Nerve Bundles and Deep Dyspareunia in Endometriosis

Christina Williams, Williams C, Lien Hoang, Hoang L, Ali Yosef, Yosef A, Alotaibi F, Fahad T. Alotaibi, Fahad Alotaibi, Catherine Allaire, Allaire C, Lori Brotto, Lori A. Brotto, Ian S. Fraser, Fraser Is, Mohamed A. Bedaiwy, Tony Ng, Ng TL, Tony L Ng, Anna F. Lee, Paul J. Yong
Reproductive sciences (Thousand Oaks, Calif.) · 2015 · vol. 23(7) , pp. 892–901 · doi:10.1177/1933719115623644 · PMID:26711313 · W2412658806
article OA: green CC0 ⤵ 32 in-corpus citations
🔓 Open OA copy Full text JSON View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by gemini-2.5-flash-lite+body, 2026-06-12 ⓘ

This study found a significantly higher density of nerve bundles in the cul-de-sac/uterosacrals of women with endometriosis and deep dyspareunia compared to control groups.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This study investigated whether nerve bundle density in the cul-de-sac/uterosacrals (Zone II) is associated with deep dyspareunia among women with endometriosis, using a blinded retrospective immunohistochemistry design at a tertiary referral center (2011–2013; n=58). Women were stringently phenotyped into a study group with endometriosis (deep dyspareunia, tender Zone II, and endometriosis lesion in Zone II excised at surgery) and two control groups (nontender endometriosis; and tender non-endometriosis with normal histology in Zone II), with PGP9.5 staining used to quantify nerve bundles. Nerve bundle density (bundles/HPF) differed significantly across groups (ANOVA F[2,55]=6.39, p=0.003) and was higher in the study group than both controls. The main limitation stated is that the analysis is retrospective and observational, so it provides evidence of association rather than proof of causality. This paper is centrally about endometriosis—specifically nerve bundle density as a potential etiological factor for deep dyspareunia.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

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.
Full text 4,883 characters · extracted from oa-html · click to expand
- Library Home / - Search Collections / - Open Collections / - Browse Collections / - UBC Faculty Research and Publications / - Nerve bundles and deep dyspareunia in endometriosis Open Collections UBC Faculty Research and Publications Nerve bundles and deep dyspareunia in endometriosis Williams, Christina; Hoang, Lien N.; Yosef, Ali; Fahad, Alotaibi; Allaire, Catherine; Brotto, Lori A.; Fraser, Ian S.; Bedaiwy, Mohamed Ali, 1968-; Ng, Tony Ling Tin; Lee, Anna F.; Yong, Paul J. 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 two 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 non-tender Zone II on examination, and an endometriosis lesion in Zone II excised at surgery. Control Group 2 (tender non-endometriosis, n=12) consisted of patients with deep dyspareunia, a tender Zone II on examination, and a non-endometriosis lesion (e.g. normal histology) in Zone II excised at surgery. 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/HPF) was then scored by a pathologist blinded to the Group. We found a significant difference in PGP9.5 nerve bundle density between the three Groups (ANOVA, F[2,55]=6.39, p=0.003). Mean PGP9.5 nerve bundle density was significantly higher in the Study Group (1.16+/-0.56 bundles/HPF [+/-SD]), compared to Control Group 1 (0.65+/-0.36, Tukey test, p=0.005) and Control Group 2 (0.72+/-0.56, Tukey test, p=0.044). This study provides evidence that neurogenesis in the cul-de-sac/uterosacrals may be an etiological factor for deep dyspareunia in endometriosis. Item Metadata | Title | Nerve bundles and deep dyspareunia in endometriosis | | Creator | | | Date Issued | 2015 | | Description | 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 two 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 non-tender Zone II on examination, and an endometriosis lesion in Zone II excised at surgery. Control Group 2 (tender non-endometriosis, n=12) consisted of patients with deep dyspareunia, a tender Zone II on examination, and a non-endometriosis lesion (e.g. normal histology) in Zone II excised at surgery. 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/HPF) was then scored by a pathologist blinded to the Group. We found a significant difference in PGP9.5 nerve bundle density between the three Groups (ANOVA, F[2,55]=6.39, p=0.003). Mean PGP9.5 nerve bundle density was significantly higher in the Study Group (1.16+/-0.56 bundles/HPF [+/-SD]), compared to Control Group 1 (0.65+/-0.36, Tukey test, p=0.005) and Control Group 2 (0.72+/-0.56, Tukey test, p=0.044). This study provides evidence that neurogenesis in the cul-de-sac/uterosacrals may be an etiological factor for deep dyspareunia in endometriosis. | | Subject | | | Genre | | | Type | | | Language | eng | | Date Available | 2017-02-01 | | Provider | Vancouver : University of British Columbia Library | | Rights | Attribution-NonCommercial-NoDerivatives 4.0 International | | DOI | 10.14288/1.0303148 | | URI | | | Affiliation | | | Citation | Williams, C., Hoang, L., Yosef, A., Alotaibi, F., Allaire, C., Brotto, L., . . . Yong, P. J. (2015). Nerve bundles and deep dyspareunia in endometriosis. Reproductive Sciences, | | Publisher DOI | 10.1177/1933719115623644 | | Peer Review Status | Reviewed | | Scholarly Level | Faculty | | Copyright Holder | SAGE | | Rights URI | | | Aggregated Source Repository | DSpace | Item Media Item Citations and Data Rights Attribution-NonCommercial-NoDerivatives 4.0 International

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-html ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

dyspareuniaendometriosischronic_pelvic_pain

MeSH descriptors

Dyspareunia Dyspareunia Endometriosis Nerve Fibers Uterus Adolescent Adult Dyspareunia Dyspareunia Endometriosis Female Humans Middle Aged Nerve Fibers Nerve Fibers Pelvic Pain Pelvic Pain Retrospective Studies Ubiquitin Thiolesterase Ubiquitin Thiolesterase

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (31)

Cited by (35)

Source provenance

europepmc
last seen: 2026-09-01T06:12:48.306406+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-05-13T22:17:33.600579+00:00
License: CC0 · commercial use OK