Posts from — April 2010

Hi. I’m really scared and worried. I had sex a week ago and don’t really remember it due to an alcohol blackout (which is horrible in and of itself), but apparently it was for an extended period of time so I think I was pretty dry for the duration. I thought the first couple of days that I had a vaginal infection due to a lot of irritation and pain when urinating. I was constantly searching on the internet for an answer. (I couldn’t get in for a doctor’s appointment until this coming week – on 10/26.) Last Wednesday though, I noticed when I felt into my vaginal area, that it feels as though my vaginal walls have collapsed and it’s near my vaginal opening. I’m almost positive it’s a pelvic organ prolapse, but I haven’t read anywhere that it can be caused due to intercourse. Everything seems to mention childbirth and age being the causes. It must be possible through intercourse too because I think it’s happened to me. I’m horrified at how this will affect my life — quality of life, having kids, having sex. I’m only 36 years old and have not had children yet. Also I haven’t had very many partners and the last time I had sex before this was two years ago. If you would please respond back with any insight and advice, I would really appreciate it. Thanks.

Hello Ms. M,
By now you likely have your answer, as the response to your question failed to post and it’s been some time since you wrote in. Now, prolapse is definitely much more common in women who have given birth, but can and does occur in young, fit healthy women who have never been pregnant. Sex is not a known cause of prolapse – if you DO have prolapse, likely it was happening to you gradually with the sex/irritation/self-palpation of prolapse a coincidence. My youngest “never pregnant” patient with prolapse was a 31 year old, very fit, dancer, yoga practitioner who came in with severe enterocele and uterine prolapse. It can happen to anyone is the point, even if you are thin, young, fit and never stressed your pelvis with a pregnancy.

If you do have prolapse, it needs pessary support to keep it from getting worse, or surgical repair done carefully to resuspend the prolapsed parts without using any permanent graft materials that might complicate a pregnancy. Keep me posted – and for more information, you may want to peruse my book on incontinence, prolapse and vaginal rejuvenation – see http://www.plumbingandrenovations.com.

Best Regards,

Dr. R

I am a 57 yo female with chronic health issues. My clitoris has shrunk to almost nothing and I noticed that when urinating It comes from inside my vagina. I can see where the urine is coming from. Can you tell me what has happened to cause this problem. Possible prolapse of the vaginal wall? I do not have any symptoms other than a vague feeling of fullness in my vagina. Any comments would be greatly appreciated. I do have an appt with gyn coming up on the 1st of Dec. Thanks

Hello,
Explain your symptoms to your gynecologist exactly as you did here, and ask about thinning and shrinking of the vaginal and vulvar skin and structures due to estrogen deprivation. This condition is called atrophy, and is common after menopause, causing many of the symptoms you describe here. You may find this link helpful – http://www.drozfans.com/dr-ozs-advice/dr-oz-womens-health-taboos-pain-during-intercourse-sex/

I agree, your symptoms do not sound like prolapse, however you can ask your gynecologist to double check for prolapse just to be sure.
Best Regards,
Dr R

Hello! Thank you for a wonderful website!
Are there any surgeons trained to do the Uterosacral Vaginal Hysteropexy
 proceedure in Asheville, North Carolina?
Hello Ms. S,
My specific uterine resuspension technique is known to a few colleagues in the specialty, thus far all in and around New York. You may be able to find a specialist skilled at an alternative uterine resuspension procedure, however, by going to http://www.augs.org find a physician page and asking the office staff whether uterine resuspension is something specialists close to home can do for you. Or come on up to New York – I take care of patients from all over, and for out of town patients we have arrangements with several hotels. If you want to learn more about the alternatives, you may also find my book a helpful and portable resource – see http://www.plumbingandrenovations.com. I am pleased that you are better informed about your prolapse options!
Best Regards.
Dr. R

Hi

I have urge in urination . My uterus has one gland inside which is very small which is situated beside the bladder. Hope this is pressurising the bladder.
Please suggest to get rid of this.

Thanks

Hello -
Urge urination has several possible causes. Urge urination is most often due to the condition called overactive bladder.You are best served by seeing your gynecologist, a urogynecologist or female urologist for a bladder function evaluation to determine which therapies may work for you, and whether or not the cyst you describe in your uterus is contributing to your symptoms. 

Best Regards,
Dr. R

Yes I am a physically active healthy senior !
Yes I do have four adult children!
Yes I do wear an E-ring.
Yes I was having a wonderful sexually active relationship.
But now I have urethral prolapse and feel as if I cannot cope. Is there anyone willing to respond to my problem? Here at UCSF the idea that I would wish to continue feeling like a normal woman at my advanced age is not considered valid. yes I would travel for more care.

