Endometriosis is often one of the most underdiagnosed, misdiagnosed and mistreated diseases in reproductive-aged women. Because the first step to receiving any successful treatment is first a proper diagnosis, it is imperative to find an endometriosis surgeon who will use and review all diagnostic tools to his disposal. This includes imaging techniques such as sonography, MRI, and laparoscopy. However, another crucial diagnostic tool that often goes underappreciated, is a physical exam, which entails the patient providing a thorough discussion of the symptoms they are experiencing and their past medical history. It is important to find a surgeon who will listen to these complaints as such signs as painful periods, painful sex (dyspareunia) and even gastrointestinal distress, which can often be seen in young age women in the form of constipation, painful bowel movements, and diarrhea, can all be highly suggestive indicators for a presumptive endometriosis diagnosis. Thus it is key to find a surgeon who is not only knowledgeable, but also compassionate and patient enough to listen to your full story, as all these elements can help to make up a highly accurate, but still speculative, diagnosis.
Diagnosing endometriosis requires 3 levels of diagnostic evaluation:
Endometriosis exists in different forms with different symptoms, signs, and prognoses. Though a growth in awareness of the variations of the disease has given rise to an increase in diagnoses, it still remains a seldom recognized and poorly understood illness. Confusion about appropriate management continues to surround the disease.
Despite advances in diagnostic technology and all the other presurgical imaging tests that help determine whether or not a patient may have endometriosis, a confirmation of endometriosis requires surgical biopsy. This is commonly obtained through minimally invasive laparoscopy.
The use of ultrasounds, magnetic resonance imaging (MRI), computerized tomography (CT scan), and certain endometrial biopsy samples may be used as part of a diagnostic workup, but to date, anything less than surgical confirmation of endometriosis is considered uncertain. There are also no specific and sensitive blood tests to diagnose endometriosis.
Physical Exam: There are a variety of tests that we like to perform in diagnosing endometriosis before a patient has surgery. After your symptoms, history, and complaints are well noted during an examination, we will conduct a thorough physical exam, which on top of a comprehensive pelvic exam, will include other tests such as checking for neuropathy in your lower back and legs, checking for costovertebral angle (CVA) tenderness, inspecting the cervix and evaluating the upper vagina with digital palpation. Nodularity, thickening, and shortening of the uterosacral ligament, rectovaginal, cul-de-sac, and lateral vaginal walls are all evaluated in this manner. Tenderness of these locations is significant in measuring the extent of the disease. Lastly, a gentle single digital pelvic bimanual examination is performed. The tenderness of the cervix to touching and mobilization during this exam (CMT, or cervical motion tenderness) is promptly noted, and subsequently the anterior and posterior cervix, then the upper vagina is also evaluated with digital palpation.
Transvaginal Ultrasound: For patients experiencing painful bowel movements, we like to perform a transvaginal rectovaginal sonogram (transvaginal ultrasonography or transvaginal ultrasound) as well. Transvaginal Ultrasound performed after a bowel preparation improves the ability to properly diagnose intestinal lesions and provides invaluable details, including which layers of the intestine, are affected and the distance between the lesion(s) and the anal border. The uterine walls, endometrial canal, and endometrial cavity are then carefully evaluated for the presence of adenomyosis, fibroids, and polyps. The cul-de-sac and rectovaginal septum are then scanned. Finally, it is important during a transvaginal ultrasound to inspect the ovaries. Having treated women with endometriosis for nearly three decades, we have come to strongly believe that ovarian cancer is directly associated with endometriosis. Transvaginal ultrasound has consistently proven to be the most promising imaging method for routine screening of ovarian cancer. It is also very effective in screening for endometriosis.
Sonohysterography: Sonohysterography is used along with an ultrasound to make detailed images of the uterine cavity in order to aid in identifying endometrial lesions of submucosal fibroids and polyps, particularly in patients with a history of infertility and heavy periods, regardless of their pain.
Hysteroscopy: Before any excision surgery, we will conduct a hysteroscopy in order to visualize the lining of the uterus (endometrium), allowing us to see if there is any uterine cause for heavy menstrual bleeding, pelvic pain or infertility.
Laparoscopy: Following your hysteroscopy, small incisions will be made into the abdominal and pelvic region. A laparoscope is then inserted into the incision sites and the images are depicted on two monitors, one for the surgeon and one for the attending resident. All surgeries we conduct are done via laparoscopy. This allows us to clearly visualize any believed endometriosis lesions.
ABC technique (™),: One diagnostic tool that we use, which is strictly unique to us, is the Aqua Blue Contrast Technique (ABC). This patented surgical technique is used during laparoscopic excision surgery in order to clearly visualize endometriosis scar tissue by use of an aqua blue contrast solution. While some lesions may be invisible to the typical surgeon using a laparoscopic light, the ABC technique eliminates light reflection in order for the surgeon to visualize, and thus identify and excise endometriosis lesions fully. Using this method, we ensure our patients that we can identify areas of endometriosis development throughout the body.
So many patients diagnosed with endometriosis go through several surgeries, only to have their symptoms keep returning. Often times the reason for this lies in the fact that not all of their endometriosis lesions have been identified and thus much more scar tissue remains in the body. Therefore it is crucial to research and read how your surgeon will identify endometriosis lesions throughout the body, in order to ensure a thorough and successful surgery.
Using common diagnostic tools such as ultrasound, MRI, and hysteroscopy, in combination with our unique method of laparoscopy with ABC technique, we spare no expense in ensuring that no visible endometriosis lesion goes undetected. But on top of all of these diagnostic tools, the first step in identifying your endometriosis is through communication.
After years of excessively painful periods, a serious loss of quality of life, and a series of uninformed and uninterested doctors, Dr. Seckin and Dr. Goldstein turned my life around. I was told I woke up from my surgery almost a year ago with a smile on my face, and I haven't stopped since. Before I heard of Dr. Seckin, I was experiencing almost daily terrible pain to the point where I had difficulty walking, inability to eat, inexplicable weight…
Dr Seckin and his team gave me back my life! Tomorrow will be 1 month since my surgery and I feel great. Dr. Seckin, Dr Liu, and Dr Goldstein are not only beyond words talented and amazing Doctors, but they are also genuinely wonderful and caring people. I cannot say enough great things about Holly, Asiye and Kim as well. They were all caring, kind, patient, and took the time to listen to me and explain anything I needed to…
Dr. Seckin and his staff spared me from years and years of heavy periods and unbearable endometriosis pain. After having surgery with him (my first) I can now function like a regular human. No more eating NSAIDs like candy and calling out sick from work. Thank you, Dr. Seckin!
I underwent surgery with Dr. Seckin in 2017 and have felt like a new woman ever since. If you have, or suspect you have endometriosis, Dr. Seckin and his compassionate team of surgeons and staff are a must-see.
I have struggled with endometriosis and adenomyosis since first starting my period at 13. I was diagnosed at 21 and what followed was a series of unsuccessful surgeries and treatments. My case was very aggressive and involved my urinary tract system and my intestines. After exhausting all of my local doctors I was lucky enough to find Dr. Seckin. We traveled over 5 hours each way to see him, but it was definitely worth it. He removed disease from several…
Seckin and Dr. Goldstein changed my life!
Like so many women who have tirelessly sought a correct diagnosis and proper, thorough medical treatment for endometriosis, I found myself 26 years into this unwanted journey without clear answers or help from four previous gynecological doctors and two emergency laparoscopic surgeries. I desperately wanted to avoid the ER again; a CT scan for appendicitis also revealed a likely endometrioma on my left ovary, for the second time in my life. This is when I finally found Dr. Seckin and…