Ask The Expert |
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"It is in your best health interest to see your gynecologist or primary care physician regarding specific medical problems or concerns." This month's topics
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| Thank-you~ A Road to Healing | ||
| I just wanted to thank you and
share my success story with your readers. I suffered from a
chronic yeast infection for six months. The doctors gave me
DiFlucan, one dose, and told me it would clear up. It did not
clear up and only got worse. My vestibular glands became irritated
from the yeast and the
pain was debilitating. When I returned to the doctor, he told me I
was not testing for yeast and I needed to insert antibiotics and apply
hydrocortisone. The problem persisted. About eight months in to this nightmare, I came upon your website. With information I learned from you and your readers, I went to a new physician for help. She tested my Thyroid levels and discovered I was low thyroid. She gave me medication for the Thyroid problem. She then put me on a very strict diet that excluded sugar, alcohol, white flour, cheeses, fermented products like vinegar, and moldy foods. I also began taking two natural antifungals; caprylic acid and garlic. It did take a full eight weeks, but the yeast infection finally cleared up and the vestibular glands normalized. My thyroid condition had compromised my immune system; with a weak immune system, my body was unable to fight the Candida. Interestingly, with the diet and the supplements, several other symptoms disappeared: fatigue, loss of concentration, PMS, dry skin. I truly feel like a new person! I hope you will share this information with your readers so others may possibly avoid the frustration and misery I endured. Thank you again for being part of my roadmap to restored health. |
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| Chronic Pelvic Pain | ||
| Question:
Vaginal Pain For the past seven years my wife, now 69, has complained of a terrible pain in the vaginal area, (about two inches inside). As I have investigated, I have found a "hair like string" from the top to the bottom of the vaginal. For the past two years a Dr. has been "stretching" this area. To date the "string" is still there and the pain is constant with intercourse. If you have any suggestions, We would certainly appreciate it. I have been trying to find out about lazier surgery, with no avail. Or do you have something better. Husband Bob. |
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| Answer: I would suggest your wife consult a gynecologist and have a complete history and physical examination. I am not sure I understand the current situation (for example, is this "string" a small vaginal septum; if so, it is unlikely to be responsible for pain, and regardless could be excised if absolutely necessary rather than stretched). Good luck, and thank you for your
e-mail! |
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Question:
Diamond Cut Surgery My daughter has been suffering from chronic pelvic pain in her vagina, it has been going on for about one year. The doctor can see a sensitive spot with an examination and it is more painful when touched, during the exam. He has tried various shots medications and steroids and now wants to do what they call a diamond cut surgery to remove the sensitive area. Have you ever heard of this surgery, what are the odds that this will help? What is the down side? |
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| Answer: I am not aware of this procedure, and would suggest a second opinion just to be prudent. This is nothing against your daughter's doctor, but it is appropriate in many cases to seek a second opinion before an elective procedure since there are different ways to approach chronic pelvic pain. In any event, the diagnosis is not entirely clear from your description. For example, does your daughter have vulvodynia (chronic vulvar pain syndrome)? In such cases, surgical treatment is a last resort, although there are instances where it may be beneficial. I would also clarify the nature of the surgery-perhaps her doctor is referring to making a diamond-shaped incision to excise the painful area, but I am not clear what is being treated by this. If there is vaginal endometriosis, excision would be very appropriate, but is there a definite lesion associated with the sensitive area, and if so would a small office biopsy be appropriate? I would recommend clarifying the situation before embarking on any surgical procedure, which is perhaps a good principle in general. Thank you for
your e-mail! |
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Question:
Why am I not pain free? I was diagnosed with endometriosis after having a laparoscopy about 7 weeks ago. I have always had extremely painful periods and cramps...and finally I thought "yeah!! finally something is being done about this!" My doctor said it was all removed and that I should be pain free from then on. Well, I'm not. I had my first cycle after the surgery and I was in bed for 4 days before I even started my period and then another 4 days during from excruciating pain. I couldn't even walk. It was the same old thing. If I had all the endo removed, then why is my pain still so terrible and maybe even worse? (with definitely heavier bleeding and clots) What was the point of getting the lap. done if I am still living in pain? Is this normal? My doctor said something about endo being where they couldn't see it in a normal lap. and that is another whole surgery in itself. What is that about? I was so excited not to have to live with this anymore, now I am just really depressed and angry because I am still having serious pain. Is this normal? |
