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It appears as though Overton and colleague are advocating the early
referral of every woman with a set of symptoms which may or may not be
endometriosis,a condition which even gynaecologists may fail to diagnose
after extensive diagnostic investigations,and/or to subject them to a
battery of tests in primary care to rule out other diagnostic
possibilities of which chlamydia is the most relevant; or indeed to rule
out irritable bowel syndrome, a much favoured diagnosis of gynaecologists
with which to explain or label most unexplained pelvic pain.
Overton neglects to include possible psycho-emotional causes of pelvic
pain (such as sexual abuse) which is all too prevalent in this
population, thus approaching the problem in a one dimensional fashion.
Happily many general practitioners, having taken an appropriate history
and performed an appropriate examination, will use time as a management
tool in these circumstances, to observe over a period of time in order to
create an holistic picture of the problem before rushing into unnecessary
(and sometimes harmful) referrals, investigations and the giving of
labels which should be consigned to the diagnostic dustbin.