The Concept of Clinical Endometriosis: A Paradigm Shift in Africa

The clinical symptoms of endometriosis, an illness characterized by ectopic endometrium (glands and stroma) outside the uterus, are mainly dysmenorrhea, dyspareunia, cyclic urinary symptoms and infertility. Although imaging modalities such as pelvic ultrasound can identify and localize endometriotic deposits in the ovary (endometrioma) and in bladder wall, diagnosis of the disease is impossible where such imaging modalities are unavailable or where clinicians are not trained to clinically diagnose endometriosis during consultation. Especially in sub-Saharan Africa, clinicians should be familiar with certain predisposing risk factors for endometriosis such as early age at menarche, shorter menstrual length and low body mass index. Delay in the diagnosis of endometriosis not only prolongs the duration of suffering, pain and discomfort but also lowers quality of life and increases cost of treatment. This article focuses on how gynecologists and clinicians in sub-Saharan Africa can easily identify the symptomatology of endometriosis. Clinical presentations of endometriosis in Black African women may not be different from presentations among Caucasian women. Though a confusing illness for the patient and for the clinician, at least, African gynecologists, clinicians and general practitioners can have a suspicion of endometriosis when a Black African woman presents with a combination of infertility, pelvic pain, dysmenorrhea and dyspareunia. This article discusses various conditions associated with endometriosis in adolescent women and in women in child-bearing age group.