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Questions about Endometriosis – Endometriosis FAQs


QPainful sex? Extreme Pelvic Pain?

AMany women downplay their symptoms or delay seeking help because they think their pain is just a normal part of being a woman or that it isn’t severe enough to warrant surgical or other medical intervention. However, we’ve found that many women who think this are actually spending several days per month in so much pain that they can’t fully participate in their usual daily activities. Contrast this to the lives of women who don‘t have endometriosis, who experience relatively few if any days of life-disrupting pain. Pain with menstruation or any other chronic pelvic pain should never be accepted as normal. For over 30 years Dr. Nezhat has been able to break the cycle of unremitting pain for countless women who had been living lives awash in anguish. And since we accept most major insurance plans, your first evaluation is very affordable. Please see more answers to frequently asked questions below.


QExtreme pain with periods? Vomiting and passing out from pain?

ANo matter what you’ve heard before, painful periods are not normal. And, severe pain with menstruation – so-called killer cramps – is definitely abnormal and indicates that immediate medical care is needed.

The myth that suffering painful periods is a woman’s inescapable, biological destiny has been perpetuated for thousands of years, but that doesn’t make it true! In fact, not only is this tired, old dogma absolutely not true, more importantly there are now treatments that work; you can live a pain-free life. And, you’ve come to the right place because Dr. Camran Nezhat is the world’s foremost expert in treating severe menstrual pain and helping women return to a normal life, one free of pain. Even if you’ve been diagnosed with severe stage 4 endometriosis, you can still be surgically treated in a completely minimally invasively way, without resorting to a large incision (laparotomy), without having to remove your uterus or ovaries, and without leaving behind any disease.

Don’t settle for living another day in unbearable pain.

Why is it so painful
Overview of endometriosis, which can cause extremely crippling pain with periods
Myths about painful periods and endometriosis
Patients testimonies from those who used to have crippling periods
Endometriosis Surgery Myths
Endometriosis Excision Surgery White Paper
Bowel Endometriosis Surgery
Bladder Endometriosis Surgery
Diaphragm Endometriosis Surgery
Thoracic Endometriosis Surgery
Alternatives To Surgery
History of how women with painful periods have been treated for 4000 years
Other reasons for abdominal (pelvic) pain



QFrozen Pelvis? Obliterated Cul-de-Sac?

ANo matter what you’ve heard before, severe stage IV endometriosis can be surgically treated minimally invasively, without resorting to a large incision (laparotomy) and without leaving behind any disease. Please see more answers to frequently asked questions below.


QWhy is it so painful? Did you know that endometriosis can grow on various nerves throughout the body, causing nerve damage and severe nerve pain (neuralgia, pudendal neuralgia, etc)?

AThe painful, nerve-invading viral disease called shingles provides for a useful comparison. Almost universally, both men and women say that being afflicted with shingles was one of the most excruciatingly painful experiences of their lives. Because it’s recognized as one of the most painful disorders on the planet, it’s accepted as perfectly normal for doctors to prescribe very powerful pain medication and for those suffering from the disorder to be treated with kindness and compassion for their suffering.

For those women who have had both shingles and endometriosis, many have said that the nerve pain of endometriosis is more painful than shingles. Yet because endometriosis is still so poorly understand, few seem to appreciate just how truly incapacitating the pain can be. If the world learned that endometriosis is as painful, if not more so, than shingles, then perhaps women would get the compassionate care they need and more understanding from family and friends about just how devastating this chronic condition can be for millions of women.

Unlike shingles, however, nerve endometriosis can be surgical removed. However, many doctors are not able to remove endometriosis that has invaded the nerves. This is because it takes exceptional surgical skill and experience to perform these types of extremely meticulous surgeries. Contact us to learn more about the special techniques surgeons can now use to treat nerve endometriosis. Please see more answers to frequently asked questions below.


QA Pain-Free Life is Possible?

ANo matter what anyone has told you before, it’s not in your head; your endometriosis pain is real and it can be successfully treated. You can have a pain-free life. Contact us to learn more about Dr. Nezhat’s unique surgical approaches that have been restoring health and hope to women for over 30 years. Please see more answers to frequently asked questions below.


