A Case of Endometriosis in Episiotomy Scar with Anal Sphincter Involvement

Endometriosis is defined as the presence of endometrial tissue apart from its usual location (endometrium). It is the second most prevalent benign gynecologic disease after the presence of fibroids in women of childbearing age (incidence of 10% - 25%). Endometriosis predominantly locates on peritoneal surfaces, but it also affects the vagina, vulva, recto-vaginal septum and perineum, usually secondary to surgical or obstetric trauma. We present a case of a patient with perineal endometriosis (single nodule) in the scar of episiotomy and involvement of external anal sphincter with local and catamenial pain but with continence maintained. The endometric nodule was removed, and wide dissection and sphincteroplasty were performed. Afterwards, treatment with GnRh analogues was prescribed for a four-month period. Surgical outcome was successful and the patient was asymptomatic during subsequent menstruations.