Feel Good Fridays

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We made it through the week, and what a busy week this has been!  *whew*

Today’s Feel Good Fridays quote is by Roman philosopher, Seneca:

“In a moment the ashes are made, but a forest is a long time growing.”

Remember, whatever “moment” you endured which you feel may have ruined you, or at least scarred you, that there will a time when you are whole again.  You will heal.  This experience will only make you stronger.  Endure.  Grow.  Be reborn from the ashes.

May you have a wonderful weekend!

Yours, Lisa

Truth, Theory, or Tall Tale?

op room

A woman with Endometriosis may require surgeries to cut out the disease for the rest of her life.

Truth

Excision surgery is the “gold standard” for treating the symptoms associated with Endometriosis.  Surgeons cut out (excise) the Endometriosis implants that are found within the body, and also remove/cut free any adhesions that may be sticking organs together.  Some women claim immediate pain relief after their first surgery, some do not.  And countless women have to later undergo numerous excision surgeries, some in as little as six months after their last surgery.  Some women are pain-free for several years before having to go under the knife yet again.

Hysterectomies and menopause do not even relieve some womens’ Endometriosis symptoms.  Many women who are post-hysterectomy or even post-menopausal continue to suffer from Endometriosis pain and symptoms and continue to undergo excision surgeries.

Many in the medical community claim to be “the best” at an excision surgery; stating that once a patient sees them, they never have to undergo another surgery. Ever again.  Alas, while that may be true for some very lucky women, it is not true for all women.  And many patients who have seen these “experts,” later return for subsequent excision surgeries.  It’s not the surgeon’s fault…Endo just continues to fester and grow.

It remains that excision surgery is the most widely accepted treatment of Endometriosis.  And despite a well-balanced “endo diet,” supplements, prescription medication, and/or lifestyle changes, many women continue to suffer after their surgeries, and continue to require more.

It’s a vicious cycle.

Feel Good Friday

Picture_of_Edith_Wharton

Good morning! We made it to another Friday, albeit a rainy one (it’s good though, we need the rain)!

Today’s quote is by American novelist, Edith Wharton:

“In spite of illness, in spite even of the archenemy sorrow, one can remain alive long past the usual date of disintegration if one is unafraid of change, insatiable in intellectual curiosity, interested in big things, and happy in small ways.”

I loved this quote the moment I saw it.  And I’m going to leave it at that.

Yours,

Lisa

Reader’s Choice : Can Men Get Endometriosis?

Male symbol

Last night, my boyfriend and I were talking about Endo’s “weirdness” how it can pop up in strange and unheard of places, and he popped the question (no, not THE question…), “Are there any reports of men having Endometriosis?”  I remembered reading somewhere that there were a few rare cases of it, but hadn’t read them deeply enough to understand their situations, diagnoses, and prognoses.  So, we have our topic for today!!

In rare cases, men develop Endometriosis.  It appears many have been treated with long-term or large doses of estrogen therapy, but some are healthy men who have no history of cancer or estrogen treatment.  Here’s what I could find:

A 21-year-old man complained of lower abdominal pain.  He suffered from a condition known as PMDS (Persistent Mullerian Duct Syndrome) and had been undergoing testosterone treatment since he was 18 years old.  PMDS is a rare medical condition where both male and female sexual organs are present.  An MRI of his abdomen revealed that he had a cervix and uterus with gonads (ovaries) and Fallopian tubes!  He underwent a hysterectomy, removing his uterus, gonads, and fallopian tubes.  All of the tissue was biopsied and was shown to have Endometriosis.  It is unknown how he fared after surgery, or if he received any sort of subsequent treatment.  However, there was one article that men with PMDS who have a hysterectomy and remove their ovaries may be thrown into menopause! Poor guys!

A 27-year-old man went to his physician with complaints of scrotal pain.  Unfortunately, the abstract does not describe his medical history or diagnosis but does hint that whatever it was that was bothering him was found to have inflammation of a tube at the back of one of his testicles, which was later shown to be Endometriosis.

