COMPARISON OF TRANSVAGINAL SONOGRAPHY AND BIMANUAL PELVIC EXAMINATIONIN PATIENTS WITH LAPAROSCOPICALLY CONFIRMED ENDOMETRIOSIS

To determine the usefulness of noninvasive clinical tests to diagnose symptomatic endometriosis, we retrospectively reviewed the medical rec ords of 91 patients with chronic pelvic pain and laparoscopically conf irmed endometriosis. Thirty-seven women (41%) had pelvic peritoneal en dometrial implants with adhesions; in 44 (48%) the ovaries were also a ffected, and in 10 (11%) the disease involved both the uterus and ovar ies. Seventy-nine (87%) women had dysmenorrhea, dyspareunia, or both. Forty-three (47%) had a normal bimanual pelvic examination and 37 (41% ) an unremarkable transvaginal sonographic evaluation (no significant difference). The women were divided into two groups: group 1, in whom the disease extended to the ovaries and uterus, and group 2, those in whom only peritoneal implants and adhesions were present. In group 1, 48 women (89%) had an abnormal ultrasonographic evaluation compared wi th only 4 (11%) in group 2 (p <0.001). Our findings indicate that bima nual pelvic examination and transvaginal sonography are equally accura te in detecting endometriosis; however, when the uterine surface and o varies are involved, the latter is more informative. Therefore, patien ts with chronic pelvic pain, especially pain related to menstruation o r coitus, should be evaluated laparoscopically to diagnose mild endome triosis adequately.