ABSTRACT
Most primary care physicians consider pelvic pain as a common clinical problem which accounts for as much as 25% of routine gynecologic office visits.1 About 15% of cases of pelvic pain are due to endometriosis.2 Endometriosis is frequently associated with several types of pelvic pain such as dysmenorrhea, chronic pelvic pain, deep dyspareunia, and, occasionally, painful defecation. Specifically, endometriosis was found in 37-74% of women undergoing laparoscopy for chronic pelvic pain.3-5
The endometriosis-related pelvic pain has no relation with the localization of the lesions3-5 and with the stage of the disease, as categorized according to the revised American Fertility Society (r-AFS) classification.6 In fact, the r-AFS classification system is inadequate to express the severity of the symptomatology because it does not reflect the disease in terms of cellular mass or activity.5,7-9
Several medical treatments have been proposed to treat secondary chronic pelvic pain due to endometriosis,2 but little data are available regarding the effectiveness of these treatments on quality of life of women with endometriosis,2 which seems to be deeply impaired.9,10
About 20% of women with chronic pelvic pain due to endometriosis are unresponsive to medical treatment.2 In these selected cases, surgery represents the final diagnostic and therapeutic option.2,11,12 Several procedures have been described to treat medically untreatable pelvic
pain.13 Furthermore, nonconservative procedures such as hysterectomy14,15 are questionably effective in terms of pain relief, can even be associated with a decrease in quality of life,16 and are unacceptable to many woman who wish to preserve intact their reproductive organs.