A study published on January 31, 2018, discusses the case of a 40-year-old man who complained of lower abdominal pain on the right side the radiated into his right flank.  It had been constant for the past three days and he began to bloat.  He was in good health except for some asthma, which he treated with steroids a week before.  A CT scan and MRI both confirmed the presence of a cyst on the tube that carries sperm from his testicles to his urethra.  A cystourethroscopy was performed, which allowed his doctors to see inside his urethra and prostate.  The mass was surgically removed during a laparoscopy, described as a cyst filled with brown fluid, and biopsied.   He received a “highly unexpected diagnosis” of Endometriosis.  And the symptoms and pain were gone after surgery.  The authors of this study are intrigued and hope that the findings of Endometriosis in men may prove against the retrograde menstruation theory.

A study published in September 2018’s edition of International Journal of Surgical Pathology highlights the cases of two men, 43 and 50 years old, who developed a testicular mass.  Both biopsies came back as Endometriosis.  And neither man had been exposed to any significant chemicals or hormones.  The authors state that the fact that the masses were found in the Müllerian ducts support the theory of Endometriosis developing from embryonic remnants.

A 47-year-old man had undergone three prior surgeries to repair his inguinal hernia.  He went to the hospital for a fourth inguinal hernia surgery and also had complaints of infertility.  While in surgery, a mass was discovered next to his spermatic cord, which was removed and biopsied.  It was discovered to be Endometriosis.  Prior to this discovery, the patient had been taking Fertilin, an anti-estrogenic medicine to help combat his infertility and boost his sperm health and activity.  The article does not disclose any prognosis of the patient after his release from the hospital.  The article does state; however, that it was interesting that most men who develop Endometriosis have a history of estrogen therapy, but their patient had a history of ANTI-estrogen therapy…Interesting indeed.

In 1979, a 50-year-old man was found to have Endometriosis in his bladder.  In 1955, he had his prostate removed due to the presence of an adenocarcinoma.  Over the next five years, all of his annual rectal exams were normal.  Eleven years later, he suffered from a ruptured appendix and bowel blockage, requiring surgery.  Three months later, he was readmitted to the hospital with complaints of rectal bleeding and diarrhea.  It was discovered that he had a hard nodule in his rectum. Biopsy found it similar to the adenocarcinoma that was previously excised from his prostate, so both of his testes were removed.  He was prescribed 12 mg of Tace (estrogen therapy) to be taken daily.  In 1972 (four years later), he complained of blood in his urine.  A cystoscopy revealed a nodule inside his bladder.  A portion was removed for biopsy: it appeared identical to endometrium, but a diagnosis of Endometriosis was not given.  Instead, his Tace dosage was doubled to 24mg per day.  Nearly a year later, he was hospitalized due to blood in his urine.  Imaging studies showed a build-up of fluid in his left kidney due to a bladder obstruction.  A cystoscopy was performed and a large lesion was blocking his ureter opening.  Biopsy confirmed the presence of Endometriosis on and within his bladder wall.  At that time, is prior specimens were re-biopsied and confirmed as Endometriosios.  That portion of his bladder was resected.  He was taken off of Tace and prescribed a regimen of birth control pills.  He continued to have intermittent blood in his urine and four months after starting birth control had a “hemorrhagic episode,” the birth control was discontinued, and he underwent a further resection of the newly-bleeding bladder.  His symptoms disappeared.

A study published in 2014 shows a 52-year-old man went to the E.R. with complaints of “excruciating stabbing pain in the right lower abdomen and pelvis area for 3 weeks.  The pain was worse on getting up from a supine position and was not relieved by bowel movements. It slightly increased upon urination as well.”  Seven months before, he had undergone inguinal hernia repair (which had been surgically repaired a few times before) and had a medical history of cirrhosis due to Hepatitis C.  He underwent a diagnostic laparoscopy and a mass was discovered attached to his bladder and his hernia site.  It was filled with blood, was removed, and biopsied.  It was Endometriosis, complete with it’s own estrogen and progesterone receptors.  After his surgery, his pain completely resolved.

In 2019, a study was published of a 54-year-old man who began to have blood in his urine. It didn’t hurt, it was just there. He had a medical history of hypertensoin, Diabetes, and he was obese. A cystoscopy was performed and a lesion was discovered at the base of his bladder. A transurethral resection was performed and the lesion was removed. A biopsy confirmed it was, in fact, Endometriosis. The possibilty of a lab mix-up was considered, but the results were confirmed as belonging to that 54-year-old man. And a follow-up six months later found no recurrent lesion growth. The authors stress that male Endometriosis is incredibly rare, but possible. And stated that obesity can increase aromatase activity, converting testosterone to estrogen.

