Obturator neuralgia is commonly diagnosed and treated in orthopedics. It produces groin pain, sensory alteration in the medial thigh (dysesthesia, sensory loss, or pain), adductor muscle weakness and pain/restriction of hip movements. Basically, the clinical diagnosis of obturator neuralgia is made by producing pain during internal rotation of the hip against resistance ("obturator sign") or by extension and lateral leg movements. We postulate obturator neuralgia can induce lower urinary tract symptoms and dyspareunia and be diagnosed by using three clinical signs characterizing neuralgia everywhere on the body: painful nerve trunk (at the entrance of the obturator canal; by vaginal or rectal examination), abnormal sensibility and painful skin rolling test in its cutaneous innervation territory (inferomedial skin of the thigh). To support our assumptions, three female patients with longstanding lower urinary tract symptoms and/or dyspareunia and a clinical examination suggestive of obturator neuralgia (three clinical signs positive) were treated by perineural injections of dextrose 5% in sterile water (D5W). The three patients were clinically improved or cured after the treatment with two of them being cured after a single injection. While waiting for confirmation of these findings by randomized controlled trials, we suggest that obturator neuralgia should be sought in every patient with lower urinary tract symptoms and/or dyspareunia and that obturator perineural D5W injections be tried to relieve these patients.

Perineology is the result of the merging between urogynecology and coloproctology. This “three-axis approach” is now becoming widely accepted but Perineology is more than a “three axis approach” of the perineum… Perineology deals only with the perineum functional troubles (including pains). Organic diseases (cancer, stones, polyps,...) at any of the three levels must be treated as usual by urologist, gynecologist or coloproctologist. This approach has to be interdisciplinary and not multidisciplinary. There is only one boss who is the “architect of the perineum”, somebody who knows a lot about the anatomy and the physiology of the three axis. This new specialist is called “perineologist”. This person could be the surgeon or somebody who tells the surgeon what to do. The perineologist should have a holistic view (integration of the psychology, the way of life, the abdominal wall muscles... in the approach) of the women and should respect the limits of the concept. The aim of Perineology is to restorate “ad integrum” the anatomy in the respect of biomechanics and physiology. Ideally, each defect must be corrected without inducing troubles on the other levels (primum non nocere). The benefit - risk ratio has to be evaluated for each of the procedures. In surgery, seven key procedures are proposed to obtain such a result (defect specific, efficient and low risk) in the majority of the cases. The functional state of the perineum can be summarized by a T.A.P.E. (Three Axis Perineal Evaluation diagram): - gynecological axis = sexual troubles - prolapse - urological axis = urinary incontinence-dysuria - coloproctological axis = constipation - fecal incontinence. The normal shape of the T.A.P.E is hexagonal. It is a good tool to introduce all the practitioner of this area in a more holistic approach of the woman. It is based on the history of the patient not on the clinical examination.

International Journal of Gynecology & ObstetricsVolume 70, Issue S4 p. D8-D8 Invited communication Perineology: Primum non nocere a new approach to pelvic floor dysfunctions Practical perineology: Examples Jacques Beco, Jacques BecoSearch for more papers by this authorJack Mouchel, Jack MouchelSearch for more papers by this author Jacques Beco, Jacques BecoSearch for more papers by this authorJack Mouchel, Jack MouchelSearch for more papers by this author First published: 11 December 2003 https://doi.org/10.1016/S0020-7292(00)82507-2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume70, IssueS42000Pages D8-D8 RelatedInformation

International Journal of Gynecology & ObstetricsVolume 70, Issue S4 p. D7-D8 Invited communication Perineology: Primum non nocere a new approach to pelvic floor dysfunctions From urogynecology to perineology Jack Mouchel MD, Jack Mouchel MDSearch for more papers by this author Jack Mouchel MD, Jack Mouchel MDSearch for more papers by this author First published: 11 December 2003 https://doi.org/10.1016/S0020-7292(00)82505-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS42000Pages D7-D8 RelatedInformation

anatomic approach developed by Delancey in the "hammock hypothesis."It is also possible to suspect pudendal nerve damage with a clinical examination and easy to confirm it with electrophysiologic exploratory procedures.Releasing these nerves with Shafik's procedure is the most appropriate and best-adapted solution to this type of problem. 3 This procedure, easily associated with suburethral sling and vaginal lifting procedures, brings about a better muscular control of both urinary and anal continence.Subsequently, the future, as conceived by Delancey, over the next 10 years is in many respects for us already reality.This reality, however, is still limited to a few practitioners who did not buy into Enhorning's theory.By not succombing to fashion and trends, they pursued the anatomic approach, which had guided their masters before them.

A new technique for curing urinary stress incontinence using the vaginal route and a sling of synthetic material, GORE-TEX, is described. The sling is fixed at one end on the junction between the cervix and the urethra in the centre, and at the edges to the tendons of the pubo-coccygeal muscles. The situation is worked out from a urethral profile. Thirty cases have been treated and the results have been satisfactory. If they are confirmed by other operators it will show that a new reliable technique which is very simple and non-aggressive can be used.

Twelve years experience with 6,000 incisions carried out in the Tertre Rouge clinic in Le Mans and 1,545 cases published by other authors demonstrate that the suprapubic transverse incision with section of the recti abdominis muscle is becoming more popular for pelvic surgery. The technique of the operation and its variations according to different authorities in different countries are fully described. There is also a review of the indications for the procedure, to show how it can be used for caesarean section especially when carried out under epidural anaesthesia. Finally, the incision is compared with those more usually used.