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Nerve Bundles and Deep Dyspareunia in Endometriosis

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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.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of British Columbia, Center for Pelvic Pain and Endometriosis, F2—4500 Oak Street, V6H 3N1, Vancouver, British Columbia, Canada

    Christina Williams MD, Ali Yosef MBBCh, MSc, Fahad Alotaibi BSc, Catherine Allaire MD, Lori Brotto PhD, Mohamed A. Bedaiwy MD, PhD & Paul J. Yong MD, PhD

  2. Department of Pathology, University of British Columbia, Vancouver, Canada

    Lien Hoang MD, Tony L. Ng MD, PhD & Anna F. Lee MDCM, PhD

  3. School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia

    Ian S. Fraser MD, DSc

Authors
  1. Christina Williams MD
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  2. Lien Hoang MD
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  3. Ali Yosef MBBCh, MSc
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  4. Fahad Alotaibi BSc
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  5. Catherine Allaire MD
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  6. Lori Brotto PhD
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  7. Ian S. Fraser MD, DSc
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  8. Mohamed A. Bedaiwy MD, PhD
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  9. Tony L. Ng MD, PhD
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  10. Anna F. Lee MDCM, PhD
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  11. Paul J. Yong MD, PhD
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Corresponding author

Correspondence to Paul J. Yong MD, PhD.

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Williams, C., Hoang, L., Yosef, A. et al. Nerve Bundles and Deep Dyspareunia in Endometriosis. Reprod. Sci. 23, 892–901 (2016). https://doi.org/10.1177/1933719115623644

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