A 69-year-old man who had prostate cancer and undergone 9 years of hormonal therapy developed Endometriosis.  A lesion was found within his testicle, which had also developed cysts.  Tests of the tissue and cysts confirmed the presence of Endometriosis lesions.  They attribute that the prolonged estrogen therapy to the development of Endometriosis.

A 73-year-old man had tissue removed from his bladder, which was “histologically indistinguishable” from Endometriosis.  He had begun to suffer from hydronephrosis, which is when your kidney swells due to a build-up of urine, which had been caused by his bladder Endo lesions.  For the past five years, he had been treating his prostate cancer with Estrogen therapy.

A 74-year-old man complained of having blood in his urine.  Five years prior he had his prostrate removed due to prostate cancer and had been treated with Leuprolin (a form of Lupron) and Ethinyl Estradiol (an oral contraceptive).  Bladder cancer was suspected due to the blood in his urine and he underwent imaging studies and an exploratory surgery of his bladder.  He had a small tumor inside of his bladder, which was partially removed and biopsied.  The mass had estrogen and progesterone receptors and was determined to be Endometriosis.  Six months after he stopped taking Ethinyl Estradiol, the mass shrank.  The authors of the study suspect that it was his estrogen treatment that led to the development of Endometriosis, and also attribute it’s disappearances to the discontinuation of the oral contraceptives.

Back in 1971, an 80-year-old man was found to have Endometriosis on his bladder, but only after several procedures to confirm this.  He was previously medically castrated in 1958 due to blood in his urine and a suspected case of prostatism.  At that time, it was discovered that he had a blockage in the bladder neck.  The blockage was removed, later confirmed as a adenocarcinoma (a tumor).  After the procedure, he was prescribed estrogen, 12mg to be taken daily.  Four months later, he went in for surgery to have his prostate gland removed.  Biopsy showed abnormal cell growth on the prostate, as well as a carcinoma, which was removed.  He continued to take the 12mg of Tace daily…with no recurrence of the carcinoma during annual examinations.  In 1968, he was once more seen by physicians due to blood in his urine.  Testing failed to reveal a cause.  Nearly a year later, the blood in the urine returned.  This time, it was so “profuse” that it required several transfusions before physicians could perform a cystoscopy to look up into the bladder.  Once inside, they found a 1cm “dark-brown lesion) on the right side of his bladder.  The pathology suggested Endometriosis and the physicians thought maybe there had been a mix-up in the lab and some uterine tissue was mixed in with the sample.   Two months later, (yep…you guessed it) there was more blood in his urine.  The biopsy for this third cystoscopy came back as a bladder infection.  He continued to have regular blood in his urine after that procedure.  In April 1970 (six months the “bladder infection” diagnosis), he underwent yet another cystoscopy, wherein another dark lesion (in the same spot) was located and biopsied.  Once more, it was strongly suggested to be Endometriosis.  A week later, a resection of his bladder was performed.  A “firm, golf-ball size, growth-like structure” was found within his bladder and in the bladder wall..  Upon examination of the growth, it ruptured – spilling “old blood”  (sound familiar?).  They dug around in his pelvic cavity searching for any signs of female organs:  100% male insides. The patient did well after the procedure.  This may very well be the first written account of Endometriosis in a male patient.

An 83-year-old man developed an endometrioma (chocolate cyst) in his abdominal wall.  He had previously received over 10 years of TACE treatment (a chemotherapy procedure to kill tumors) for prostate cancer.  This abstract hints that the endometrioma was removed, with no recurrence.  However, he continued to suffer from his prostate cancer, but died in 1979 of heart disease.  His physicians had hoped to more thoroughly examine his remains for clues as to why he developed an endometrioma, but no postmortem examination was conducted.

