What are other Names for this Condition? (Also known as/Synonyms)

• Vaginal Endometriosis

What is Endometriosis of Vagina? (Definition/Background Information)

• The endometrium is the lining of the uterus that proliferates during the menstrual cycle and sheds during menstruation. This cyclical pattern is created by the response of glands and blood vessels present in the endometrium to fluctuating levels of estrogen and progesterone during the menstrual cycle
• Endometriosis is the presence of benign endometrial tissue in abnormal locations outside of the uterus in the pelvis and occasionally, the abdomen and elsewhere. Endometriosis of Vagina is tissue of the endometrium occurring in the walls of the vagina
• Vaginal Endometriosis may be either asymptomatic or cause pelvic pain, irregular bleeding, and infertility. Endometrial tissue outside of the uterus responds to cyclic hormone changes just as normal endometrial tissue does by bleeding. The blood typically cannot exit the body and eventually forms scar-like lesions on pelvic structures
• Vaginal Endometriosis can be managed through medications, oral contraceptives, and the use of hormone derivatives. In some cases, a surgical excision can help in treating the condition adequately. The prognosis is generally good, though pain and discomfort may last for a prolonged period, or even up to menopause

Who gets Endometriosis of Vagina? (Age and Sex Distribution)

• According to studies, Endometriosis of Vagina affects menstruating women; although many cases may remain asymptomatic. Most women are in the age range of 25-35 years, at the time of diagnosis
• Women with infertility problems or pelvic pain may also be affected
• The condition is observed worldwide and all racial and ethnic groups are generally at risk

What are the Risk Factors for Endometriosis of Vagina? (Predisposing Factors)

The risk factors of Endometriosis of Vagina may include the following:

• A family history of endometriosis
• Anatomic malformations blocking the reproductive outflow tract
• First menstrual cycle at an early age
• Frequent menstrual cycles or periods lasting greater than 7 days
• No prior pregnancy
• Exposure to diethylstilbestrol in utero (mother receiving the drug when pregnant)
• Exposure to dioxin and dioxin-like compounds found in industrial waste
• Low birth weight (of the woman)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Endometriosis of Vagina? (Etiology)

Many theories exist that explain the condition, but the exact cause of extrauterine endometrial lesions is unknown.

• Endometriosis of Vagina may take place due to abnormally-placed endometrial tissue in ‘denuded’ vagina, or from Müllerian remnants in the space between the rectum and vagina (known as the rectovaginal septum)
• Retrograde menstruation from the uterus through the fallopian tubes and into the peritoneum (opposite direction of normal flow) is one potential mechanism by which endometrial tissue could seed extrauterine locations
• Another theory involves the spread of endometrial cells through blood vessels or lymphatics to other pelvic structures

What are the Signs and Symptoms of Endometriosis of Vagina?

Most patients of Endometriosis of Vagina are asymptomatic. The signs and symptoms may include:

• Pelvic pain; pain during intercourse and early in the menstrual cycle
• Discomfort or pain during bowel movements or urination
• Irregular and/or excessive bleeding
• Backaches
• Vaginal spotting, rarely

Vaginal Endometriosis occurs in the upper portion of the vaginal tract.

How is Endometriosis of Vagina Diagnosed?

The diagnosis of Endometriosis of Vagina is undertaken using the following tools:

• Physical examination with detailed medical history: A pelvic examination and palpation of pelvic organs can suggest a diagnosis of endometriosis; in such cases, the treatment may be started without any additional tests being performed
• Laboratory tests, such as a complete blood count, urinalysis, and vaginal swab cultures, may be undertaken to rule out pelvic pain, due to a sexually-transmitted infection
• Transvaginal ultrasound may aid in investigation of pelvic pain
• Examination of an endometrial biopsy sample obtained during laparoscopy or laparotomy is necessary to confirm the diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be the gold standard, in arriving at a conclusive diagnosis
• Suspected endometriosis may be treated without confirming with endometrial biopsy, if other causes of pelvic pain are ruled out
• However, the symptoms of Vaginal Endometriosis may be similar to those in other conditions, such as pelvic inflammatory disease. Hence, other causes of pelvic pain and infertility must be ruled out

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Endometriosis of Vagina?

The following complications of Endometriosis of Vagina may be expected:

• Infertility is associated with endometriosis in a sizeable number of cases
• Endometriosis is associated with a higher risk of ovarian cancer; though, it is not a pre-malignant condition
• During pregnancy, Vaginal Endometriosis may induce an Arias-Stella reaction that could lead to the formation of a clear cell adenocarcinoma (a malignant tumor) within the vagina

How is Endometriosis of Vagina Treated?

The treatment of Endometriosis of Vagina is based on the severity of symptoms and the location of endometrial lesions.

• Pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs such as acetaminophen, ibuprofen, and naproxen) may provide relief of mild symptoms
• Oral contraceptives may also provide pain relief, by interrupting the menstrual cycle
• Hormone derivatives including progestins, testosterone and gonadotropin-releasing hormone (GnRH) may be prescribed; these work by antagonizing the effects of estrogen or suppressing the cyclic hormone cycle
• Surgery to remove the endometrial lesions may improve infertility and pain, but lesions may recur
• Pain that is unresponsive to medication may improve following a hysterectomy (removal of the uterus)

How can Endometriosis of Vagina be Prevented?

Currently, there are no known preventative measures for the development of Endometriosis of Vagina.

What is the Prognosis of Endometriosis of Vagina? (Outcomes/Resolutions)

• The prognosis for endometriosis is usually excellent. Single focus of endometriosis, can be cured through excision, multiple foci may be difficult to cure, even though the symptoms can usually be managed through adequate treatment. Usually endometriosis is multiple foci at different parts of the body
• In a small percentage of women, the symptoms resolve with or without treatment in less than one year. Many women will have symptoms until menopause, although medication and surgery can improve pain and infertility
• In some women, local excision and removal of Vaginal Endometriosis can result in a cure. Symptoms may recur in some patients who undergo surgery to remove endometrial lesions
• A hysterectomy with removal of the ovaries and fallopian tubes is most effective for a complete resolution of the condition in many women
• Occasionally, Vaginal Endometriosis can be the source of endometrioid adenocarcinoma of vagina

Additional and Relevant Useful Information for Endometriosis of Vagina:

• Vaginal hysterectomy is a surgical procedure characterized by the surgical removal of the uterus through an incision within the vagina

The following article link will help you understand vaginal hysterectomy:

http://www.dovemed.com/common-procedures/procedures-surgical/vaginal-hysterectomy/