title: The potential role of endometrial nerve fibers in the pathogenesis of pain during endometrial biopsy at office hysteroscopy.
abstract: We aimed to evaluate whether nerve fibers are present in the endometrial layer of patients submitted to office hysteroscopy and their potential contribution to the pathogenesis of pain during that procedure. Through a prospective case-control study performed in tertiary centers for women's health, endometrium samples were collected during operative office hysteroscopy from 198 cycling women who previously underwent laparoscopy and/or magnetic resonance imaging investigation for infertility assessment. Samples were classified according to the degree of the pain patients experienced and scored from values ranging from 0 (absence of discomfort/pain) to 10 (intolerable pain) on a 10-cm visual analog scale (VAS). The presence of nerve fiber markers (S100, NSE, SP, VIP, NPY, NKA, NKB, NKR1, NKR2, and NKR3) in the endometrium was also evaluated by morphologic and immunohistochemical analyses. We found that S-100, NSE, NKR1, NK-A, NK-B, VIP, and NPY, were immunolocalized in samples of endometrium, in significantly (P < .01, for all) higher levels in samples collected from patients with VAS score > 5 (group A) than ≤ 5 (group B) and significantly (P < .0001 for all) positively correlated with VAS levels. A statistically significant (P = .018) higher prevalence of endometriosis and/or adenomyosis was depicted in patients of group A than group B. Data from the present study led us to conclude that nerve fibers are expressed at the level of the functional layer of the endometrium and may contribute to pain generation during office hysteroscopy, mainly in women affected by endometriosis and adenomyosis.
authors.affiliation: Department of Gynecology and Obstetrics and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Spiezio Sardo
authors.affiliation: U.O.C. Obstetrics & Gynecology, "S. Giuseppe" Hospital, Empoli, Italy floriop@hotmail.com.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Florio
authors.affiliation: Department of Gynecology and Obstetrics and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy.
authors.forename: Loredana Maria Sosa
authors.initials: LM
authors.lastname: Fernandez
authors.affiliation: Department of Medicine and Health Sciences University of Molise, Campobasso, Italy.
authors.forename: Germano
authors.initials: G
authors.lastname: Guerra
authors.affiliation: Department of Gynecology and Obstetrics and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy.
authors.forename: Marialuigia
authors.initials: M
authors.lastname: Spinelli
authors.affiliation: Department of Gynecology and Obstetrics and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Di Carlo
authors.affiliation: U.O.C. Obstetrics & Gynecology, "S. Giuseppe" Hospital, Empoli, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Filippeschi
authors.affiliation: Department of Gynecology and Obstetrics and Pathophysiology of Human Reproduction, University of Naples "Federico II," Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Nappi
mesh_terms: D062788:Adenomyosis / Q000473:pathology* / Q000503:physiopathology; D000328:Adult; D000553:Ambulatory Care; D001706:Biopsy / Q000009:adverse effects*; D016022:Case-Control Studies; D004715:Endometriosis / Q000473:pathology* / Q000503:physiopathology; D004717:Endometrium / Q000294:innervation* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D007150:Immunohistochemistry; D007558:Italy; D008875:Middle Aged; D009412:Nerve Fibers / Q000737:chemistry; D009479:Neuropeptides / Q000032:analysis; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D010147:Pain Measurement; D011446:Prospective Studies; D062606:Tertiary Care Centers
chemical_list: D009479:Neuropeptides
keywords: adenomyosis; endometriosis; neuropeptides; office hysteroscopy; pain