Persistence of dysmenorrhea and nonmenstrual pain after optimal endometriosis surgery may indicate adenomyosis. Fertil Steril 2006;

Reply: Poor results after surgery for rectovaginal endometriosis can be related to uterine adenomyosis Sir, We appreciate our colleagues ’ considerations regarding the need for preoperative investigation of simultaneous presence of adenomyosis in patients with severe endometriosis. We agree that the presence of uterine adenomyosis can influence the post-operative improvement pattern of pain symptoms associated with endometriosis. We also agree that preoperative evaluation of concomitant adenomyosis should be included in the preoperative workup when endometriosis is clinically suspected, particularly in patients desiring a pregnancy. However, in this study, our primary end-point was to evaluate the