A detailed profile of pain in severe endometriosis

Objective: To investigate the detailed nature of pain symptoms reported by women with endometriosis and those without current gynecological complaint. Design: Self-administered cross-sectional study was conducted using a structured questionnaire. Setting: Teaching hospital clinic, specialist gynecologist, and family practice patients; endometriosis community support group members; and university staff and students. Subjects: A total of 737 women returned completed surveys: women with endometriosis (n = 529) and with no current gynecological complaint (n = 208). Intervention(s): None. Main outcome measure(s): Demographics, experience of pain symptoms: frequency, severity, and characteristics. Results: All pain symptoms were significantly more common among women with endometriosis compared with controls. Women with endometriosis all reported experiencing dysmenorrhea to some degree (N = 527, two missing), although the severity was “slight” for 5%. Dyspareunia was reported by 92% of women with endometriosis, most commonly during intercourse, rather than at the start or post-coital. The other pain symptoms experienced by women with endometriosis, in order of frequency, were lower back pain (93%), pain at ovulation (87%), pelvic pain other than during menses, ovulation, urination or intercourse (79%), dysuria (71%), and rectal pain (67%). The great majority of women with endometriosis reported multiple sources and types of pain. Among women with endometriosis there were clear associations between the severity of dysmenorrhea and the frequency of experiencing dyspareunia and other pain symptoms. Conclusion: Pain symptoms in women with endometriosis were generally much more extensive and complex than recognized by most clinicians.