Endometriosis infiltrating the bowel can be treated medically in accurately selected women not seeking conception and without overt obstructive symptomatology. When the rectosigmoid junction is involved, the probabilities of intestinal symptoms relief, undergoing surgery after treatment failure, and developing bowel obstruction during hormonal treatment are around 70%, 10%, and 1-2%, respectively. When the lesion infiltrates exclusively the mid-rectum, thus in cases of true rectovaginal endometriosis, the probabilities of intestinal symptoms relief and undergoing surgery are about 80% and 3%, respectively. Endometriotic obstructions of the rectal ampulla have not been reported. A recto-sigmoidoscopy or colonoscopy should be performed systematically before starting medical therapies, also to rule out malignant tumours arising from the intestinal mucosa. Progestogens are safe, generally effective, well tolerated, inexpensive, and should be considered as first-line medications for bowel endometriosis. Independently of symptom relief, intestinal lesions should be checked periodically to exclude nodule progression during hormonal treatment.

La distanza anogenitale (AGD) (ovvero la distanza misurata dall'ano al tubercolo genitale) è una caratteristica corporea androgeno-dipendente, che risente dell'esposizione ormonale intrauterina. Studi sull'uomo hanno evidenziato che alterazioni della AGD possono essere associate a malattie dell'apparato riproduttivo, sia negli uomini che nelle donne. In particolare, studi recenti suggeriscono una correlazione tra differenze nella lunghezza della AGD e presenza di patologie ginecologiche, come l'endometriosi e la sindrome dell'ovaio policistico (PCOS). In queste condizioni, infatti, l'esposizione ormonale prenatale (in particolare a ormoni steroidei) può rappresentare un fattore di rischio per lo sviluppo della malattia in età adulta. In questa review narrativa della letteratura vengono riportate le più attuali evidenze sulla relazione tra AGD e la presenza di endometriosi e PCOS. I risultati degli studi a disposizione suggeriscono che una AGD più corta possa essere correlata alla presenza di endometriosi, mentre una AGD più lunga ad un aumentato rischio di PCOS. Alla luce di questi risultati viene discusso il ruolo della misurazione dell'AGD in donne adulte, quale potenziale biomarker (semplice e facilmente riproducibile) di endometriosi e PCOS. Tuttavia, le evidenze scientifiche a disposizione appaiono insufficienti, e sono necessari studi per confermare i limitati risultati attuali.

AGD is the distance measured from the anus to the genital tubercle. Recent evidence suggests that a shorter AGD, a sensitive biomarker of the prenatal hormonal environment, could be associated with higher endometriosis risk. However, studies investigating AGD in affected women are scanty. We have set up a case-control study recruiting nulliparous women (aged 18-40 years) with endometriosis between 2017 and 2018. Cases were 90 women with a surgical or with a current nonsurgical diagnosis of endometriosis (n = 45 deep infiltrating endometriosis (DIE), and n = 45 ovarian endometrioma (OMA)). Controls were 45 asymptomatic women referring for periodical gynaecological care and without a previous diagnosis of endometriosis. They were matched to cases for age and BMI. For each woman, two measures were obtained using a digital caliper: AGDAC, from the clitoral surface to the upper verge of the anus, and AGDAF, from the posterior fourchette to the upper verge of the anus. Each distance was derived from the mean of six measurements acquired from two different gynaecologists. The mean±SD AGDAC in women with DIE, OMA and without a diagnosis of endometriosis was 76.0±12.1, 76.1±11.1, and 77.8±11.4 mm, respectively (p = 0.55). The mean±SD AGDAF in women with DIE, OMA and without a diagnosis of endometriosis was 22.8±5.0, 21.7±9.0, and 23.7±7.8 mm, respectively (p = 0.38). Our study failed to find an association between AGD and the presence of endometriosis. AGD does not seem to represent a reliable indicator of the presence of endometriosis to be used in clinical practice.

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