Mapping the source and character of pain due to endometriosis by patient-assisted laparoscopy.

STUDY OBJECTIVE: To determine by patient-assisted laparoscopy (PAL) the relationship of lesions of endometriosis to pelvic pain.

DESIGN: Prospective non-randomized study (Canadian Task Force classification II-1).

SETTING: University based facility.

PATIENTS: Fifty women with endometriosis.

INTERVENTION: Lesions of endometriosis were examined as to color and size, and these areas were mapped for pain.

MEASUREMENTS AND MAIN RESULTS: Lesions in all categories of colors and shapes were palpated. In lesions that did provoke a pain response, red and vascular lesions were most painful, followed by clear and white scar lesions. Least painful were black lesions. Pain extended beyond lesions to normal-looking peritoneum for up to 27 mm, but was not consistent with respect to type of lesion.

CONCLUSION: Pain of endometriosis has little relationship to location or color of lesions. It can extend beyond visible lesions to normal peritoneum. Input from patients by PAL may be essential to achieve successful therapy and eliminate excessive surgery and risk.