Diagnosis and treatment of rectovaginal endometriosis: an overview

Abstract

Rectovaginal endometriosis can be a cause of severe pain, dyspareunia and intestinal problems. A thorough examination is needed and should include diagnostic imaging, such as transvaginal or transrectal ultrasound or magnetic resonance imaging. Medical therapies, such as oral contraceptives, progestins and levonorgestrel-releasing intrauterine devices, all seem to reduce pain and should always be considered. Surgical treatment is challenging and implies a risk of severe complications. It is preferable to treat endometriotic lesions with superficial infiltration into the rectal wall by local laparoscopic excision, while segmental rectal resection is needed in the case of severe intestinal infiltration. This review describes available diagnostic tools, the possibilities for medical treatment and the alternative surgical approaches.

Long‐term follow‐up and recurrence rate after mesorectum‐sparing bowel resection among women with rectovaginal endometriosis

“…Deep infiltrating endometriosis of the rectovaginal septum is difficult to assess. Evaluating the rectovaginal septum by inspection and palpation requires high expertise [1,2] (Fig. 1).…”

Desogestrel‐only contraceptive pill versus sequential contraceptive vaginal ring in the treatment of rectovaginal endometriosis infiltrating the rectum: a prospective open‐label comparative study

“…In patients with rectovaginal endometriosis, hormonal therapies decrease the severity of pain , decrease the size of the nodules , and improve quality of life , sexual function and patient satisfaction . In the last few years, several studies have shown that medical therapies (such as norethisterone acetate, low‐dose oral contraceptive pill, triptorelin and letrozole) improve pain and gastrointestinal symptoms of patients with bowel endometriosis and decrease the size of the nodules .…”

Video-assisted laparoscopy for the detection and diagnosis of endometriosis: safety, reliability, and invasiveness

“…One concerning exception is the postmenopausal patient, in which ovarian cysts with ‘ground glass’ appearance are associated with a 44% risk of malignancy 12. Additionally, TVS may play a role in the evaluation of disease involving the bladder and rectum 14,15…”