Endometriosis vagina and perineum

Endometriosis posterior vaginal fornix
Fig. 10. Endometriosis posterior vaginal fornix.

Vagina most often affected by endometriosis after implantation of the particles of the endometrium in wounds and abrasions its walls formed during childbirth.
We watched 45 patients with vaginal localization (1,85 % of the patients with endometriosis). This group is not included women with endometriosis posterior vaginal fornix, evolved as a result of growth in behind him cervical lesion (Fig. 10).
A rare defeat endometriosis vagina, apparently, can be explained by physiological effects of postpartum amenorrhoea, preventing engraftment implanted in the wall of the vagina particles endometrium. The longer amenorrhea after birth, the less likely to develop endometriosis in the wall of the vagina and perineum.
From a group of 45 patients with only 2 women were not pregnant. The other gave birth. 18 of them managed to find out the time of recovery month after delivery. 15 it was equal to 2-3 4 months and 3, 6-7. 2 patients from 45 could allow embryonic Genesis of the disease (early clinical manifestation, the symmetrical arrangement of ectopy in the side walls of the vagina and the presence of adenomyosis of the uterus, also manifested at a young age). On the possibility of fetal origins of endometriosis vaginal of the split-off parts mullerova of moves or the remnants of the lower section of volfova body pointed F. Reklinghausen (1895), Herff (1897), Pfannenstiel (1897), P. Buiko, Century Lisovitskiy (1931).
Leading complaint with endometriosis this localization are a pain in the vagina and the depth of the basin, from moderate to very strong and painful. Usually pain are cyclical in nature. They are amplified when sexual life, a week before and after menstruation. Severe pain were observed when the involvement of the front crotch and external sphincter rectum. The defecation is difficult and accompanied by excruciating pain during periods of exacerbation (before, during and in the first days after menstruation). Pain throbbing, burning like when you boil). During the month the patient themselves probes painful nodes, swelling or cystic education. After a month they diminish or disappear completely, and in their place are painful scars with patches of brown pigmentation.
Unreasonable diagnosis of rechica and sphincteric (when endometriosis affects the outer sphincter, rectum) and the appointment of warm sedentary baths and other thermal processes lead to increased pain. One of our patients (patient K., 24 years) at the opening of the alleged ulcer in the field of the sphincter and perineum got brown liquid, however, continued on the treatment of sphincteric.
Pain in vagina and perineum can be accompanied by a local itching. Some patients say bloody and brown vaginal discharge, spontaneous and during coitus. These captures appear 5-7 days before and after menstruation.
Objective examination in the thickness of the walls of the vagina or perineum felt tight painful nodes, scarring or thickening. The vaginal mucosa over them Rubtsovskaya and may contain brown or dark blue inclusion. Before and during menstruation become visible cystic education from 0.2-0.3 to 2-3 cm in diameter, and the color is more vibrant. Of separate entities or areas of ulceration, typically, there are dark-brown selection.
Some patients endometriosis vagina looks polypous, easily bleeding growths. Bleeding more pronounced on the eve and during menstruation.
The patient K., 50 years, endometriosis vagina was a 5 stalked, rounded formations purple-bluish color, length from 3 to 6 cm and a diameter of 0,3-0,6 cm, tapering towards the top and bottom. They proceeded from the middle third of the rear wall of the vagina, and rounded ends reached the entrance to the vagina.
Diagnosis is based on a cycle of complaints and data, objective research. In doubtful cases is histology byobserving material.
Pregnancy can cause difficulty in diagnosis in connection with the termination of pain (stored only local pain on palpation) and change the appearance nodular cystic forms of endometriosis, which take violet and can find similarities with the horionepiteliome. The definition of the title chorionic gonadotropin, histological with the obligatory account of the decidual reactions due to pregnancy will allow to avoid serious errors in diagnosis.
Treatment of patients with endometriosis vagina carried out by the General principles set out in the relevant Chapter. Here it should be emphasized that determinisme treatment in existing modifications not justified. Moreover, usually diathermocoagulation and excision contribute to the progression of the disease.