These are not all of the reported cases of men with Endometriosis; I’m sure I’ve missed a few.  Most of the men diagnosed with Endometriosis had the commonality of estrogen therapy.  Another two shared a history of recurrent inguinal hernia surgeries.  One young man had a functioning uterus and ovaries, which produced estrogen.  And some men have no abnormal medical or treatment history; just a spontaneous development of symptoms.

Many doctors believe that the role of estrogen may aid in the development of Endometriosis in men.  Others believe the men may have “bits of female organs” still in their bodies from their developmental stages as a fetus, although several tested did not show signs of any remnant female bits.  As usual : Endometriosis is a mystery; in women, as well as men.  However, I would think that these few, rare cases would prompt the medical and scientific community to research further any link between heightened estrogen levels and Endometriosis…

What are your thoughts? I’d love to hear them!

*Updated March 27, 2019*

Resources:

Avicenna Journal of Medicine : Article (2014) An Unusual Cause of Abdominal Pain in a Male Patient : Endometriosis

Cancer : Article (1979) Endometriosis of the Urinary Bladder in a Man with Prostatic Carcinoma

Daily Mail

Fertility and Sterility : Article (2008) Endometriosis in a Male with Persistent Mullerian Duct Syndrome

Hindawi Case Reports in Obstetrics & Gynecology (.pdf download) (Jan. 2018) – Endometriosis in a Man as a Rare Source of Abdominal Pain: A Case Report and a Review of the Literature

International Journal of Surgical Pathology Abstract (Sept. 2018) – Endometriosis with Cystic Degeneration: A Rare Disease in Males

Pathology : Abstract (Feb. 2019) – The Bleeding Obvious – A Case of Male Endometriosis (You may be able to access the full study)

The Journal of Urology : Abstract (1971) Endometriosis of the Bladder in a Male Patient (you may be able to access the entire article on Scihub)

U.S. National Library of Medicine : Abstract (1980) Endometriosis of the Male Urinary System : a Case Report

U.S. National Library of Medicine : Abstract (1985) Endometriosis in the male

U.S. National Library of Medicine : Abstract (2006) Cystic Endometriosis of the Epididymis

U.S. National Library of Medicine : Article (2010) Endometriosis – Morphology, Clinical Presentations and Molecular Pathology

U.S. National Library of Medicine : Article (2012) An Unusual Cause of Inguinal Hernia in a Male Patient : Endometriosis

Pathology – Research and Practice 208 : Abstract (2012) Paratesticular Endometriosis in a Man with a Prolonged Hormonal Therapy for Prostatic Carcinoma

Wiley Online Library : Article (2012) Bladder Endometriosis Developed After Long-term Estrogen Therapy for Prostate Cancer

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Endometriosis on your skin

Diagram of human skin

It’s about time I research more about Endometriosis being found in places other than your pelvic region.  We’ve already covered lungs, spine, and eyes, and today we’re going to delve into cases of Endometriosis and skin.  Skin? Yes, skin.  I’ve read that it’s rare, just like the other areas outside of the pelvic cavity…but, it does occur.  Some theorize it is implanted via the lymphatic or vascular systems; others think the cells are transplanted via surgery.

There seem to be two common categories of Endometriosis and the skin : spontaneous Endometriosis and scar Endometriosis.  Spontaneous Endo simply appears in random places on healthy skin (cutaneous or subcutaneous).  Scar Endo is found within scar tissue from prior surgeries or injuries.  It appears that surgical excision/removal of the Endometriosis lesions from the skin is the most common and effective way of handling the lesions.  Some surgeries may leave defects, which may (or may not) be repaired or rebuilt with a surgical mesh.  Some studies suggest that hormonal treatment may be too harsh for the patient for solitary lesions.

The first recorded case of Endometriosis (or an endometrioma) in the belly button was reported in 1886, and was referred to as a “Villar’s Nodule,” named so after  Dr. Francis Villar.  It’s described in his publication Tumeurs de L’ombilic. You will still find credit and citations to Dr. Villar in many current studies and reports regarding cutaneous Endometriosis.

A study presented in 1967 involved a 27-year-old woman who complained of pain and discharge from her anus during her periods.  Upon close inspection, nodules were discovered on her anal sphincter.  They were surgically removed and biopsied, and Endometriosis was confirmed.  Unfortunately, I do not have access to the entire article and cannot recant how her recovery ended.  But…the anus? Ugh. It’s everywhere… (insert “pain in the ass” joke here).

