Is it a normal variant?

Some time ago colleagues and I took laparoscopic photographs of the pelvis in three groups of women –  those with pelvic pain, those without pain who were undergoing laparoscopy prior to being sterilised, and women without pain who were undergoing it to investigate infertility.

We then asked independent experts to score the photos without knowing which group the patient was in. Our reasoning was that if the surgeon knows the patient had pain, he or she might look hard for endometriosis. But if the operation was being done for another reason, such as sterilisation, the surgeon may not even notice mild spots of disease. This may lead to a spurious association.

We found that moderate and severe endometriosis (AFS score >5) was more common in women with pain than in those without pain undergoing sterilisation. No surprise there. But mild disease (score 1-5) was equally common among women who were just being sterilised.

I interpreted that as mild endometriosis being a normal variant.  Unfortunately when we submitted our paper for publication to high powered journals the referees said “Everyone knows that already!”  So it ended up in Eur J Obste Gynaecol.  Not very high impact.   But some people have recently asked to see a copy, so here it is.  pelvic pain EJOGRB

Jim Thornton