Endometriosi e dolore pelvico: il ruolo del ginecologo

This paper reviews chronic pelvic pain with a focus on endometriosis, outlining prevalence estimates, distinguishing gynecologic versus non-gynecologic causes, and describing a diagnostic strategy emphasizing detailed history/exam and laparoscopic evaluation when surgical gynecologic causes are likely. Drawing on the authors’ experience with 280 women and a prior cohort of 90 women undergoing laparoscopy, it reports that endometriosis was confirmed in 40%, while pain symptom patterns correlated particularly with deep endometriosis, pelvic adhesions, and—through multivariable analysis—endometriomas as indirect risk factors; it also notes that pain associations vary depending on lesion site and the disease staging system used. The authors discuss uncertain mechanisms of endometriosis-related pain (inflammation, nerve infiltration, mediators, adhesions) and the lack of consensus that hampers definitive medical or surgical treatment selection, explicitly mentioning limitations such as discordant data and the absence of long-term trials for many therapies. This paper is centrally about endometriosis — it focuses on how gynecologists assess and interpret endometriosis as a cause of chronic pelvic pain and relates lesion characteristics to pain symptoms.

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