This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Endometriosis, Adenomyosis, Subject name: Gynaecology & Obstetrics
Which of these is true for pain in endometriosis? 
Select and explain. 
A. Dysmenorrhea usually stas from day 2 of periods and subsides with end of menstrual flow, B. Dysmenorrhea is more common in ovarian endometriomas than peritoneal lesions, C. Dyspareunia is more common with peritoneal lesions in pouch of douglas, D. Pelvic pain is usually unilateral
C: Dyspareunia is more common with peritoneal lesions in pouch of douglas
Answer: C: Dyspareunia is more common with peritoneal lesions in pouch of douglas 
Explanation: Dysmenorrhea in endometriosis is usually congestive type that stas prior to onset of menstruation. All endometriosis lesions are associated with pelvic pain including minimal to mild endometriosis. IN regards to option 'b' , dysmenorrhea is less frequent in women with 'only ovarian endometrioma' compared with other locations. A strong association is found between pelvic pain, dyspareunia and posterior cul-de-sac ( POD) lesions. Distribution of pain is usually variable but its mostly bilateral.