Deep infiltrating endometriosis is associated with clinically severe endometriosis.

Adenomyosis is present in about half of patients. Koninckx et al suggest DIE should be equated with adenomyosis externa.


Locations of involvement:

(1) rectovaginal region

(2) uterosacral ligaments

(3) small and large bowel

(4) lower urinary tract


Number of lesions: often multiple


Size of lesions: usually > 1 cm


The foci show infiltrative growth with scarring and fibrosis which can result in strictures.


Patients tend to have severe symptoms with:

(1) dysmenorrhea

(2) dyspareunia

(3) abnormal uterine bleeding

(4) urinary tract symptoms

(5) bowel-related symptoms

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