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Human Reproduction Update Advance Access originally published online on September 19, 2005
Human Reproduction Update 2005 11(6):595-606; doi:10.1093/humupd/dmi029
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications

A. Fauconnier1,2 and C. Chapron3,4

1 Unité Inserm 149, Recherches Épidémiologiques en Santé Périnatale et Santé des Femmes, Port-Royal, 2 Service de Gynécologie, Obstétrique et Médecine de la Reproduction CHI Poissy-St-Germain, Saint-Germain-En-Laye and 3 Service de Gynécologie Obstétrique II, Assistance Publique – Hôpitaux de Paris, Unité de Chirurgie Gynécologique, CHU Cochin, Port-Royal, Paris, France

4 To whom correspondence should be addressed at: Service de Gynécologique et Obstétrique II, CHU Cochin–Saint-Vincent de Paul–La Roche-Guyon, 123, bd de Port-Royal 75079, Paris cedex 14, France. E-mail: charles.chapron{at}cch.ap-hop-paris.fr

Submitted on May 19, 2005; revised on June 30, 2005; accepted on July 18, 2005

The relationship between chronic pelvic pain symptoms and endometriosis is unclear because painful symptoms are frequent in women without this pathology, and because asymptomatic forms of endometriosis exist. Our comprehensive review attempts to clarify the links between the characteristics of lesions and the semiology of chronic pelvic pain symptoms. Based on randomized trials against placebo, endometriosis appears to be responsible for chronic pelvic pain symptoms in more than half of confirmed cases. A causal association between severe dysmenorrhoea and endometriosis is very probable. This association is independent of the macroscopic type of the lesions or their anatomical locations and may be related to recurrent cyclic micro-bleeding in the implants. Endometriosis-related adhesions may also cause severe dysmenorrhoea. There are histological and physiopathological arguments for the responsibility of deeply infiltrating endometriosis (DIE) in severe chronic pelvic pain symptoms. DIE-related pain may be in relation with compression or infiltration of nerves in the sub-peritoneal pelvic space by the implants. The painful symptoms caused by DIE present particular characteristics, being specific to involvement of precise anatomical locations (severe deep dyspareunia, painful defecation) or organs (functional urinary tract signs, bowel signs). They can thus be described as location indicating pain. A precise semiological analysis of the chronic pelvic pain symptoms characteristics is useful for the diagnosis and therapeutic management of endometriosis in a context of pain.

Key words: chronic pelvic pain / dysmenorrhoea / dyspareunia / endometriosis / questioning


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