PERINEOLOGY: A NEW AREA

Abstract

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.