There is probably no more sinister title for a gynaecological condition than “deep-infiltrating-endometriosis”. It is “deep” in the pelvis, “infiltrates” through the pelvis, and, causes much pain. As a result the surgical treatments are becoming increasingly radical including different patterns of operations that we usually reserve for cancer. Whatever we do – the pain persists, though probably in a lesser form.
In this month’s BJOG there will be a short description of DIE as either (1) an injury in chilbirth where the uterosacral ligaments tear off their attachment to the rectovaginal septum, that is a site of injury for the attachment of endometriosis, or, (2) the result of persistent straining during defecation that leads to thickened US ligaments, fusion of the rectum and vagina with deposits of endometriosis on all these abnormal tissues. In both cases there are injuries to pelvic nerves and it is the regenerating nerve-lets that result in pain some years after the original injury. Treatment is difficult – though might reasonably be directed at regenerating nerves than removing as much tissue as possible.
DIE is the apogee of contemporary gynaecological problems. Many gynacologists still believe it is important to use a knife to deal with it – when most of the time it is entirely preventable.