{"paper_id":"f9349237-a60e-4ded-b91e-00f512faa862","body_text":"Abstract\nDifficult intrapartum episodes and persistent straining during defecation cause injuries to uterine nerves and uterosacral ligaments. Injuries to uterine nerves (denervation) result in loss of fundocervical polarity, uterotubal dysmotility and retrograde menstruation. Ectopic endometrium, delivered by retrograde menstruation, adheres to injuries to uterosacral ligaments and peritoneal surfaces. Difficult vaginal deliveries result in laparoscopic appearances of asymmetry of uterosacral ligaments with, or without, ectopic endometrium. Straining during defaecation causes the “classic” appearances of nulliparous endometriosis including hypertrophy of the uterosacral ligaments often with large volumes of ectopic endometrium. Laparoscopic appearances depend on the site, nature, extent, and timing of tissue injury, as well as the presence of available endometrium. Tissue repair, including reinnervation in the uterine isthmus, cervix, vagina and uterosacral ligaments, contributes to chronic pelvic pain, dysmenorrhea, dyspareunia and subfertility some time after the primary injuries.\nSimilar content being viewed by others\nReferences\nSlocumb JC (1990) Chronic somatic, myofascial, and neurogenic abdominal pelvic pain. Clin Obstet Gynecol 33(1):145–153\nQuinn M (2009) Endometriosis: an elusive epiphenomenon. J Obstet Gynaecol 29(7):590–593\nStoll G, Muller HW (1999) Nerve injury, axonal regeneration and neuronal regeneration: basic insights. Brain Pathol 9(2):313–325\nCervero F (2000) Visceral hyperalgesia-revisited. Lancet 356:1127–1128\nSampson JA (1921) Perforating hemorrhagic (chocolate) cysts of the ovary. Their importance and specially their relation to pelvic adenomas of endometriotic type (“adenomyoma” of the uterus, rectovaginal septum, sigmoid etc.). 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Arch Gynecol Obstet 284, 1423–1429 (2011). https://doi.org/10.1007/s00404-011-2063-y\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-011-2063-y","source_license":"CC0","license_restricted":false}