**2. Clinical condition**

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 violaceous lesions in the vagina [2].
