Neurogenic Inflammation in the Context of Endometriosis—What Do We Know?
Open accessAbstract
Endometriosis (EM) is an estrogen-dependent disease characterized by the presence of epithelial, stromal, and smooth muscle cells outside the uterine cavity. It is a chronic and debilitating condition affecting ~10% of women. EM is characterized by infertility and pain, such as dysmenorrhea, chronic pelvic pain, dyspareunia, dysuria, and dyschezia. Although EM was first described in 1860, its aetiology and pathogenesis remain uncertain. Recent evidence demonstrates that the peripheral nervous system plays an important role in the pathophysiology of this disease. Sensory nerves, which surround and innervate endometriotic lesions, not only drive the chronic and debilitating pain associated with EM but also contribute to a growth phenotype by secreting neurotrophic factors and interacting with surrounding immune cells. Here we review the role that peripheral nerves play in driving and maintaining endometriotic lesions. A better understanding of the role of this system, as well as its interactions with immune cells, will unearth novel disease-relevant pathways and targets, providing new therapeutics and better-tailored treatment options.
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The pathophysiology of pain in rectovaginal endometriosis is multifactorial and not determined solely by anatomical involvement.
“The pathophysiology of pain in RVE is multifactorial and not determined solely by anatomical involvement.”
From Pain and functional outcomes after surgical versus hormonal treatment in rectovaginal endometriosis: a retrospective cohort study (2026) · cites this paper as [24]
Section 3, “Pathophysiology of Endometriosis Related Pain” (page unavailable), describes peripheral and central sensitization and says severe pain can occur even without pathological findings. This supports the claim that endometriosis pain is not determined solely by anatomical involvement, but the passage does not specifically address rectovaginal endometriosis (RVE). (LLM, conf=0.84)
Experimental — accuracy not yet measuredLesion removal does not necessarily eliminate the biological processes that sustain pain.
“However, lesion removal does not necessarily eliminate the biological processes that sustain pain [8, 16, 24, 26].”
From Pain and functional outcomes after surgical versus hormonal treatment in rectovaginal endometriosis: a retrospective cohort study (2026) · cites this paper as [24]
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- Authors
- Velho, R. V., Taube, E., Sehouli, J., & Mechsner, S.
- Affiliations
- Stiftung Charité (DE)
- Charité – Universitätsmedizin Berlin (DE)
- Corresponding author
- Mechsner, Sylvia
- Venue
- International Journal of Molecular Sciences
- Publisher
- MDPI AG
- Published
- 2021-12-03
- Volume
- 22
- Issue
- 23
- Pages
- 13102
- ISSN
- 1422-0067 (ISSN-L)
- PMC
- PMC8658724
- OpenAlex
- W4200199913
- Cited by
- 62
- References
- 99
- Citations by year
- 2026: 21 · 2025: 7 · 2024: 17 · 2023: 14 · 2022: 2
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Molecular Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Refubium (Universitätsbibliothek der Freien Universität Berlin) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Universitätsbibliothek der FU Berlin Hochschulschriftenstelle u. Dokumentenserver (cc-by)
- Funders
- Deutsche Forschungsgemeinschaft
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Plant and fungal interactions
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Keywords
- endometriosis, neurogenic inflammation, peripheral nervous system, sensory nerves, chronic pelvic pain, endometriotic lesions, neurotrophic factors, immune cell interactions, endometriosis pathogenesis, dysmenorrhea, dyspareunia, dyschezia, infertility
- MeSH terms
- Endometriosis, Female, Gene Expression Regulation, Humans, Nerve Growth Factors, Sensory Receptor Cells, Pelvic Pain, Neurogenic Inflammation
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