Is painful rectovaginal endometriosis an intermediate stage of rectal endometriosis?

Objective

To compare the history of pain complaints of women presenting rectovaginal and rectal endometriosis to show that rectovaginal locations may progress to a rectal involvement of the disease.

Design

Retrospective comparative study.

Setting

Department of Gynecology and Obstetrics, University Hospital Rouen, France.

Patient(s)

Thirty-two patients with rectovaginal endometriosis and 16 patients with rectal involvement.

Intervention(s)

Standardized questionnaires recording the clinical history of painful deep endometriosis up to diagnosis.

Main Outcome Measure(s)

Length of time from onset of pain to diagnosis, types of pain, disability related to the pain, and number of physicians consulted before the diagnosis was made.

Result(s)

Women with rectal endometriosis had an earlier onset of dysmenorrhoea. The age of dysmenorrhoea and the length of time between the onset of the first pain to the first time that the endometriosis was suspected were significantly increased in women with rectal endometriosis. Pain during defecation was more frequent in patients with rectal endometriosis. Women consulted an average of three physicians before the endometriosis diagnosis was suggested. A nongynecologist physician made the diagnosis of rectovaginal and rectal endometriosis in respectively 26% and 31% of cases.

Conclusion(s)

Rectal endometriosis is associated with an earlier onset and a longer history of painful symptoms until the diagnosis was made when compared with rectovaginal endometriosis locations. These observations support the hypothesis that rectovaginal location may be an intermediate stage of rectal endometriosis.

Key Words: Pain, rectovaginal endometriosis, rectal endometriosis, diagnosis