Contents


**1**

**Chapter 1**

**1. Introduction**

**2. Clinical condition**

ceous lesions in the vagina [2].

**3. Diagnostic evaluation of endometriosis**

Introductory Chapter: Changes

in the Approach of the Patient

Development of Genetics and

Molecular Biology in Gynecology

Endometriosis is characterized by the presence of endometrial-like functional tissue located outside the uterine cavity, most commonly in the pelvic peritoneum, ovaries and rectovaginal septum, and more rarely in the pericardium, pleura and central nervous system. The studies indicate a prevalence of up to 20% of women of

The clinical condition of the patient with endometriosis is quite variable. The patient may be asymptomatic, refer only to infertility, or have symptoms such as severe dysmenorrhea, profound dyspareunia, chronic pelvic pain, ovulatory pain, urinary symptoms or peri-menstrual bowel movements, and chronic fatigue. Gynecological examination may be normal, but the presence of pain in uterine mobilization, uterine retroversion, or increase in ovarian volume is suggestive of endometriosis, although it is not specific. Other conditions, such as irritable bowel syndrome, pelvic inflammatory disease, and interstitial cystitis may present similar symptoms and should be included in the differential diagnosis. Signs suggestive of deep infiltrative endometriosis are palpable nodulations in the posterior vaginal fornix or rectovaginal septum, thickening of the uterosacral ligaments, or viola-

Although the definitive diagnosis of endometriosis requires surgical intervention, preferably through videolaparoscopy, several findings in physical, imaging, and laboratory tests can already predict, with a high degree of reliability, that the patient has endometriosis. To date, no biochemical marker can be considered as an endometriosis endpoint, but Ca-125, when collected on the first or second day of the menstrual cycle, may be useful for the diagnosis of advanced stage endometriosis when the values are higher than 100 IU/mL [3]. Although normal

reproductive age [1] and 30–50% of infertile women with endometriosis [1].

with Endometriosis and the

*Giovana Aparecida Gonçalves*