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| Answer: I sympathize-in general, it is unrealistic to assume all patients will be "pain free" after treatment of chronic pelvic pain, including that due to endometriosis. While surgical treatment of endometriosis is often very successful, not every woman will benefit. There are a few points I would like to make along with some questions: * One cycle after surgery is perhaps too early to judge the success or failure of a procedure for endometriosis. In some cases immediate benefit is apparently seen but diminishes with time, and in other cases no immediate benefit is seen but is obvious later on. * It is possible that deeper endometriosis remains, which can be responsible for pain. Even with excisional methods, this may happen. * Some endometriosis may not be visible even with the most careful laparoscopy, which is what I think your doctor is indicating as well. * Was your endometriosis excised (removed) or was it vaporized using either a laser or cautery? * Was the diagnosis confirmed with a biopsy? This is not necessary in
many cases, but a positive biopsy would of course absolutely confirm
that your symptoms are likely due to endometriosis and not something else. Good luck, and thank
you for your e-mail! |
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Question:
Endometriosis & IBS I am a 23 years old and have had pelvic pain for three years. Last year I was diagnosed with endometriosis and irritable bowel syndrome. I have had minor pain associated with these diagnosis. The past two moths my pain has been severe and I have seen my obgyn doctor several times. He writes a pain prescription and sends me on my way. Please Help Me!!! |
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| Answer: My only suggestion would be to discuss your care with your doctor, pointing out your perceptions that you might not be receiving the attention you require. If that is not successful, you may want to consult another gynecologist, preferably one who is specialized in the management of endometriosis and chronic pelvic pain. Good luck, and thank you for your e-mail! |
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| Question:
Hemorrhagic Nodule For the past two years I have been in pain. I had a laparoscopy and was told I have endometriosis. I have had three other surgeries including a LAVH/ Lso and Rso/Appendectomy. I was also DX with Adenomyosis and adhesional disease. The thing that is bothering me is, they keep finding these nodules. Pathology states it is a hemorrhagic nodule. What are these nodules? Why do they cause pain and will they continue to grow? Or could the pain be caused by the Endo? The doctors said I need to learn to accept that I will always be in some sort of pain for the rest of my life. I can't accept that, I just can't. |
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| Answer: In a nutshell (and with apologies to my pathology colleagues for my omissions), such nodules are part of an inflammatory process. Whether or not they are responsible for pain is hard to say, but my suspicion is that you have pelvic adhesions (not surprisingly, given your surgical history along with endometriosis). That being said, I respectfully disagree with whomever said that you have to accept your pain for the rest of your life. There are many things that can be done to manage pain, and this may be a matter that is ideally addressed in a multidisciplinary pain center. I do think that additional surgery, in my experience, may not be helpful. A management plan to deal with your pain in a non-surgical manner would be preferable, and this is where a multidisciplinary center can be particularly helpful. Keep in mind that such centers may benefit only about 50% or less of patients with chronic pain, but that is still higher than most other management options. You may want to ask your doctors about such centers along with other options to manage your pain in a way that is optimal, safe and effective. Good luck, and thank you for your
e-mail! |
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| Question:
Lower Abdomen Pain I have been experiencing pain in my left lower abdomen since the end of May. I went to the doctor and have had several tests performed. I have had both an abdominal and pelvic ultrasound, an Upper GI, Barium Enema, and Sigmoidoscopy. All tests came back negative. I am scheduled for a laparoscopy. The past week I was in the emergency room because the pain had was so bad that I couldn't even sit in a chair. Do you have any advice or suggestions? It would be greatly appreciated if you could give me your opinion on what else to do. I feel like I am mental. |
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| Answer: I cannot offer any additional insight, since many things are possible. The planned laparoscopy may help clarify the situation, so any comments by me would be premature at this time. Good luck, and thank you for your e-mail! |
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| Question:
Humungous Varicose Veins I'm 32 years old and I have been having pelvic pain on my right side for about 2 1/2 years. I had a laparoscopy in September of '99 and my doctor found humungous varicose veins. I have never had children. He said that this type of problem is usually found in women who have had children. He asked other doctor's and they said they have never seen anything like it. He recommended a hysterectomy but would not do it because of my age. I saw a second and when he saw the pictures taken from the laparoscopy, he was stunned. He showed his colleagues and they recommended a hysterectomy. The part that really gets to me is having constant pain on my right side, getting sick in the morning such as throwing up and every now and then, I have a fever. Hopefully if you can direct me to a website, I would appreciate it. |
