Pelvic pain. Endometriosis. Adenomyosis. Pudendal neuralgia.

Below is a case of a patient who came to our center for pelvic pain associated with urinary and bowel disorders, severe vaginismus and dyspareunia.?The cause of these symptoms was multiple.?Disorder was more complex, the patient presenting both endometriosis/adenomyosis, as well as a peripheral neurological condition that we diagnosed more and more frequently, pudendal neuralgia (predominantly on right side).?

To have the diagnosis is not very easy, but careful anamnesis, a thorough pelvic examination and ultrasound can diagnose these pathologies in over 90% of cases. MRI examination is useful to diagnose the extension of pelvic endometriosis, as well as to exclude/diagnose a cause of pudendal neuralgia.?

The video below is a didactic one, apart from the thorough excision of endometriosis lesions, showing the resection of the presacral nerve (symptomatic treatment of adenomyosis), as well as the decompression of the right external pudendal nerve.