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This month's topics

 

Chronic Pelvic Pain

Question: Chronic Pelvic Pain 
I am twenty-five years old and had a vaginal birth in 1999.  Sex was never the same for me, it was uncomfortable and painful.  I contributed this to the fact that my body was still recovering from my episiotomy which was 4th degree laceration.  I gave birth to my second child  a year and a half later.  Now the pain is sometimes unbearable, and has altered my joyful personality.  The tissue all around my vaginal area is tender and the muscles sometimes feel like they're being stretched and torn (not just when I'm having intercourse), this is a daily thing.  When I do "try" to have intercourse, it feels like all the tissue inside is being ripped, and when we finish, I am visually swollen all over inside, even around the urethra and the labia. My gynecologist thought this may be a lack of lubrication, but that is not the case at all.  We've used lubricants and get the same results.  I can no longer use tampons, which has definitely made my life more uncomfortable.  I have been to see my gynecologist time and time again but he has no answers.  He sent me to a "specialist" at the Vulvar Clinic.  This specialist was no specialist.  I went to see another (female) gynecologist, thinking since she was female, she would be more sensitive and understanding.  I still don't have answers.  They say my tissue looks normal and healthy.  I've been given one cream after another.  I'm tired of creams; I'm tired of paying medical bills that I can't afford.  All I know to do is cry.  I always try to give up until a month or two goes by, then I get the determination to look for answers again, in the hopes that there is somebody out there that can help me have a normal sex life, or at least numb the pain. Is there something somebody can do?  I hope you can help me, this is extremely depressing.  Thanks for your time in reading this lengthy letter!!  I appreciate any suggestions!

Answer:
While I cannot be of assistance personally, please do not get discouraged. I would suggest you continue to seek out a specialist who might be helpful. Please be aware, however, that we do not understand everything, or even much of anything, about chronic pelvic pain, and even the best specialist in this area may not be able to meet every patient’s expectations. Perhaps a discussion of expectations with your doctors might be helpful. Good luck, and thank you for your e-mail!  

David Toub, M.D.  


Question:  Can Fibroids Cause Back Pain? 
I am 48 years of age.  Fifteen years ago I had and laparotomy and laparoscopy done to remove endometriosis.   

A few years ago I started hemorrhaging at work and had a D&C.  They discovered I had many fibroids of various sizes.  The fibroids caused no further problems until about 2 years ago when I noticed a lot of low back pain and heavy periods.  In the last three months I have had severe, on and off on my right side.  I thought was either my ovary or possibly appendix.  I had an ultrasound done and my right ovary is enlarged.  I have a 1.8 centimeter cyst on my right ovary but my doctor is surprised that I am in this kind of pain for such a "small" cyst and has ordered a CT scan.  My mother died of ovarian cancer, both my sisters have both had hysterectomies due to ovarian cysts and tumors.  I'm deeply worried about what might be wrong.  My doctor tells me its probably pain caused by fibroids.  Can fibroids cause this type of pain?

Answer:
Yes, fibroids can cause back pain, particularly if they are in the back of the uterus and compress the sacrum (tail bone). However, given your cyst and history of endometriosis, as well as your family history, all possibilities should be considered. Please discuss this further with your doctor. Good luck, and thank you for your e-mail!  

David Toub, M.D.  


Question: Pain During Intimacy  
I'm a 17 year old who has never been sexually active.  I am scheduled for my first appointment with a gynecologist in the next couple of weeks because of a very irregular menstrual cycle.  I'm mentioning that not because I believe it has anything to do with my question, but more because it could a factor and I'd rather bring it up than risk leaving it out.  Just recently I decided that I might be interested in becoming sexually active with a close friend of mine who I have gotten to know quite well over the past couple of years.  I feel very comfortable with him, however, when we started to get intimate, and he touched my lower body, I experienced sharp jabs of shooting pain on both sides of my pelvic area.  At one instance my neck also stiffened simultaneously with the jabs.  So long as he didn't touch that region of my body I was fine.  Do you think this is my body's way of telling me that I'm not ready to be sexually active, or could there be something more serious going on?  It has taken me a very long time to feel this willing to share myself on an intimate level with another human being, and I'm frustrated by how resistant my body seems to be.  If you have any ideas about what might be going on, I'd appreciate any insight on the matter.

Answer:
Your doctor would be the best resource for you in determining what is going on. There are many possible things that could be going on, including tense muscles, anxiety, etc. as well as physical conditions such as vulvodynia, (chronic vulvar pain syndrome). It is good that you are open to discussing your situation, and your doctor can work with you to identify what is going on and how best to make things better. Good luck, and thank you for your e-mail!

David Toub, M.D.


