Endometriosis physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Joseph Nasr, M.D.[2], Aravind Kuchkuntla, M.B.B.S[3], Mohammed Abdelwahed M.D[4]

Examination findings on digital vaginal examination and speculum examination include a fixed retroverted uterus, palpable nodularity of the uterosacral ligaments, and cul-de-sac with narrowing of the posterior fornix. Reduced uterine mobility and posterior cul-de-sac tenderness are additional findings suggestive of deep infiltrating disease. Physical examination may be normal in some patients, and absence of findings does not exclude endometriosis.^[1][2]

Physical examination findings in a patient with endometriosis include:^[3]

Patient may have:

• Pallor (due to anemia)

• Decreased breath sounds and tenderness, especially on the right side (commonly present in patients with thoracic endometriosis)

• Lower abdominal tenderness
• Fixed and tender retroverted uterus (on bi-manual examination)
• Adnexal mass suggestive of ovarian endometrioma (if present and sufficiently large).^[4]

Common physical examination findings on digital examination include:^[5]

• Fixed retroverted uterus
• Nodularity of the uterosacral ligaments
• Uterosacral ligament thickening.^[1][2]
• Narrowing of the posterior vaginal fornix in patients with stage 3 and stage 4 disease
• Tenderness of the posterior cul-de-sac.^[1][2]
• Lateral displacement of the cervix

• Pelvic floor muscle tenderness may be present.^[6][7]
• Reproduction of pain with palpation of pelvic floor muscles may occur.^[6][7]
• Myofascial trigger points may be identified on examination.^[6][7]

Speculum examination may reveal:

• Lesions of endometriosis on the cervix or vagina
• Cervical displacement