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Endometriosis

In this rendering based on electron photography, endometrial tissue (in red) has naturally implanted within the delicate hair-like tissues of a healthy uterus (in blue).In this rendering based on electron photography,
endometrial tissue (in red) has naturally implanted
within the delicate hair-like tissues of a healthy uterus (in blue).

In its most natural and functional state, endometrial tissue is found on the internal uterine walls and is designed to be the rich, nurturing sustenance for a fertilized egg. If no pregnancy occurs, the tissue exits the body with each menstrual cycle, and the uterus awaits a fresh influx of endometrial tissue at the next cycle. In this rendering based on electron photography, endometrial tissue (in red) has naturally implanted within the delicate hair-like tissues of a healthy uterus (in blue).

Endometriosis refers to a condition in which endometrial tissue that normally lines the uterus, is found in other areas of the body. It often appears on or near the reproductive organs, or within the abdominal cavity. When it appears, it causes inflammation, often accompanied by the adhesions that form when we heal from any inflammation.

This misplaced endometrial tissue responds to the menstrual cycle as if it were in the uterus. But unlike menstrual fluid that leaves the body every cycle, endometrial implants have no place to go. Like tissues on the walls of the uterus, these tissues may swell during each monthly cycle.

Endometriosis and adhesions can form outside the uterus and cause painEndometriosis and adhesions can form
outside the uterus and cause pain

Endometrial implants are often accompanied by adhesions. Clinically, we feel that these tiny bonds can pull on pain-sensitive structures when we walk, move, or breathe. We believe that the pull of these adhesions on pain-sensitive structures is what causes the severe, debilitating pain in many women with endometriosis.

Endometriosis is a common but poorly understood disease. Its prevalence has been alternately estimated as 5 to 6 million US women, or roughly 10% of American women of childbearing age. Some women with endometriosis have severe pelvic or intercourse pain; others have "mystery pain" in the abdomen or elsewhere. Some have little or no pain at all.

Endometriosis is also associated with infertility and other conditions, such as poor digestion, irritable bowel and wide-ranging pain symptoms. This disease can affect a woman’s whole existence - her ability to work, to reproduce, to have a wonderful relationship with her spouse, children, co-workers, and friends.

Endometriosis can cause abdominal, pelvic or low back pain or dysfunction, including infertility. Other conditions such as sexually transmitted and pelvic inflammatory diseases, and vaginal, bladder or yeast infections may also cause adhesions to form, increasing the problem. Due to the adhesions which form as part of the healing process, pain tends to become chronic, unless these adhesions are removed or their bonds broken by our therapy, or by surgery.

Endometriosis and Adhesions

Unfortunately, endometriosis and adhesions have become intimately related over the years. In many cases, surgery has been successful in decreasing endometriosis pain. We feel that part of the mechanism of that pain reduction is that surgery breaks or detaches the adhesive bonds that form after endometrial inflammation. However, when the body heals from the surgery, adhesions may form anew in the wake of that healing process.

Close-up of endometriosis and adhesionsClose-up of endometriosis and adhesions

We know of only two ways to decrease endometrial adhesions: surgery and our therapy. Surgeons save lives and improve lifestyles for their patients daily. But no matter how skilled the surgeon, even the best physician cannot stop adhesions from forming. The terrible irony is that adhesions often form from the very surgery designed to reduce adhesions.

Some studies question the efficacy of surgery to decrease adhesions in some women. A large study in Lancet, the British Journal of Medicine (May, 1999) concludes that 35% of patients who had open pelvic or abdominal surgery were readmitted to the hospital for at least two follow-up surgeries to treat adhesions, within ten years of their first surgery. The article states that "22% occurred in the first year after surgery, and (hospital) readmissions continued steadily over the next ten years."

Surgical adhesions have been implicated as causing infertility, intestinal obstruction, and chronic pelvic pain. Another Lancet study showed that 67% to 93% of patients develop adhesions following open abdominal surgery and 55% to 100% of patients develop adhesions following open gynecologic surgery.

Conscientious surgeons are concerned by the possibility of an ongoing adhesion-surgery-adhesion cycle in their patients. Unfortunately, there was little or no other option until we began conducting clinical studies. At this time, we have very good evidence that we can decrease pelvic and abdominal adhesions, backed by scientific studies published in peer-reviewed medical journals.

Scientific data on our ability to decrease adhesions for patients with endometriosis is reflected in data from two of our recently published studies, with some of that data summarized below in graphs. All of our study summaries are available at our medical studies page.

Scientific Research Findings

Endometriosis pain study: After hearing stories of dramatically decreased pain in many of our endometriosis patients, we conducted the first study of its kind called "Treating endometriosis pain with a manual pelvic physical therapy." In it, we examined pain from endometriosis at several times during the cycle

Results showed significant improvement at all times during the menstrual cycle, with the greatest improvements at the (typically) most painful times – menstruation and sexual intercourse. Scientific and statistical results are as follows:

Results: The Wilcoxon Sign-Rank Test (2-sided) showed a statistically significant improvement in dyspareunia and in the total difference at all three phases of the cycle: pre-menstruation, menstruation and ovulation (P = 0.014). Decreased menstrual pain was significant (P = 0.008), and decreased intercourse pain was significant (P = 0.001). Percent of participants who reported decreased or eliminated pain after therapy were:

This study attracted the attention of the American Society of Reproductive Medicine (ASRM) who asked us to present our findings to its several physician members in the Fall of 2006. The abstract was published in Fertility and Sterility (9/06).

Endometriosis sexual function study: Due to the compelling nature of our non-surgical work and our promising results, the ASRM requested that we present a second endometriosis study abstract to their membership. This one, also published in Fertility and Sterility (9/06) was titled “Improving sexual function in patients with endometriosis via a pelvic physical therapy.” In this oral presentation, we reported to ASRM the results of our therapy in women with endometriosis on the six domains of sexual function that are measurable by science: desire, arousal, lubrication, orgasm, satisfaction, and pain.

Results showed a significant improvement in all six areas, and overall, with the greatest improvements in intercourse pain. In statistical language, the results were as follows:

Results:The Wilcoxon Sign-Rank Test (2-sided) showed a statistically significant improvement (P =<0.001) on the full scale score. The percent of participants showing improvement on the six individual domains of sexual function were:

  		• Desire 71% (P = 0.011)
  		• Arousal 86% (P = 0.004)
  		• Lubrication 79% (P = 0.001)
  		• Orgasm 64% (P = 0.004)
  		• Satisfaction 71% (P = 0.005)
  		• Pain 93% (P < 0.001)