So my doctor and the reproductive radiologist (what a great specialty) are pretty sure that the masses the ultrasound shows on both ovaries are endometriomas. The bigger one is making my ovary 7cm long, which is much bigger than an ovary should be. And it's on the more painful side. Finally a mild observable correlation with my actual problems!
I also have one small and two minuscule fibroids in the uterine wall; these I think are probably not contributing much to my pain as they were not there five years ago and my periods are actually better managed now than they were then. They will probably get worse with time until menopause, though, and could be problematic in future. Mom had a giant one removed at about my age.
So basically, laparoscopic surgery to solidly diagnose the endo is definitely recommended, and they would remove any badness they see while they're in there. The doctor confirmed that there is no way to see bits of rogue endometrium that might be causing adhesions using imaging techniques, and you just have to go look around in there. I was about ready to do that for just the amount of pain I've been having, so I am totally on board with that.
Since I have never wanted to be pregnant, I am pretty much decided on having my uterus out at the same time. The doc is good with this. It is a faulty uterus that makes me very miserable, it's likely to get even worse with time, and I'm not using it. Sliiiightly on the fence about taking out an entire organ, but it's an organ that's been misbehaving for 25 years, and if this really is endometriosis then removing a possible source of MORE jerkass wandering cells is a really good idea. Also pretty sure that the period I am about to start will remind me of why I do not want it! ( Somehow I have chosen to draw the TMI veil over only this part. )
I asked about sexual function and her response was pretty much, "most people find that not being in pain makes them better able to enjoy sex." WHICH SEEMS LEGIT. And having a built-in vagina means I wouldn't need to use dilators or anything the way people with constructed vaginas do, it's all good even if the uterus isn't in there to anchor the other end. She and I are totally agreed on keeping as much of my ovaries as they can rescue from the masses on them, as bones are important and I like my sex hormones generally.
This is actually pretty much the optimal outcome considering my pain situation, which is quite bad! And it was nice to surprise the doc by being happy and excited that she found something, which is not the usual reaction. So I'll talk about it with my boss tomorrow -- the recommended recovery period for surgery is two weeks and I want to keep him up to date since we talked recently about how things were pretty bad and affecting my performance. Within a few days the surgery scheduler should call me to set up various pre-, operative, and post- appointments.
I am still pretty darn happy with this whole development. Little scary, still the tiny possibility that it's something more serious, but overall? Fucking YAY they found THINGS they can DO something about.