Impact of surgical resection of rectovaginal pouch of Douglas endometriotic nodules on pelvic pain and some elements of patients' sex life

Study Objective. To assess the impact of laparoscopic resection of endometriotic nodules in the rectovaginal pouch of Douglas on womens' pain symptoms, analgesic intake, work absenteeism, work difficulties, and some elements of sex life. Design, Observational study (Canadian Task Force classification II-2). Setting. Gynecology department at a university hospital. Patients. Twenty-six women with rectovaginal pouch of Douglas endometriotic nodules and no evidence of other potential cause of pain at physical examination, laparoscopy, and transvaginal ultrasonography. Intervention, Laparoscopic resection of endometriotic nodules with the CO2 laser until no residual induration was felt in surrounding tissues. Measurements and Main Results. Significant statistical differences were found between preoperative and postoperative pain scores, percentages of women absent from work, percentages taking analgesics or nonsteroidal antiinflammatory drugs, and percentages having work difficulties due to pain. A significant difference also was found in frequencies of sexual desire and coitus. Conclusion. Endometriotic nodules in the rectovaginal pouch of Douglas may be responsible for major pelvic pain and also for sexual dysfunction (lack of sexual desire, dyspareunia). Laparoscopic resection of the nodules significantly improves these conditions.