Anatomical Distribution of Deep Infiltrating Endometriosis and Its Relationship to Pelvic Pain

Background: Deeply infiltrative endometriosis (DIE) is found in many anatomical locations in the pelvis and causes chronic pelvic pain (CPP). Objective: The goal of this research was to investigate the relationship between several types of pelvic pain with anatomical locations of DIE lesions. Materials and Methods: This was a retrospective observational study that included 59 women who underwent surgical exeresis of DIE. Clinical and surgical data were collected on the anatomical locations of lesions (uterosacral ligaments, retrocervical, rectovaginal septum, vagina, bowel, bladder, and others), and pelvic adhesions. Multivariate analysis and logistic regression were used to study the relationship between the types of pelvic pain and sites of DIE as well as the locations/extents of pelvic adhesions. Results: Most women presented with more than one type of pelvic pain (46; 78%) and multifocal DIE (36; 61%). DIE was more frequently encountered in the bowel (40; 34.2%) and uterosacral ligaments (31; 26.5%). Deep dyspareunia was associated with vaginal DIE (odds ratio [OR]: 3.17; 95% confidence interval [CI]: 0.9-10.7) and rectovaginal septum DIE (OR: 4.42; 95% CI: 1.0-19.3). Pelvic adhesions in the cul-de-sac were associated with dyschezia (OR: 7.58; 95% CI: 0.9-66.3) and intestinal DIE (OR: 10.2; 95% CI: 2.79-37.3). Conclusions: Deep dyspareunia was associated with DIE in the vagina and rectovaginal septum. Dyschezia was related to cul-de-sac adhesions, whereas intestinal endometriosis was associated with cul-de-sac obliteration. Specific types of pelvic pain may be predictive of DIE locations and can be used to help plan surgical interventions.