Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis
Open Access
- 16 January 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in Human Reproduction
- Vol. 27 (3), 702-711
- https://doi.org/10.1093/humrep/der462
Abstract
The objective of this study was to evaluate the significance of severe preoperative pain for patients presenting with ovarian endometrioma (OMA). Three hundred consecutive patients with histologically proven OMA were enrolled at a single university tertiary referral centre between January 2004 and May 2010. Complete surgical excision of all recognizable endometriotic lesions was performed for each patient. Pain intensity was assessed with a 10-cm visual analogue scale (VAS). Pain was considered as severe when VAS was ≥7. Prospective preoperative assessment of type and severity of pain symptoms (VAS) was compared with the peroperative findings (surgical removal and histological analysis) of endometriomas and associated deeply infiltrating endometriosis. Correlations were sought with univariate analysis and a multiple regression logistic model. After multiple logistic regression analysis, uterosacral ligaments involvement was related with a high severity of chronic pelvic pain [odds ratios (OR) = 2.1; 95% confidence interval (CI): 1.1–4.3] and deep dyspareunia (OR = 2.0; 95% CI: 1.1–3.5); vaginal involvement was related with a higher intensity of lower urinary symptoms (OR = 13.4; 95% CI: 3.2–55.8); intestinal involvement was related with an increased severity of dysmenorrhoea (OR = 5.2; 95% CI: 2.7–10.3) and gastro-intestinal symptoms (OR = 7.1; 95% CI: 3.3–15.3). In case of OMA, severe pelvic pain is significantly associated with deeply infiltrating lesions. In this situation, the practitioner should perform an appropriate preoperative imaging work-up in order to evaluate the existence of associated deep nodules and inform the patient in order to plan the surgical intervention strategy.Keywords
This publication has 51 references indexed in Scilit:
- Increased Nerve Density in Deep Infiltrating Endometriotic NodulesGynecologic and Obstetric Investigation, 2010
- Accuracy of transvaginal sonography and rectal endoscopic sonography in the diagnosis of deep infiltrating endometriosisUltrasound in Obstetrics & Gynecology, 2007
- Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosisHuman Reproduction, 2007
- Pain, mast cells, and nerves in peritoneal, ovarian, and deep infiltrating endometriosisFertility and Sterility, 2006
- Innervation of ectopic endometrium in a rat model of endometriosisProceedings of the National Academy of Sciences of the United States of America, 2004
- Preferential infiltration of large bowel endometriosis along the nerves of the colonHuman Reproduction, 2004
- Hyperalgesia, nerve infiltration and nerve growth factor expression in deep adenomyotic nodules, peritoneal and ovarian endometriosisHuman Reproduction, 2002
- Relationship between endometriotic foci and nerves in rectovaginal endometriotic nodulesHuman Reproduction, 2000
- Neurotrophic Factors and PainThe Clinical Journal of Pain, 2000
- Revised American Fertility Society Classification of Endometriosis: 1985Fertility and Sterility, 1985