Endometriosis occurs when endometrial cells, normally found only in the uterus, become imbedded in locations outside the uterus. These locations are usually within the pelvic cavity on reproductive organs, supportive ligaments, or structural systems like the bladder or bowel.
This misplaced tissue forms growths that look like dark spots. These growths respond to the menstrual cycle and break down and bleed each month, the same way the lining of the uterus does. This causes cyclical pain and inflammation - called dysmenorrhea. Additionally, the body’s immune response to this internal bleeding and breakdown of blood and tissues begins to cause scar tissue and adhesions (affected pelvic organs or structures adhering to one another) which can also cause ongoing pain.
Endometriosis affects millions of women but is often over diagnosed as the primary cause of pelvic and sexual pain. If the pain or deep sexual discomfort is intermittent and all month long, even though it may become worse leading up to the menstrual period, endometriosis may not be the primary reason for the pain. If you have been diagnosed and treated for endometriosis and you don't begin to get signifiant improvement either after medication or surgical treatment, insist on further evaluation for bladder, bowel, musculoskeletal, or nerve related causes of your pain.
Take a look at the image in the blog post just below. This image of the female pelvis is incomplete because there is a great deal more to the anatomy of the female pelvis that is just not shown in this image. The pictures in this blog post show much more of the complete anatomy of the pelvic region.
The actual causes of chronic, persistent pain itself are in all of these neuro-myofascial components: Nerves, Muscles, and Ligaments. Bladder, bowel, and reproductive organs are commonly acting as "triggers" that set off painful, but protective responses in the region. Just as in any other area of the body, the muscles, nerves, and ligaments go into a protective bracing mode as a result of current tissue injury, protecting against further injury, and even when the system is reminded of past injury. These structures are trying to immobilize the region in order to control the pain.
Comprehensive assessment and treatment of chronic pelvic pain therefore will naturally include specialized pelvic floor physical therapy to rehab and release long term muscle spasming and trigger points, as well as a working knowledge of diagnosing and managing chronic nerve type pain in the pelvic and genital region.
Recognize this imagery? You've probably seen it on your doctor's examining room walls and in your health books since middle school. However, there are 2 important misleading and incomplete aspects of this depiction of the female pelvis.
First, the uterus and ovary seen on this picture are deceivingly pictured way up near the umbilicus or “belly button” - that positioning of this anatomy does not actually happen until about 15 to 16 weeks of pregnancy and as can obviously be seen, the uterus in this picture is not pregnant. In this respect this picture is a “cartoon” type drawing that is not anatomically correct. It is simply meant to show that the 3 main organ systems in the pelvis are the lower urinary tract, the reproductive organs, and the lower bowel.
This may not seem important, but in actuality, it is terribly misleading in many circumstances such as when a young woman goes to her doctor or the emergency room doubled over in pain and everyone believes it must be her ovary or certainly a “female” issue, when in fact her ovaries are located considerably deeper or further down in her pelvic “core” than what this picture indicates. So when the ultrasound, the CT scan or any of the other tests don’t show anything abnormal, everyone is puzzled. When this happens repeatedly in young women, they begin to believe and are even told that the pain “must be in their heads”, that they are seeking attention, and/or they are just “drug seekers”.
The second and considerably more important reason this picture of the pelvic region is wrong or incomplete, and which begins to explain why all those tests patients may have undergone did not show anything obviously serious - is that there is indeed a great deal more to the anatomy in the pelvic region that is just not shown in this picture.
To be continued..
Stephanie Yeager: Passionate about spreading the word of hope and healing for those like her, influencing a paradigm shift in the medical community toward greater understanding of chronic pelvic pain disorders, and prevention initiatives that may protect young women before onset can occur.