The patient is a 46-year-old woman, gravida 3, para 3, admitted to the hospital for a sched uled vaginal hysterectomy and bilateral salpingo-oophorectomy.

The patient is a 46-year-old woman, gravida 3, para 3, admitted to the hospital for a sched uled vaginal hysterectomy and bilateral salpingo-oophorectomy. The patient has an extensive gynecologic history and was most recently seen for dysmenorrhea and dyspareunia. She stated she was having prolonged, heavy menses with disturbing premenstrual syndrome that was last ing 3-4 days before the onset of the menses. Six months ago, an outpatient laparoscopy was performed and extensive endometriosis of the uterus, ovaries, tubes, and pelvic peritoneum was found. Lysis of adhesions and ablation of the endometriosis was attempted but due to the extensive nature of the disease, it was known the procedure would not be entirely successful. In addition, the patient has been diagnosed and treated for genital herpes on one occasion, mol luscum contagiosum, diagnosed by vulvar biopsy, and cervical dysplasia described as mild to moderate that was investigated with 11 different biopsies. All subsequent pap smears have been normal. Despite continued treatment, the patient still suffers from chronic pelvic pain, dysmenor thea, and dyspareunia. After discussing her treatment options, the patient consented to a vaginal hysterectomy and bilateral salpingo-oophorectomy to treat the extensive endometriosis of the various sites previously described. The surgery was accomplished without difficulty, and the patient was able to go home on day 3. An additional diagnosis was added to the record when the pathology report was reviewed by the surgeon. The pathologist’s report confirmed the endome triosis as well as a small lesion of the cervix that was found to be carcinoma in situ of the cervix