In the healthy endometrium, progesterone and estrogen signaling coordinate in a tightly regulated, dynamic interplay to drive a normal menstrual cycle and promote an embryo-receptive state to allow implantation during the window of receptivity. It is well-established that progesterone and estrogen act primarily through their cognate receptors to set off cascades of signaling pathways and enact large-scale gene expression programs. In endometriosis, when endometrial tissue grows outside the uterine cavity, progesterone and estrogen signaling are disrupted, commonly resulting in progesterone resistance and estrogen dominance.
It was estimated that around two‐thirds of women with endometriosis suffer from some type of sexual dysfunction, such as pain at intercourse, low satisfaction, lack of desire, low arousal, orgasm difficulties, with a negative impact on women's psychological health and intimate relationships. Sexual functioning is an important dimension that impacts on women's physical and psychological health, and quality of life. Female sexual functioning can be negatively affected by a variety of factors, such as operative vaginal delivery and life stressors related to medical illness, including infertility.
In rare cases where laparoscopy is unsuitable, a laparotomy may be recommended.
A large incision is made in the abdomen. This incision might be horizontal at the bikini line, and look similar to a C-section (caesarean section) incision, or it may be a vertical incision depending on the nature of your procedure. The incision can be as long as 15 to 20 centimeters in length. Once your surgeon makes the incision, they will be able to view the inside of your abdomen and pelvis. From there, they may remove endometrial-related cysts, called endometriomas, from the ovaries. Ultimately, as much endometriosis is removed as possible during this procedure to hopefully relieve pain and other endometriosis-related symptoms.
Some common risks associated with a laparotomy include, but are not limited to:
• Severe bleeding (hemorrhage), including internal bleeding
• Injury to organs such as the bladder or the bowel that may impact their functioning
• Infection (operation site infection, pelvic infection, or urinary tract infection)
• Development of scarring at the incision site
• Numbness near the incision site
• Development of a fistula between the vagina and bladder
• Development of blood clots
• Scar tissue that can cause similar symptoms as before the procedure
Endometriosis affects an estimated 1 in 10 women during their reproductive years. There is no cure for endometriosis. Even after this type of surgery, your endometriosis can come back, along with its pain.

https://endometriosis.net/surgery/laparotomy/
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13031
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