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Re: Allen-Masters syndromeFrom: quinnobgyn@aol.comThu Mar 22 08:36:34 2007
re Allen-Masters syndrome Very important set of observations in the 1950's when Allen (Nobel Prize for Medicine) and Masters (of Masters and Johnson) found these fascial injuries in women with wide-ranging pelvic pain ( and other irritative symptoms). They performed laparotomy on 28 and repaired the injuries - no-one got better. The key observation was that all the patients had prior difficult vaginal deliveries. In 1971 Allen returned to the subject and said that even relatively minor events like a deflexed head could be associated with such injuries (and concomitant neural injuries). We now know that these fascial injuries are firmly associated with extensive reinnervation (Atwel, 2005, Quinn, 2002-07). Hysterectomy not only removes much of the abnormal innervation but also the afferent pain pathways. There are two key sources of neural injury - sustained straining in childbirth and to overcome constipation. Hysterectomy with, or without, oophorectomy may be more effective in one aetiology or the other. Reinnervation appears to account for many gynaecological problems; denervation at the endometrial-myometrial interface may account for many antenatal problems (unproven). A fuller explanation with appropriate images will be found at http://www.anatomycourse.co.uk in two weeks time (upgrade in progress). If vaginal delivery (denervation) causes most of our present gynaecological epidemics. On what authority can any clinician turn down an informed request for Caesarean section - given that he cannot advise her of the 10 year risks (to her) of two vaginal deliveries or two Caesarean sections ? Regards. -----Original Message----- From: jane@helwig.net To: ob-gyn-l@dns.obgyn.net Sent: Wed, 21 Mar 2007 11.01PM Subject: Allen-Masters syndrome I had a new patient who walked in "to schedule a hysterectomy." She brings with her a paper from her former gyn in another location giving her a dx of Allen Masters syndrome. If anyone is knowledgable about this diagnosis I would appreciate enlightenment. Thanks,
-- Jane Helwig, MD, FACOG Private practice, 2 MDs Lancaster, SC
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