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Cited by 164Endometriosis Research and TreatmentGynecological conditions and treatmentsEctopic Pregnancy Diagnosis and Management

Pain typology and incident endometriosis

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Schliep, K.C., Mumford, S.L., Peterson, C.M., Chen, Z., Johnstone, E.B., Sharp, H.T., Stanford, J.B., Hammoud, A.O. +2 more·2015·Human Reproduction
DOI 10.1093/humrep/dev147PMC PMC4573450
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Abstract

STUDY QUESTION: What are the pain characteristics among women, with no prior endometriosis diagnosis, undergoing laparoscopy or laparotomy regardless of clinical indication? SUMMARY ANSWER: Women with surgically visualized endometriosis reported the highest chronic/cyclic pain and significantly greater dyspareunia, dysmenorrhea, and dyschezia compared with women with other gynecologic pathology (including uterine fibroids, pelvic adhesions, benign ovarian cysts, neoplasms and congenital Müllerian anomalies) or a normal pelvis. WHAT IS KNOWN ALREADY: Prior research has shown that various treatments for pain associated with endometriosis can be effective, making identification of specific pain characteristics in relation to endometriosis necessary for informing disease diagnosis and management. STUDY DESIGN, SIZE, DURATION: The study population for these analyses includes the ENDO Study (2007-2009) operative cohort: 473 women, ages 18-44 years, who underwent a diagnostic and/or therapeutic laparoscopy or laparotomy at one of 14 surgical centers located in Salt Lake City, UT or San Francisco, CA. Women with a history of surgically confirmed endometriosis were excluded. PARTICIPANTS/MATERIALS, SETTING AND METHODS: Endometriosis was defined as surgically visualized disease; staging was based on revised American Society for Reproductive Medicine (rASRM) criteria. All women completed a computer-assisted personal interview at baseline specifying 17 types of pain (rating severity via 11-point visual analog scale) and identifying any of 35 perineal and 60 full-body front and 60 full-body back sites for which they experienced pain in the last 6 months. MAIN RESULTS AND THE ROLE OF CHANCE: There was a high prevalence (≥30%) of chronic and cyclic pelvic pain reported by the entire study cohort regardless of post-operative diagnosis. However, women with a post-operative endometriosis diagnosis, compared with women diagnosed with other gynecologic disorders or a normal pelvis, reported more cyclic pelvic pain (49.5% versus 31.0% and 33.1%, P < 0.001). Additionally, women with endometriosis compared with women with a normal pelvis experienced more chronic pain (44.2 versus 30.2%, P = 0.04). Deep pain with intercourse, cramping with periods, and pain with bowel elimination were much more likely reported in women with versus without endometriosis (all P < 0.002). A higher percentage of women diagnosed with endometriosis compared with women with a normal pelvis reported vaginal (22.6 versus 10.3%, P < 0.01), right labial (18.4 versus 8.1%, P < 0.05) and left labial pain (15.3 versus 3.7%, P < 0.01) along with pain in the right/left hypogastric and umbilical abdominopelvic regions (P < 0.05 for all). Among women with endometriosis, no clear and consistent patterns emerged regarding pain characteristics and endometriosis staging or anatomic location. LIMITATIONS, REASONS FOR CAUTION: Interpretation of our findings requires caution given that we were limited in our assessment of pain characteristics by endometriosis staging and anatomic location due to the majority of women having minimal (stage I) disease (56%) and lesions in peritoneum-only location (51%). Significance tests for pain topology related to gynecologic pathology were not corrected for multiple comparisons. WIDER IMPLICATIONS OF THE FINDINGS: Results of our research suggest that while women with endometriosis appear to have higher pelvic pain, particularly dyspareunia, dysmenorrhea, dyschezia and pain in the vaginal and abdominopelvic area than women with other gynecologic disorders or a normal pelvis, pelvic pain is commonly reported among women undergoing laparoscopy, even among women with no identified gynecologic pathology. Future research should explore causes of pelvic pain among women who seek out gynecologic care but with no apparent gynecologic pathology. Given our and other's research showing little correlation between pelvic pain and rASRM staging among women with endometriosis, further development and use of a classification system that can better predict outcomes for endometriosis patients with pelvic pain for both surgical and nonsurgical treatment is needed. STUDY FUNDING/COMPETING INTERESTS: Supported by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (contracts NO1-DK-6-3428, NO1-DK-6-3427, and 10001406-02). The authors have no potential competing interests.

