Editorial
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EDITORIAL: PERINEOLOGY… THE STORY BEHIND THE CONCEPT

by Jack Mouchel, Clinique du Tertre Rouge, Le Mans, France and Jacques Beco, Liege University, Belgium


The development during the early eighties of the procedure we later called the Mini-Vaginal-Tape (MVT) was the frst step on the road to the concept of Perineology.

Development of vaginal surgery for hysterectomy and genital prolapse during the late seventies and the early eighties led inevitably to the need for an efficient vaginal procedure for the cure of the stress urinary incontinence which proved to be frequent in this kind of patients.

Apart from the Marion-Kelly technique, no vaginal procedure was at that time regarded as effcacious enough and the “Gold Standard” for the cure of this urinary dysfunction was then (and remained until the late nineties) the Goebbel-Stoeckel and Burch procedures. The results of the MVT procedure, frst done in July 1985, led us not only to abandon the abdominal procedures but also to raise doubts with regard to the theory of Enhorning on which was
based these gold standard procedures.

In the same time our understanding of anatomy gained from surgical experience became more concrete during the late eighties with the three dimensional information provided by the new modality of pelvic ultrasound. This led us to defne collectively (with physiotherapists and radiologists) a purely anatomical concept (in contrast with the functional) to explain the different pelvic foor dysfunctions.

Finally, collaboration with Professor Ahmed Shafk of Cairo which started in 1994, led to a better understanding of pudendal neuropathy and levator plate sagging as the aetiology of some pelvic foor dysfunctions. This anatomical approach now is widely accepted but perhaps too focused on the connective tissue defects. It tries to explain the different perineal dysfunctions in terms of specifc anatomical defects. Connective tissue defects are more obvious but behind these are hidden other muscular and neurological defects responsible for the gradual development of the different anatomical and functional problems.

In reality it is the same anatomical structures (pudendal nerve, levator plate, pubo-rectalis , superfcial muscles of the perineum, pubo-cervical and recto-vaginal fascia) which are all involved in the anatomical arrangement of the perineum and in the integrated command of the different perineal functions. This led us to gather all the dysfunctions brought about by the defects of one or several of these structures into a sole concept which we called “Perineology”.
The frst detailed description of this integrated approach is in : “L’acte sexuel feminin, Mise à jour 1996, Publication du Collège Français de Gynécologie-Obstétrique, Vigot Ed, Paris”.

In order to bring together the physicians interested in the study and the treatment of these dysfunctions the “ Groupement Européen de Périnéologie (GEP) “ was created in November 1996. The GEP is a non-proft association that then organized three meetings in 1997, 1998 and 1999 and collectively published the book : “ La Périnéologie… Comprendre un équilibre et le préserver “. At the same time, the website www.perineology.com was created to facilitate communication between members and to propagate the ideas of the group.

Although the name “Perineology” had been quickly adopted, the concepts and teachings of the GEP were not readily understood or accepted. Firstly the concepts of Perineology were not widely disseminated outside the French language and secondly, adoption of these teachings were opposed by some French and Belgian academics who were self proclaimed key leaders in the understanding of pelvic foor dysfunction. The control of the conventional
medical media by these individuals has delayed the understanding of the concept of Perineology around the world but despite this the concepts pioneered by the GEP and like minded individuals have continued to gain credibility and the survival and future development of Perineology is now assured.



RESOURCES AVAILABLE FOR CLINICIANS
In addition to the information available on the Perineology website www.perineology.com the following references are provided.

Mouchel J. La fxation aux tendons pubo-coccygiens d’une fronde de Gore-Tex. Une technique simple de la cure d’incon tinence urinaire d’effort par voie vaginale pure. J Gynec Obstet Biol Reprod 1987; 16: 507-512.
Beco J, Sulu M, Schaaps JP, Lambotte R. Une nouvelle approche des troubles de continence chez la femme: l’échographie urodynamique par voie vaginale. J Gynecol Obstet Biol Reprod 1987; 16: 987-998.
Mouchel J. Traitement chirurgical de l’incontinence urinaire d’effort de la femme par soutènement sous-uretral par une bandelette de polytétrafuoroéthylène. Rev Fr Gynec Obstet 1990; 85: 399-405.
Mouchel J. Conception purement anatomique des troubles urinaires. In “Les troubles de la statique pelvienne”, Blanc B., Boubli L., Bautrant E., d’Ercole C., Arnette Editeur, Paris, 1993.
Beco J, Mouchel J. Faut-il encore faire des Burch? J Gynecol Obstet Biol Reprod 1995; 24: 772-774.
Mouchel J, Beco J, Bonnet P, Isambert J.L, Mouchel F, Wurst C. L’acte sexuel féminin: son intégration dans la conception anatomo-physiologique du plancher pelvien. In: Mise à jour en Gynécologie-Obstétrique 1996, Collège National des Gynécologues et Obstétriciens Français, M. Tournaire et H. J. Philippe éditeurs, Vigot diffusion, Paris.
Mouchel J, Beco J. Stress Urinary Incontinence : Here we are. Am J Obstet Gynecol 1997;177: 1561.
La Périnéologie… Comprendre un équilibre et le préserver. GEP Editeur, Odyssee 1372, Verviers, Belgique, 1998.
Mouchel J. From Urogynecology to Perineology. XVI FIGO World Congress, September 3-8 2000, Washington DC.
Beco J, Mouchel J. Practical Perineology: Examples. XVI FIGO World Congress, September 3-8 2000, Washington DC.
Beco J., Mouchel J.: Understanding the concept of Perineology. Int Urogynecol J 2002; 13: 275-277.
Beco J, Mouchel J. Perineology : a new area. Urogynaecologia International J 2003; 17: 79-86.
Mouchel T., 3D modelization of the pelvic foor : Static and dynamic aspects of normal, pathological and post-surgery anatomy. DVD (in French), GEP 2007



A TRIBUTE TO PROFESSOR AHMED SHAFIK

Ahmed Shafik Md. PhD.It is with a profound sense of sadness that we announce the untimely death of our Honoured President:

Ahmed Shafik, MD., PhD.

Professor of Surgery and Experimental Research in Cairo, Egypt

Professor Shafik published more than 1000 peer reviewed papers during his long and celebrated career. Many of these papers were landmark papers concerning the anatomy and physiology of the pelvic floor. He always thought of the perineum as a whole and was probably the first real Perineologist.

Since 1994, we have had the great privilege to be taught by Professor Shafik who became a true mentor as he transmitted to us part of his huge knowledge. Professor Shafik was a generous and kind teacher and a wonderful human being. His publications which describe the role of the pudendal nerve and the levator plate will remain keystones in the understanding and teaching of Perineology.

Thank you Professor Shafik. We are very sad you are already gone.

For the “Groupement Européen de Périnéologie”

Jack Mouchel and Jacques Beco

Contact Details: Contact the GEP via the website at www.perineology.com
Dr Jacques Beco E-mail: jacques.beco @ skynet.be