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Endometriosis—the consequences of neurologic dysfunction

      To the Editors: The rate of surgery for the patient of Matalliotakis et al
      • Matalliotakis I.M.
      • Mahutte N.G.
      • Goumenou A.G.
      • Arici A.
      Twenty-year history of endometriosis-associated pelvic pain: too much surgery or not enough?.
      with endometriosis-associated pelvic pain is salutary. One view of the condition is that damage to the inferior hypogastric plexus by sustained maternal efforts in childbirth (parous) or through constipation (nulliparous) leads to denervation followed by medium-term reinnervation. Disordered uterine motility causes impaired gamete transport (subfertility) and retrograde menstruation with endometrium adhering to damaged myofascial supports and peritoneal surfaces (endometriosis). The progressive pain is associated with reinnervation in, and around, the myofascial supports.
      • Quinn M.J.
      • Kirk N.
      Uterosacral reinnervation in parous endometriosis.
      Surgery, particularly hysterectomy, may be regarded as a denervatory procedure, although long-term reinnervation occurs, with women having symptoms that are frequently associated with prolapse (eg, my insides are “falling out” or “sitting on a tennis ball”). There is often no mechanical evidence of genital prolapse although there is a neuroma at the vaginal vault. Effective medical treatment to deal with reinnervation is not yet available. Much of gynecology, and its surgical treatment, may represent cycles of denervation and reinnervation. This patient may be fortunate to avoid further surgery.

      References

        • Matalliotakis I.M.
        • Mahutte N.G.
        • Goumenou A.G.
        • Arici A.
        Twenty-year history of endometriosis-associated pelvic pain: too much surgery or not enough?.
        Am J Obstet Gynecol. 2003; 188: 1103-1104
        • Quinn M.J.
        • Kirk N.
        Uterosacral reinnervation in parous endometriosis.
        J Obstet Gynaecol. 2004; (In press)