The Neural Immune Mechanisms and Genetic Influences on C

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Chronic pelvic pain accounts for 10 percent of all gynecology visits and is a significant problem for thousands of women. Most women with chronic pelvic pain have endometriosis. To determine the possible contribution of pelvic adhesions in women with pelvic pain, we evaluated adhesion reformation following laparoscopic excision of endometriosis and adhesiolysis in women with chronic pelvic pain in 38 women who had two surgeries. Adhesions, or adhesions combined with endometriotic lesions, were significantly more likely to reform at second surgery compared to sites having only an endometriosis lesion. Thick adhesions were associated with a significantly increased likelihood of adhesion reformation, compared to thin adhesions. Endometriotic lesions or adhesions involving the ovary were more likely to be associated with adhesions at a subsequent surgery, compared to lesions in the adjacent ovarian fossa or fallopian tube. Most patients developed adhesions after radical surgical excision of endometriosis for pelvic pain. The high incidence of adhesion formation following surgery for endometriosis underscores the importance of optimizing surgical techniques to potentially reduce adhesion formation. In order to better understand endometriosis, chronic pelvic pain and their co-morbidities, we analyzed a survey of almost 4000 women with surgically diagnosed endometriosis conducted by the Endometriosis Association. Almost all responders had pain (99%), and many reported infertility (41%). In this cohort of women with endometriosis, hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies, and asthma were all significantly more common than in women in the general U.S. population. In the coming year, we plan to conduct a more in depth analysis of women with endometriosis to assess the diagnostic process and utilization and effectiveness of treatments, to estimate the prevalence of co-morbid diseases including cancers, endocrine diseases, and infections, and to evaluate the reproductive and gynecologic health of women who responded to the survey.