RESUMO
INTRODUCTION AND IMPORTANCE: We report a rare case of post-orgasmic pain associated with endometriosis of the left hypogastric nerve and posterior vaginal wall. It is not a typical symptom of dyspareunia and has not been frequently associated with endometriosis in previous reports. CASE PRESENTATION: A 36-year-old woman presented with post-orgasmic pain exclusively at orgasm, but no dyspareunia during intercourse. She also reported bladder irritation and secondary dysmenorrhea. CLINICAL DISCUSSION: Physical examination revealed a small mass on the posterior vaginal wall and thickening of the left uterosacral ligament (USL) associated with severe pain. Pelvic magnetic resonance imaging (MRI) revealed endometrial tissue infiltration of the USL, hypogastric nerve tract, and posterior vaginal wall, consistent with endometriosis. Laparoscopic surgical excision was performed. Complete en bloc peritonectomy excision of the posterior pelvic compartment and complete removal of the lesions identified on MRI was performed. There were no postoperative complications and symptoms resolved completely. Histopathological examination revealed endometriosis. CONCLUSION: Orgasm-associated pain is rarely associated with endometriosis of the hypogastric nerve. In most cases there is no obvious cause for this symptom in this type of dysorgasmia. The complete resolution of symptoms after removal of the endometriosis by peritonectomy of the posterior pelvic compartment and en bloc excision strongly suggests a causal relationship between endometriosis of the hypogastric nerve and the orgasmic pain and urinary symptoms observed in this case. Also, the effective surgical technique used to treat endometriosis.
RESUMO
O câncer de colo de útero é uma doença invasiva causada pelo vírus oncogênico do HPV. Sendo o terceiro câncer maligno mais comum na mulher. O tratamento das lesões de câncer colo uterino é realizado a partir de métodos ablativos ou excisionais. Este estudo teve como objetivo avaliar o sucesso e a frequência de margens livres nas peças cirúrgicas obtidas por meio de cirurgia de alta frequência (CAF), utilizando uma alça diatérmica triangular modificada. Foi um estudo transversal, retrospectivo e descritivo. Os dados foram obtidos através de prontuários de pacientes submetidas a CAF com documentação do exame anatomopatológico, entre 07/10/15 até 31/08/2020. A coleta foi realizada em 34 pacientes que realizaram esse tratamento. Os resultados mostraram que 29 pacientes tiveram margens tanto ectocervical como endocervical livre. Conclui-se que a técnica utilizando a alça diatérmica triangular modificada mostrou-se eficaz no tratamento de lesões no colo do útero por HPV
Cervical cancer is an invasive disease caused by the oncogenic virus HPV. It's the third most common malign cancer in women. The treatment of the cervical cancer lesions is performed by ablative or excisional techniques. This study's objective was to evaluate the success and frequency of resection margins on surgical resections obtained by large loop excision of the transformation zone (LEEP), using a modified triangular diathermy loop. It was a cross-sectional, retrospective and descriptive study. The data was obtained through the records of patients who had undergone LEEP with the documentation of the anatomopathological examination between October 7th 2015 and August 31st 2020. The collection was performed in 34 patients who had undergone this treatment. The results showed that 29 patients had both ectocervical and endocervical resection margins. The conclusion was that the technique using a modified triangular diathermy loop presented itself as effective in the cervical cancer lesions treatment
