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Tubal Reversal
Reproductive Surgery
Dr Martin
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Dan C. Martin, MD
UT Medical Group, Inc.

University of Tennessee Health Science Center (UTHSC)

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Daniel Clyde Martin, M.D.
UT Medical Group, Inc.
Infertility and Gynecology
Reproductive Surgery
Germantown Office Building
7945 Wolf River Boulevard
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Germantown, Tennessee
TN 38138-1733

(901) 347-8331
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Glenn Ann Martin, Ph.D.
Clinical Psychologist

Symptomatic and Asymptomatic Endometriosis

Adapted from "Recognition of Endometriosis" in
Laparoscopic Appearance of Endometriosis, Lecture Supplement
Martin DC (ed), Resurge Press, Memphis, (c)1991

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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)

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bulletFedele, L., Parazzini, F., Bianchi, S., Arcaini, L., & Candiani, G. B. (1990). Stage and localization of pelvic endometriosis and pain. Fertil Steril, 53, 155-158.
bulletFukaya, 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.
bulletGomibuchi, 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.
bulletKempers, R. D., Dockerty, M. B., Hunt, A. B., & Symmonds, R. E. (1960). Significant postmenopausal endometriosis. Surg Gynecol Obstet, 111(Sept), 348-356.
bulletKoninckx, P. R., & Martin, D. C. (1992). Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa? Fertil Steril, 58, 924-928.
bulletKoninckx, 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.
bulletMartin, D. C., Hubert, G. D., Vander Zwaag, R., & El-Zeky, F. A. (1989). Laparoscopic appearances of peritoneal endometriosis. Fertil Steril, 51, 63-67.
bulletMoen, M. H. (1991). Is a long period without childbirth a risk factor for developing endometriosis. Hum Reprod, 6(10), 1404-1407.
bulletMoen, M. H., & Muus, K. M. (1991). Endometriosis in pregnant and non-pregnant women at tubal sterilization. Hum Reprod, 6(5), 699-702.
bulletMoore, J. G., Binstock, M. A., & Growdon, W. A. (1988). The clinical implications of retroperitoneal endometriosis. Am J Obstet Gynecol, 158, 1291-1298.
bulletPerper, 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.
bulletRawson, J. M. R. (1991). Prevalence of endometriosis in asymptomatic women. J Reprod Med, 36, 513-515.
bulletRipps, B. A., & Martin, D. C. (1991). Focal pelvic tenderness, pelvic pain and dysmenorrhea in endometriosis. J Reprod Med, 36, 470-472.
bulletRipps, 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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