Effect of Surgical Removal of Endometriomas on Cyclic and Non-cyclic Pelvic Pain.

Murat Api, Murat Apı, Ayşen Boza, Aysen Telce Boza, Semra Kayataş, Semra Kayatas, Mustafa Eroglu, Mustafa Eroğlu
International journal of fertility & sterility · 2015 · vol. 9(2) , pp. 183–8 · doi:10.22074/ijfs.2015.4252 · PMID:26246876 · W2154267348
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Laparoscopic removal of ovarian endometriomas, with or without peritoneal lesion ablation, relieved non-cyclic pelvic pain and dysmenorrhea but not dyspareunia in symptomatic women.

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This prospective observational before-after study evaluated whether laparoscopic surgical removal of ovarian endometriomas affects pelvic pain symptoms, including non-cyclic pelvic pain, cyclic dysmenorrhea, and dyspareunia. Twenty-three women with sonographically diagnosed and pathologically confirmed endometrioma but without signs or symptoms of deep infiltrative endometriosis were assessed for pain before and after surgery, with exclusion of factors such as adhesions and prior pelvic inflammatory disease. After surgery, the proportion reporting non-cyclic pelvic pain and cyclic dysmenorrhea decreased significantly, and non-cyclic pelvic pain intensity shifted toward lower categories, but dyspareunia showed minimal improvement (only 1 case reported relief among sexually active participants). This paper is centrally about endometriosis — it specifically examines how endometrioma removal impacts cyclic and non-cyclic pelvic pain and dyspareunia in women with ovarian endometriomas.

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Abstract

BACKGROUND: Endometriosis is a complex disease with a spectrum of pain symptoms from mild dysmenorrhea to debilitating pelvic pain. There is no concrete evidence in the literature whether endometriotic cyst per se, causes pain spectrum related to the disease. The aim of the present study was to evaluate the effect of surgical removal of endome- triomas on pain symptoms. MATERIALS AND METHODS: In this prospective, observational, before-after study, which was conducted between March 2012 and January 2013 in Training and Research Hospital,Adana, Turkey, a total of 23 patients including 16 sexually active and 7 vir- gin symptomatic women were questioned for non-cyclic pelvic pain (NCPP), intensity of the NCPP, presence of cyclic dysmenorrhea, and dyspareunia before and after the endometrioma operation. Participants who were sonographically diagnosed and later pathologically confirmed as having endometrioma without sign and symptoms of deep infiltrative endometriosis (DIE) were also questioned for pain symptoms before and after the laparoscopic removal of cyst wall. Patients with intraabdominal adhesions, history of pelvic inflammatory disease, and pathological diagnosis other than endometrioma were excluded. No ancillary procedures were applied for pain management, but if pain was present, pelvic peritoneal endometriotic lesions were ablated beside the removal of ovar- ian endometriotic cysts. RESULTS: Out of 23 cases with endometrioma, 91 and 78% reported to have NCPP and dysmenorrhea, respectively, before the operation, while 60 and 48%, respec- tively, after the operation (McNemar's test, P=0.016 for both figures). Among the sexually active cases, 31% (5/16) had dyspareunia before the operation and only 1 case reported the pain relief after the operation (McNemar's test, P=1). Intensity of NCPP were reported to be none (8.7%), moderate (21.7%), severe (56.5%) and un- bearable (13%) before the operation and decreased to none (43.5%), mild (43.5%), moderate (4.3%) and severe (8.7%) after the operation (Wilcoxon signed-rank test, P<0.001). CONCLUSION: In symptomatic cases with ovarian endometrioma, without sign and symptoms of DIE, laparoscopic removal of the cysts with/without ablation of the peritoneal endometriotic lesions yields relief of NCPP and cyclic dysmenorrhea, but not dyspareunia.
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International Journal of Fertility and Sterility (Jul 2015) Effect of Surgical Removal of Endometriomas on Cyclic and Non-cyclic Pelvic Pain Abstract Background Endometriosis is a complex disease with a spectrum of pain symptoms from mild dysmenorrhea to debilitating pelvic pain. There is no concrete evidence in the literature whether endometriotic cyst per se, causes pain spectrum related to the disease. The aim of the present study was to evaluate the effect of surgical removal of endome- triomas on pain symptoms. Materials and Methods In this prospective, observational, before-after study, which was conducted between March 2012 and January 2013 in Training and Research Hospital,Adana, Turkey, a total of 23 patients including 16 sexually active and 7 vir- gin symptomatic women were questioned for non-cyclic pelvic pain (NCPP), intensity of the NCPP, presence of cyclic dysmenorrhea, and dyspareunia before and after the endometrioma operation. Participants who were sonographically diagnosed and later pathologically confirmed as having endometrioma without sign and symptoms of deep infiltrative endometriosis (DIE) were also questioned for pain symptoms before and after the laparoscopic removal of cyst wall. Patients with intraabdominal adhesions, history of pelvic inflammatory disease, and pathological diagnosis other than endometrioma were excluded. No ancillary procedures were applied for pain management, but if pain was present, pelvic peritoneal endometriotic lesions were ablated beside the removal of ovar- ian endometriotic cysts. Results Out of 23 cases with endometrioma, 91 and 78% reported to have NCPP and dysmenorrhea, respectively, before the operation, while 60 and 48%, respec- tively, after the operation (McNemar’s test, P=0.016 for both figures). Among the sexually active cases, 31% (5/16) had dyspareunia before the operation and only 1 case reported the pain relief after the operation (McNemar’s test, P=1). Intensity of NCPP were reported to be none (8.7%), moderate (21.7%), severe (56.5%) and un- bearable (13%) before the operation and decreased to none (43.5%), mild (43.5%), moderate (4.3%) and severe (8.7%) after the operation (Wilcoxon signed-rank test, P < 0.001). Conclusion In symptomatic cases with ovarian endometrioma, without sign and symptoms of DIE, laparoscopic removal of the cysts with/without ablation of the peritoneal endometriotic lesions yields relief of NCPP and cyclic dysmenorrhea, but not dyspareunia. Keywords

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endometriosisdie_deep_infiltratingendometriomadysmenorrheadyspareunia

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