ENDOMETRIOSIS AND PELVIC PAIN - RELATION TO DISEASE STAGE AND LOCALIZATION

Objectives: To determine whether prevalence and severity of pain sympt oms are related to endometriosis stage and site, with particular refer ence to deep infiltrating vaginal lesions. Design: Systematic assessme nt of chronic pelvic pain symptoms. Setting: University hospital endom etriosis center. Patients: A total of 244 consecutive symptomatic pati ents with endometriosis diagnosed at laparoscopy or laparotomy. Interv entions: Assessment of dysmenorrhea and nonmenstrual pain by means of a 10-point linear analog scale, a 7-point multidimensional rating scal e, and a 3-point verbal scale evaluation of deep dyspareunia with the first and third systems only. Main Outcome Measures: Prevalence and se verity of pain symptoms in relation to endometriosis stage and site of lesions. Correlation between revised American Fertility Society score and symptoms severity, as well as between two pain scales to assess d ysmenorrhea and nonmenstrual pain. Results: Eighty-eight women had sta ge I and II disease and 156 had stage III and IV disease. Only ovarian endometriosis was present in 108 patients, only peritoneal implants w ere present in 37, combined ovarian and peritoneal lesions were presen t in 57, and histologically confirmed vaginal endometriosis was presen t in 42. The frequency and severity of deep dyspareunia and the freque ncy of dysmenorrhea were less in patients with only ovarian endometrio sis than in those with lesions at other sites. Patients with vaginal e ndometriosis had a significantly increased risk of deep dyspareunia co mpared with those whose lesions were at other sites (odds ratio, 2.55; 95% confidence interval, 1.21 to 5.39). Stage per se, independent of lesion site, was not correlated with frequency and severity of dysmeno rrhea and nonmenstrual pain. The severity of deep dyspareunia was rela ted inversely to the endometriosis score (Spearman correlation coeffic ients for linear analog and verbal rating scales, respectively, -0.22 and -0.20). Kendall test by ranks revealed a correlation between linea r analog and multidimensional pain scales in the rating of both dysmen orrhea and nonmenstrual pain (respectively, tau-b, 0.59 and tau-b, 0.6 8). Conclusions: Endometriosis stage in the current classification was not related consistently to pain symptoms. The presence of vaginal le sions was associated frequently with severe deep dyspareunia. Dysmenor rhea and nonmenstrual pelvic pain were assessed with equal accuracy by a linear analog and a multidimensional scale.