Can endometriosis be decisively diagnosed by pelvic exam?

Endo: The gold standard for the diagnosis of endometriosis is laparoscopy. On a personal note in the prescence of pain with menses and significant pain when I do my exam and stretch the uterosacral ligaments, i find endo at the time of laparoscopy about 90% of the time.

Yes and no: On pelvic exam, nodules that are palpable on the ligaments that support the uterus can be highly suggestive of endometriosis especially in the setting of historic patient data (painful periods that improve while on birth control pills)...Ultimately, the "gold standard" diagnosis is visualization with laparoscopy but often times this can be misleading bc endo may not be superficially visible.