Endometriosis: a consequence of varying injuries to pelvic autonomic nerves

Ectopic endometrium appears in the pelvis following injuries to uterotubal nerves that result in uterotubal dysmotility and retrograde menstruation (1Quinn M. Endometriosis—the consequence of uterine deneration-reinnervation.Arch Gynaecol Obstet. 2011; 284: 1423-1429Crossref PubMed Scopus (21) Google Scholar). These neural injuries result from prolonged straining during defecation, difficult vaginal deliveries, excessive traction to the pregnant cervix at surgical evacuation of the uterus, and miscellaneous injuries yet to be fully described (2Atwal G.S.S. Armstrong G. Duplessis D. Slade R. Quinn M. Differences in uterine innervation at hysterectomy for chronic pelvic pain with, or without, endometriosis.Am J Obstet Gynecol. 2005; 193: 1650-1655Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar). Retrograde menstruation enables adhesion of endometrium to contemporary pelvic injuries (1Quinn M. Endometriosis—the consequence of uterine deneration-reinnervation.Arch Gynaecol Obstet. 2011; 284: 1423-1429Crossref PubMed Scopus (21) Google Scholar). After some years, laparoscopic findings may include symmetric thickening of the uterosacral ligaments with fusion of the vagina to the rectum and extensive deposits of ectopic endometrium (recurrent straining at stool), asymmetric injuries to uterosacral ligaments with variable deposits (sporadic, difficult vaginal deliveries), minor deposits around the uterosacral insertions (excessive traction to the pregnant cervix), and endometriomas following injuries to the surface of the ovaries at ovulation (1Quinn M. Endometriosis—the consequence of uterine deneration-reinnervation.Arch Gynaecol Obstet. 2011; 284: 1423-1429Crossref PubMed Scopus (21) Google Scholar) or combinations of these presentations. Aberrant reinnervation in the respective organs contributes to symptoms of dysmenorrhea (uterus), dyspareunia (cervix, vagina), chronic pelvic pain (uterus and uterosacral ligaments), and subfertility (uterus, fallopian tubes) (1Quinn M. Endometriosis—the consequence of uterine deneration-reinnervation.Arch Gynaecol Obstet. 2011; 284: 1423-1429Crossref PubMed Scopus (21) Google Scholar, 2Atwal G.S.S. Armstrong G. Duplessis D. Slade R. Quinn M. Differences in uterine innervation at hysterectomy for chronic pelvic pain with, or without, endometriosis.Am J Obstet Gynecol. 2005; 193: 1650-1655Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar). Endometriosis is no longer an enigma; it is, for the most part, a preventable condition caused by Western diets and lifestyles, and, obstetric and gynecologic interventions (3Donnez J. Endometriosis: enigmatic in the pathogenesis and controversial in its therapy.Fertil Steril. 2012; 98: 509-510Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar). No single view can account for each and every individual case, nevertheless, injuries to pelvic autonomic nerves may explain many clinical and laparoscopic presentations, and, failures of medical and surgical treatment. Autonomic denervation, with its remote and wide-ranging consequences, may account for many features of reproductive ill health, and in some cases, later systemic disease (4Quinn M.J. Origins of Western diseases.J R Soc Med. 2011; 104: 449-456Crossref PubMed Scopus (3) Google Scholar). Endometriosis: enigmatic in the pathogenesis and controversial in its therapyFertility and SterilityVol. 98Issue 3PreviewThe pathogenesis of endometriosis is enigmatic. Its therapy is still controversial. Full-Text PDF