To make a presumptive diagnosis of endometriosis, your teen's doctor may need to rule out other potential problems by looking for the following:
l Pelvic organ abnormalities: The most common symptom experienced by teenagers with a uterine abnormality is severe menstrual cramps caused by backward (retrograde) flow of menstrual blood through the tubes. Early surgical correction of such an abnormality can avoid the development of severe endometriosis is some patients. Pelvic ultrasound, performed through the vagina or abdominal wall, can verify that the uterus and ovaries are normal. Unfortunately, unless an endometri-oma is present in the ovary, ultrasound can't "see" endometriosis.
l Sexually transmitted diseases (STDs): Doctors must differentiate between endometriosis and a sexually transmitted disease because the diseases have some of the same symptoms but need very different treatment. Unfortunately, the first diagnosis many doctors consider when teens have severe pelvic pain is an STD rather than endometriosis.
Many doctors incorrectly assume that a teen with pelvic pain is having sex. This assumption can be embarrassing for a teen who isn't sexually active and can lead to a lack of trust in a doctor who jumps to conclusions. However, if a teen is sexually active, she needs to be honest; otherwise, the doctor may overlook an important problem.
Doctors can diagnose STDs by taking a blood sample (for syphilis) or a cervical swab (for chlamydia and gonorrhea). If a teen has been sexually active, the speculum may be easier to insert into the vagina than with a teen who isn't sexually active. A Pap test is also necessary if a teen has had intercourse because the test can detect changes in the cervix that may lead to cervical cancer, which the doctor can then treat relatively early and easily.
Having an STD doesn't mean a teen can't also have endometriosis, so she should follow up after STD treatment if symptoms haven't disappeared!
I Sexual abuse: Healthcare providers have finally begun to realize that sexual abuse can cause symptoms similar to endometriosis. During the exam, the doctor can look for signs.
l Other organ system problems: Intestinal or urinary tract disease can also mimic the symptoms of endometriosis and can be affected by the menstrual cycle (see Chapter 2).
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