Reported symptoms in patients with endometriosis have shown poor correlation with the extent of disease at surgery. Recent data have suggested that signs and symptoms may correlate with depth and volume of individual implants. In this study preoperative focal tenderness was correlated with the presence or absence of endometriosis, depth and volume of the endometrial implants and the presence of other pathology. The findings suggest that focal tenderness has limited value in predicting the stage of endometriosis, but is strongly associated with the presence of disease in the cul de sac and uterosacral ligaments. There was also significant association of tenderness with deeper and larger volumes of implants, a finding that may be of clinical significance in the surgical management of endometriosis-associated symptoms and tenderness.