Endometriosis in an episiotomy scar

Endometriosis that is defined as the presence of functional endometrial tissue outside the uterine cavity is seen 5-10% of reproductive age women. Endometriosis can be seen any other site of the body; but the most frequently affected areas are ovaries, pelvic peritoneum, uterosacral ligament and Douglas pouche. Several teories exist for the development of endometriosis including retrograde menstruation, venous or lymphatic metastasis and immun dysfunction. Endometriosis of the perineum and vulva are extremely rare with the most common sites being episiotomy scars. Scar endometriosis is likely to be caused by mechanical transplantation of endometrium from the uterine cavity into the wound at the time of the surgery. The primary treatment for scar endometriosis is total surgical excision of the lesion. It is important not to leave residual tissue during surgery to prevent the recurrence. Here we present a patient who had her vaginal delivery 5 years ago, have a complaint of painful vulvar lump at the right mediolateral episiotomy scar since 1 year during her every menstruation period and whose final diagnosis was endometriosis after surgical removal and histopathologic examination. Althought vulvar endometrosis is rare, it should be considered in the patients who had a vaginal delivery and complaining painful vulvar lump with swelling in her mestrual cycle.