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Symptoms - Endometriosis


Endometriosis symptoms

What are the symptoms of endometriosis?

In this page, we try to summarize the principal symptoms exhibited by endometriosis patients.

If you should have some of these symptoms, we recommend doing the free online test offered by the Italian Endometriosis Foundation and, then, going to see a specialist.

Let’s start…

1. Pelvic Pain

Pelvic pain indicates suffering in the lower part of the trunk, that is, abdominal pain below the belly button.

Pelvic pain is categorized as follows:
– Acute: it lasts no more than 2 or 3 months;
– Chronic: it continues for 6 months or more.

Diagnosing pelvic pain in a woman is extremely hard since it can be attributed to different causes, such as gynaecological, reproductive, gastrointestinal, urinary and musculoskeletal disorders. Both chronic and acute pelvic pain entail sensory, motor, affective and behavioural responses.

Visceral pain coming from internal organs (uterus, intestine, etc.) is poorly localized. It is often intense and diffuse, and it is accompanied by painful autonomic reflexes, nausea, diaphoresis and anxiety. In the case of chronic gynaecological pain, the sensory innervation of the reproductive organs can propagate to the bladder and urethra. In contrast, the somatic pain of the cutaneous structures of fascial bands or muscles (anus, urethra, external genitalia and parietal peritoneum) is precisely localized since these areas are rich in sensory nerves. The pain propagates from the dermatomes of the spinal cord that, via peripheral nerves, innervate the viscera involved.

2. Dysmenorrhea (intense menstrual pain)

Intense menstrual pain, called dysmenorrhea, is not a physiological condition of the female reproductive cycle and should not be considered normal.

Attention should always be paid to this symptom, which is a signal requiring further diagnostics to determine its cause. Often, dysmenorrhea is superficially underestimated, even in the family environment, leading to a delayed diagnosis of endometriosis.

3. Dyspareunia (pain during sexual intercourse)

Dyspareunia is not a physiological condition, especially when it arises after a period of painless sexual intercourses. An accurate exam by a specialist can generally identify its causes.

This is an important symptom of deep endometriosis, that is, endometriosis developed within the pelvic connective tissue, usually around the lower uterus or the vagina, or between the vagina and the rectum or bladder.

4. Rectal discomfort

Rectal discomfort includes various symptoms of variable frequency, such as rectal tenesmus (false urge to defecate), stabbing pain in the rectum, difficulty in sitting normally and a sensation of back weight.

These symptoms can indicate that endometriosis has developed in the back pelvic cavity, between the uterus, vagina and rectum or laterally to the rectum. Attention must be paid to whether these symptoms are more frequent during the menstrual, perimenstrual or ovulation period and if they are associated with other symptoms. The deep disease is mainly diagnosed via manual examination, while ultrasound and resonance investigations are notoriously misleading and, thus, useless.

Evaluation of the pelvic pain

The pelvic pain is not always anatomically localized where it origins from; this principle is paramount for a correct evaluation of the pain and the identification of its causes.

An extensive anamnesis of the patient is crucial for the diagnosis. The following aspects must be described: pain, systemic symptoms, symptoms’ location, menstrual history, methods adopted for contraception and for protection against sexually transmitted diseases, detailed urinary symptoms, gastrointestinal functioning and previous diseases (including sexual abuses and mental disorders).

A general examination of the patient is important, including her body temperature, appearance and anxiety level. The pelvic exam must also be conducted, according to accuracy and delicacy criteria since pressing the organs can induce discomfort; thus, the patient must be distracted to allow her muscle relaxation.

The bimanual examination must be performed following a precise order of organ inspection, from outside inwards; the rectal exam must always be conducted after the vaginal inspection.


The pelvic pain diagnosis requires to determine whether the patient is pregnant and analyse the vaginal secretion and the quantity of bacterial flora, besides culturing for gonorrhea and chlamydia in the case of excessive vaginal secretion.

If the diagnosis cannot be achieved via physical examination, pelvic or transvaginal ultrasound is recommended.

Magnetic resonance and laparoscopy represent only the final step in the pelvic pain evaluation; these analyses are conducted if the previous tests have not led to a definitive diagnosis. Sometimes, the diagnosis needs a multidisciplinary approach.

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