Question: Ilioinguinal Neuralgia
I have not been able to locate information of Ilioinguinal Neuralgia not relating to the hernia. What is Ilioinguinal Neuralgia and what are the symptoms besides pain, painful periods and intercourse? Are there physical problems with this Neuralgia as well?

Thank you. I love your web site!

Answer:  
Thank you for your kind words! Ilioinguinal neuralgia generally causes pain relating to the nerve endings. Your doctor can be helpful in suggesting treatments and other resources. Good luck, and thank you for your e-mail!

David Toub, M.D.


Question: CPP   
In July, I sent you an e-mail about stabbing pain in the lower left region of the pelvic area.  At that time, I had seen a Gastroenterologist.  I have been having very severe pain, it doesn't matter what I am doing, it is still there.  It feels like someone is taking a knife into the left side of my pelvis, and most of the time I double over in pain.  I have been hospitalized 5 times for ruptured ovarian cysts in the last 3 years.  I have had two laparoscopies within 1 1/2 years, with only small cysts found.  I have been for pain management injections, physical therapy (heat & massage), hypnosis, birth control, Lupron, and the whole nine yards.  My ob/gyn told me before this last surgery, that if she finds nothing there she doesn't know what can be wrong with me!  I am scared to have intercourse with my husband, because it is very painful, and he truly understands what I am going through.  I am tired of not knowing what is wrong with me, and being in pain!  Is there a specialist out there that could possibly help me?  Thanks in advance!

Answer:  
I empathize, but the best person to discuss this with is your own doctor. You might want to ask him or her about local resources for pain management beyond what you have already encountered. If you have not been evaluated by a multidisciplinary pain center (which may or may not include the pain management service you consulted), that might be an appropriate option to consider with your doctor. Good luck, and thank you for your e-mail!

David Toub, M.D.


Ovarian Pain & Cysts

Question: Ovarian Cysts on the Pill?
I had surgery this past January to remove an ectopic pregnancy, and a large ovarian cyst. I went on the pill right after the surgery. The past couple months I have been experiencing lower pelvic pain in my left hand side, abdominal and pelvic swelling and bloating, and constipation. I had a CT SCAN by my regular physician, and they found no abnormalities except for multiple small cysts in both of my ovaries. I thought that was odd because I thought that you could not get functional cysts while taking combination pills. Also, the cysts are present in both ovaries. I am very confused and concerned, and would appreciate a response.

Answer:
While I would suggest you discuss this further with your doctor, there is no evidence that the pill prevents ovarian cysts, even though one would think it might. I am also assuming that you had a negative pregnancy test, since that is certainly a consideration in any woman with a history of ectopic pregnancy. If you have not had a pregnancy test, please contact your doctor immediately. Good luck, and thank you for your e-mail!  

David Toub, M.D.  


Endometriosis & Adenomyosis

Question:  Pain Post Hysterectomy 
I am a 41 year old women with severe pain, cramping, burning, in my right side. Almost 7 years ago I had a hysterectomy with removal of the left ovary.  At the time of surgery I had severe endometriosis, fibroids and everything was stuck together including the bladder and bowel. I thought after surgery everything was supposed to be ok and that surgery would take care of it.  Is it possible to get that stuff BACK??? Any information you can give me I would appreciate. My doctors act like it has to be in my head. 

Answer:
Unfortunately, hysterectomy is not necessarily a definite cure for many women with severe endometriosis. In some cases, recurrent pain may be due to adhesions (scar tisse), both from he endometriosis itself as well as the surgery. In other cases, endometriosis may persist. Please consult your doctor to discuss options, including ways to best manage your pain. Good luck, and thank you for your e-mail!

David Toub, M.D.


Surgery Pain & Adhesions

Question:  Severe Pelvic Adhesions
Can you tell me is there any non-surgical relief that can help with my SEVERE abdominal pain?  I have had severe abdominal adhesions and surgeries for them including a hysterectomy.  In March I had a right oophorectomy due to the ovary twisting and rupturing and becoming gangrene by the time they went in.  Adhesions were noted, but removal of them are questionable.  I have had severe problems with adhesions for approx. 10 years stemming from my first c-section.  I am very skeptical about having any more surgeries (the thought terrifies me) but the pain at the end of the day from just normal activities is killing me.  (Not to mention the fact that I can't exercise at all).  

Answer:
Your hesitation to have additional surgery is certainly understandable. Please contact your doctor to discuss possible non-surgical methods of pain management. Consultation with a pain specialist, such as an anesthesiologist, can also be helpful. Good luck, and thank you for your e-mail!  

David Toub, M.D.  

