Plumbing and Renovations » Ask Dr. R. http://www.urogynics.org/blog The official blog of Lauri Romanzi, MD Tue, 13 Dec 2011 09:25:50 +0000 en hourly 1 http://wordpress.org/?v=3.1.1 Ask Dr R: painful sex- perineoplasty? http://www.urogynics.org/blog/2011/08/ask-dr-r-painful-sex-perineoplasty/ http://www.urogynics.org/blog/2011/08/ask-dr-r-painful-sex-perineoplasty/#comments Mon, 22 Aug 2011 10:10:44 +0000 Lauri Romanzi http://www.urogynics.org/blog/?p=1297 Painful sex after menopause

Hello Dr. R,

I am a 51 year old that has pain upon entry, visited my doctor and he is suggesting a perineoplasty, is that the same procedure as a Fenton’s?  Is there anything else that wouldn’t be as invasive? I do not want to take hormones and I am not ready for my sexual life to be over.  Once the opening is loosened up a bit it doesn’t hurt as long as I use a lubricant. Would this be a senario for a perineoplasty?  Thank you so much!

 

Painful sex (dyspareunia) after menopause is best treated with a dose of creativity - rush not to the knife!

Dyspareunia: perspective from a urogynecologist

Hello L,

Without examining you, it is impossible to know if a perineoplasty is your only treatment option for painful sex (dyspareunia). I strongly suggest you seek second opinions from urogynecology specialists in your area, which you may locate through American Urogynecologic Society. Therapies may include vaginal estrogen, dilators, pelvic floor physical therapy, pelvic floor electrical stimulation, valium vaginal suppositories, or some combination there-of.  You may consider perineoplasty and Fenton’s to be synonymous for this indication. Keep us posted…

Dr R

 

Content herein does not represent medical advice. To learn more about pelvic floor disorders such as fistula, pelvic organ prolapse, dropped bladder, dropped uterus, hysteropexy uterine resuspension, vaginal laxity, rectocele, postpartum rehabilitation, vaginal rejuvenation, labiaplasty, vaginoplasty, Kegel exercise or incontinence please visit other posts in this blog and the Urogynics website at www.urogynics.org.
]]> http://www.urogynics.org/blog/2011/08/ask-dr-r-painful-sex-perineoplasty/feed/ 0 Ask Dr R: Pregnancy after urethral sling? Having second thoughts… http://www.urogynics.org/blog/2011/06/ask-dr-r-pregnancy-after-urethral-sling-having-second-thoughts/ http://www.urogynics.org/blog/2011/06/ask-dr-r-pregnancy-after-urethral-sling-having-second-thoughts/#comments Mon, 13 Jun 2011 02:30:44 +0000 Lauri Romanzi http://urogynics.org/blog/?p=1207 Urethral Sling & Pregnancy

Can you have a Urethral Sling operation and still have a child afterwards?  What are the option and risks? I had one about a year ago, and am having second thoughts about another child.C
Hello C, Some recent data shows that women have safely carried a baby to term and delivered vaginally after urethral sling operations. The risks are best discussed with the surgeon who placed the sling and your obstetrician who delivered your child(ren). Once a surgeon has operated on a patient, that patient always has the right to return to ask any question related to the surgery at any time.
All the best to you!
Dr. R

