ABSTRACT
The possibility of endometriosis should be considered in any woman presenting with infertility or with worsening dysmenorrhoea, pelvic pain or dyspareunia. Clinical findings in endometriosis are markedly variable. In mild cases, routine gynaecological examination is likely to reveal no abnormality. Deep disease is generally suspected when there are palpable nodules associated with focal tenderness on clinical examination. Examination with a speculum reveals either a normal vaginal mucosa or a protruded endometriotic nodule in the posterior fornix. Sensitivity in the detection of focal endometrial implants is poor. Hyperechoic wall foci and multilocularity also point towards an endometrioma. Endometriomas are usually adherent to the pelvic side wall. This immobility is a useful diagnostic indicator. The pouch of Douglas is a potential space, and is not well seen by computed tomography (CT) unless distended by fluid or a mass.
