PELVIC PAIN - ENDOMETRIOSIS AS A DIFFERENTIAL-DIAGNOSIS IN ADOLESCENTS

Endometriosis is reported in the literature to be a differential diagnosis for chronic pelvic pain in adolescents. Dysmenorrhea, acquired and of increasing severity, is usually the primary symptom in these adolescents. Other symptoms include abnormal vaginal bleeding, dyspareunia, and GI and bladder dysfunction. Adolescents may have no discernible pathology upon pelvic examination. A high percentage of adolescents with endometriosis show preoperative posterior cul-de-sac tenderness and a lower percentage display cul-de-sac nodularity. Although endometriosis does exist in some adolescents with uterine anomalies, the majority of endometriosis in adolescents occurs without associated anomalies. Possible etiological theories for endometriosis in the adolescent include retrograde menstruation and defective immunoregulation. Laparoscopy is a safe and effective means of definitive diagnosis in adolescents.