PMC5971254_01
(a) Fresh, vulnerable, histologically confirmed rectovaginal endometriosis in the posterior fornix (Medivan video colposcope). The visual analogue score for the examination (VASexamination) before dienogest therapy was 9. (b) Remission of the same endometriotic lesion in the posterior fornix 3 months later after daily vaginal dienogest application. VASexamination score was now 4.
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fig1
A rectovaginal gynecological examination revealed fresh endometriosis in the posterior fornix, with slight bleeding (Figure 1(a)). The rectovaginal gynecological examination identified the endometriosis in remission in the posterior fornix (Figure 1(b)). In addition, the vaginal part of endometriosis was clearly in remission as demonstrated by vaginal colposcopy (Figures 1(a) and 1(b)).
(a) Vaginal ultrasound appearance of the rectovaginal bowel involvement before the start of treatment in the symptomatic patient. (b) No change in the vaginal ultrasound findings after 3 months of vaginal dienogest administration (2 mg/d) in the patient who was now de facto asymptomatic.
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fig2
At approximately 10 cm ab ano, palpation identified a typical firm, painful node with a diameter of approximately 3 cm, and poorly displaceable bowel mucosa, which was also clearly visible on vaginal ultrasonography (Figure 2(a)). The firm endometriosis node approximately 3 cm in size and approximately 10 cm ab ano was still palpable, but it was much less painful (Figure 2(a)).