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| Answer: I can't direct you to any Web site per se, but I can say that the indication for hysterectomy is not entirely clear, nor is the source of your morning sickness and fever. You may want to consider a second opinion for another perspective on this. Good luck, and thank you for your
e-mail! |
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Question:
Chronic Pelvic Pain Since the age of sixteen, I am now 22, I have been experiencing severe pain in my lower left pelvic area. I had been diagnosed with PID, but all tests for STDs have come back negative on several different occasions. I began seeing a GYN when the pain was beginning to increase dramatically and intercourse was no longer possible. My GYN performed a laparoscopy in which nothing was found, however, she did say that had she only seen the photos that were taken during the surgery without actually seeing it while performing the surgery, she would have diagnosed me with endo (does that mean I could possibly have endo?). She did find a large mass of entangled veins, but stated that shouldn't cause any severe pain. I have been given three choices and I really don't know what to do: 1) start on Lupron 2) have my nerve endings damaged 3) have another test done to determine if I have endo underneath my tissue-is that possible? The problem with the last option is I would have to travel at least three states away since their is no hospital nearby that furnishes the correct equipment for the procedure. Other than during intercourse, I am only experiencing the severe pain on occasion, usually lasting for 2-3 weeks at a time, then subsiding. Someone suggested I see a doctor specializing in internal medicine, rather than a gyn. What would you suggest? Thank you in advance for your thoughts and advice. |
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| Answer: It is not unusual for laparoscopic findings to be normal even in the presence of sever chronic pelvic pain. In some cases, deep endometriosis may be unrecognized at the time of surgery (which can happen even with the best laparoscopic surgeons). In other cases, the reason for the pain is not evident based on our limited knowledge of the causes of chronic pelvic pain in general. I am not, of course, in a position to make any sort of recommendation regarding your treatment. In a general sense, however, I can say that operations to interrupt pelvic nerves are not usually the first line of treatment. Uterosacral nerve ablation is not as useful as many of us once hoped, at least based on recent studies. Presacral neurectomy may be appropriate for a select group of women, but results are variable and it is hard to make any definitive statement on this due to lack of prospective studies. Also, presacral neurectomy can be occasionally associated with significant complications although when performed by skilled surgeons in appropriate patients it may be very useful on an anecdotal basis. Very importantly, however, neither procedure is effective in treating lateral pain (pain that is not in the middle of the pelvis). They will not treat pain on the lower left side of the body, for example. While there are special MRI studies that are promising with regard to detection of endometriosis, it is hard to say based on current data if they are better than laparoscopy in detecting clinically-significant areas of endometriosis. You may want to consider obtaining a second opinion, perhaps from a multidisciplinary pain center. I would not generally suggest seeing an internist over a gynecologist for this sort of issue, although it is certainly reasonable to consider non-gyn causes of chronic pelvic pain such as irritable bowel syndrome. I would also want to weigh the risks and benefits of any suggested intervention. Good luck, and thank you for your
e-mail! |
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| Question:
Chronic Pain Post Pregnancy My wife had a baby 6 months ago, since then she's had chronic pain. Its just inside the vagina both sides, she also gets a burning pain, and sharp pain down the legs. She's been to 6 or 7 doctor's none seem to be able to help, she's also been to physical therapy, they say its muscle damage. They started internal massages but this just made things worse. She's getting desperate and sees no end in site, can you suggest a way to go? |
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| Answer: Much would depend on what is the cause of the pain. For example, was an episiotomy performed, and/or was there significant birth trauma during delivery? Was a Cesarean section performed or was this a vaginal delivery? If a thorough evaluation has been done, the main focus would likely be on managing the pain and reducing its level. Evaluation at a multidisciplinary pain center may be appropriate, depending on the specialties of the providers who have already evaluated your wife. There are many things that can be done, but the important thing is to hook up with one or more specialists in pain management. Good luck, and thank you for your
e-mail! |
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| Question:
