"Studying endometriosis is like nailing Jello to a tree."
Donna Vogel, National Institute of Health 2000
Click to download free PDF of:
Laparoscopic Appearance
of Endometriosis Color Atlas
1991 revised 2007 & 2017
Endometriosis Links

Theories and Concepts
There are more than 70 theories and concerns.  It generally
takes 6 theories or concepts to explain what I have seen and
several more to introduce what I have read.

Endometriosis Fertility Index
The EFI is the only validated staging system for endometriosis

Stage V endometriosis has been discussed by Canis and
suggested as part of the
Endometriosis Fertility Index by


The microscopic characteristics of endometriosis were described
more than 150 years ago by Rokitansky in 1861.

Unrecognized microscopic ovarian endometriosis was recognized
more than 100 years ago by Russell in 1899. He postulated the
embryonic origin of endometriosis as Müllerian remnants.

Lockyer (1917) published the first classification of endometriosis.

Sampson published an extensive series of articles and first used
the name endometriosis from 1921 to 1940. He described
chocolate cysts, blebs, adenomyomatous infiltration in the
rectovaginal septum, adherent surfaces, red raspberries, purple
raspberries, blueberries, deep infiltration, inflammatory reactions,
cancer arising in endometriotic implants and peritoneal pockets.

Sampson originally used earlier theories on embryonic origin,
ovarian epithelial metaplasia, dissemination form ovarian
endometriosis, lymphatic spread, and venous emboli, but
subsequently postulated retrograde menstruation of tissue
fragments as the origin of endometriosis.  His retrograde theories
are included in recent theories including retrograde stem cells and
epigenetic changes.

Colorless, amenorrheic lesions were seen by Fallon in 1950.

Karnaky (1969) published an age dependent appearance of
endometriosis starting with an initial water blister appearance.

Goldstein (1980) found endometriosis in 47% of adolescents with
chronic pain using a close-up view.  There were only petechial-like
lesions and blebs in 20% of those

Semm (1987) noted subtle clear lesions detected using meticulous
search with magnification and discussed invisible lesions noted
only after coagulation.
Daniel Clyde Martin, M.D., Richmond,
Virginia, Memphis, Tennessee,