Endometriosis

I recently had a patient present with pain during periods and deep pain during intercourse. On her physical exam I felt a nodule or mass at the top of the vagina. This can be very common in patients with endometriosis. At the time of her surgery she had a thick endometriosis nodule behind her uterus that corresponded to the findings on physical exam. This is a very common place to find endometriosis. One of the difficulties with endometrisosis in this area, is that it can grow in close proximity to the ureter. That is a tube that carries urine from the kidney down to the bladder. A surgeon must be careful in dissecting this area to avoid injury to the ureter. I usually just use my scissors without any electricity or very minimal. If there is extensive endometriosis in the ureteral area, it may be necessary to close the uterine vessels on the same side to avoid significant bleeding durring removal of the endometriosis.

Some patients may also have endometriosis cysts on the ovary. These are referred to as endometriosis cysts or "chocolate cysts." The fluid and old blood inside the cyst often as a liquid chocolate appearance when opened. These are best treated by actually opening the cyst and removing the wall of the cyst. Any minor bleeding can be controlled with cautery or with large cysts, the cyst bed can be sewn closed.