title: Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis.
abstract: BACKGROUND
  The objective of this study was to evaluate the significance of severe preoperative pain for patients presenting with ovarian endometrioma (OMA).
  
  
  METHODS
  Three hundred consecutive patients with histologically proven OMA were enrolled at a single university tertiary referral centre between January 2004 and May 2010. Complete surgical excision of all recognizable endometriotic lesions was performed for each patient. Pain intensity was assessed with a 10-cm visual analogue scale (VAS). Pain was considered as severe when VAS was ≥ 7. Prospective preoperative assessment of type and severity of pain symptoms (VAS) was compared with the peroperative findings (surgical removal and histological analysis) of endometriomas and associated deeply infiltrating endometriosis. Correlations were sought with univariate analysis and a multiple regression logistic model.
  
  
  RESULTS
  After multiple logistic regression analysis, uterosacral ligaments involvement was related with a high severity of chronic pelvic pain [odds ratios (OR) = 2.1; 95% confidence interval (CI): 1.1-4.3] and deep dyspareunia (OR = 2.0; 95% CI: 1.1-3.5); vaginal involvement was related with a higher intensity of lower urinary symptoms (OR = 13.4; 95% CI: 3.2-55.8); intestinal involvement was related with an increased severity of dysmenorrhoea (OR = 5.2; 95% CI: 2.7-10.3) and gastro-intestinal symptoms (OR = 7.1; 95% CI: 3.3-15.3).
  
  
  CONCLUSIONS
  In case of OMA, severe pelvic pain is significantly associated with deeply infiltrating lesions. In this situation, the practitioner should perform an appropriate preoperative imaging work-up in order to evaluate the existence of associated deep nodules and inform the patient in order to plan the surgical intervention strategy.
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Universitaire Ouest, Centre Hospitalier Universitaire Cochin Saint Vincent de Paul, Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Paris, France. charles.chapron@cch.aphp.fr
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
authors.forename: Pietro
authors.initials: P
authors.lastname: Santulli
authors.forename: Dominique
authors.initials: D
authors.lastname: de Ziegler
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Noel
authors.forename: Vincent
authors.initials: V
authors.lastname: Anaf
authors.forename: Isabelle
authors.initials: I
authors.lastname: Streuli
authors.forename: Hervé
authors.initials: H
authors.lastname: Foulot
authors.forename: Carlos
authors.initials: C
authors.lastname: Souza
authors.forename: Bruno
authors.initials: B
authors.lastname: Borghese
mesh_terms: D000293:Adolescent; D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D017699:Pelvic Pain / Q000209:etiology* / Q000601:surgery; D012044:Regression Analysis