As we may all be familiar with classic smptoms of endometriosis the signs and the findings of endometriosis are dependent on phycisian evaluation.
Let us review the the classic symptoms of endometriosis. Number one cardinal symptom is painful periods, dysmenorrhea, around and during menstruation.The painful periods due to endometrioiisis is unique. It lasts more than two days, usually crampy( killer in nature) particularly during adoloscent years.later accompanied by achyness with constant discomfort. It may progress into further crdinal symptoms of endometriosis. The second cardinal symptom of is gastrointestinal triad of bloatiness,and gassiness, associated with or without diarrhea, constipation which is more pronounced around menstruation.
The third and fourth cardinal symptom of endometriosis point to a deeper involvement of recto vaginal septum and pelvic lateral walls. The forth cardinal symptoms is painful sex, wahich at times positional.Similarly again due to deeper involvement painful boel movemnts and .Painful sex may be followed by aftereffects such back pain, and leg pain the following day.
The fourth cardinal symtom is painful bowel movements, and leg pain often with back pain during periods. Last but very frequent and elusive symptom is infertility. Not able to get pregnant is many patients are unnessarily treated with in vitro treatments without endometriosis being addresed.
The signs and findinds of endometriosis are revealed during office visit.It takes an experinced doctor without any difficulty promptly recognize all associated aspect in this critical junture of office visit. The timing of this visit is ideally during the perio or around the period. Addominal, pelvic pain is evaluated by palpation. CVA tenderness is checked , together with leg tests of raising and crossing i performed. Then vagina and cervix is inpected by speculum. Cervix is inspected for presense of stricture or pin hole appearance. Then a gentle single digital pevic bimanual examination is performed. The tenderness of cevix to touching and mobilization is promptly noted.(Cervical Motion Tenderness) Subsequently anteriour and posterior cervix, then upper vagina is evaluated with digital palpation.. Nodularity, thickening, shortening of uterosacral ligament and recto vaginal, cul de sac, and lateral vaginal walls are evaluated. Tendernes of these lecations have sigificant value with respect ot the stage of the disease.
Following the bimanual examination the next step becomes the transvaginal sonograhic evaultion. The uterine walls, endometrial canal and endometrial cavity are carefully evaluated for the presence of adenomyosis, fibroids and polyps. The culdesac and rectoginal setum are scanned.Some patients may be requested to have bowel prep prior to this exam of sonographic evaluation( Transvaginal Recro-vaginal sonogram). Sono hysterographic exam further may enhance the presence of endometrial lesions of submucocal fibroids and polyps particularly in patients with history of infertility and and heavy periods irregardless of their pain symptoms. Ovaries then becomes the most important organ in transvaginal sonogram. Endometrioma needs to be ruled out recognizing the very special unique appearance.