A study published in 1995 focused around a 46-year-old woman who had complained of a “nodule” on her belly button for the past year and abdominal pain for the past two years.  Her belly button would occasionally bleed.  She had no prior surgical history, did not take birth control, and did not complain of painful periods.  The nodule was surgically removed, biopsied, and Endometriosis was discovered.  After the removal of the mass, she did not have any recurrence.

A study was published in 2007 where a 47-year-old woman had complaints of a darkened  spot on her caesarean scar, which became increasingly painful during her periods.  She had her caesarean delivery 12 years prior, and had no previous health issues.  Upon inspection, beneath the discoloration was a small, subcutaneous mass.  An initial incision biopsy of the mass’s tissues revealed the presence of Endometriosis, and the mass was excised.  Endometriosis can be found in many scars, and because hers took 12 years to manifest, physicians reported, “[t]his leads us to the hypothesis that the mechanical migration theory played an important role in the development of the disease, since it appeared on the caesarean scar (a low-resistance point) after many years.”

In 2009, a 46-year-old woman was reported to have a lesion in her umbilicus (aka belly button), which had a little black “mass.”  It was surgically removed and biopsied…the results were consistent with Endometriosis.  One theory as to why Endo grows in your belly button is that the cells were transferred during abdominal surgery and unknowingly deposited there…however, this woman had no history of abdominal surgeries.  She also did not have any abnormal menstruation history .  It was a mystery.  Eighteen months later, she had no recurrent growths or symptoms.  A photograph of the black mass in her belly button can be seen by clicking the Acta Dermato Venereologica article under “Resources.”

In another study published in 2009, a 36-year-old woman would swell and bleed from her belly button during her monthly cycles.  The surgeons removed the mass from her umbilicus, which was biopsied and the presence of Endometriosis was confirmed.  A year later, she was still free of recurrent symptoms.

A 2010 study analyzed the case files of 376 women who were treated at the Fundacion Jimenez Diaz in Madrid, Spain.  Of those, 15 were treated for cutaneous Endometriosis.

In 2011, a 15-year-old girl went to the Emergency Room with complaints of pain and swelling to her vulva.  She had suffered an abrasion (they don’t go into details of “how”), 11 months prior.  The E.R. suspected Herpes due to the presence of lesions and treated her for such.  Regardless, her Herpes test came back negative.  After recurring symptoms of the same issues, biopsies were performed of the lesions found on her vulva, and were determined to be Endometriosis.  Unfortunately, her specific treatment at the E.R. is a common occurrence for many Endo sufferers who go to the E.R. : an STD is initially insinuated and tests are run, resulting in humiliation and a general sense of mistrust for the medical community.

A study published on May 1, 2015, in the Journal of Clinical and Diagnostic Research highlights an 18-year-old girl had begun to bleed from her fingertip during her menstrual cycle.  Her pelvic and rectal examinations were normal, but her fingertip had a small, discolored lesion, which had a distinct point which would continuously ooze blood during her periods over the past three months.  Due to financial issues, she could not afford to have an MRI or exploratory laparoscopic surgery of her abdomen.  Instead, doctors decided to biopsy the tissue around the lesion on her finger.  Lo and behold : Endometriosis.  The surgical excision of the lesion on her finger resolved her bleeding finger completely.  If you’d like to see a photograph, please feel free to click on their article referenced under “Resources” below.

A 2016 published case report was of a 49-year-old woman who had her gall bladder removed laparscopically in 1991.  In 2012, the muscle area beneath her belly button had become very painful.  She was previously diagnosed with painful periods and Endometriosis and she insisted on hormone therapy, which helped reduce her painful symptoms.  Two years later, the mass had grown to approximately 30mm (a little bigger than an inch) beneath her belly button and she had it surgically removed.  It was biopsied and confirmed as Endometriosis.  Although Endometriosis has been known to transfer during Endometriosis excision surgeries, this is the first report (as far as the authors know) of the tranferrance occuring during a gall bladder removal surgery.

