Prospective, Observational Study Looking at How Much Pain (VAS) Endometriosis Patients Experience, As Well As the Types and Degrees of Adhesions

Aim: Evaluating degree of pelvic pain and comparing it with the type and degree of adhesions in patients of Endometriosis. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynecology, NSMCH, Amhara, Bihta, Patna, India for 10 months. Total 80 women; aged 20-50 years, diagnosed as having endometriosis by clinical history, abdominal and pelvic examination, trans vaginal sonography and colour Doppler were included in the study. Pain intensity was assessed by visual analogue scale (VAS). Pain intensity was scored from 0 to 10, in which score 0 means no pain and 10 means worst pain. A score of 1-3, 4-6 and ≥7 was classified as mild, moderate and severe pelvic pain respectively by looking at the facial expression of the patients. Results: Out of 80 women with endometriosis, 20 women (25%) had mild pain, 50 women (62.5%) had moderate pain and 10 women (12.5%) had severe pain. Forniceal thickening was present in 65 women (81.25%), cyst was felt in 44 women (55%), uterine mobility was restricted in 32women (40%) and pouch of Douglas (POD) thickening was present in 27 women (33.75%). Out of 80 women with endometriotic cysts, 64(80%) had unilateral cysts while the remaining 16(20%) had bilateral cysts. Unilateral tubal adhesions were present in 64(80%) women and bilateral adhesions were present in 16(20%) women. Among the types of adhesions, flimsy adhesions were most common, being present in 64(80%) women, isolated dense adhesions were present in only 2(2.5%) women, while combination of flimsy and deep adhesions were present in 14 (17.5%) women. Less than 1/3rd tubal adhesions were present in 10(12.5%) women, 1/3rd-2/3rd tubal adhesions were present in 41(51.25%) while more than 2/3rd tubal adhesions were present in 29(36.25%) women. All the ovarian adhesions were flimsy. Out of 80 women with endometriosis, ovarian adhesions were present in 15(18.75%) women while absent in 65(81.25%) women. Less than 1/3rd ovarian adhesions were present in only 4(5%) women, 1/3rd-2/3rd ovarian adhesions were present in 7(8.75%) women and more than 2/3rd ovarian adhesions were present in 4(5%) women. Conclusion: The severity of pain correlated with type of adhesions being more commonly associated with dense adhesions as compared to flimsy adhesions.