ABSTRACT
Endometriosis is a chronic inflammatory condition defined by endometrial stroma and glands found outside of the uterine cavity. The initial evaluation of any adolescent with either acute or chronic pelvic pain should be directed toward excluding organic pathology. Both acute and chronic pelvic pain can be associated with trigger points in the abdomen, vagina, or sacral area. In a systematic review published in 2013, approximately two-thirds of adolescent girls with chronic pelvic pain or dysmenorrhea were found to have laparoscopic evidence of endometriosis. In many circumstances, bimanual exam may not even be necessary, but palpation or inspection of the anus may help elucidate the presence of pelvic floor spasm, and a rectal, rather than a rectovaginal, examination may be useful for patients with suspected deep infiltrating endometriosis. Surgical management of endometriosis is indicated for pain refractory to medical management, advanced disease with involvement of the bowel, ureters, or nerves, and associated subfertility.