A 2017 article discusses a 30-year-old woman with no history of Endometriosis or prior surgeries.  She was on Depo Provera and 9 months after stopping the contraceptive, she developed painful, bleeding little brown lumps in her belly button (this study has photos!).  They bled when she was on her period.  She had been to several physicians complaining of the bumps and had most recently been diagnosed with contact dermatitis and given creams.  When those didn’t work, she was referred to a dermatologist.  They took a shave biopsy of the bumps and they came back positive as Endometriosis.  She was then referred to a plastic surgeon to remove the bumps and a gynecologist to look further into a possible Endometriosis diagnosis.  Unfortunately, the study ends there.  The authors of this study stress the importance of conducting biopsies of masses before offering any type of diagnosis.

A 2017 abstract is about a woman who complained of a nodule in her belly button that bled while she was on her period.  Her physicians treated it as if it was a keloid scar, with cortisone injections.  But when those didn’t help, they suspected umbilical endometriosis.  A biopsy was performed on the nodule and confirmed as Endometriosis.  She was referred to her gynecologist for further treatment.

A study published in August 2017 was of a 29-year-old woman who had a nodule in her belly that would swell and bleed when she was on her period.  She had her appendix removed when she was 6 years old.  Imaging studies led to an exploratory laparoscopy.  They found extensive Endometriosis and excised it, as well as the lump from her belly button, which was biopsied and confirmed as Endo.

An October 2017 study follows the tale of a 49-year-old woman who had a lump develop in her belly button.  It would swell, bleed, and stink during her period…and she had it for the past six years!  She had delivered four children naturally…no c-sections involved…and had no prior history of Endometriosis or irregular periods.  She opted to have the lump removed surgically; it was excised and biopsied and confirmed as Endometriosis.  She received no further treatment.  And two years after her surgery, it had not returned.  Magically-spontaneous Endometriosis o’the navel.

In September of 2018, another study was published of a woman who had an appearance of a blotch in her belly button.  A 33-year-old woman complained of pain and swelling in her belly button for the past 2 years, it got worse during her periods.  She had no prior history of pelvic or abdominal surgeries.  She received an ultrasound as well as a fine needle aspiration cytology.  The ultrasound showed a lesion and pathology results of the FNAC suggested umbilical endometriosis.   A laparoscopy was done to search for any pelvic Endometriosis.  None other was found.  The belly button lesion was removed and sent off to pathology.  The umbilical Endometriosis suspicion was confirmed.  Her next period yielded no problems.

A 2019 abstract discussed a 42-year-old woman who had no prior surgical history. She presented with a weird nodule (skin-colored) on the left side of her torso near her inguinal area. The nodule was tender, but she had no other symptoms. It was removed and tested, and found to be Endometriosis – just developed out of the blue with very little to no symptoms. The abstract doesn’t state if they were going to pursue any sort of exploratory surgery to search for other Endometriosis within her body.

Another 2019 study in the International Journal of Women’s Dermatology was of a 41-year-old woman who had a painful lump in her belly button for 5 months. The pain flared up during her period. Her medical history included a 2009 miscarriage as well as a 2012 surgery that removed her left fallopian tube due to an ectopic pregnancy. She had been undergoing treatments for her infertility. A punch biopsy confirmed it was cutaneous Endometriosis, but she put off hormonal therapy since she was trying to get pregnant. She received a referral for excision surgery. They theorize the endometriosis cells were transferred to her belly button during her 2012 surgery. The study continues to outline several cases of cutaneous Endometriosis and states that only 1% of endometriosis cases involve the skin.

One study summed up what any Endo suffer already knows:

“Education of all doctors, including the primary care physicians, is important to help early diagnosis and treatment of this agonising condition.” ~Cutaneous Endometriosis; A. Agarwal, Y.F. Fong

What did I learn from all of this?  So much!!  But most importantly?  Pay attention to your body.  If something doesn’t look or feel right, don’t be afraid to ask your doctor.  And if you’re bleeding out of a weird spot during your periods, dude…seriously…have your doctors check it out!

