Traditionally, surgeons had to diagnose endometriosis and determine themselves which lesions were painful, since the patients were anesthetized. Performing laparoscopy under local anesthesia allows the woman to assist the physician in deciding which lesions are painful and require therapy, and lets the patient determine the results of therapy. Patients reported that black lesions were not painful or were the least painful, followed by white scarred areas. The vascular lesions around the outer edge of the white lesions were significantly more painful, especially the hypervascular areas and endometriotic windows. After a 6-month course of danazol, at second-look laparoscopy, patients reported that the treated areas were no longer painful. Having the patient assist the physician during laparoscopy under local anesthesia leads to a more accurate assessment of endometriosis and outlines the boundaries of therapy more precisely.