]]> http://www.urogynics.org/blog/2011/06/ask-dr-r-pregnancy-after-urethral-sling-having-second-thoughts/feed/ 0 Ask Dr R – To operate or not to operate? http://www.urogynics.org/blog/2011/01/ask-dr-r-to-operate-or-not-to-operate/ http://www.urogynics.org/blog/2011/01/ask-dr-r-to-operate-or-not-to-operate/#comments Mon, 17 Jan 2011 05:23:52 +0000 Lauri Romanzi http://www.urogynics.org/blog/?p=1006 I am scheduled in two weeks for cystocele and rectocele repairs and I am getting very apprehensive about these surgeries..about 3 months ago I got very constipated due to the rectocele..this caused 2 anal fissures and for my hemorrhoids to get worse..i went to an awesome colorectal doctor who did the lateral sphincterotomy surgery and the hemorrhoid stapling..i was also impacted and have no idea how that happened because i was having bowel movements every day…the colorectal doctor took care of the fissures and the hemorrhoids and put me on a high fiber diet..i am doing great now as far as that’s concerned..i still have the rectocele but it’s not causing any problems right now..i have an extreme fear of having the surgery and having problems start again with my bowels..would vagifem and kegel exercises work better for me?.sorry this is such a long comment.
Hello W:
The best situation for prolapse surgery, be it rectocele surgery, cystocele (dropped bladder) surgery, uterine prolapse surgery, or combination prolapse surgery, is when the benefits outweigh the risks. One of the advantages of considering prolapse surgery is that it is rarely if ever an emergency and usually not mandatory. So you have plenty of time to discuss the pros and cons with your surgeon, to get second, third, and fourth opinions, and to read more about your condition and treatment options, even if that means postponing the scheduled operation. I urge you to learn more about your options and the risks and benefits of each treatment option, surgical and non-surgical, before you undergo surgery that you are not sure you need. To find specialists in your area, search American Urogynecologic Society clinician locator. You can search by city or zipcode. Keep us posted!
]]> http://www.urogynics.org/blog/2011/01/ask-dr-r-to-operate-or-not-to-operate/feed/ 0 Ask Dr R: Orgasm vanished after removal of troublesome IUD http://www.urogynics.org/blog/2010/11/ask-dr-r-orgasm-vanished-after-removal-of-troublesome-iud/ http://www.urogynics.org/blog/2010/11/ask-dr-r-orgasm-vanished-after-removal-of-troublesome-iud/#comments Sun, 07 Nov 2010 21:39:42 +0000 Lauri Romanzi http://www.urogynics.org/blog/?p=845 Dr R,
I had a IUD put in and caused pain and bleeding and swelling to my uterus after intercourse. I had to go to the emergency room. Now Ive had one small orgasam in six months since and it made me bleed bad. Did it damage something inside. Can I repair this. Im afraid that my sexual life is over and Im only 37. Help
It is highly unlikely that the IUD and the inflammation of the uterus has ruined your orgasm. Discuss this immediately with your gynecologist, who can help you understand that your sex life is not over and your body is most likely working just fine, orgasms and all. If your gynecologist cannot help you, I suggest you visit  www.isswsh.org/resources/provider to find a sexual clinician convenient to you.
Best Regards,
Dr R
Dr R,
I had a IUD put in and caused pain and bleeding and swelling to my uterus after intercourse. I had to go to the emergency room. Now Ive had one small orgasam in six months since and it made me bleed bad. Did it damage something inside. Can I repair this. Im afraid that my sexual life is over and Im only 37. Help
It is highly unlikely that the IUD and the inflammation of the uterus has ruined your orgasm (anorgasmia). Discuss this immediately with your gynecologist, who can help you understand that your sex life is not over and your body is most likely working just fine, orgasms and all. If your gynecologist cannot help you, I suggest you visit  International Society for the Study of Womens Sexual Health – find a clinician to find a sexual clinician convenient to you.
Best Regards,
Dr R
