Prof. Prof. DK Prof. Dr. med. Marc Possover, MD, PhD

Endometriosis of the Sciatic Nerve

Why This Is Not a Gynecological Disease, and Why Neuropelveology Is the Only Correct Diagnostic and Surgical Approach

Endometriosis is traditionally considered a gynecological disease.
When endometriosis involves the uterus, ovaries, or pelvic peritoneum, this is correct.

However, endometriosis of the sciatic nerve is not a gynecological disease.
It is a neurological disease occurring inside the pelvis.

And this distinction changes everything.

A Disease of the Nervous System - Not of the Uterus

The sciatic nerve is the largest nerve in the human body.
When endometriotic tissue infiltrates this nerve, the disease affects:

• nerve conduction
  • sensory and motor pathways
  • autonomic pelvic control
  • gait, muscle strength, and reflexes

This is not a disorder of reproductive organs, it is a primary pelvic neuropathy caused by endometriotic nerve infiltration.Therefore, the diagnosis belongs to neurology, and the surgery belongs to neurosurgery - not to classical gynecology.

Why Classical Neurology Cannot Diagnose Pelvic Nerve Disease

Here lies the paradox:

Pelvic nerves are deep intrapelvic structures, that cannot be examined with standard neurological testing. The only reliable clinical examination of pelvic nerves is:

• transvaginal nerve palpation
  • transrectal nerve palpation

These examinations are gynecological by access, but neurological by nature. They are completely outside the training, legal scope, and ethical framework of classical neurology. A neurologist cannot perform intravaginal pelvic nerve palpation. This would be unthinkable and unacceptable.

As a result, pelvic nerve diseases were historically “invisible” to neurology.

They simply had no diagnostic doorway.

Why Classical Gynecology Cannot Treat Pelvic Nerve Disease

Gynecologists are trained in:

• genital organs and retroperitoneal surgery
  • pelvic oncology
  • peritoneal endometriosis
  • fertility preservation

They are not trained in nerve diagnostic and not trained in neuro-surgical nerve procedure and reconstruction. Being able to expose a nerve laparoscopically does not make someone a neurosurgeon. Pelvic nerve surgery requires:

• neuroanatomical mapping
  • neurofunctional preservation
  • microsurgical nerve decompression
  • intraneural dissection techniques
  • regeneration-oriented nerve handling
• expertise in neurofunctional surgery and neuromodulation

This is neuro-surgery - not gynecological surgery.

Neuropelveology: The Missing Discipline

Neuropelveology was created precisely to solve this paradox.

It is the discipline that:

• performs neurological diagnosis adapted to pelvic nerves
  • uses gynecological access routes (vaginal, rectal, laparoscopic)
  • applies neurosurgical principles to pelvic nerve surgery
  • reconstructs pelvic neural pathways
  • treats pelvic neuropathies at their true origin

Sciatic nerve endometriosis is a neuropelveological disease.

Its diagnosis is neurological.
Its surgery is neurosurgical.
Its access is gynecological.
Its discipline is Neuropelveology.

A Dangerous Trend: “Social-Media Neuropelveology”

In recent years, a growing number of surgeons have begun to present themselves online as “specialists in sciatic nerve endometriosis surgery” — without:

• formal neuropelveological training
  • neurological diagnostic competence
  • neurosurgical nerve education
  • scientific outcome publications
  • peer-reviewed evidence
  • certified expertise

Self-declaration on social media is not qualification.

Pelvic nerve surgery without neurological diagnosis is blind surgery.

Blind nerve surgery causes permanent neurological damage.

What Patients Must Demand

Patients suffering from sciatic pain, foot drop, pelvic neuralgia or unexplained neurological symptoms must demand:

• documented neuropelveological diagnosis
  • peer-reviewed scientific publications
  • certified training in pelvic nerve surgery
  • verifiable surgical outcome data

Not Instagram expertise.
Not self-proclaimed titles.
But science, certification, and proof.

Conclusion

Sciatic nerve endometriosis is not “deep endometriosis.”

It is pelvic nerve disease caused by endometriotic nerve infiltration.

It belongs to neurology by pathology, neurosurgery by treatment, and Neuropelveology by reality.

And it can only be treated safely by those trained in all three.

References

1. Possover M. Laparoscopic morphological aspects and tentative of explanation the etiopathogenesis of isolated endometriosis of the sciatic nerve: a review based on 267 patients. Facts Views Vis Obgyn, 2021;13(4): 331-337
2. Possover M. Laparoscopic management of isolated infiltrating endometriosis of the sciatic nerve. Video-article, Journal of Minimally Invasive Gynecology 2020.
3. Possover M. Five-Year Follow-Up After Laparoscopic Large Nerve Resection for Deep Infiltrating Sciatic Nerve Endometriosis. J Minim Invasive Gynecol. 2017 Jul - Aug;24(5):822-826.
4. Possover M. Pathophysiologic explanation for bladder retention in patients after laparoscopic surgery for deeply infiltration rectovaginal and/or parametric endometriosis. Fertil Steril 2014; 101:754-8
5. Possover M. Laparoscopic therapy for endometriosis and vascular entrapment of sacral plexus. Fertil Steril 2021; 95(2): 756-8.
6. Possover M. Laparoscopic neurolysis of the sacral plexus and the sciatic nerve for extensive endometriosis of the pelvic wall. Minim Invasive Neurosurg 2007; 50: 33-36.
7. Possover M, Chiantera V. Isolated infiltrative endometriosis of the sciatic nerve: about three cases. Fertil Steril 2007; 87: 417-9.
8. Possover M, Kerstin Rhiem, Vito Chiantera. The “neurologic hypothesis: a new concept in the pathogenesis of the endometriosis? Gynecolog Surge 2005; (2): 107-111.
9. Possover M. Vorgehen bei der ausgedehnten retroperitonealen Endometriose. Gyn Praktische Gynäkologie, 2003, 2:110-124.
10. Possover M, Mallmann P. Follow-up of patients after laparoscopic vaginal resection of the endometriosis of the rectovaginal septum with colorectal anastomosis. Journal of Pelvic Surgery 2002,8: 83-88.
11. Possover M, Diebolder H, Plaul K, Schneider A. Laparoscopic-assisted vaginal resection of recto-vaginal endometriosis. Obstetrics and Gynecology, 2000; 96, 304-307.
12. Possover M, Diebolder H, Stöber S, Schneider A. Laparoskopisch assistierte vaginale Resektion der Endometriose. Ambulant Operieren 1999; 2: 46-50.

— Prof. Marc Possover
Founder of Neuropelveology

We’re Here to Help

Possover International Medical Center – Zurich
☎️ +41 44 520 3600
📍 Klausstrasse 4, CH-8002 Zürich
🌐 www.possover.com
📧 mail@possover.com

Let us help you find the cause of your pain - and finally start your journey toward healing.

If you or someone you know is struggling with chronic pelvic pain, pelvic nerve disorders, endometriosis, or consequences of pelvic surgery, please contact us via email at international@possover.com to begin the process. Because we want to avoid the scenario where a patient travels to Zurich, only to discover that we may not be able to offer help for their specific situation, we have Pre-Consultation Zoom process. How does it work?

1. Patients will first receive a Pre-Consultation Form.
2. Based on the information provided, we will assess whether a Zoom consultation is necessary.
3. If indicated, we will schedule a Pre-Consultation Zoom Call to help determine if a full evaluation at our center makes sense for your case.