(128) Pelvic Pain in Tarlov Cyst: Pathognomony in Gender Inequality

Abstract

Abstract Introduction The production of knowledge having long been the prerogative of men, scientific research and patients care are still largely unequal in the field of medecine and surgery: the construction of a weak, spontaneously painful female nature is accepted as a cause of the historical delay of 130 years in the diagnosis of endometriosis. but who knows Tarlov cysts, getting lost in a maze of protean urogenital and somatic symptoms? Pelvic pain leads always to the search for a local cause by examination, ultrasounds, sometimes MRI as well as biological explorations. At least, if nothing is found, the pain is mainly attributed to depression, whereas depression is a consequence of this chronic pain and lack of adequate care. Objective To be able to identify symptomatic Tarlov cysts in front of pelvic pain with or without other various symptoms. -in presence of unexplained pelvic pain, urogenital or sexual symptoms without local cause and without compatible clinical features such a Marfan syndrome, neurofibromatosis, Ehlers Danlos, other -especially if it exists urinary or sphincters disorders -knowing that Tarlov cyst can become symptomatic after childbirth -know that when discovered incidentally, an asymptomatic Tarlov cyst does not usually require treatment Methods Literature review on PubMed for the last ten years Results For the last ten years we found only eleven relevant results for the keywords Tarlov cyst and pelvic pain and Tarlov cyst and adnexal mass: in the presence of atypical or persistent pelvic pain the differential diagnosis occurs at four levels: -pain persists despite the treatment of a first etiology -a large Tarlov cyst can mimic an adnexal mass, although this is very rare, with only twelve cases described so far -gaining the patient's trust may lead her to describe the persistent genital arousal disorder, that is unwanted, intrusive and sometimes painful sensation of genital arousal, more than 60% of these patients would have a Tarlov cyst according to some authors. -Some symptoms such as early sensation of bladder filling, or urinarybladder or lumosacral symptoms might be overlooked by the patient herself, making diagnosis more difficult. Conclusions Tarlov cysts are extradural menigeal cysts, usually at the sacral level of the spine. their prevalence can reach up 13% of the population, and is largely female, 75 to 90% of the described cases, may be explained by thinner meninges in women compared to men and by the tilt of the pelvis, providing a stress on the spine. 1% of Tarlov cysts are symptomatic and require a specific,,usually surgical, treatment. This work has limitations in particular because of a poor literature about this subject, but highlights: - the importance of a neurological opinion in front of pleiomorphic female pelvic symptoms - the lack of scientific research for an essentially female pathology. Disclosure No