]]> http://www.urogynics.org/blog/2010/11/ask-dr-r-orgasm-vanished-after-removal-of-troublesome-iud/feed/ 0 Ask Dr. R: 5 year marriage ruined by painful sex http://www.urogynics.org/blog/2010/10/ask-dr-r-5-year-marriage-ruined-by-painful-sex/ http://www.urogynics.org/blog/2010/10/ask-dr-r-5-year-marriage-ruined-by-painful-sex/#comments Sun, 31 Oct 2010 01:25:05 +0000 Lauri Romanzi http://www.urogynics.org/blog/?p=843 For almost 5 years now I’ve only had sex with my husband about 4 times due to very painful sex.  I’ve tried physical therapy, estrogen treatments, and dilators.  I’m at my wits end.   I don’t know who to go to or talk to about this since it is a very sensitive subject.  It is almost impossible for him to get the head of his penis inside my vagina.  Is there a way to loosen a vagina?  Please help.  Thank you.
From Dr. R:
Pain with sex can be caused by several conditions – vestibuilitis, endometriosis, spasm of the pelvic muscles, congenital defects of the vagina, urethra or bladder, and poorly healed scars from childbirth, among others. One of the best doctors I know of for sexual pain is Dr. Andrew Goldstein, <a href=”http://www.cvvd.org”>. A consultation with a gynecologist, physiatrist or physical theraptist who specialises in vestibulitits will be a good start on the road to a normal, pain-free sex life.
Best Regards,
Dr R
For almost 5 years now I’ve only had sex with my husband about 4 times due to very painful sex.  I’ve tried physical therapy, estrogen treatments, and dilators.  I’m at my wits end.   I don’t know who to go to or talk to about this since it is a very sensitive subject.  It is almost impossible for him to get the head of his penis inside my vagina.  Is there a way to loosen a vagina?  Please help.  Thank you.
From Dr. R:
Pain with sex can be caused by several conditions – vestibuilitis, endometriosis, spasm of the pelvic muscles, congenital defects of the vagina, urethra or bladder, and poorly healed scars from childbirth, among others. One of the best doctors I know of for sexual pain is Dr. Andrew Goldstein, Andrew Goldstein, MD, Vestibulitis Specialist. A consultation with a gynecologist, physiatrist or pelvic floor physical therapist who specialises in vestibulitits will be a good start on the road to a normal, pain-free sex life.
Best Regards,
Dr R
]]> http://www.urogynics.org/blog/2010/10/ask-dr-r-5-year-marriage-ruined-by-painful-sex/feed/ 0 Ask Dr. R: Want to Volunteer in the Democratic Republic of Congo? http://www.urogynics.org/blog/2010/10/ask-dr-r-want-to-volunteer-in-the-democratic-republic-of-congo/ http://www.urogynics.org/blog/2010/10/ask-dr-r-want-to-volunteer-in-the-democratic-republic-of-congo/#comments Wed, 27 Oct 2010 20:40:56 +0000 Lauri Romanzi http://www.urogynics.org/blog/?p=823 How do I volunteer for this?
Linda McDermott, CNM, FNP
Los Angeles CA
Hello!
To investigate volunteer options, go to www.hhi.harvard.edu and let them know you are interested in volunteering. This is the group I work with.
Or you can check out http://www.theirc.org/volunteering, which also has an established DRC post, and a volunteer program!
Best Regards,
Dr. R
How do I volunteer for this?
L M
Los Angeles CA
Hello LM,
To investigate volunteer options in Democratic Republic of Congo, go to Harvard Humanitarian Initiative and let them know you are interested in volunteering. This is the group I work with.
Or you can check out Volunteer Program at the International Rescue Committee , which also has an established DRC post in Goma, on the other side of the lake from Panzi Hospital Panzi Hospital in Eastern DRC.
Best Regards,
Dr. R
]]> http://www.urogynics.org/blog/2010/10/ask-dr-r-want-to-volunteer-in-the-democratic-republic-of-congo/feed/ 0 Ask Dr. R: 32 year old new mother with perineal damage, fecal incontinence and sexual pain http://www.urogynics.org/blog/2010/10/ask-dr-r-32-year-old-new-mother-with-perineal-damage-fecal-incontinence-and-sexual-pain/ http://www.urogynics.org/blog/2010/10/ask-dr-r-32-year-old-new-mother-with-perineal-damage-fecal-incontinence-and-sexual-pain/#comments Wed, 27 Oct 2010 13:13:57 +0000 Lauri Romanzi http://www.urogynics.org/blog/?p=821 Hi Dr. R.,
