Celiac disease as a cause of chronic pelvic pain, dysmenorrhea, and deep dyspareunia

BACKGROUND: Celiac disease may be subclinical and difficult to diagnose in adults. It has been associated with infertility and miscarriage but rarely with other gynecologic symptoms. CASE: A 43-year-old woman complaining of chronic abdominal and pelvic pain, deep dyspareunia, dysmenorrhea, diarrhea, and a 5-kg weight loss during the last 6 months was referred to our institution. Laboratory and clinical examinations were negative. At laparoscopy, numerous small leiomyomata were seen. A few filmy adhesions between the small bowel and the abdominal wall were lysed. With the exception of deep dyspareunia, all symptoms remitted after surgery, only to recur at 6 months of follow-up. A diagnostic work-up for celiac disease revealed the presence of antigliadin and antiendomysial antibodies. The diagnosis was confirmed at gastroduodenoscopy including biopsy. A gluten-free diet was prescribed, and the patient is now free of symptoms. CONCLUSION: Celiac disease should be considered in women presenting with unexplained chronic pelvic pain, dysmenorrhea, and deep dyspareunia.