title: Nerve Bundles and Deep Dyspareunia in Endometriosis.
abstract: The etiology of deep dyspareunia in endometriosis is unclear. Our objective was to determine whether nerve bundle density in the cul-de-sac/uterosacrals (zone II) is associated with deep dyspareunia in women with endometriosis. We conducted a blinded retrospective immunohistochemistry study (n = 58) at a tertiary referral center (2011-2013). Patients were stringently phenotyped into a study group and 2 control groups. The study group (tender endometriosis, n = 29) consisted of patients with deep dyspareunia, a tender zone II on examination, and an endometriosis lesion in zone II excised at surgery. Control group 1 (nontender endometriosis, n = 17) consisted of patients without deep dyspareunia, a nontender zone II on examination, and an endometriosis lesion in zone II excised at surgery. Control group 2 (tender nonendometriosis, n = 12) consisted of patients with deep dyspareunia, a tender zone II on examination, and a nonendometriosis lesion (eg, normal histology) in zone II excised at surgery. Protein gene product 9.5 (PGP9.5) immunohistochemistry was performed to identify nerve bundles (nerve fibers surrounded by perineurium) in the excised zone II lesion. PGP9.5 nerve bundle density (bundles/high powered field [HPF]) was then scored by a pathologist blinded to the group. We found a significant difference in PGP9.5 nerve bundle density between the 3 groups (analysis of variance, F2,55 = 6.39, P = .003). Mean PGP9.5 nerve bundle density was significantly higher in the study group (1.16 ± 0.56 bundles/HPF [±standard deviation]) compared to control group 1 (0.65 ± 0.36, Tukey test, P = .005) and control group 2 (0.72 ± 0.56, Tukey test, P = .044). This study provides evidence that neurogenesis in the cul-de-sac/uterosacrals may be an etiological factor for deep dyspareunia in endometriosis.
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Williams
authors.affiliation: Department of Pathology, University of British Columbia, Vancouver, Canada.
authors.forename: Lien
authors.initials: L
authors.lastname: Hoang
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Yosef
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
authors.forename: Fahad
authors.initials: F
authors.lastname: Alotaibi
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Allaire
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
authors.forename: Lori
authors.initials: L
authors.lastname: Brotto
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
authors.forename: Ian S
authors.initials: IS
authors.lastname: Fraser
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Bedaiwy
authors.affiliation: Department of Pathology, University of British Columbia, Vancouver, Canada.
authors.forename: Tony L
authors.initials: TL
authors.lastname: Ng
authors.affiliation: Department of Pathology, University of British Columbia, Vancouver, Canada.
authors.forename: Anna F
authors.initials: AF
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada paul.yong@vch.ca.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Yong
mesh_terms: D000293:Adolescent; D000328:Adult; D004414:Dyspareunia / Q000209:etiology* / Q000378:metabolism / Q000473:pathology*; D004715:Endometriosis / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009412:Nerve Fibers / Q000378:metabolism / Q000473:pathology*; D017699:Pelvic Pain / Q000150:complications; D012189:Retrospective Studies; D043222:Ubiquitin Thiolesterase / Q000378:metabolism; D014599:Uterus / Q000294:innervation* / Q000378:metabolism / Q000473:pathology; D055815:Young Adult
chemical_list: C482860:UCHL1 protein, human; D043222:Ubiquitin Thiolesterase
keywords: dyspareunia; endometriosis; immunohistochemistry; laparoscopy; nerve