A. Endometriosis is characterized by cyclical pain, usually beginning prior to menses. Deep dyspareunia and sacral backache with menses are common.
B. Infertility is a frequent consequence of endometriosis. Premenstrual tenesmus or diarrhea may indicate rectosigmoid endometriosis. Cyclic dysuria or hematuria may indicate bladder endometriosis.
C. Tender nodules are often palpable through the posterior vaginal fornix on bimanual examination and along the uterosacral ligaments on rectovaginal examination. Ovarian enlargement, fixation of the adnexal structures, and uterine retrodisplacement may also be detected.
D. Ultrasound may identify adnexal masses. Endometriosis can be definitively diagnosed only by laparoscopy.
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