Endometriosis-associated nerve fibers, peritoneal fluid cytokine concentrations, and pain in endometriotic lesions from different locations  Brett McKinnon, Ph.D., Nick A. Bersinger, Ph.D., Carlos Wotzkow, Michael D. Mueller, M.D.  Fertility and Sterility  Volume 97, Issue 2, Pages 373-380 (February 2012) DOI: 10.1016/j.fertnstert.2011.11.011 Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions

Figure 1 PGP9.5-positive nerve fibers and their prevalence and proximity to endometriotic lesions of different locations. Samples were grouped based on the presence and proximity of nerve fibers to endometriotic lesions. Group 1 (endometriosis-associated nerve [EAN]+) consisted of samples from both the peritoneal (A) and rectovaginal septum (RVS) region (C) with endometriotic lesions with a PGP9.5-positive nerve fiber (brown staining) less than 1.5 mm from an endometriotic lesion. Group 2 (EAN−) consisted of samples from both the peritoneal (B) and RVS regions (D) that no PGP9.5-positive nerve fibers could be found within 1.5 mm of an endometriotic lesion. Bars = 50 μm. (E) The total number of nerve fibers found associated with lesions in the RVS was significantly greater than either the peritoneal (∗∗P=.018) or ovaries (∗∗∗P=.002) and the (F) average distance of these nerve fibers from the closest endometriotic lesion was significantly smaller in the RVS samples compared with the peritoneal samples (∗P=.029). Fertility and Sterility 2012 97, 373-380DOI: (10.1016/j.fertnstert.2011.11.011) Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Pain reported by women with endometriosis, based on lesion location. Before surgery women with endometriosis completed a visual analogue pain scale. Women reported significantly higher menstrual pain (A) when lesions were present in the rectovaginal septum (RVS) (P=.008) and peritoneal wall (P=.038) compared to when lesions were present on the ovaries. Although a higher abdominal pain (B) was reported by women with RVS lesions, it was not significantly higher than that experienced by women with lesions in other locations. A significantly higher dyspareunia score (C) was also reported for women with lesions of the RVS, compared with lesions on the ovaries (∗P=.035). Fertility and Sterility 2012 97, 373-380DOI: (10.1016/j.fertnstert.2011.11.011) Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Pain reported by women in endometriosis-associated nerve (EAN)+ and EAN− groups. (A) In all the samples more pain was reported by women in the EAN+ group for all pain parameters; however, this difference was only significant in menstrual pain (∗∗P=.005). (B) In samples from the peritoneal wall higher pain was reported in all pain conditions; however, this difference was only significant for menstrual pain (∗P=.018). (C) In samples from the rectovaginal septum no significant difference was observed in any of the pain parameters measured. Fertility and Sterility 2012 97, 373-380DOI: (10.1016/j.fertnstert.2011.11.011) Copyright © 2012 American Society for Reproductive Medicine Terms and Conditions