title: Deep infiltrating endometriosis: relation between severity of dysmenorrhoea and extent of disease.
abstract: BACKGROUND
  Little is known about the precise nature of the relationship between dysmenorrhoea (DM) and endometriosis. Our aim was to evaluate the relationship between the severity of DM in women with posterior deep infiltrating endometriosis (DIE) and indicators of the extent of their disease.
  
  
  METHODS
  Various indicators of the extent of DIE were recorded during surgery in 209 women. The severity of their DM was assessed with a pain scale. The scale was retrospective for 155 women and prospective for 54. Correlations were sought with an ordinal logistic regression model with cumulative odds.
  
  
  RESULTS
  On univariate analysis the following variables were related to the severity of DM: number of previous surgical procedures for endometriosis; revised American Fertility society classification; extensiveness of adnexal adhesion; Douglas obliteration; size of the posterior DIE implant; extent of the sub-peritoneal infiltration by the posterior DIE (rectal, vaginal or both versus sub-peritoneal only). Current infertility was associated with less severe DM. After multiple regression analysis, presence of a rectal or vaginal infiltration by the posterior DIE and extensiveness of adnexal adhesion were the only factors that remained related to DM severity.
  
  
  CONCLUSIONS
  The concept of 'very deep infiltrating endometriosis', defined as implants invading the wall of the pelvic organ, should be tested in future classification systems specifically addressed to the prediction of endometriosis-related pain.
authors.affiliation: Service de chirurgie gynécologique, Clinique universitaire Baudelocque, CHU Cochin, Saint Vincent de Paul, La Roche-Guyon, 123, bd Port-Royal 75079 Paris Cedex 14, France. charles.chapron@cch.ap-hop-paris.fr
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fauconnier
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Dubuisson
authors.forename: Habib
authors.initials: H
authors.lastname: Barakat
authors.forename: Marco
authors.initials: M
authors.lastname: Vieira
authors.forename: Gérard
authors.initials: G
authors.lastname: Bréart
mesh_terms: D000290:Adnexa Uteri / Q000473:pathology; D000328:Adult; D004412:Dysmenorrhea / Q000209:etiology* / Q000503:physiopathology*; D004715:Endometriosis / Q000145:classification / Q000150:complications* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005831:Genital Diseases, Female / Q000473:pathology; D006801:Humans; D007247:Infertility, Female / Q000209:etiology; D016015:Logistic Models; D010147:Pain Measurement; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000267:Tissue Adhesions / Q000473:pathology; D014623:Vaginal Diseases / Q000473:pathology