QHighest Success Rates

AWhen it comes to achieving successful long-term outcomes – without resorting to laparotomy – Dr. Nezhat is recognized as being in a league of his own. Don’t believe the myths: Don’t settle for a laparotomy: Don’t settle for hysterectomy: Don’t settle for infertility. No matter what you’ve been told, Dr Nezhat is capable of performing even the most complex, reconstructive surgeries through the least invasive means. Tied tubes, blown-out bowels, huge fibroids, obliterated cul-de-sacs, congenital abnormalities, endometriosis of the diaphragm, lungs, liver, Fallopian tubes, ovaries – you name it, Dr. Nezhat can treat it.


QWhy did my pain return even after having excision surgery?

AMany are claiming that a thorough excision surgery performed by a top endometriosis specialist is practically guaranteed to provide pain relief for 100% of patients. This is absolutely not true and well-designed, peer-reviewed medical studies authored by these very specialists attest to this.

However, even for the most severe cases, Dr. Nezhat has one of the highest success rates in the world for providing relief from the symptoms of endometriosis. And this is true, even though he takes on the most difficult cases and has the largest volume of surgeries than any other living endometriosis surgeon. Dr. Nezhat is able to achieve these superior results for a few key reasons. First, because of his unsurpassed surgical skill – what many refer to as legendary – Dr. Nezhat is able to remove endometriosis from delicate areas of the anatomy that other surgeons simply are not skilled enough to treat. For example, endometriosis of the nerves can cause excruciating pain; yet only a very small handful of surgeons in the world are skilled enough to remove lesions from this area, especially when the pelvis and organs are severely distorted or fused together due to adhesions and advanced disease. For surgeons who are not able to remove endometriosis of the nerves or other delicate areas, this means they have no choice but to leave it behind, where it will continue to cause pain and other symptoms.

Having performed over 14,000 surgeries, Dr. Nezhat is also the world’s most experienced endometriosis surgeon; there is no other living surgeon who has performed more endometriosis surgeries, all with the highest success rates and least complications.


For some women their form of endometriosis is more virulent and may require more than one surgery to treat. In the medical literature, average recurrence rates after conservative surgical intervention fall somewhere between about 25% to as high as 55% within 5-7 years after surgery (Sutton 1990, Fedele 2004, Shakiba 2008). For surgeons recognized as among the most highly skilled, their reported rates of histopathologically confirmed recurrence of disease is lower, hovering in the approximately 6-7% range.

Though some suggest that untreated microscopic endometriosis is a possible reason for recurrence, the reality is that we don’t really know for sure what factors play a role. Recent studies suggest that dysregulated endometrial stem/progenitor cells may play a key role in reactivating new endometriotic growths. Since stem cells can derive from bone marrow or other sources besides menstrual blood, this means that the stem cell theory has explanatory power in cases where menstrual blood cannot be a factor, such as in instances where endometriosis has developed in men, fetuses, premenarcheal girls, or in post-hysterectomy or post-menopausal women.

As elegant and promising as the stem cell theory is, alas, it remains, like all the others, an unproven hypothesis, a sea of supposition upon slippery supposition. In fact, all of this continued etiologic uncertainty stands as a stark reminder that what we really need is more research funding to help uncover the cause/s, so that we can springboard to the cure, or at least, toward a non-invasive diagnostic test and better treatment choices.

Setting aside all of these etiological unknowns, what we can say with more assurance is that, no matter how endometriosis arises, once activated, its lesions and nodules can take on a life of their own, creating their own veritable biological chemical factories, capable of reprogramming genetic pathways to support such complex processes as angiogenesis, apoptosis resistance, and immune system tolerance, while synthesizing all of the biological substances needed to survive, independently of the reproductive hormones; In other words, endometriosis can be self-perpetuating, thriving even in premenarcheal girls or in post-menopausal or post-hysterectomy with bilateral salpingo-oophorectomy (removal of uterus, cervix, both ovaries, and both Fallopian tubes) women. Despite these formidable complexities, one silver lining is that, in post-menopausal or post total hysterectomy women especially, there is a greater likelihood that thorough eradication and/or excision of any remaining endometriosis by an experienced surgeon will provide significant relief to most, if not all refractory symptoms.

