What Endometriosis Can Actually Look Like

Reviewed 13 September 2026

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Illustrative surgical appearances and locations; photographs alone do not confirm a diagnosis.

1. Normal pelvis

Laparoscopic view of a pale pink rounded structure at the upper centre with a thin curved tubular structure beside it, a dark instrument entering from the left and yellow tissue across the lower left; small, low-resolution image.

A reference view of normal pelvic anatomy, including the ovary and fallopian tube.

2. Superficial endometriosis: red appearance

Laparoscopic view of a pale pink glossy surface with fine red blood vessels and a few small dark red spots in the upper half, above a darker grey-brown lobulated surface in the lower half.

Red-appearing lesion. Color alone cannot establish a lesion's age, biological activity or diagnosis.

3. Superficial endometriosis: dark appearance

Laparoscopic view of pink tissue with a serrated metal instrument entering from the upper left; several small dark spots lie near the instrument tip and one dark brown-black patch lies to the right of centre.

Superficial implants may also appear dark brown or black rather than red.

4. Ovarian endometrioma

Laparoscopic view of a dark red rounded structure at the right, held against a metal instrument entering from above, with pink tissue at the upper left, glossy pale strands at the centre and yellow tissue across the lower part.

Endometriosis involving the ovary. These cysts contain old blood and are often called 'chocolate cysts'.

5. Deep endometriosis

Laparoscopic view of pale glossy fibrous strands running diagonally across the centre between pink and orange-yellow tissue, with a small yellow nodule at the upper right and dark red areas at the lower right.

Deep disease extends beneath the peritoneal surface and may cause fibrosis, scarring and distorted anatomy.

6. Bladder endometriosis

Laparoscopic view of a pale pink-yellow surface with a network of fine red blood vessels and a small dark red raised area at the upper centre, with the tip of a metal instrument at the right edge.

Deep endometriosis can involve the bladder wall – an example of disease beyond the reproductive organs.

Deep Endometriosis Can Involve Other Organs

Authentic surgical photographs demonstrating ureteral and bowel involvement

7. Ureter + large-bowel involvement

Laparoscopic view of red and pink tissue with a pale band running diagonally from the upper left to the centre, a pale yellow-pink lobulated mass at the centre right and a grey instrument entering from the lower right.

Deep endometriosis can involve structures close together in the pelvis, including the ureter and large bowel.

8. Cut section of large bowel

Photograph of a pink-red tissue specimen lying on a green surgical drape, held at the top by a gloved hand; a strip of partly cropped, illegible overlay text runs along the top edge.

A cut bowel specimen, labeled as deep endometriosis in the supplied file. Extent and diagnosis require correlation with the operative and pathology records.

9. Large-bowel endometriosis

Laparoscopic view of a metal grasping instrument entering from the upper left and holding a small pale yellow area, with a dark blue-grey rounded structure below it, pink and yellow tissue across the lower half and dark red tissue at the left.

Another operative view of bowel involvement, illustrating the anatomical complexity of deep endometriosis.

These photographs show different phenotypes and locations – not an inevitable step-by-step progression.

How to Read These Photographs

A short patient explanation and scientific context

Three major forms are commonly recognized

Endometriosis can present as superficial peritoneal disease, ovarian endometrioma ('chocolate cyst'), and deep endometriosis. More than one form can occur in the same patient.

Deep disease can involve organs

Deep endometriosis extends beneath the peritoneal surface and may affect the uterosacral ligaments, pelvic sidewall, vagina, bowel, bladder or ureter.

Appearance is not the same as symptoms

A visually small amount of disease can be associated with substantial pain, while extensive disease may sometimes produce fewer symptoms. Conventional stage does not reliably predict pain or surgical complexity.

How to interpret the captions

The sequence shows different appearances and anatomical locations, not an inevitable progression or pain-severity scale. The supplied clinical labels must be checked against the original operative/pathology records before publication.

The photographs are educational examples, not a diagnostic test. Color alone does not establish lesion age or activity.

Evidence & references

What Endometriosis Actually Looks Like
Version 1.1 · Reviewed 13 September 2026

Appearances and limitations

Superficial, ovarian and deep disease can coexist. Color, visible extent and conventional stage do not reliably determine pain, lesion age or activity. Photographs cannot replace clinical assessment or pathology.

Case labels remain provisional

The nine images and their layout are retained. Their labels describe the supplied intended examples, not independently verified diagnoses. Match each image to its source operation/pathology before public use. The series is not a step-by-step progression scale.

Full references

[S01] ESHRE. Endometriosis guideline. 2022. Freely available
[S11] Working group of ESGE, ESHRE and WES, Saridogan E, et al. Recommendations for the Surgical Treatment of Endometriosis. Part 1: Ovarian Endometrioma. Hum Reprod Open. 2017;2017(4):hox016. doi:10.1093/hropen/hox016. PMID 31486802. Freely available
[S12] Working group of ESGE, ESHRE, and WES, et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open. 2020;2020(1):hoaa002. doi:10.1093/hropen/hoaa002. PMID 32064361. Freely available
[R34693033] International Working Group of AAGL, ESGE, ESHRE and WES et al. An international terminology for endometriosis, 2021. Hum Reprod Open. 2021;2021(4):hoab029. doi:10.1093/hropen/hoab029. PMID 34693033. Freely available

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Medical information

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This material is for educational purposes only and does not constitute medical advice or create a clinician-patient relationship with GEM.