Diaphragm difficulties with endometriosis.

A 35-year old woman visited her general practitioners clinic because she was having more and more trouble inserting her diaphragm and tampons. She had had no difficulties in the past. She also reported experiencing pain during intercourse. She switched to another barrier method condoms because she did not want to use hormonal contraception or the IUD. Switching methods did not alleviate the pelvic pain or dyspareunia however so her general practitioner referred her to a gynecologist. Laparoscopy revealed endometriosis so the physician used a carbon dioxide laser to remove the deposits and laparoscopic uterine nerve ablation. The symptoms subsided. The woman chose not to use contraception because she wanted to become pregnant. Pelvic pain infertility dyspareunia and dysmenorrhea are the most common symptoms of endometriosis. It is often found on the uterosacral ligaments and this patients diaphragm probably exerted pressure on these ligaments. She probably would have better tolerated the cervical cap since it does not exert as much pressure as the diaphragm. Physicians should advise women with endometriosis to use nonhormonal contraceptive methods if they are being treated with danazol gestrinone and gonadotropin-releasing hormone analogues. Even though they could use the IUD insertion of the IUD may induce pain and the IUD itself increases the menstrual flow. Some evidence indicates that IUD use increases the incidence of endometriosis. If a women is not on antiendometriosis thereby and she has no contraindications for oral contraceptives (OCs) particularly the low-dose combined OCs she can safely take them. Parenterally administered medroxyprogesterone acetate (150 mg every 3 months to 150 mg each month) has proven to treat endometriosis effectively.