With a pelvic exam, your health professional is able to determine the size and position of the pelvic organs. Endometriosis may cause abnormal growths in the uterus, the vagina, the ovaries, the area between the uterus and rectum (cul-de-sac), and the strong bands of tissue (ligaments) that attach to the uterus to hold it in place.

Why It Is Done

A pelvic exam is done if endometriosis is suspected. It is the first step used to determine whether endometriosis is the cause of bothersome symptoms.

Results

Results of a pelvic exam may include the following.

Normal

Pelvic exam is normal.

• No abnormal tissue is found in the area between the uterus and rectum (cul-de-sac) or in the ligaments that hold the uterus in place.
• No pelvic pain or tenderness is present.
• No hardening of tissue (induration) is felt.
• The uterus, fallopian tubes, and ovaries are normal in size and location.
• The uterus can be moved slightly without causing pain.

Abnormal

Uterus

Results that may indicate endometriosis include the following:

• Your health professional may not be able to move the uterus even slightly during the exam, indicating that scar tissue (adhesions) may be binding the uterus.
• You have pain or tenderness when the uterus is moved slightly.

Outside of the uterus

Results that may indicate endometriosis include the following:

• You have pain when the area between the uterus and rectum is touched.
• Abnormal tissue is felt near the uterus or between the uterus and rectum.
• The ovaries are painful when touched, are enlarged, or are not movable. This indicates that adhesions may be holding the ovaries in place.
• Hardening of tissue is felt.
• The folds of skin around the opening of the vagina (external genitalia, labia) have small bluish bumps (lesions).
• Lesions are present on the surface of the vagina or cervix.

What To Think About

Your pelvic exam can be normal, even when endometriosis is present.

If your symptoms strongly suggest endometriosis, and pain is your primary concern, your health professional may recommend trying hormone therapy (such as birth control pills) to see whether your symptoms improve. Or, if your health professional suspects severe endometriosis or another pelvic problem, or if you are trying to get pregnant, you may need laparoscopy to confirm the diagnosis.

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