Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis

Charles Chapron, Chapron C, Santulli P, Piétro Santulli, Pietro Santulli, de Ziegler D, D. de Ziegler, Dominique de Ziegler, Jean-Christophe Noel, Noel JC, J.C. Noël, Anaf V, Vincent Anaf, Isabelle Streuli, Hervé Foulot, Foulot H, H. Foulot, Carlos Augusto Bastos de Souza, Souza C, Carlos Souza, Bruno Borghese
Human Reproduction · 2012 · vol. 27(3) , pp. 702–711 · doi:10.1093/humrep/der462 · PMID:22252082 · W2122948440
article OA: bronze CC0 ⤵ 115 in-corpus citations
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Severe pelvic pain in ovarian endometrioma patients was significantly associated with deeply infiltrating endometriosis, particularly involving the uterosacral ligaments, vagina, and intestines.

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Abstract

BACKGROUND: The objective of this study was to evaluate the significance of severe preoperative pain for patients presenting with ovarian endometrioma (OMA). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

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Outcome instruments

VAS-pain

Condition tags

endometriosischronic_pelvic_painendometriomadysmenorrheadyspareunia

MeSH descriptors

Endometriosis Pelvic Pain Adolescent Adult Endometriosis Endometriosis Endometriosis Female Humans Multivariate Analysis Pelvic Pain Pelvic Pain Regression Analysis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (58)

Cited by (50)

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