If you’d like to read medical journal articles about endometriosis recurrence rates, the stem cell theory of pathogenesis, surgical complications, and surgical techniques that may reduce pain, we’ve found that the following sites are very useful:

  1. The effect of surgery for symptomatic endometriosis: the other side of the story
  2. Recurrence rates, up to 40-50% after 3 years
  3. Recurrence rates after surgery for stage III-stage IV
  4. Recurrence rates after surgery and after GnRH treatment


QI’ve heard that thorough excision surgery can cure endometriosis; is this true?

ANo, this is not true. There is no cure for endometriosis. However, just as with all things, surgeons have varying degrees of skill and experience. The two main factors correlated with successful surgical outcomes are the skill and experience of the surgeon. It is for this reason that women with endometriosis are urged to seek care from an endometriosis specialist. This is because those with limited exposure to endometriosis would not have had enough experience to safely and thoroughly perform the advanced procedures required in endometriosis surgery. And, because endometriosis can exist in very subtle forms, those with limited experience often fail to diagnose endometriosis in the first place.

In addition to the skill and experience of the surgeon, there are also other factors that influence the outcomes of surgery. The severity of disease influences recurrence rates. For example, studies suggest that, generally speaking, women with more severe, deeply-infiltrating disease (stage IV), particularly when the pouch of Douglass is obliterated, have the highest rates of recurrence. (Vercellini et al, 2009) Therefore, if surgeons only perform surgery on patients with stage I-III endo, they may appear to have a higher success rate. In the case of Dr. Nezhat, however, even though he takes on the most difficult cases – the ones that other surgeons have said were inoperable –he still is the world’s leader when it comes to achieving the highest long-term success rates.

For further reading on these subjects, please see the following links/sites:

  1. Active endometriosis even after hysterectomy with removal of ovaries
  2. Recurrence rates after excision surgery
  3. Retrograde menstruation’s hypothesized role in pathogenesis and recurrence
  4. Safer surgical methods that reduce the risk for post-operative pain, complications, & adhesions
  5. Recurrence rates after excision surgery (repeat from above)


QCan excision surgery performed on my Fallopian tubes cause permanent damage or otherwise interfere with my fertility?

AThe short answer is yes. Some surgical techniques and instruments are too risky for using on the Fallopian tubes and should therefore be avoided. If a surgeon uses instruments or techniques that are too aggressive for this very delicate organ, then there is a high risk for complications, including permanent damage. And as I’m sure you know, damage to the Fallopian tubes would destroy a woman’s fertility and require either IVF or additional surgeries to try to reverse the damage. That’s why it’s important to ask your surgeon questions about what methods he or she will use to remove endometriosis from delicate organs like the Fallopian tubes, blood vessels, and nerves.

However, a skilled and experienced endometriosis surgeon will be able to avoid such complications. For example, Dr. Nezhat uses gentle techniques that he developed to thoroughly remove endometriosis from the Fallopian tubes. Because Dr. Nezhat is one of only a few surgeons in the world who is able to remove endometriosis from the Fallopian tubes without destroying them, his patients experience superior pain relief and improved fertility outcomes.

To read more about this topic, please see some of the links to peer-reviewed articles, endometriosis organizations, and other useful resources that we’ve provided below.

  1. Plasma Jet: Safer, new techniques for treating endometriosis
  2. Fallopian tubes extremely delicate and easily damaged:
  3. Complications of excision surgery


QWhy are dangerous electro-surgical instruments still being used?

ASurgeons have known for decades that certain types of electro-surgical instruments can produce unpredictable shocks of heat energy, which in turn can cause unintended injury to surrounding healthy organs and tissue. In fact, it was because electro-surgical instruments carried such a high risk for serious complications that surgeons began turning to newer technologies, such as laser, bipolar, thermal, and Plasma Jet, just to name a few. This is why it’s important to ask your endometriosis surgeon whether he or she has experience using today’s safer surgical instruments.  Many surgeons still use outdated dangerous electro-surgical instruments simply because those are the only instruments they know how to use.