Is laparoscopy just a band-aid for CPP? I have had chronic pelvic pain for two years now. The pain is so intense I am in bed for two days. I have been checked for fibroids but none have been found. My doctor wants to do a laparoscopy and my second opinion said the laparoscopy is just a band-aid and if I have surgery I might as well have a hysterectomy. He also suggested I might have a lower GI, to make sure my pain is not from my lower intestines contracting during my cycle causing pain. At this point I have two different opinions and I am confused. I don't mind having a hysterectomy but what would your suggest be? |
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| Answer: Personally, I would mind having a hysterectomy especially if it is unclear at this point if it is or is not appropriate. I don't mean to disagree with anyone's personal physician since he or she is most familiar with a patient's situation, but laparoscopy as part of a chronic pelvic pain evaluation is not what I would call a band-aid. Only a minority of hysterectomies result in a relief of pelvic pain, so I would strongly suggest you consider other options first. There are many reasons why chronic pelvic pain can occur, including nongynecologic causes, so it is best to obtain a thorough evaluation before undergoing a fairly radical solution with unproven efficacy. You should discuss this with both gynecologists to help you make a truly informed decision. Good luck, and thank you for your
e-mail! |
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| Question:
Chronic Labor Cramps For several months I have been suffering with a series of severe abdominal pains, lasting for several hours after intercourse. They can only be described as very similar to labor cramps. My lower stomach gets hard and I feel the need to go to the bathroom. The only way I can cope with these pains is by sitting on the toilet for several hours and bearing down. After several trips to my GP, they eventually completed an internal, smear test and a scan to check for cysts, all tests came back normal. The only solution my GP can offer is that these pains must be the result of the mini-pill I am taking, which I switched to after several years of taking the combined pill. I have been advised to try the coil. I really find it hard to believe that the mini-pill can be the cause of my abdominal pains and I am frustrated by the lack of concern my GP is showing. This problem is also starting to affect my sex life as I am frightened that the pains will occur. I really would appreciate some advise about this distressing and problem. |
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| Answer: I share your concern. You may be better served by consulting a gynecologist. Not that general practitioners cannot practice routine gynecology, but no physician can be a master at everything. It is often best to consult someone who deals with these matters more frequently, particularly when your current provider has not been as helpful as you would desire. Good luck, and thank you for your
e-mail! |
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| Question: Chronic
Mystery Pain I've had pelvic pain on and off for the last year, about 6 times. The pain seems to appear in different areas, the lower abdomen and pelvis, but never lasting for more than 2-3 weeks. The pain increases dramatically with movement. I have consulted my family doctor and gynecologist who have not been able to find anything. I would greatly appreciate it if you could help to orient me as to what might be the cause and what specialist I might see. I also suffer from Reiter's syndrome. |
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| Answer: I'm not sure if Reiter's has anything to do with it, although it is important to know that you suffer from it. I would defer to your two physicians since they have much more comprehensive information about your situation. There are many potential causes of chronic pelvic pain, and it is not possible to speculate without knowing details of the evaluation to date. You may want to consider a referral to a gynecologist who specializes in chronic pelvic pain or even a multidisciplinary pain center, but that may or may not be necessary depending on the evaluation you have already undergone and the background and experience of the physicians you currently see. Good luck, and thank you for your
e-mail! |
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| Question: Chronic
Burning Pain I have had a sharp, burning sensation in my left lower abdomen, which has been increasing in intensity of pain and location. The pain begins one week before my period and continues until 2-3 days after, however this month the pain has dissipated but not disappeared. A recent ultrasound revealed several intramural fibroids on the right side of my uterus. Could this account for all of the pain I experience? I have had cultures taken for STD's which were negative. I don't have any pain during intercourse. |
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| Answer: The fibroids may or may not account for your pain; an accurate assessment can only be made by your personal physician or other healthcare professional. You should certainly follow-up with him or her regarding this matter. Thank you for your e-mail! |
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| Question: Pain
During Intercourse Worse Post Hysterectomy I am 38 and 2 years post/vaginal hysterectomy, ovaries intact. A posterior & anterior repair with needle suspension for bladder surgery was done at my request due to a prolapsed uterus. I sought surgery due to pain during intercourse, now it seems I have more pain than before. The pain is like childbirth and lasts 2-3 days after intercourse. I also have a sense of heaviness in the pelvic region. Before surgery, I went through a battery of tests and everything checked out ok. Is there anything I can do? I have been asked by a dear friend if my bladder has fallen, is this possible? Incontinence is no longer evident since surgery. |