I was wondering if you could help me.  I’m 32, I delivered my first child after 2 years of trying (1 year with fert. treatments); suffered a 4th degree tear.  I have a very thin perineal wall left, my repair has broken down &amp; I’m having issues with fecal incont.  I have also been dealing with the skin at the tear sight reopening when I have intercourse with my husband &amp; I believe it opens with a bulky bm. I was given an estrogen cream (a couple of months ago) to see if that would help thicken the skin but I’m not really seeing too much improvement.   I have seen 2 rectal/colon surgeons (who have told me that there is  nerve &amp; muscle damage – also that the original repair has broken down) &amp; I was wondering if there is someone who I could go to to help me with both sides of the perineal wall?  Is there someone you could suggest?  I live in the Phila area, but I can travel to see someone who could help me.  These issues have effected my life not just physically but emotional too.
Thank you for any help you can give me.
H
Hello H,
I can certainly help you with your childbirth injury conditions. A careful evaluation will help sort out what therapies and procedures or surgeries will give you the best possibility of restoring your anatomy and function. To discuss and schedule a consultation please call my office. Bring all relevant operation, imaging and test reports with you. We take care of many out of state and international patients and my staff will help you with travel and hotel arrangements if needed.
If you cannot travel from Philadelphia to New York City, please use www.augs.org “find a provider” link to find a urogynecologist near you. Call each office to speak to the office manager or clinical care coordinator to explain your circumstances before scheduling. Do it now – there is nothing to be gained by waiting.
Best Regards,
Dr. R
Hi Dr. R.,
I was wondering if you could help me.  I’m 32, I delivered my first child after 2 years of trying (1 year with fert. treatments); suffered a 4th degree tear.  I have a very thin perineal wall left, my repair has broken down; I’m having issues with fecal incontinence.  I have also been dealing with the skin at the tear sight reopening when I have intercourse with my husband; I believe it opens with a bulky bowel movement. I was given an estrogen cream (a couple of months ago) to see if that would help thicken the skin but I’m not really seeing too much improvement.   I have seen 2 rectal/colon surgeons (who have told me that there is  nerve & muscle damage – also that the original repair has broken down). I was wondering if there is someone who I could go to to help me with both sides of the perineal wall?  Is there someone you could suggest?  I live in the Phila area, but I can travel to see someone who could help me.  These issues have effected my life not just physically but emotional too.
Thank you for any help you can give me.
H
Hello H,
I can certainly help you with your childbirth injury conditions. A careful evaluation will help sort out what therapies and procedures or surgeries will give you the best possibility of restoring your anatomy and function. To discuss and schedule a consultation please call my office. Bring all relevant operation, imaging and test reports with you. We take care of many out of state and international patients and my staff will help you with travel and hotel arrangements if needed.
If you cannot travel from Philadelphia to New York City, please use urogynecologist locator to find a urogynecologist near you. Call each office to speak to the office manager or clinical care coordinator to explain your circumstances before scheduling. Do it now – there is nothing to be gained by waiting.
Best Regards,
Dr. R
]]> http://www.urogynics.org/blog/2010/10/ask-dr-r-32-year-old-new-mother-with-perineal-damage-fecal-incontinence-and-sexual-pain/feed/ 0 Ask Dr. R: painful sex, PCOS, tilted uterus, vaginal septum http://www.urogynics.org/blog/2010/10/ask-dr-r-painful-sex-pcos-tilted-uterus-vaginal-septum/ http://www.urogynics.org/blog/2010/10/ask-dr-r-painful-sex-pcos-tilted-uterus-vaginal-septum/#comments Wed, 27 Oct 2010 12:58:50 +0000 Lauri Romanzi http://www.urogynics.org/blog/?p=819 Hi Dr. Romanzi,
I’m a 25 y/o female and have always had pain during sexual penetration. I have PCOS and a retroverted uterus, and am wondering if there might be a connection among those factors. Additionally, I had a transverse vaginal septum that was surgically severed 5 years ago. I was wondering if a physical examination and consultation with you would help me zone in on the potential cause(s) of my discomfort. I hope there are options for me, as sex should not be painful!
Best,
S
Hello S,
