Endometriosis, Pelvic Pain and Surgery
So, I have said this before and I will say it again and again and well, I guess again.
Endometriosis is a common disease. It causes infertility, inflammation, painful intercourse, painful periods, bladder problems, pelvic floor problems and bowel problems among others.
I always have to ask the question – why, if so many women have endometriosis do they not all have pain?
That’s correct – not all women with endometriosis have pain. As a busy gynecologic surgeon I frequently see endometriosis (and prove it with a biopsy) in women who are having surgery for other problems such as fibroids and cysts. They may have no pain complaints but they definitely have endometriosis.
The general answer to the question is that different people have different thresholds for pain. Pain in and of itself is a complex disease. We are just beginning to scratch the surface in our understanding of pain as a disease. So, rather than focus on endometriosis, when present,as the sole disease in a women with pelvic pain I believe it is important to treat endometriosis as a critical pain generator in such patients.
This way of thinking allows me to treat endometriosis and at the same time consider underlying pain mechanisms in a patient in whom not all pain may be accounted for by endometriosis. This way of thinking allows me to manage women with much more complex pain problems than simply managing endometriosis would allow. Further, it guides my understanding of the best way to intially manage endometriosis.
If endometriosis is thought of as a pain generator that over a long period of time can effect the way the central nervous system (brain and spinal cord) views and handles pain signals then one must come to the conclusion that the best way to manage such a pain generator is to remove it. A poor way to manage such a pain generator is to put a hormonal band aid (such as lupron) on it and expect great long term results.
So, in my practice I have become a nationally recognized expert at removing endometriosis. I call the procedure a fertility sparing (for women who wish to retain their fertility) radical resection of endometriosis. During this procedure I remove all visible areas of endometriosis. In doing so, I go all the way to the root of the endometriosis lesions. I sometimes have to remove endometriosis from the ureter and sometimes from the bowel and areas in between the vagina and rectum. Sometimes the endometriosis is so severe that I call in a colorectal surgeon to remove a portion of bowel.
Having said all of that here’s my advice in choosing an expert to manage your endometriosis and pelvic pain:
1. Choose someone who has advanced skills in laparoscopic and robotic laparoscopic surgery. Generally, people who focus on gynecology and gynecologic surgery only may be qualified. Ask your surgeon is he or she is able to perform the surgery as described above.
2. Choose someone who understands and can manage all the aspects of pain associated with endometriosis. If your surgeon says, “I only do removal of endometriosis” then it is likely he will miss other pain issues that will crop up later. This single modality approach almost never works for long term relief.
3. Choose a doctor who isn’t afraid to explore the possibilities and work with doctors in other specialties. Pain is a problem that can effect your entire body and multiple systems. Just because you have endometriosis – this does not have to be your only problem. To treat patients with endometriosis as if it the only problem is too narrow and poor practice of medicine.
4. Choose someone who takes your insurance. There are several qualified surgeons across the NY area who can manage these problems effectively. There is no reason to shell out more than $20,000 when you can do it for a $15 copay. Arguably, the surgeons such as myself who do take insurance carry a higher level of ethics (because we are not in it for the big money) and are more experience because we see more patients.
I wish you the best of luck in your search for relief from your pain. Please feel free to visit our website -
www.pelvicpainnewyork.com. You can always reach me directly drlevey@pelvicpainnewyork.com
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