In the same edition of “The Obstetrician & Gynaecologist” (August 2011) a Scottish psychiatrist writes on “Medically Unexplained Gynaecological Symptoms” and cognitive behavioural therapy (CBT). Aside from the new, and unfortunate, acronym – MUS – he suggests that uterine, vaginal and vulval pain are examples of MUS – and – that they improve with CBT and antidepressants ! -
Another item in “The Obstetrician & Gynaecologist” discusses endometriosis and subfertility (August, 2011). There is no doubt that there is a relationsip between endo and fertilty – but it does not look like a uniform relationship. Clearly women with grade 4 endometriosis have substantial difficulties to overcome though the relationship between grade 1 endometriosis and fertility is less clear. -
“Origins of deep infiltrating endometriosis” appeared in the British journal of Obstetrics & Gynaecology (August, 2011). The brief note explained the causes as injuries in childbirth and straining during defecation. In China you can add three or four surgical terminations of pregnancy where pulling on the cervix under general anaesthesia -
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, -
I saw a patient yesterday who was having her third labour induced at 36 weeks by a colleague because of severe and persistent pain. She had a difficult first labour complicated by induction, epidural, intravenous oxytocin and forceps delivery. It was a prolonged affair (more than 12 hours in the active phase). Her pain started at 20 weeks and had been unrelenting throughout pregnancy. -
In another report, 129 adolescent girls with endometriosis received progesterone for 11 months – with some positive effects in terms of relief fo pain. The mechanism may be through reductions in blood flow. Side effects included headache, nausea, hot flushes and acne. -
The Daily Mail reports a new “surgical cure” for endometriosis at £7000-9000 per operation.
http://www.dailymail.co.uk/health/article-1387748/Surgery-end-monthly-pain-threatening-fertility-1-5m-women.html?ito=feeds-newsxml
The operation is based on the idea that Continue reading →
The role of alternative treatments in endo is unclear. Given that conventional treatment has little impact on injuries to autonomic nerves, there may be a case for wider use of alternative treatments. Particularly – in nulliparous women who are having trouble with their bowels – for whatever reason. -
The editor of the British Journal of Obstetrics and Gynaecology, Professor Phil Steer, was kind enough to publish a brief note on the causes of gynaecology in the UK this month in response to an important (technical) article on MR imaging of the pelvic floor (levator ani muscles). -
The second striking aspect of endometriosis/chronic pelvic pain (CPP) in China is the quality of the surgery. There were three outstanding surgeons in the unit that I visited who, for various reasons, made surgery in the UK look slightly “primitive”. -
