Can endometriosis be decisively diagnosed by pelvic exam?
A. As with symptoms, the clinical signs of endometriosis during a pelvic exam may be nonexistent, minimal, or marked as a function of location and total mass of the disease. However, there are clinical signs that can increase the index of suspicion in patients with symptoms of endometriosis: thickness and feeling of nodularity in the posterior pelvic area; pain and tenderness during pelvic examination; fixation or relative decreased mobility in the tubes or the ovaries due to the presence of pelvic adhesions; presence of a uterus tilted backward and, in more advanced cases, due to the presence of endometrioma, feeling of pelvic mass. However, none of these clinical signs are a decisive sign of endometriosis, and final diagnosis can only be confirmed by laparoscopy.
