Endometriosis

Quality statement

Women and people presenting with suspected endometriosis have an abdominal and, if appropriate, a pelvic examination.

Rationale

By performing an abdominal and, if appropriate, a pelvic (internal vaginal) examination when a woman or person first presents with symptoms of endometriosis, delays in diagnosis and treatment can be reduced. A physical examination of the abdomen, and the pelvis if appropriate, can identify signs of endometriosis such as abdominal or pelvic masses, reduced organ mobility or enlargement, points of tenderness, or visible vaginal endometriotic lesions. This enables the healthcare professional to consider a working diagnosis of endometriosis and begin a treatment plan.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

What the quality statement means for different audiences

Service providers (such as GP practices, sexual health clinics, and emergency departments) ensure that staff are aware of the symptoms and signs of endometriosis and that facilities are in place for women and people presenting with a symptom or sign of endometriosis to have a physical examination. They ensure that staff know that a pelvic (internal vaginal) and abdominal examination should be carried out if appropriate. They should ensure that staff are aware that a pelvic examination may not be appropriate for some groups, for example women and people with learning disabilities, very young women and people, and women and people who have never been sexually active. These groups, and those who decline a pelvic examination, should have an abdominal examination.

Healthcare professionals (such as GPs, practice nurses, sexual health nurses and emergency department practitioners) consider endometriosis as a possible diagnosis when women and people present with a symptom or sign that suggests endometriosis. They carry out an abdominal and pelvic (internal vaginal) examination, if appropriate, to exclude other possible causes as soon as possible, either when the woman or person initially presents or a short time afterwards. They are aware that a pelvic examination may not be suitable for some groups, for example women and people with learning disabilities, very young women and people, and women and people who have never been sexually active. They carry out abdominal examination for these groups, and for those who decline a pelvic examination. They are aware that the possibility of endometriosis should not be ruled out if the examination findings are normal.

Commissioners ensure that they commission services that raise awareness of endometriosis among staff and have clinical protocols in place for detailing symptoms and signs of endometriosis and the need for different types of examination, depending on the woman or person's circumstances, when endometriosis is suspected.

Women and people with symptoms or signs of endometriosis (such as chronic pelvic pain, severe period-related pain or deep pain during or after sexual intercourse) have an examination of their abdomen, and of their pelvis (internal vaginal) if this is appropriate, the first time they visit a healthcare professional to discuss these symptoms or signs, or shortly afterwards if they prefer. This examination can help to rule out other possible conditions and means that treatment for endometriosis can be started quickly.

Source guidance

Endometriosis: diagnosis and management. NICE guideline NG73 (2017, updated 2024), recommendations 1.3.5 and 1.3.6

Definitions of terms used in this quality statement

Equality and diversity considerations

Practitioners should be aware that some women and people may feel particularly anxious or have extreme difficulties undergoing some procedures such as abdominal and pelvic examinations. There could be a number of reasons for this, for example their culture or age, or a learning disability. Consideration should therefore be given to carrying out an abdominal examination only, if this is clinically appropriate or the woman or person declines a pelvic examination, and ensuring that they can bring a friend or relative as a chaperone if they wish. Some women and people may also prefer to have a female practitioner carry out the examination.

Transgender men should have endometriosis considered as a possible diagnosis if they present with suspected endometriosis.