Do you, or someone you know, have skin Endometriosis?  I’m so fascinated (and terrified), I’d love to hear the story! Drop a comment below…

*Updated July 12, 2019*

Resources:

Acta Dermato Venereologica : Article (2007) Diagnosis and Treatment of Post-caesarean Scar Endometriosis

Acta Dermato Venereologica : Article (2009) Spontaneous Endometriosis in an Umbilical Skin Lesion

Deep Dyve : Article (2010) Cutaneous Endometriosis : A Review of 15 Cases Diagnosed at a Single Institution

Dermitol Sinica : Article (1995) Cutaneous Endometriosis of the Umbilicus

EC Gynaecology : Article (2017) Extra-Gonadal Endometriosis with Unusual Presentation: A Case Report

Gallica

Indian Obstetrics & Gynaecology: Article (2018) Primary Umbilical Endometriosis: A Case Report  

International Journal of Women’s Dermatology: Article (2019) Cutaneous Endometriosis

Journal of Clinical and Diagnostic Research : Article (2015) Spontaneous Fingertip Endometriosis : A Rare Case Report

Journal of Endometriosis and Pelvic Pain Disorders : Abstract (2011) A Case of Cutaneous Endometriosis Following Vulvar Injury

Journal of Rare Disorders: Diagnosis and Therapy : Article (2017) Spontaneous Cutaneous Endometriosis of Umbilicus: A Case Report

Keio University : Abstract (2016) Abdominal Wall Endometriosis that Developed at the Port Site After Laparoscopic Cholecystectomy

Papersearch : Abstract (2019) A Case of Primary Inguinal Endometriosis Without Previous Surgical History

Royal Australasian College of Surgeons : Article (2017) Umbilical Endometriosis: A Potential Encounter for General Surgeons

Singapore Medical Journal : Article (2008) Cutaneous Endometriosis

Springer Link : Abstract (1967) Endometriosis of the Anal Canal : Presentation of a Case

U.S. National Library of Medicine : Abstract (2009) Spontaneous Endometriosis in an Umbilical Skin Lesion

U.S. National Library of Medicine : Abstract (2009) Spontaneous Umbilicus Endometriosis : a Case Report with One-year Follow-up.

U.S. National Library of Medicine : Abstract (2017) Umbilical Endometriosis Mimicking a Keloid in a Young Black Woman: A Case Report

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Truth, Theory, or Tall Tale?

blood-20745_640

Endometriosis can be diagnosed by blood tests, imaging studies, or pelvic examinations.

TallTale

There are many ways a physician may begin to suspect that a woman has Endometriosis.  A review of her pain, symptoms, and medical history; a pelvic examination; ultrasounds or MRIs; and blood tests.  But can these tests actually confirm a diagnosis of Endometriosis?

No.

The only “golden standard,” tried-and-true method of confirming the presence of Endometriosis is surgically opening a woman’s abdomen, peeking inside, and seeing the presence of the implants, lesions, and/or adhesions.  A study published on July 13, 2016 (click here to read it) concludes, again, that surgery is the “golden standard” method of diagnosing Endometriosis.  It further states that these non-invasive tools should only be used in a research setting…

Presently, there are ongoing studies and research to develop non-invasive ways of being able to confirm Endometriosis; however, those end results are long off.

For more info, click here.

*Updated August 18, 2016*

New Study : Endometriosis and Semen

New unused condom

So there’s an article that was recently published that has a lot of EndoSisters in an uproar today on Facebook.  The article was title, “How your sex life may influence endometriosis,” published on May 1, 2015, by MedicalXpress. My initial knee-jerk reaction last night was to be furious.

I interpreted the article as saying that sex can cause and affect Endometriosis growth; to be more precise: seminal fluid can affect Endo growth.  Semen.  Baby-MoJo.  I’ve had my Endo pain since my early years in high school.  And I did not have sex until I was 21.  And my cramps were pretty damn bad back then.  How dare a study suggest that sexual activity had anything to do to heighten my endo symptoms or progression.   And my outrage was further fueled by other EndoSisters’ reactions about the same conclusion.

I’ve decided to take my time, read the study slowly, and try to digest what it is the study is trying to tell us. Wait. Step back. Breathe, breathe.  Relax.  Now go read the study…

Prior Studies

There have long been studies of seminal fluid and any affects it may have on the female anatomy.  Some studies found that seminal fluid promotes an inflammatory response of the cervix, in order to facilitate fertilization.  One study concluded, “further studies are required to examine the duration of the response and whether seminal fluid signaling extends to the higher regions of the uterus to exert direct effects on embryo development and implantation, as well as to investigate the downstream effects of seminal fluid-induced immune responses on pathways affecting fertility and infertility, infection, and disease.”