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| Answer: One thought, which may be totally off-base, would be some irritation from the sutures used during the urinary incontinence procedure. Without knowing the exact procedure (I'm assuming is was a vaginal procedure, but this may not have been the case) it is hard to say with any degree of certainty. Your best bet is to contact the physician who performed the surgery, since anything I write at this point is only speculation. Good luck, and thank you for your
e-mail! |
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| Ovarian Pain & Cysts | ||
| Question: Chronic
Ovarian Pain I am a 29 years old and I have had chronic ovarian pain for almost 10 years. I have been to several doctors, and recently had a laparoscopy which showed nothing but a small cyst on my ovary. The pain has not subsided, and has recently become worse. I suffer from severe nausea and dizziness with the pain. No one seems to be able to figure it out. I have lived with it so long that it has just simply become part of my daily life, but it is growing increasingly worse. Do you have any suggestions? |
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| Answer: You may want to ask about a referral to a specialist in pelvic pain, possibly even a multidisciplinary pain center if available. There are many potential reasons for chronic pelvic pain, some of which are not gynecologic in origin, so it is important to undergo a detailed evaluation from those clinicians with particular expertise in this area. Good luck, and thank you for your
e-mail! |
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| Hysterectomy Pain | ||
| Question:
Pelvic Pain Post TAH I had a hysterectomy, due to many uterine fibroids. Since the surgery I have had a lot of pain, and it's getting worse every day. My doctor put me on medication for chronic pain and depression. I work full time and by the time I get home in the evening I am in a lot of pain. I have had a diagnostic laparoscopy and not much was found, except a "fatty apron" which they removed. Unfortunately, the pain has become worse. I am seeing my HMO physician and he is doing his best to help. Is there any other course of action that can be taken? Any help you could offer would be helpful and appreciated. |
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| Answer: I would defer to your current physician in this matter, since he/she is most familiar with your situation. Given that this has been going on for almost 2 years, evaluation by a multidisciplinary pain center may be a good option if necessary. Thank you for your e-mail! |
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| Question:
Pelvic Pain & Lost Ovary? I had a TAH with conservation of ovaries in 1999, due to a large fibroid. The surgery and recovery went extremely well, and it wasn't until October of this year that I started having lower right pelvic and back pain. I had a pelvic ultrasound and nothing was found, however, they could not locate an ovary. Could it be covered by adhesions and is this the reason for my pain? I have been referred to my OBGYN and I am waiting for my appointment. I have no other symptoms other than this pain. What is your perspective? |
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| Answer: While it is possible that ovarian remnant syndrome could be responsible (a particularly painful but uncommon condition caused when retained ovaries are trapped in scar tissue after hysterectomy), it could just as easily be due to pelvic adhesions in general. The fact that one ovary was not visualized does not implicate ovarian remnant syndrome; ovaries are visible by ultrasound regardless of the presence of adhesions, and it is not uncommon for one or both ovaries to be non-visable on ultrasound. Often this is interpreted as evidence that no ovarian enlargement is present, but unless the ovaries are seen and measured to be normal this is not definitive. It is good that you are having your pain evaluated, and this will likely be more helpful that my speculative comments. Good luck, and thank you for your
e-mail! |
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| Vulvodynia, Vulvar Pain | ||
| Question:
Vulvodynia I have read with much interest your advice regarding vulvodynia. I have had pain upon intercourse for years and no one has been able to identify a source for it. It seems to improve immediately after an antifungal regimen, such as Cleocin, as I am often diagnosed with a nonspecific vaginal infection. The pain upon penetration seems to return almost immediately. I plan to seek out a gynecologist in my area that specializes in vulvar pain. How do you recommend finding such a specialist? Also, my husband and I have had to resort to having sex using a condom, even though unnecessary for birth control due to his vasectomy years ago, because after sex I get a burning sensation from his semen. We use a common water based lubricant so I don't believe it is from dryness. I often tease him that I am allergic to him. Unfortunately, it is no teasing matter. Between the pain upon penetration and the discomfort after, we have not had intercourse in years. I would appreciate any suggestions you might have. |
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| Answer: One possibility is that you may have a sperm allergy-it is unusual, but might account for your symptoms. Regardless, one way to locate a specialist is to speak with your gynecologist or other personal physician about a referral. you may also want to seek out local teaching hospitals, since they are more likely to have academic-based gynecologists with expertise in this area. Don't give up trying to find someone who best meets your needs. Thank you for your e-mail! |
