Case Report on Ayurvedic Management of Post-Hysterectomy Vaginal Deep Endometriosis

Abstract

Endometriosis is a disease of contrast, a benign but locally invasive condition characterized by functioning endometrium in sites other than uterine mucosa. It manifests clinically with dysmenorrhea, abnormal uterine bleeding, infertility, dyspareunia, chronic pelvic pain and abdominal pain.  Hysterectomy with or without salpingo-oophorectomy is considered the definitive management option in women who completed the family. Persistent or recurrent pain and vaginal spotting after a hysterectomy are one of the most frustrating clinical scenarios in benign gynecology. A 36-year-old parous woman had persistent severe lower abdominal pain, low back ache, and intermittent spotting per vagina after a laparoscopic hysterectomy and left salpingo-oophorectomy for abnormal uterine bleeding with adenomyosis and fibroid.  Magnetic Resonance Imaging was suggestive of vaginal deep endometriosis. As the patient presented with yonithoda (lower abdominal pain), krishna alpa thanu ruksha arthava sravam (brownish discharge per vagina), vankshana parswa vyadha (low back ache) and gulma (Hemorrhagic cyst on ultrasonography) it is considered as vathiki yonivyapath. Even though the condition is Vata pradhana, the pain is mainly due to pitha raktha kapha pradhana sopha. So vatanulomana pitha raktha kapha samaka, sophahara and grandhihara chikitsa     were the line of management. The symptoms were relieved considerably after one month of treatment and completely cured in the follow-up at the Department of Prasootitantra and Striroga, Govt. Ayurveda college, Trippunithura, Ernakulam, Kerala.