A study published in 2010 was conducted to see if seminal fluid had any affect on the growth of endometrial cells in women who have endometriosis.  The study found that it “may promote the growth of endometrial cells derived from women with endometriosis. Our findings may suggest some detrimental effect of unprotected sexual intercourse in women with endometriosis.”

All the Hullaballoo

A new study published in The American Journal of Pathology in January of 2015, found that there may be a direct link between the contact of seminal plasma and endometrial cells, and the production of endometrial tissue and lesions. The study, conducted by the research staff at the University of Adelaide, found “these data suggest that seminal plasma enhances the formation of endometriosis-like lesion via a direct effect on endometrial cell survival and proliferation, rather than via macrophage-mediated mechanisms. These findings raise the possibility that endometrial exposure to seminal plasma could contribute to endometriotic disease progression in women.”

Associate Professor Louise Hull stated “the next stage of the research will look at what this means for women with and without endometriosis…we now need to apply these laboratory findings to real life and determine whether the exposure of seminal fluid that occurs naturally during intercourse puts women at increased risk of developing endometriosis. And if modifications to sexual activity could lower the severity of the disease in women with endometriosis,” (Courtesy of MedicalXpress.com)

A side note

A study published in 2009 suggests that a woman who has endometriosis may create a toxic and infertile environment for sperm.  Byproducts of our inflamed tissues and over-reactive immune system may produce toxic fluids which reach the uterus through the Fallopian tubes.  It concludes, “there was evidence of significantly higher sperm DNA damage in samples incubated with [peritoneal fluid] from patients with endometriosis compared with samples incubated with [peritoneal fluid] from healthy women and controls at the three incubation periods studied…We are proposing that endometriosis-induced sperm DNA damage may be one of the underlying causes of reduced natural fertility in these cases.” More studies, of course, are needed. It’s just frustrating for those EndoSisters who are striving to become pregnant.

My Two Cents

So, this new study is not saying that seminal fluid causes Endometriosis.  My knee-jerk reaction was done in poor taste. It is simply suggesting that seminal fluid may play a role in the development or progression of endo. However, it appears more studies will be necessary to determine if unprotected sex may influence the severity of symptoms in women with endometriosis, and if it may raise the risk of women developing endometriosis. On that note, there have been several Sisters on Facebook today stating they have had, and continue to have, protected sex using condoms, and the severity of their symptoms have always been severe. It will be interesting to watch how this develops.

(Updated March 28, 2019)

Resources:

Examiner.com

Fertile Care for Women

MedicalXpress.com

ResearchGate : Article (2009) The Impact of Peritoneal Fluid from Healthy Women and from Women with Endometriosis on Sperm DNA and its Relationship to the Sperm Deformity Index

The American Journal of Pathology : Abstract (2015) Seminal Plasma Promotes Lesion Development in a Xenograft Model of Endometriosis

The Journal of Immunology : Article (2012) Seminal Fluid Induces Leukocyte Recruitment and Cytokine and Chemokine mRNA Expression in the Human Cervix after Coitus

U.S. National Library of Medicine : Abstract (2010) Effect of human seminal fluid on the growth of endometrial cells of women with endometriosis

~ Again, I am a layman.  I do not hold any college degrees, nor mastery of knowledge.  Please take what I say with a grain of salt.  If curious, do your own research 😉 Validate my writings.  Or challenge them.  And ALWAYS feel free to consult with your physician. Always.  Yours ~ Lisa

Feel Good Friday!

candles

So today is a special Friday, it’s my birthday!  Going with the theme, today’s quote is brought to you (supposedly) by American President, Abraham Lincoln:

And in the end, it’s not the years in your life that count. It’s the life in your years.

Live! Enjoy your friends and family.  Create lasting memories.  Laugh.  Cry.  Take pictures.  Make a difference.  Smile at a stranger.  Do what you love.  Make these years count! 🙂 And have a wonderful weekend!!!

Yours, Lisa