Aurelia
Hello Aurelia,
I hear you! Regardless of age, no woman should suffer uneccessarily with pelvic floor disorders. And you need not travel – UCSF has a fantastic urogynecology team – please contact the department of gynecology to schedule a urogynecology appointment. Urethral prolapse is treatable and you need not travel far.
Best Regards,
Dr. R

hi, my name is holly and I’m 27, after the birth of my second child i began experiencing an intense pain on the vagina when having sex (always) and inserting tampon (sometimes).  The pain is in the exact spot of my episiotomy(the five oclock hour on the vaginal entrance ) anyways my ob-gyn has tried cortisone creams as well as a hormonal cream and feels at a loss hes considering doing surgery to cut out that spot and resew it although isnt certain it will help. He’s baffled by the fact that there is no scar tissue or anything visible but is certain that there is some trigger point there. Is this something you deal with in your practice or is there someone you might know of that might im from the tri state area also i had come across something called a fentons procedure is that related to my issue

thank you very much

holly

Hello Holly,
It can be difficult to figure out exactly what is causing this kind of vaginal pain when there is no evidence of scarring in the area. You may want to see a vulvar pain specialist, and I recommend http://www.cvvd.org for this condition. It is something that I see in my practice as well. I believe your doctor’s reticence to rush in and operate is wise, as the balance between relieving the pain and inducing more pain is clinically challenging even in the most experienced hands.
Best Regards,
Dr. R

Dr. Romanzi, I had a partial hysterectomy (only uterus removed) in 1999 because of Fibroid Tumors, there were so many of them the doctor lost count. My problem is now my bladder is weak and I have constipation. I went to a doctor recently and he told me about vaginal prolaspe because he could see it when he examined me. I was told I did not have to have any more pap smears because of the partial hysterectomy. My doctor says the ligaments from the removal of my uterus may be attached to my intestine cause my constipation. I am so miserable, I lucky if I have two bowel movements in a week, and when I do they are so hard and very little is defecated. He said I could have surgery to remedy all this, oh yes, I initially went to him because I have a large cyst on my left ovary that is now causing discomfort. He said the size is the size of a golf ball, it was 7 it is now 4, the cyst was found September of 09. Please advise and thank you.

Hello Ms. C,
Your prolapse, constipation, bladder control problems, ovarian cyst and pain are certainly a complex mix of problems. I suggest that you work carefully with your doctor, so that you understand what is contributing to these symptoms and how surgery may help you. It is often helpful to see a constipation specialist or a general gastroenterologist, so that diet and medications may be tried for the constipation symptoms even before going to the operating room for the ovarian cyst and prolapse. You may also benefit from non-surgical therapies for the bladder control problems, and these therapies are sometimes helpful even before prolapse surgery.
Best Regards,
Dr. R

Desperate to see another MD after two failed surgeries in less than 3 yrs. First had complete hysterectomy, sling proedure w rectocele repair. Second was sacral colpopexy using synthetic mesh. Saw same urogynocologist this wk who wants me to have anal sonogram defecography, standing pelvic mri. Would you consider seeing me? Otherwise healthy, trim, married. What are other options? This current Dr says pessary is temp solution. Please advise-thanks so much.
Hello Ms. L,
You situation is most difficult. All reconstructive surgeries are prone to complications, like recurrence, or persistent dysfunction in the involved body parts even after everything is put back into place, and I am sorry this is happening to you. I can certainly help you if you want to contact the office to schedule an appointment. Please fax or email your operation reports, imaging, and other (cystoscopy, urodynamics, defecography, the MRI if you get it done…) in advance of the visit for my review. Or you may go to http://www.augs.org to find another urogynecologist in your area. If symptoms are primarily colon and/or rectum, you may also benefit from a consultation with a colorectal surgeon. 

 Best Regards,
Dr. R

My mother is 77 years old and her uterus is almost hanging out. It is protruding so much that you can see it. What do we need to do ?

Hello Ms. Jones,
The formal name for your mother’s condition is uterine prolapse. Prolapse may be managed without surgery using a pessary. Most gynecologists and gyn nurse practitioners (and a few midwives!) fit pessaries, so you might start with her gynecologist of record. Or you can use http://www.augs.org to find a prolapse specialist in your area to fit a pessary that her gynecologist can then manage for her. If pessaries don’t work, reconstructive surgery may be considered. I hope this helps – you may use my book on prolapse as a guide – http://www.plumbingandrenovations.com. While it is frightening, please keep in mind it is not life threatening and it can be managed comfortably almost all of the time.
Best Regards,
Dr. R

On Dr OZ show , you talk about hormonal
vaginal cream and suppository for painful sex during menopause . what are
the name of the creamand suppository ?
Thank you .
Hello Jo-ann,
The vaginal estrogen cream may be compounded by your local pharmacist, or ordered by your physician. The one I most frequently use is called Estrace. The suppository likewise may be compounded by your pharmacist, or your doctor can prescribe VagiFem – this was the one I used on Dr. Oz show. The estrogen ring we talked about on the show is called Estring. You gynecologist can help figure out which one of these options is best for you. They all deliver plant-derived Estradiol, the major estrogen coming out of the pre-menopausal ovary. Keep me posted!
Sincerely,
Dr. R