Objective: Endometriosis lesion characteristics have not been consistently correlated with pelvic pain location. We investigated the relationship between pain location, type, and severity with surgical findings in women with pelvic pain undergoing surgery for endometriosis excision. Design: Prospective study comparing self-reported pelvic pain characteristics with location of endometriosis lesions excised at surgery. Materials and Methods: Reproductive-aged healthy women with chronic pelvic pain were followed over one menstrual cycle. Prior to surgery, women noted menstrual, nonmenstrual and coital pain (M, NM, C), pain location, pain severity by visual analog scale (0–20), and described other pelvic symptoms on standardized questionnaires. Pelvic pain location was divided into 5 anterior and 3 posterior areas. At surgery, all lesions were excised. Endometriomas, adhesions, lesion size, depth, color, and location were recorded. Endometriosis extent was classified by ASRM stage. Multiple and logistic regression models were used to determine if endometriosis lesion location and extent predicted pain location, type, severity, and other pelvic symptoms. This study was supported by the Intramural Research Program of the National Institutes of Health. Results: Of 77 women undergoing surgery, 57 had histological verification of endometriosis. Of those women, 97% reported menstrual pain with 53% reporting more than 2 days/month lost due to pain. 97% also had non-menstrual pain with 61% suffering almost every day. Degree of debility, pelvic pain chronicity and severity was similar regardless of ASRM stage. Lesion characteristics (number, color, average size, and maximum depth) by pelvic region did not correlate with pain location. Pain type (M, NM, C) and severity did not predict the total number, average size or maximum depth of lesions, and presence of endometriomas or adhesions. Other common symptoms reported among women with histologically-diagnosed endometriosis included upper (41%) and lower (72%) GI symptoms, rectal symptoms (47%), problems with sex (52%), and urinary symptoms (30%). Women often had other pain symptoms, such as headaches (68%), back pain (83%), and leg pain (30%). Heavy periods, experienced by 66% of women, were associated with back pain and dysmenorrhea (p=0.0035 and p=0.04, respectively). Conclusion: In this study in which the location of lesions was carefully mapped, endometriosis lesion location did not correlate with pelvic pain location. Women with pelvic pain not only had menstrual pain but had high rates of nonmenstrual and coital pain as well as headaches, gastrointestinal and urinary pain. These findings raise the question of whether endometriosis lesions per se are the cause of pelvic pain in these women.