Correlation between endometriosis and pelvic pain

Study Objective. To evaluate the relationship between prevalence and severi ty of chronic pelvic pain (CPP) and stage, site, and type of endometriosis. Design. Prospective, observational study (Canadian Task Force classificatio n 11-2). Setting. University Hospital. Patients. Of 90 consecutive women with biopsy-proved endometriosis, laparos copy was performed in 69 for pelvic pain and in 21 for infertility or clini cal and ultrasonographic suspicion of ovarian endometriosis. Intervention. Preoperatively, using a 10-point visual analog scale, the sev erity of dysmenorrhea, CPP, and deep dyspareunia was assessed. During lapar oscopy all visible endometriotic lesions were recorded and treated. Measurements and Main Results. Ten women (11.1%) had no pain; 72 had dysmen orrhea (mild in 13, moderate in 37, severe in 22); 55 had CPP (mild in 11, moderate in 25 severe in 19); and 39 deep dyspareunia (mild in 5 moderate i n 31, severe in 3). The severity of dysmenorrhea significantly correlated w ith the presence and extent of pelvic adhesions (p = 0.004); the severity o f CPP correlated with deep endometriosis on the uterosacral ligaments (p = 0.0001) and extent of pelvic adhesions (p = 0.02); and deep dyspareunia cor related with deep endometriosis on the uterosacral ligaments (p = 0.04). To tal pain score significantly correlated with deep endometriosis on the uter osacral ligaments (p = 0.0001), peritoneal adhesions (p = 0.01), and extent of adnexal adhesions (p = 0.01). No significant correlation was found amon g revised American Fertility Society stage of endometriosis; presence and s ize of ovarian endometriomas; extent type, and sire of peritoneal lesions; and pain scores. By logistic regression analysis, the presence and intensit y of total pain could be predicted simultaneously by the presence of deep e ndometriosis (p = 0.0001) and presence and extent of adnexal adhesions with out cystic endometriosis (p = 0.01), and by the presence of ovarian endomet rioma with periovarian adhesions (p = 0.03). Chronic pelvic pain was predic ted by both deep endometriosis (p = 0.0001) and ovarian endometriomas with adnexal adhesions (p = 0.03). Deep dyspareunia was predicted simultaneously by deep endometriosis (p = 0.01) and an ovarian endometrioma with periovar ian adhesions (p = 0.008). Conclusion. Deep endometriosis, pelvic adhesions, and ovarian cystic endome triosis were independent predictors of pelvic pain. These data strongly sug gest that it is not the size of ovarian cystic endometriosis but the associ ation with adhesions that causes pelvic pain.