Table 2 Clinical investigations for the work-up of deep infiltrating endometriosis.

Investigation	Evidence provided
Inspection (double-bladed speculum)	Visible endometriosis in the posterior fornix
Palpation (always including rectal)	Uterus often retroverted; dense, nodular, tender infiltration of the rectovaginal septum (retrocervical)
Transvaginal ultrasound	Changes in the uterus in the presence of concurrent adenomyosis and information about possible ovarian endometriomas, good visualization of deep rectal involvement
Renal ultrasound	Be alert to back-up of urine (parametrial, pelvic wall and ureteral endometriosis)