purposeful sampling to represent different types of endometriosis [i.e. superficial endometriosis, ovarian endometriosis or deeply infiltrating endometriosis (DIE)], the women were selected so that at least five sites of endometriosis were included in the study. The clinicians were experts in endometriosis management. Forty-one patients were recruited, in four reference centres. Among them, 33 had DIE in various locations, including intestinal endometriosis (n = 12) or bladder endometriosis (n = 5), 14 had ovarian endometriosis (including three without associated DIE) and 5 had only superficial endometriosis.The nine experts were French-speaking gynaecological surgeons practicing in university teaching hospitals (seven), a general hospital (one) or a private centre (one). In total, 47 themes were identified of which 30 were perceived by both patients and clinicians, 12 by patients only and 5 by clinicians only. Themes fall into five general categories: (i) severe pelvic pain and dysmenorrhoea, (ii) dyspareunia, (iii) gastro-intestinal symptoms, (iv) bladder symptoms, (v) other symptoms. Patients' and clinicians' descriptions of symptoms were in agreement for general categories, but the clinicians' comprehensive description was incomplete, in particular concerning the severe pelvic pain and dysmenorrhoea's themes and the dyspareunia theme. Patients did not report any clear-cut distinction between pelvic pain and dysmenorrhoea and expressed a dimension of suffering and impaired quality of life inherent to painful symptoms. Most of the patients in the study had already had treatment for endometriosis, including ongoing hormonal treatment. Furthermore, all but a few patients had documented endometriotic lesions and no specific investigations to eliminate additional causes of functional pelvic pain were done. Finally due to the qualitative design of the study the result must be regarded as inferences. The present study provides a first person viewpoint of the painful experience of endometriosis by the patients in a subjective, phenomenological perspective, and points out the differences of perceptions between the physicians and the patients. The considerable variability in patients' descriptions suggests several distinct mechanisms are involved in explaining the pain related to endometriosis. The discordance between clinicians and patients might also reflect this kind of problem with the wording of the items. In future, if the goal is to properly understand the pain experienced by women with endometriosis, assessment tools using the words and phrases used in narratives of pain would potentially be very useful. Funded by IPSEN, Boulogne-Billancourt, France. None of the authors has any conflict of interest to declare. Not applicable.
    Human Reproduction 07/2013; 28(10). DOI:10.1093/humrep/det310 · 4.57 Impact Factor
Show more