I can certainly help you figure out why sex is painful. Some, all or none of the conditions you describe may be contributing to your sexual pain. I also have a colleague who is expert in vestibulitis, a common source of sexual pain.  His website is www.cvvd.org, and his offices are in NYC, Washington DC and Maryland. An appointment with either one of us will be of great help to you.
Best Regards,
Dr. R
Hi Dr. Romanzi,
I’m a 25 y/o female and have always had pain during sexual penetration. I have PCOS and a retroverted uterus, and am wondering if there might be a connection among those factors. Additionally, I had a transverse vaginal septum that was surgically severed 5 years ago. I was wondering if a physical examination and consultation with you would help me zone in on the potential cause(s) of my discomfort. I hope there are options for me, as sex should not be painful!
Best,
S
Hello S,
I can certainly help you figure out why sex is painful. Some, all or none of the conditions you describe may be contributing to your sexual pain. I also have a colleague who is expert in vestibulitis, a common source of sexual pain.  His website is www.cvvd.org, and his offices are in NYC, Washington DC and Maryland. An appointment with either one of us will be of great help to you.
Best Regards,
Dr. R
]]> http://www.urogynics.org/blog/2010/10/ask-dr-r-painful-sex-pcos-tilted-uterus-vaginal-septum/feed/ 1 Ask Dr. R: Lichen planus and bladder irritability ruining 45 years of marital bliss http://www.urogynics.org/blog/2010/10/ask-dr-r-lichen-planus-and-bladder-irritability-ruining-45-years-of-marital-bliss/ http://www.urogynics.org/blog/2010/10/ask-dr-r-lichen-planus-and-bladder-irritability-ruining-45-years-of-marital-bliss/#comments Wed, 27 Oct 2010 12:48:50 +0000 Lauri Romanzi http://www.urogynics.org/blog/?p=816 65 year old female married 45 years, dropped bladder; lichen planus of vaginal opening experiencing decreased ability to urinate; discomfort; fullness of bladder/stomach AFTER ORGASM.
To ease discomfort next day I rest with pelvis tilted up while lying on my back &amp; feel “normal” again.  Exercise? Surgery? Medication? Is lichen planus catchy? Thinking of giving up sex….unhappy spouse. Feeling kinda sad.
Hello CP,
There is no need for you to amputate your sex life with your husband, and I’m certain you can restore your intimacy to it’s original state by working with a urogynecologist in your area. Visit http://www.mypelvichealth.org/FindaProvider to find a urogynecologist convenient to you. If locating a convenient urogynecologist is not possible, find a gynecologist who does only gynecology (no obstetrics) with a focus in menopause management.
65 year old female married 45 years, dropped bladder; lichen planus of vaginal opening experiencing decreased ability to urinate; discomfort; fullness of bladder/stomach AFTER ORGASM.
To ease discomfort next day I rest with pelvis tilted up while lying on my back; feel “normal” again.  Exercise? Surgery? Medication? Is lichen planus catchy? Thinking of giving up sex….unhappy spouse. Feeling kinda sad.
Hello C,
There is no need for you to amputate your sex life with your husband, and I’m certain you can restore your intimacy to it’s original state by working with a urogynecologist in your area. Visit http://www.mypelvichealth.org/FindaProvider to find a urogynecologist convenient to you. If locating a convenient urogynecologist is not possible, find a gynecologist who does only gynecology (no obstetrics) with a focus in menopause management.
Best Regards,
Dr R
]]> http://www.urogynics.org/blog/2010/10/ask-dr-r-lichen-planus-and-bladder-irritability-ruining-45-years-of-marital-bliss/feed/ 0 ivillage asks Dr R – what’s the deal with “sneeze and pee?” http://www.urogynics.org/blog/2010/07/ivillage-asks-dr-r-whats-the-deal-with-sneeze-and-pee/ http://www.urogynics.org/blog/2010/07/ivillage-asks-dr-r-whats-the-deal-with-sneeze-and-pee/#comments Mon, 19 Jul 2010 22:36:24 +0000 Lauri Romanzi http://www.urogynics.org/blog/?p=645 ivillage.com asked Dr. R to help out on a piece about urinary incontinence and many other embarrassing topics of the feminine persuasion – here’s a direct link to Dr R’s portion:

ivillage asks Dr R about exert and squirt urinary incontinence

Scroll through all the other topics as well. This review has something for everyone, guaranteed.

]]> http://www.urogynics.org/blog/2010/07/ivillage-asks-dr-r-whats-the-deal-with-sneeze-and-pee/feed/ 0