Association between preoperative pelvic exam findings and locations of endometriosis

Endometriosis causes an inflammatory reaction, with likely irritation of certain nerve fibers. Nerve irritation can then contribute to localized and generalized pain. Lesions can occur anywhere in the pelvis. Prior studies have focused on whether symptomatology can diagnose endometriosis, finding that the association between symptoms and location of endometriosis is inconsistent. While there are physical exam findings suggestive of endometriosis, there is limited data investigating physical exam findings and location of endometriosis. This study investigated whether there is an association between preoperative physical exam findings and the location of pathology confirming endometriosis. This was a retrospective cohort study of all women with surgeries performed by MedSTAR Minimally Invasive Gynecologic Surgeons in Washington, DC from March 2018 through March 2021 who were found to have pathological proven endometriosis. Our primary outcome was assessing the association between physical exam findings and intra-operative surgical findings. Chi-square and Fisher exact test was performed to calculate variables with a P<.05 based on bivariable analysis. A total of 381 patients with endometriosis were assessed. There is a statistically significant association between levator ani tenderness, obturator tenderness, fixed uterus/ cervix, cervical motion tenderness, and vestibulodynia and the presence of endometriosis found in the lateral pelvis, posterior pelvis, and uterosacral ligaments (Figure 1). The most common sites for endometriotic lesions were noted in the lateral pelvis (47.2%), uterosacral ligaments (43.6%), and the posterior pelvis (41.2%) (Figure 2). Interestingly, there was no association between uterosacral ligament tenderness and uterosacral ligament endometriosis. However, uterosacral tenderness was associated with adhesions in the pelvis (p=.0341). Additionally, there was also an association between ovarian fossa tenderness and lateral pelvis endometriosis and uterosacral endometriosis, but not with posterior pelvis endometriosis. Positive exam findings are associated with locations of pelvic and GI endometriosis lesions which can assist in surgical planning. The most common sites for endometriosis locations are the lateral pelvis, uterosacral ligaments and the posterior pelvis. Numerous physical exam findings correlate with endometriosis, but the specificity of a physical exam may be limited. Most patients with endometriosis had positive physical exam findings, however the location of the pain was not specific for the location of disease.View Large Image Figure ViewerDownload Hi-res image Download (PPT)