Perineal endometriosis is a rare complication of episiotomy. This is a case of a 44-year old woman with cyclic perineal pain and a history of episiotomy. A wedge biopsy of the perineal mass confirmed the diagnosis of endometriosis. Awareness of the occurrence of this rare type of extrapelvic pain during menses secondary to perineal cudometriosis is important.
Human ; Female ; Adult ; ANAL CANAL ; ENDOMETRIOSIS ; NEURALGIA

Background: PCOS is a common gynecologic disorder and recent studies have found that they are more prone in developing depression and anxiety compared to the general population. The Hospital Anxiety and Depression Scale (HADS) is a popular and simple self-administered instrument reliable for detecting states of anxiety and depression. Using this simple screening tool, it may lead to the identification of such mental disorders that may warrant timely psychiatric referral. Objectives: We aim to determine the prevalence of anxiety and depression among PCOS patients using the HADS-P questionnaire. We also aim to determine association between depression & anxiety and disease characteristics. Methods: This is a cross-sectional study using convenience sampling of PCOS patients >18 years old in Philippine General Hospital. The HADS-P, a self-administered rating scale with independent subscales for anxiety and depression, was administered to the participants after securing consent. A cut–off score of >8 points on either of the depression and anxiety subscale was used to determine their respective prevalence. Logistic regression analysis was used to determine the association of clinical variables with anxiety or depression. Results: A total of 253 patients with PCOS were recruited. On the basis of a HADS-P score of >8.0 per category, the prevalence of PCOS patients who were suggestive to have anxiety was 46.25% (n: 117, 95% CI: 39.98-52.60%), while 9.09% (n: 23, 95% CI: 5.85-13.33%) of them were suggestive to have depression. Crude logistic regression identified presence of depression, infertility, impaired glucose tolerance and prominent acne as predictors of anxiety; whereas low parity, hirsutism and presence of anxiety were predictors of depression. Adjusted logistic regression identified only presence of depression and infertility were significant predictors of anxiety (n: 116, LR χ2 (5): 15.46, p<0.01); while presence of anxiety increase the odds of depression by 2 to 13 fold, it was not statistically significant (n: 116, LR χ2 (5): 9.79, p: 0.08). Conclusion There is a high prevalence of anxiety and depression among PCOS patients. The factors that were seen to be significantly associated with the development of anxiety were the presence of depression, impaired glucose tolerance, infertility and prominent acne, while for the development of depression were the presence of anxiety, hirsutism and low parity. Screening for anxiety and depression is of paramount importance and physicians should be vigilant for the need of possible psychiatric intervention.
Anxiety ; Depression ; Hads ; 4-amino-4' ; -hydroxylaminodiphenylsulfone ; Polycystic Ovary Syndrome