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| Question:
Vulvar Pain I was diagnosed with vestibulitis about two years ago and still don't understand much about it. I am able to manage pain a little with biofeedback. I have pain in the lower portion of the vaginal opening as well as in the vagina during intercourse. I almost always tear, regardless, of how much lubrication I use. I also have group B Strep and herpes. On top of that I come down with bacterial vaginosis and yeast infection at least once a month. I sometimes have as many as four different infections at a time. My husband and I are only able to have intercourse about once a month. I have tried everything, gentle soaps & detergents, baking soda baths, cold & warm compresses and therapy twice a day. I have tried steroid creams and estrogen creams. WE make sure we are both clean before and after intercourse. I have tried many more treatments too numerous to list. I am 24 years old and I just still can't believe this is happening to me. Why are there no answers. Why do I keep getting these infections that I had never had before these last two years. Will this ever go away. Will anyone ever know what causes this or how to cure it? I am sorry but I am desperate for help. I have been to countless doctors many of whom have never even heard of this, even the specialist in this field have few answers. I would appreciate any information you could give me. |
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| Answer: While we still don't fully understand vulvodynia (vulvar pain syndrome) and its variations, there are a number of things that can be useful in many women. These include medications like Elavil (an antidepressant that interestingly also affects vulvar nerve endings, hence its use in this disorder) and certain types of laser therapy (generally with a Candela laser). Rarely surgery is employed, but really is best used as a last resort after trying many less radical approaches. Any of a number of specialists in vulvar pain syndromes can hopefully be useful to you. Good luck, and thank you for your
e-mail! |
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| Other Questions | ||
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Question:
Should I get a Second Opinion? I was told I have an ovarian remnant. The left side of my scar from c-sections and other surgeries is very painful, it feels hard under the skin and it seems to bulge. It will burn and send pain up toward my belly button. My doctor wants to remove my uterus and cervix because there is a nodule on the back side of the cervix, and also remove the ovarian remnant. A few weeks ago I felt a pop and then a cold running sensation just above the bulge and the GYN said it may have been an egg being released. I had a tubal pregnancy 3 1/2 years ago and had an emergency surgery to remove it and the ovary (I lost the right ovary several years earlier). If it is just a remnant how can any eggs still be there? I have pain every day. My GYN is not going to cut into the scar because he thinks this remnant is giving me the pain and I think it is the bulge. Should I get a second opinion? I do not want to have this surgery and then still have this pain. |
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| Answer: My personal bias is that a second opinion never hurts when it comes to elective surgery. Any reasonable physician will not mind his or her patients seeking a secondary consult. Whether or not to seek out a second opinion is your own decision, but if there is uncertainty it may help clarify your decision. Good luck, and thank you for your
e-mail! |
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Question:
How do I find a doctor? I have been going from one doctor to the next since I was married. One specialist casually mentioned I may have vulvar vestibulitis and tells me I am too tense and my pain is psychological. I know that it's not a mental problem and am very frustrated that he brushes it off. If it really is this vulvar vestibulitis, can you recommend how I can find a specialist who will help? |
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| Answer: I share your frustration. The best ways I know to locate someone who has expertise in the area of vulvodynia (chronic vulvar pain syndrome) is to consult your local hospitals (particularly academic teaching hospitals), and consider some of the resources on the Web, albeit with caution. There are sites that contain lists of physicians interested in seeing patients with vulvodynia, but I do not know how such referral lists are verified and maintained so I would tread cautiously here. Academic hospitals are more likely in my experience to have the requisite specialists, particularly urogynecologists and gynecologic oncologists, who have the most experience with vulvodynia. I would probably start here, especially if the hospitals have expertise in urogynecology and vulvar pain syndromes. Good luck-finding a sensitive and experienced clinician with this knowledge base is not always easy, but well worth the time and effort. Thank you for your e-mail! |
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Question:
What is a Laparoscopy? My doctor and I are considering this procedure to try and cure a pain that's been bothering me quite a long time. My question is, how will this procedure be done and if there is any findings will it be taken care of there and then or will I need to schedule an office appointment? |