As I’m sure you’ve guessed by now, Dr. Nezhat definitely does not use dangerous instruments known to carry more risk for serious injury. From the very beginning of his career, Dr. Nezhat’s refused to rely on the high-risk devises that were prevalent three decades ago. Instead, he has always taken the time to learn how to use newer and safer instruments that have been proven to reduce the severe complications that electro-surgical instruments can cause.  (See below for links to several peer-reviewed studies which compare the dangerous instruments from yesterday with today’s safer devises).

To learn more about the safest surgical techniques and technologies currently on the market for the treatment of endometriosis, please see the links below.

  1. Patient safety during monopolar electrosurgery
  2. Electrocautery has been postulated as a risk factor for more serious wound complications
  3. Fertility considerations when treating infiltrative bowel endometriosis
  4. More discomfort and tissue damage using some electro-surgical instruments
  5. Safer methods for removing endometriosis from delicate areas
  6. Safer methods for removing adhesions from delicate areas and preventing post-operative adhesion-formation
  7. Safer methods for treating endometriosis
  8. Injury caused by monopolar instrument


QWhy did my excision expert leave endometriosis behind on my blood vessels? Won’t that cause more pain and complications down the road?

AIt’s not well-known, but many so-called excision experts do not have the advanced skills or instruments needed to be able to safely and thoroughly remove endometriosis when it has invaded delicate structures such as the blood vessels. And because they are not able to remove endometriosis from these sites, this means they have no choice but to leave it behind, where it will continue to cause pain and other potentially severe symptoms.

To learn about the safest methods for removing endometriosis from the blood vessels, please see the links provided below:

  1. Endometriosis often missed & left behind in the chest area
  2. Endometriosis often missed & left behind on the diaphragm


QCan I avoid a laparotomy (large-incision, open surgery) even if I have severe (stage IV), multi-organ endometriosis?

AThe answer is an unequivocal yes. In fact, Dr. Nezhat was the first in the world to prove it was possible to safely and thoroughly treat even the most advanced disease through a completely minimally invasive approach. If someone else tells you that your endometriosis is too severe to treat in a minimally invasive manner, now you’ll know this is simply not true.

There is one caveat though; very few surgeons are skilled enough to be able to perform these very difficult minimally invasive surgeries. That’s why it’s important to ask your surgeon how much experience he or she has with performing minimally invasive surgery on patients with severe endometriosis that has affected the bowel, bladder, blood vessels, ureters, nerves, diaphragm, lungs, and liver. If they haven’t had experience in removing endometriosis from these areas of the body, then you may want to consider obtaining a second opinion from someone who can safely and thoroughly remove endometriosis from wherever it exists in the body, without resorting to a laparotomy.

  1. Most severe cases treated without resorting to laparotomy
  2. Advanced, infiltrative disease treated laparoscopically for the first time


QI was told that, because I have severe endometriosis, my only choice was to remove my uterus, cervix, ovaries, and fallopian tubes; in other words, a total hysterectomy, with bilateral salpingo-oophorectomy. Can my reproductive organs be saved?

AAlmost without exception, the answer is a resounding yes; yes, there is a very high likelihood that your reproductive organs can be not only saved, but be freed from all endometriosis, adhesions, and any other disease that’s causing you pain, infertility, or other symptoms. Rather than removing organs, Dr. Nezhat is able to perform meticulous reconstructive surgery on organs that have been severely damaged by endometriosis. These are very difficult surgeries to perform, which is why others may suggest that hysterectomy is the only option. Therefore, if someone says that hysterectomy is your only choice, it’s definitely worth it to get a second opinion.

For more information about alternatives to hysterectomy, please see the links below:

  1. Reproductive organs repaired minimally invasively, with fertility restored
  2. Laparoscopic repair of ovaries
  3. The Role of Laparoscopic-Assisted Myomectomy (LAM)
  4. The Role of Intraoperative Proctosigmoidoscopy in Laparoscopic Pelvic Surgery
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