Hello doctor, I have endometriosis, diagnostic or excision lap was done three years back. Recently I have had GI symptoms including extreme pain on defecation, rectal bleeding with a period, and tenesmus. Last exam showed a nodule in my vaginal wall and ultrasound showed left ovarian endometrioma. About a week ago I noticed my vaginal walls seemed to have collapsed so that they are both bulging and pressed together. I felt inside and noted that my cervix was about 1 to 2 inches past the vaginal opening and it is sideways, with the cervix opening to the right side. Does this sound like a rectocele or is it possible that my uterus has tipped over or something? I am not sure what to do as it is very difficult to get in to see my gynecologist. Please help. Currently, I am taking Dienogest 2 mg OD, Taro-Tramadol ER 200 mg OD, Apo-Tramadol 50 mg Q6H PRN, Paroxetine 20 mg OD, Lorazepam 0.5 mg SL PRN.
Hi. How are you doing? You seem to be suffering a lot at this young age of 25 years. From your history and examination findings, I feel there is deep infiltrating endometriosis. Usually, bowel symptoms, distended bowels into the vagina, nodules in ligament could mean that. But the uterus will be stuck and will never descend, especially after a surgery. But when you say cervix is outside the vagina, it means cervical descent or elongation. It could mean a nulliparous prolapse. The best method would be to have an examination done, scan taken, to know if any large cyst is pushing uterus out. If everything is normal, you can have 3 to 4 doses of monthly Lupreolide 3.75 mg i.m. Followed by tablet Ormeloxifene 60 mg weekly twice for any number of years. I have found it more effective than Dienogest. If prolapse is significant, it may resolve if any cyst of pressure from inside is relieved. You have bowel symptoms and you said cervix is pushed to the right, so there must be something on the left side, the location of the colon, sigmoid colon, and rectum. Have a scan anyway.