ABSTRACT
Although digital vaginal examination may provide evidence of thickening and/or painful nodules at the posterior cul-de-sac or along the uterosacral ligaments, as reported by some investigators (5), in a certain proportion of patients the physical examination may appear normal or nonspecific, but clinical examination during menses significantly increases the detection rate. Although none of the tests for predicting rectovaginal endometriosis are perfect (7), the following markers, especially in combination, may help to identify candidates at a need of specialist referral: dyspareunia is strongly related to posterior cul-de-sac lesions [p = 0.0001; odds ratio (OR) = 2.64, 95% confidence interval (CI) = 1.68-4.24], and intensity of dysmenorrhea (8). Moreover, nonmenstrual pain increases with endometriosis stage (7). Dyspareunia (positive predictive prevalence of 87%) and, interestingly, nausea and bloating are also good predictors of rectovaginal endometriosis (9).
