Endometriosis: a body and soul disease

The topic of this issue of the Journal, endometriosis, will be addressed according to the specific clinical-therapeutic complexity of the disease. A morbid condition that certainly subverts the anatomy of the pelvis, which can present itself with extrapelvic localizations, but which above all hits those affected in their deepest identity: femininity. In fact, endometriosis has a profound impact from a physical and psychological point of view, declining its devastating effects on the individual, relational, social, sexual and reproductive dimension of the affected women.
When Marcello Ceccaroni, illustrious Guest Editor of this issue, invited me to write the editorial on the track that is its title, he favored the focus of broad, holistic per- spectives in the approach to endometriosis which is really a pathology of the body and soul. Identified a hundred years ago, endometriosis is still the subject of intense research to define its perimeters, to improve the diagnostic process which still has an average of 7-10 years from the onset of symptoms and to uniquely define the timing and methods of treatment.
So endometriosis is still a great open question. Which concerns 10% of the female population of childbearing age, who goes to the Gynecologist for pelvic pain, dyspareunia, dysmenorrhea, etc., even without pathognomonic adnexal lesions, conducting their own frantic search for a diagnosis, while the disease continues to work subtly. This translates into a cyclical limitation of sociability, of social life and in perspective, in the hypo / infertility that will further mark the personality of the young woman who has been living for years with pain and with her dimension of illness often neglected or even worse, trivialized.
That’s why it seemed particularly interesting to us, to offer our Reader a corpus of very practical information on the diagnosis and treatment of endometriosis. We think that having a 360-degree view of the disease, of the diagnostic possibilities, of the consequent treatments, from the perspective of professionals, who largely work in the most important reference center in Europe for the treatment of endometriosis, can favor the Gynecologist in defining its own Patients management flow chart. Obviously, we do not claim to have dealt with the subject in every detail. Surely, for example, it will be useful to re-check the aspect of fertility in women with endometriosis and the strategies to optimize the search for a pregnancy, or the dietary aspects in the course of endometriotic disease, or the psychological aspects. In the meantime, we have drawn up a high-level post-it that can be useful in evaluating and modulating the approach to these patients. For example, the impulse towards surgery as conservative as possible in women seeking pregnancy may clash with the need for more radical surgery to fully resolve the symptoms, which frequently recur, but necessary to restore adequate psychoemotional balance in these patients who live like a pendulum between frustration and renunciation due to chronic pain and due to the prospect or condition of infertility.
Therefore, endometriosis must always be treated as a pathology in its entirety: from diagnosis to staging, from medical therapy to surgical management of its rarest and most disabling forms such as intestinal, urinary and diaphragmatic tract, with attention to an increasingly minimally invasive approach respectful of the anatomy and innervation of these delicate structures. Furthermore, other multi-disciplinary aspects such as associated pelvic floor dysfunctions and the management of chronic pelvic pain in collaboration with rehabilitators and analgesics should not be neglected. And above all, it is necessary to grasp the limit beyond which the patient must be directed to a reference structure, to solve the problem of the disease or secondary failures, such as infertility. Only this way we will be able to aspire to healing in a holistic sense, with an absolute centralized view of endometriosis as a pathology of body and soul.