Physical examination

A. Surgical scars, hernias, and masses should be sought. Pelvic examination should include an evaluation for physical findings consistent with endometriosis, adenomyosis, or leiomyomata. Tender areas should be identified.

B. Physical findings characteristic of endometriosis are uterosacral ligament abnormalities (eg, nodularity or thickening, focal tenderness), lateral displacement of the cervix caused by endometriosis, and cervical stenosis.

C. Adnexal enlargement may be palpable if an endometrioma is present.

D. Nongynecologic physical findings that are observed more frequently among women with endometriosis are red hair color, scoliosis, and dysplastic nevi.

E. Adenomyosis and leiomyomata. Women with adenomyosis can have a slightly enlarged, globular, tender uterus. Uterine myomas are characterized by enlarged, mobile uterus with an irregular contour.

F. Chronic pelvic inflammatory disease is characterized by uterine tenderness or cervical motion tenderness. Adhesions resulting from a surgical procedure can cause pain, especially with movement of viscera. An adnexal mass suggests an ovarian neoplasm. Adnexa tenderness suggests an inflammatory process. In women with uterine prolapse, the cervix/uterus may be observed protruding from the vagina.

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