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| Answer: This is an important set of questions that is best addressed by the surgeon who will perform the procedure. Ideally, all of this should be answered as part of the usual informed consent process before the date of surgery. Please contact your doctor, whom I am sure would be very forthcoming with individualized answers to your questions. Thank you for your e-mail! |
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Question:
Unexplained Bleeding About a year ago, my doctor thought I had IBS because of some bowel problems. He scheduled me for a sigmoid, but before I had that test, a ovarian cyst rupture. I had an ultrasound done and that showed cystic lesions and fluid on my right ovary. They really couldn't find my left ovary so I am not sure if anything was going on with that one. My doctor said he would like me to have another pelvic ultrasound done in 3-4 months. A few weeks went by and now I am bleeding after intercourse. My doctor rescheduled the pelvic ultrasound done a lot sooner and that one showed nothing at all. I am still bleeding after intercourse and I'm not sure why. I know by reading one of your articles on this that lubrication could be a problem, but I feel, for me that's not a problem. Should I stop going to my GP and go to a gynecologist for a second opinion? How would I be able to find out if the bleeding is from adhesions or something worse?! I am 27 years old if that helps at all. |
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| Answer: While vaginal bleeding does not result from pelvic adhesions, consulting a gynecologist is certainly an appropriate decision. I would particularly suggest you make sure that your Pap smear is up to date, since postcoital bleeding (bleeding after intercourse) can sometimes be a sign of cervical dysplasia (precancerous changes on the cervix). Thank you for your e-mail! |
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Question:
Is there a Post UAE Syndrome? I am a woman of 50 with clots during my first few days of my period. I am exploring UAE. Is there a post-UAE syndrome and second question, what is sloughing? |
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| Answer: I'm not sure if in an academic sense a "post-UAE syndrome" has been definitively established. Anecdotally, however, some women do experience pain after uterine artery embolization for fibroids. Sloughing in general refers to a process in which a tissue layer is gradually abraded away, just as your skin rubs off with time in order for a new layer to emerge. The uterine lining also can slough off, which is what happens during a menstrual period for example. I would urge some caution, however. Before exploring any treatment such as UAE, given your age (over 35) it would be most appropriate to have some form of uterine sampling, such as an endometrial biopsy or hysteroscopy/D&C. This is in order to make sure that no premalignant or malignant (cancerous) changes are present within the uterus. Also, is your dilemma definitely due to fibroids? In women around the age of 50 with symptomatic fibroids, where there is no indication of any premalignant or malignant condition, GnRH agonist therapy may be a potential option for a few months to tide them over until they enter a natural menopause. Such medications create a temporary menopausal state (they should not be used for more than 6 months in general) that would hopefully alleviate any symptoms. Upon discontinuation of the GnRH agonist, such women may be close to entering a natural menopause by virtue of their age, in which case bleeding should no longer occur if it is an estrogen-dependent process (like fibroids). Regardless, please consult your gynecologist for more individualized advice. Thank you for your e-mail! |
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| Question:
Enlarged Uterus? What can cause an enlarged uterus? |
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| Answer: AN enlarged uterus can be caused by fibroids (most commonly), adenomyosis (a condition in which cells from the uterine lining also grow within the muscle layer), cancer, multiple previous pregnancies, and a few other conditions. Your healthcare professional can give you individualized information and advice. Thank you for your e-mail! |
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| Question:
Fibroid On Cervix I saw my doctor and was told I have a small fibroid tumor around the cervix area. What are my treatment options, since I have a lot of pressure. It feels like I can't empty my bladder. |
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| Answer: If the symptoms are severe enough to warrant treatment, options may include myomectomy (removal of the fibroid alone with preservation of the uterus), myolysis (use of electric current or cold temperatures to cause the fibroid to shrink), uterine artery embolization and hysterectomy. Which, if any, are appropriate for you depends on many things that are best discussed with your doctor. The decision must also be made in light of the potential risks of any of these treatments. Good luck, and thank you for your
e-mail! |
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| DISCLAIMER: The above represents material for educational and discussion purposes only. The material provided should NOT be used for diagnosing or treating any health problem or condition. It is NOT a substitute for consultation with and advice from qualified healthcare providers. If you have or suspect you have a health problem, consult a qualified healthcare provider. The author and any other party involved in the preparation or dissemination of the material presented are not responsible for any errors or omissions in the material provided above, or any results obtained from the use of such material. |
