{"id":243,"date":"2011-11-05T17:09:50","date_gmt":"2011-11-06T00:09:50","guid":{"rendered":"http:\/\/www.vitalhealth.com\/blog\/?p=243"},"modified":"2019-04-29T09:17:50","modified_gmt":"2019-04-29T16:17:50","slug":"the-role-of-pre-sacral-neurectomy","status":"publish","type":"post","link":"https:\/\/www.vitalhealth.com\/endo-blog\/the-role-of-pre-sacral-neurectomy\/","title":{"rendered":"The Role of Pre-Sacral Neurectomy in Treating Painful Periods, Painful Sex and Endometriosis Pain"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text css_animation=”fadeIn”]I have been asked about the effectiveness of pre-sacral neurectomy (PSN) in providing pain relief and if it should be routinely performed as a part of endometriosis and pelvic pain surgery. For those of you not familiar with this term (PSN), it is a nerve cutting procedure done during laparoscopy in an attempt to decrease pelvic pain. This should not be confused<\/span>\u00a0with another similar procedure, Laparoscopic Uterosacral Nerve Ablation (LUNA) that has been shown in multiple studies to be ineffective and is not recommended.<\/p>\n

PSN has been shown to be effective in relieving midline pelvic pain (pain only in the middle of the pelvis behind the pubic bone) but not pain on the sides (in the area wear the ovaries are located). In my experience, a patient\u2019s pelvic pain resulting from endometriosis resolves after appropriate surgical removal and additional treatment is needed.\u00a0PSN may be most useful in treating pain that is both in the midline and has been present since the first period, the medical term for this primary dysmenorrhea.<\/p>\n

Pelvic pain is transmitted through not one or two nerves but many different nerves throughout the pelvis, which is one of the reasons it can be so difficult to treat.\u00a0This is different than your pinky finger, which is innervated by only one nerve, the ulnar nerve. \u00a0If a person had chronic pain in their pinky that did not respond to other treatments a nerve block of this nerve would relieve the pain.\u00a0 There is an area inside the body on the front side of the lower back called the superior hypogastric plexus that contains the major sensory nerves from the uterus and cervix but not the ovaries.\u00a0 This is the reason a PSN helps with pain coming from the uterus or cervix (midline) but not from the ovaries (lateral or on the sides).<\/p>\n

There are surprisingly few studies on PSN. Information on the efficacy, or how well the PSN works, varies depending upon which scientific study is quoted.\u00a0Most but not all studies show that when PSN is used in conjunction with other procedures to treat endometriosis or adhesion, about 75% to 80% experience a decrease in pain, especially painful periods (dysmenorrhea) while about 60% patients not receiving PSN as part of the pelvic pain surgery experience a decrease in their pain. Some studies have shown a decrease in painful sex (dyspareunia) following PSN while others have not shown a difference. This may be due to the multiple different causes of pain with intercourse, some of which may be helped with a PSN while others are not.[\/vc_column_text]