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  • Other endometriosis-related pains are dyspareunia, dyschezia, and dysuria, usually associated with DIE lesions.

    “Other endometriosis-related pain are dyspareunia, dyschezia, and dysuria, usually associated with DIE lesions [121, 122].”

    From Hormonal treatments for endometriosis: The endocrine background (2022) · cites this paper as [122]

    The Pain typology and endometriosis section reports that dyspareunia, dyschezia, and dysuria were associated with an endometriosis diagnosis. It does not establish that these pains are usually associated with deep infiltrating endometriosis (DIE) lesions: the same section reports no clear pattern by lesion location or depth, apart from limited associations. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • According to anatomical involvement of bowel, patients may alternate constipation and diarrhea, dischezia or blood in the stool, particularly perimenstrually.

    “According to the anatomical involvement of bowel, patients may alternate constipation and diarrhea, dischezia or blood in the stool (in particular perimenstrually) [122, 123]”

    From Hormonal treatments for endometriosis: The endocrine background (2022) · cites this paper as [122]

    The Discussion reports higher dyschezia (pain with bowel elimination) among women with endometriosis and discusses relationships between lesion location and pain. The paper does not report alternating constipation and diarrhea, blood in the stool, or that these bowel symptoms occur particularly around menstruation. (LLM, conf=0.87)

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  1. [15]15. Elliott A, Reisch J. Implementing a multiple comparison test for proportions in a 2xc crosstabulation in SAS. Proceedings of the 31st Annual SAS Users Group International Conference, San Francisco, California. Cary, NC: SAS Institute Inc 2006. 26 -29 March 2006. Paper 204 -31. Available from: http:// www2.sas.com/proceedings/sugi31/204-31.pdf.
  2. [22]22. Giudice LC. Clinical practice. Endometriosis. N Engl J Med 2010; 362:2389-2398.

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Authors
Schliep, K. C., Mumford, S. L., Peterson, C. M., Chen, Z., Johnstone, E. B., Sharp, H. T., Stanford, J. B., Hammoud, A. O., Sun, L., & Buck Louis, G. M.
Affiliations
  • National Institutes of Health (US)
  • University of Utah (US)
Corresponding author
Schliep, K.C.
ORCID
Venue
Human Reproduction
Publisher
Oxford University Press (OUP)
Published
2015-08-11
Volume
30
Issue
10
Pages
2427-2438
ISSN
  • 0268-1161 (ISSN-L)
  • 1460-2350
DOI
10.1093/humrep/dev147
PMC
PMC4573450
OpenAlex
W2206931619
Cited by
164
References
44
Citations by year
2026: 5 · 2025: 25 · 2024: 21 · 2023: 15 · 2022: 23 · 2021: 13 · 2020: 28 · 2019: 17 · 2018: 5 · 2017: 7 · 2016: 5
FWCI
6.47
Type
journal article
Language
en
Open access
Locations
  • Human Reproduction (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
  • National Institutes of Health (N01-DK-6-3428, N01-DK-6-3427, and 10001406-02)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
Keywords
endometriosis, chronic pelvic pain, cyclic pelvic pain, dyspareunia, dysmenorrhea, dyschezia, endometriosis diagnosis, laparoscopy, gynecologic surgery, endometriosis staging, uterine fibroids, pelvic adhesions, benign ovarian cysts
MeSH terms
Tissue Adhesions, Adolescent, Adult, Constipation, Dysmenorrhea, Dyspareunia, Endometriosis, Female, Humans, Laparotomy, Leiomyoma, Ovarian Cysts, Pain, Pain Measurement, Laparoscopy, Peritoneum, Cohort Studies, Incidence, Prevalence, Pelvic Pain, Young Adult, Pain Management

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