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Sexuality is shaped by experience and by what has been passed down. Body image and sex influence desire and pleasure. In the case of endometriosis, suffering and pain can lead to shame and guilt. Encouraging people to talk to each other helps to create a free eroticism that resembles the couple.

Endometriosis does not always mean infertility, and treatment depends on the couple\'s prognosis and their wishes. Spontaneous pregnancy remains possible, all the more so if endometriosis treatment is initiated early in the patient\'s life. Surgery and assisted reproduction are available to couples who wish to have a child.

Managing chronic pain in endometriosis requires multidisciplinary assessment and care. The aim is not complete disappearance of symptoms, but rehabilitation through medication, non-medication treatments and overall follow-up.

Complete resection of scattered superficial lesions can be paradoxically more complex. If the endometriosis is ovarian, priority should be given to preserving the oocyte capital, and ovarian function should be assessed in patients of childbearing age who wish to become pregnant, prior to treatment by alcoholization of the cyst, abrasion of its contents by laser or plasma energy, or even cystectomy. Laparoscopic resection is recommended in cases of deep endometriosis. After a thorough clinical examination and precise imaging, deep lesions are treated by resection and shaving in the case of digestive or ureteral localizations, or even by discoid resection or digestive anastomosis resection with or without stoma, depending on fistula risk criteria. The aim is to reduce pain and functional consequences, while preserving ovarian function to improve pregnancy rates.

Endometriosis is a chronic disease defined by the presence of endometrial cells outside the uterus. Research is ongoing to better understand its etiologies, the anatomopathological forms it takes and the associated symptoms, which often have pain in common.

OBJECTIVE: We decided to conduct a study based on these multidisciplinary team (MDT) in order to investigate their impact at the University Hospitals of Strasbourg and look for ways to improve this MDT.
METHODS: This is a retrospective study of the 682 patients presented to endometriosis MDT from its inception in March 2017 to December 2020.
RESULTS: The MDT decision was different from that initially proposed by the patient\'s referent for 406 patients (60%). Surgery was chosen for 417 patients (61%) and assisted reproduction for 261 patients (38%). A review of the MRI by a referring radiologist was carried out for 348 cases (51%), with a modification of the results for 255 patients (73%). Initial underestimation of lesions was noted in 198 cases.
CONCLUSIONS: Our study has shown the importance of MDT in endometriosis since the therapeutic proposal was modified in 60% of cases. In addition, we supported the importance of radiologists specializing in this field since they made a modification in two-thirds of the MRIs reread. These results show the importance of collegial discussions, which can modify the decisions of medical teams. This underlines the importance of setting up endometriosis networks.

BACKGROUND: Endometriosis is a gynecological pathology defined by the presence and abnormal development of endometrial tissue outside the uterine cavity. Our objective was to draw up an epidemiological profile and to describe the anatomical clinical forms of endometriosis in Dakar.
METHODS: This is a retrospective study of all cases of external and internal endometriosis diagnosed in an anatomy and pathology laboratory in Dakar over a period of twenty (20) years. The study parameters were collected from anonymous data sheets. Data entry and analysis were performed using version 22 of the EPI INFO and SPSS software.
RESULTS: Our study involved 104 female patients. The mean age was 47.3±10.0. Among the patients with an adenomyosis condition, the mean age was 49.8 years. Patients with an external endometriosis condition had a mean age of 37.6 years. The location of the endometriosis was statistically correlated with the age of patients and with parity. Anatomically and pathologically, the surgical specimen 89.4% (n=93) was the main type of sampling that was found. The uterine body was the main location of the pathology, with 78.9% (n=82), followed by the umbilical location with 9.6% (n=10). Leiomyomas 44.07% (n=26) were the main associated lesions.
CONCLUSIONS: Endometriosis is a gynecological pathology that is unfortunately not well known, and which is under diagnosed in Senegal.

Pelvic surgery for endometriosis is associated with a risk of bladder and digestive sequelae. Sacral neuromodulation (SNM) has been shown to be effective in the treatment of overactive bladder (OAB) and voiding dysfunction (VD). This study aimed to evaluate the efficacy of sacral neuromodulation (SNM) in treating voiding dysfunction (VD) following endometriosis surgery. A retrospective analysis was conducted on data from women who underwent SNM testing for persistent VD after endometriosis surgery. The study included 21 patients from a French tertiary referral center. Patient characteristics, lower urinary tract symptoms, urodynamic findings, SNM procedures, and outcomes were assessed. The primary outcome was the success of SNM treatment for VD. After a median follow-up of 55 months, 60% of patients achieved successful outcomes, with significant improvements of VD and quality of life. Moreover, more than half of patients who required clean intermittent self-catheterization (CISC) before SNM were able to wean off CISC. Complications such as infections and paraesthesia were observed, but overall, SNM was found to be effective and well tolerated. Age and the interval between endometriosis surgery and SNM testing were associated with treatment success. This study adds to the limited existing literature on SNM for VD after endometriosis surgery and suggests that SNM can be a valuable therapeutic option for these patients. Further research is needed to identify predictive factors and mechanisms underlying the effectiveness of SNM in this context. MRI-compatible and rechargeable devices, has improved the feasibility of SNM for these patients. In conclusion, SNM offers promise as a treatment option for persistent VD after endometriosis surgery, warranting further investigation. LEVEL OF EVIDENCE: 4.

OBJECTIVE: Endometriosis is a chronic and progressive gynecological disease that affects 1 to 2 out of 10 women of childbearing age in France. The objective of this research was to understand the factors determining the quality of life of the patients who experience significant pain symptoms (75%), distinguished by the extent and depth of the lesions. The second objective was to evaluate the psychological repercussions of this pain. We will therefore assess the various psychological processes involved in explaining quality of life.
METHODS: In total, 1039 women aged 18-55 years completed a self-administered questionnaire, assessing different types of pain and intensity, body image (BIS), self-esteem (Rosenberg), anxiety-depressive symptomatology (HAD), and quality of life (SF-36). Socio-biographical and medical characteristics of the patients were also assessed.
RESULTS: Analyses of variance showed that patients with chronic pain had lower self-esteem and body image, more anxiety-depressive symptoms, and a poorer quality of life than women with cyclic pain and those without pain. Regression analyses showed that the determinants of physical and mental quality of life differed significantly according to the type of pain experienced.
CONCLUSIONS: The consequences of the pain associated with endometriosis reveal multiple problems that can be considered from a new perspective. Although psychological disorders can be a response to pain phenomena they can also contribute to their increase. This is where the challenge lies in providing comprehensive care.