 

For Additional Information click here: International Adhesions Society


Question: Unexplained UTI Type Infection?    
I'm a 27 year old female.  For the past three months I've been dealing with symptoms I would think point to something, however no one can seem to give me any diagnosis.  It started with UTI type symptoms - pelvic pressure and urgency. Although my tests came back negative, I was put on two different medications.  It seemed to alleviate the symptoms for the duration of the medication.  However, the symptoms returned with more pain (very similar to ovulation, but on both sides).  The symptoms also subside when I get my period, but return a week after and last until the next period.  My doctor took me off the birth control pill to be sure I wasn't suffering from a low grade infection and I tried a third medication.  The doctor did not see anything on cultures or a ultrasound.  The pain again subsided when I was on the antibiotics.  Now, I'm off the medicine, the pain has retuned to my lower pelvic area (both sides) and radiates to the groin.  I also am experiencing leg cramps and weight loss.  Sex is uncomfortable and every once in a while I have a day or so of urgency.
Any suggestions?  I've been to both a urologist and obgyn to no avail...

Answer:  
I empathize with your situation, but have little to offer if both a urologist and ob/gyn could not offer solutions. If either did not discuss the possibility of a condition called 'interstitial cystitis,' you might want to bring this up. Please consult your doctors about where to go from here, since this is important and must be individualized. Good luck, and thank you for your e-mail!

David Toub, M.D.


Vulvodynia, Vulvar Pain

Question: Simple Questions, Simple Answers?  
I'm a 56-year old, post-menopausal due to a hysterectomy around 15 years ago for fibroids. I am in the midst of a miserable "illness".  For the past 6+ weeks I've been bothered with, what I thought, was a continuing bout of UTI's.  I did have a bladder infection in the beginning.  I've been to my clinic four or five times, put on various antibiotics to treat the bladder infection and given Diflucan to treat a possible yeast infection.  I just went to the clinic again because my symptoms weren't easing and I'm getting frustrated with "non-answers".  I was put on Terazol 7 for a week and had previously been on Premarin.  I rfound an article about chronic pelvic pain on the Internet and discovered the area on vulvodynia.  The symptoms sound amazingly similar to what I'm suffering from.  I copied off several articles on vulvodynia and dropped them off at the clinic for my health care provider to read.  

My question is, what can be done to "diagnose" this condition?  After reading the articles it seems a definite possibility that this is what I have.  I'm so miserable due to the pain and discomfort that my patience is wearing very thin.  All I want is an answer and hopefully, a solution.  Can someone cut through all the "medical lingo" and just give me straight symptoms and remedies, or is that too simplistic?  At this point any help would me much appreciated.

Answer:
I would suggest you discuss this with an ob/gyn who has expertise in the area of chronic vulvar pain. However, I would also suggest contacting a urologist since you seem to have bladder symptoms and some women with vulvodynia can also have a form of bladder pain called interstitial cystitis. In any event, it is essential that the diagnosis be confirmed, since it is not clear if you do or do not have vulvodynia. Good luck, and thank you for your e-mail!  

David Toub, M.D.  


Question: Lichen Sclerosis
I recently had surgery to suspend my bladder and remove my ovaries. During my initial doctor's visits a wet-smear of my vulva area showed bacteria and a biopsy diagnosed lichen sclerosis. The condition was at its best in years following the surgery. Could the strong antibiotics by IV be responsible for this? Three months later it has flared up again, but only after my husband and I resumed sexual relations. What I have read on this condition indicates that it is not contagious but the patterns that I'm noticing leads me to believe that oral sex may have something to do with this. Could a common bacteria found in the mouth (and/or similar mucous tissues) be related to this condition?

Answer:  
Lichen sclerosus is not related to infection, and I would suggest you discuss this condition with your doctor to best understand how to manage it. Fortunately, treatment readily exists for lichen sclerosus. Good luck, and thank you for your e-mail!

David Toub, M.D.


Other Questions

Question: Cervical Dysplasia & HPV Link
I am 30 years old and recently diagnosed with CIN 1 and 2.  I am following this with my doctor, but have some questions regarding HPV and the cervical/dysplasia link.  If up to 75% of the female population will be infected with HPV at some point in their lives, how come only 5-7% develop cervical dysplasia?  I understand that some types of HPV are more likely to cause cancer and some to cause only warts or to be asymptomatic, but is that all that accounts for that difference?  There seems to be more.  Why would one woman develop cervical dysplasia, while her past sexual partners other partners don't?  Is this a difference in immunity or nutrition?  Do we know what accounts for this difference, or is this an area still under research?

Answer:
Part of if does depend on the specific types of HPV involved (types 16, 18, and 31 are more likely to be  associated with cervical cancer, for example). Part of it also depends on a person's immune status. We don't completely understand everything about this, but there does seem to be a very important immune link involved, as well as possible other factors. Please discuss this further with your doctor.  Thank you for your e-mail!

David Toub, M.D. 


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.

 
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