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Dan C. Martin, MD
UT Medical Group,
Inc.
University of Tennessee Health Science Center (UTHSC)
Academic Office
Daniel Clyde Martin, M.D.
UT Medical Group,
Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
Suite 320
Germantown, Tennessee
TN 38138-1733
(901) 347-8331
(901) 347-8188 fax
Directions to Office
Updated information is
at
UTMG 2006
Click for information
on:
Glenn Ann Martin, Ph.D.
Clinical
Psychologist
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Symptomatic and Asymptomatic Endometriosis
Adapted from "Recognition of Endometriosis" in
Laparoscopic Appearance of Endometriosis, Lecture Supplement
Martin DC (ed), Resurge Press, Memphis, (c)1991
  
The stage of endometriosis has not generally correlated with the degree of pelvic
pain. (Fedele, Parazzini, Bianchi, Arcaini, & Candiani, 1990; Fukaya, Hoshiani, & Yajima, 1993; Gomibuchi, Taketani, Doi, Yoshida, Mizukawa, Kaneko, et al., 1993; Ripps & Martin, 1991) However, the depth of infiltration does correlate with both focal tenderness and
pain (Koninckx, Meuleman, Demeyere, Lesaffre, & Cornillie, 1991; Ripps & Martin, 1992) and the intensity of dysmenorrhea correlates with the number of
implants. (Perper, Nezhat, Goldstein, Nezhat, & Nezhat, 1995) At an extreme, patients with deep retroperitoneal endometriosis (AFS score 0, stage 0) can have significant pain and damage to the bowel or ureter with no visible peritoneal
disease. (Koninckx & Martin, 1992; Moore, Binstock, & Growdon, 1988)
In looking at asymptomatic women, Moen found that 16% undergoing sterilization at pregnancy termination and 22% undergoing interval sterilization have endometriosis. When this was analyzed for the number of years since the last delivery, the odds ratio increased to 4.5 at 10 years when compared with the first five years after delivery. The prevalence of the disease was increasing as the interval from the last pregnancy increased in these symptom-free women. Endometriosis appears to be associated with both voluntary and involuntary
infertility. (Moen, 1991; Moen & Muus, 1991)
Rawson found that 50% of patients undergoing sterilization and 61% of patients having surgery for myomata had endometriosis which was
asymptomatic. (Rawson, 1991) Martin found a similar occurrence of 25% in patients having tubal sterilization
reversals. (Martin, Hubert, Vander Zwaag, & El-Zeky, 1989) In post-menopausal women, as many as 93% may be
asymptomatic. (Kempers, Dockerty, Hunt, & Symmonds, 1960)
Return to top of
page.
Bibliography
 | Fedele, L., Parazzini, F., Bianchi, S., Arcaini, L., & Candiani, G. B. (1990). Stage and localization of pelvic endometriosis and pain. Fertil Steril, 53, 155-158. |
| Fukaya, T., Hoshiani, H., & Yajima, A. (1993). Is pelvic endometriosis always associated with chronic pain? A retrospective study of 618 cases diagnosed by laparoscopy. Am J Obstet Gynecol, 169(4), 719-722. |
| Gomibuchi, H., Taketani, Y., Doi, M., Yoshida, K., Mizukawa, H., Kaneko, M., Kohda, K., Takei, T., Kimura, Y., Liang, S.-G., & Kaibara, M. (1993). Is personality involved in the expression of dysmenorrhea in patients with endometriosis? Am J Obstet Gynecol, 169(3), 723-725. |
| Kempers, R. D., Dockerty, M. B., Hunt, A. B., & Symmonds, R. E. (1960). Significant postmenopausal endometriosis. Surg Gynecol Obstet, 111(Sept), 348-356. |
| Koninckx, P. R., & Martin, D. C. (1992). Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril, 58, 924-928. |
| Koninckx, P. R., Meuleman, C., Demeyere, S., Lesaffre, E., & Cornillie, F. J. (1991). Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril, 55, 759-765. |
| Martin, D. C., Hubert, G. D., Vander Zwaag, R., & El-Zeky, F. A. (1989). Laparoscopic appearances of peritoneal endometriosis. Fertil Steril, 51, 63-67. |
| Moen, M. H. (1991). Is a long period without childbirth a risk factor for developing endometriosis. Hum Reprod, 6(10), 1404-1407. |
| Moen, M. H., & Muus, K. M. (1991). Endometriosis in pregnant and non-pregnant women at tubal sterilization. Hum Reprod, 6(5), 699-702. |
| Moore, J. G., Binstock, M. A., & Growdon, W. A. (1988). The clinical implications of retroperitoneal endometriosis. Am J Obstet Gynecol, 158, 1291-1298. |
| Perper, M. M., Nezhat, F., Goldstein, H., Nezhat, C. H., & Nezhat, C. (1995). Dysmenorrhea is related to the number of implants in endometriosis patients. Fertil Steril, 63, 500 - 503. |
| Rawson, J. M. R. (1991). Prevalence of endometriosis in asymptomatic women. J Reprod Med, 36, 513-515. |
| Ripps, B. A., & Martin, D. C. (1991). Focal pelvic tenderness, pelvic pain and dysmenorrhea in endometriosis. J Reprod Med, 36, 470-472. |
| Ripps, B. A., & Martin, D. C. (1992). Correlation of focal pelvic tenderness with implant dimension and stage of endometriosis. J Reprod Med, 37, 620-624. |
Adapted from "Recognition of Endometriosis" in
Laparoscopic Appearance of Endometriosis, Lecture Supplement
Martin DC (ed), Resurge Press, Memphis, (c)1991
The
color illustrations
that accompanied this paper are in the
Color Atlas.
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