Perineal endometrioma in episiotomy incisions: clinical features and management

Four patients, 23--34 years old, who developed endometriomas at the site of an episiotomy 19 months to 11-years postpartum are reported. Pain, Swelling and pruritus varying in intensity with the menstrual cycle were present in all. Complete excision is curative. Symptoms of incompletely excised endometriomas may be controlled by local hormonal injections or systemic hormonal manipulation. The anatomy of the endometrium and its physiologic behavior are reviewed. A concept of WHY endometriomas develop is presented which is compatible with the theories of HOW they occur.