Endometriosis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Joseph Nasr, M.D.[2], Aravind Kuchkuntla, M.B.B.S[3], Mohammed Abdelwahed M.D[4]
Overview
Examination findings on digital vaginal examination and speculum examination include a fixed retroverted uterus, palpable nodularity of the uterosacral ligaments, and cul-de-sac with narrowing of the posterior fornix. Reduced uterine mobility and posterior cul-de-sac tenderness are additional findings suggestive of deep infiltrating disease. Physical examination may be normal in some patients, and absence of findings does not exclude endometriosis.[1][2]
Physical Examination
Physical examination findings in a patient with endometriosis include:[3]
HEENT
Patient may have:
Respiratory
- Decreased breath sounds and tenderness, especially on the right side (commonly present in patients with thoracic endometriosis)
Abdominal examination
- Lower abdominal tenderness
- Fixed and tender retroverted uterus (on bi-manual examination)
- Adnexal mass suggestive of ovarian endometrioma (if present and sufficiently large).[4]
Digital examination of the vagina
Common physical examination findings on digital examination include:[5]
- Fixed retroverted uterus
- Nodularity of the uterosacral ligaments
- Uterosacral ligament thickening.[1][2]
- Narrowing of the posterior vaginal fornix in patients with stage 3 and stage 4 disease
- Tenderness of the posterior cul-de-sac.[1][2]
- Lateral displacement of the cervix
Pelvic Floor Examination
- Pelvic floor muscle tenderness may be present.[6][7]
- Reproduction of pain with palpation of pelvic floor muscles may occur.[6][7]
- Myofascial trigger points may be identified on examination.[6][7]
Speculum examination of the vagina
Speculum examination may reveal:
- Lesions of endometriosis on the cervix or vagina
- Cervical displacement
References
- ↑ 1.0 1.1 1.2 Pashkunova D, Darici E, Senft B, et al. Lesion size and location in deep infiltrating bowel endometriosis: correlation with gastrointestinal dysfunction and pain. Acta Obstet Gynecol Scand.2024;103(9):1764-1770. doi:10.1111/aogs.14921
- ↑ 2.0 2.1 2.2 Vercellini P, Fedele L, Aimi G, Pietropaolo G, Consonni D, Crosignani PG. Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod. 2007;22(1):266-271. doi:10.1093/humrep/del339
- ↑ Cranney R, Condous G, Reid S (2017). "An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma". Acta Obstet Gynecol Scand. 96 (6): 633–643. doi:10.1111/aogs.13114. PMID 28186620.
- ↑ Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2(2):CD009591. doi:10.1002/14651858.CD009591.pub2
- ↑ Vercellini P, Trespidi L, De Giorgi O, Cortesi I, Parazzini F, Crosignani PG (1996). "Endometriosis and pelvic pain: relation to disease stage and localization". Fertil Steril. 65 (2): 299–304. PMID 8566252.
- ↑ 6.0 6.1 6.2 Coxon L, Demetriou L, Vincent K. Current developments in endometriosis-associated pain. Cell Rep Med. 2024;5(10):101769. doi:10.1016/j.xcrm.2024.101769
- ↑ 7.0 7.1 7.2 Kaplan CM, Kelleher E, Irani A, Schrepf A, Clauw DJ, Harte SE. Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms. Nat Rev Neurol. 2024;20(6):347-363. doi:10.1038/s41582-024-00966-8