“Endometriosis” describes the presence of small spots of endometrium (lining of the womb) on the surfaces of pelvic organs – including the uterus, ovaries, rectum and bladder. These deposits are alleged to cause chronic pelvic pain, painful sex, painful periods and infertility.
The new view of “endometriosis” says that these symptoms are caused by injuries to pelvic nerves caused by (1) difficult vaginal deliveries, (2) straining during defaecation, (3) minor gynaecological surgery (D&C) for conditions such as miscarriage, (4) occasional direct trauma. These injuries cause “retrograde menstruation” and deposits of endometrium on pelvic organs – but these deposits of “endometriosis” do not cause symptoms; it is the injuries to pelvic nerves that cause pain.
These injuries may be identified by taking a precise clinical history, and, by performing a diagnostic laparoscopy to look at the supporting ligaments of the uterus. Some of the nerves that supply the uterus and Fallopian tubes, pass through these ligaments. If the ligaments are damaged then you may lose the nerves in both the uterus and Fallopian tube. When nerves are injured they re-grow in a chaotic fashion which causes pain 4-5 years after the original injury. Clinical presentations will depend on the site, nature and extent of these injuries – thus no two women have the same experience of these injuries.