Endometriosis is characterized by tissue, like that of the endometrium that lines the uterus, growing outside the uterus and forming lesions. These endometrial lesions swell and shed with the hormonal cycle that controls menstruation, but because they are outside the uterus (typically in the pelvic region), they cannot be expelled properly. This causes inflammation that leads to pain and, possibly, infertility.

What is a pelvic exam?

A pelvic exam is often among the first tests done to diagnose suspected cases of endometriosis. It consists of an examination of the vulva, vagina, cervix, fallopian tubes, and uterus.

How is it performed?

For a pelvic exam, the patient lies on an examination table, face up and with the feet in stirrups to spread the legs apart. A gynecologist, a specialist in women’s health, begins by examining the external part of the reproductive organs, looking for signs of irritation or infection.

Following the external exam, the gynecologist will gently insert a speculum, a metal or plastic device, into the vagina to spread it walls so as to view the cervix. He or she will take a swab of the cervical opening, which will be cultured to check for infection.

The gynecologist may also insert a gloved finger into the vagina and press upward, while pressing down on the abdomen with the other hand. This procedure is done to feel for lumps or nodules on the uterus or vagina.

Minor discomfort but no pain is normally experienced during a pelvic exam, which should take five to 10 minutes.

Symptoms of endometriosis

Lumps or fibrous masses discovered during the exam may indicate uterine fibroids caused by endometriosis, large endometrial lesions, or ovarian cysts. Endometriosis may be suspected if  the uterus, ovaries, or fallopian tubes are enlarged or tender.

A uterus that is stiff and does not move when pressed during the exam may indicate that fibrosis or scar tissue caused by endometrial lesions is binding the uterus in the abdominal cavity.

What happens next?

Depending on the results of the pelvic exam, the gynecologist may recommend an abdominal ultrasound to help visualize possible fibroids or cysts. However, the surest method of diagnosing endometriosis is laparoscopy, an abdominal surgery using a telescope-like device to visualize the endometrial lesions directly.

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