Hello Distressed,
Many women (most women) need foreplay to fully enjoy sex and to achieve orgasm. Your husband’s premarital record of routine female orgasms without foreplay is remarkable, unusual and almost unbelievable.
Your relationship would benefit from couples counseling with a board certified psychiatrist or psychologist specializing in sexual function.
This is not a problem about YOU. It is a problem about your relationship and conflicting expectations between yourself and your husband. If your husband won’t go, you will benefit from going alone.
Best Regards,
Dr R

Hello L,
You may benefit from transdermal OAB medications, of which there are 2 options, one gel and one patch. If you’ve tried these already, you may do well with an old-school treatment regimen using tri-cyclic antidepressants, medications approved for depression, one of which has a track record as a successful incontinence medication. Or it may be time to give electrical stimulation, pelvic floor physical therapy with biofeedback and bladder retraining a try. With regard to Elmiron for interstitial cystitis (IC), there are other treatment options for IC. Therapies for OAB and IC are fundamentally different, although therapies may overlap in certain patients such as yourself who suffer both syndromes. Women with your mix of conditions often need a lot of tweaking and frequent follow up in order to find the individual regimen that works for you, no small task as you are well aware.
To find a consultant for second opinion evaluation (be ready to repeat tests you may have done in the past), see http://www.augs.org patient section, and http://www.ichelp.org.
Lastly, I trust you’ve already looked at dietary and lifestyle factors that may be exacerbating your conditions. If not, start with a nutritionist skilled with IC and UC management.
Best Regards,
Dr R

Hello Kosova,
Fistula is a terrible problem. You will be best served at a University-based medical clinic in urogynecology, urology or colorectal surgery. If you are able to travel to New York, please notify us at contact@urogynics.org or by calling 0012129354343. Please keep in touch.

Dr Romanzi

Thank K

Dear K,
Even with correct technique at the time of delivery these deep tears often don’t heal perfectly due to the swelling and hormonal changes in skin and deep connective tissues during pregnancy and delivery that result in less than optimal healing from childbirth tears. That said, it is very likely that your anatomy and function can be restored or significantly improved with reconstructive surgical repair of the perineum (perineoplasty) and/or anal sphincter (anal sphincteroplasty). Sometimes perineoplasty alone is enough. Whether one or both procedures might be advised can only be determined through clinical examination, after which various other imaging and colorectal tests might be advised to determine the optimal procedure(s) for your personal situation. It’s been 19 years! Pull this up to the top of your priority list and get the information you need. Thanks for sharing your story. Please keep us posted!

Dr R

Dear Reader,
No one is “too young for a sling”, provided they suffer significant stress urinary incontinence. Two categories of incontinence apply to most women with bladder control problems, those being stress (”exert and squirt” leaking with cough, sneeze, lift, running, etc) and urge (overactive bladder, urination before seated on toilet), and about 1/3 of women with incontinence have a little of both problems.
Kegels are a good therapy for both types of incontinence in about 70% of cases, including mixed stress/urge. Once you’ve birthed the baby, you may be well served to spend 12 weeks working properly with a pelvic floor physical therapist rather than on your own with or without a Kegel exercise gadget. It’s like working with a personal trainer, typically yielding better results. If this fails, you may need medications or electric stimulation for urge incontinence, and a sling for stress incontinence. Slings do not reliably improve urge incontinence, an important distinction should a sling be recommended for you – it is likely that overactive bladder symptoms will persist after a sling, with the “exert and squirt” symptoms gone, or significantly reduced.
The vaginal laxity may also respond to Kegel exercise because the exercises can bulk up the vaginal muscles, making for snugger inner contour. If this does not work, reconstructive surgery may be done with or without concomitant sling, and your labum can be repaired at the same time. The exact best procedure for you, however, can only be determined with a proper pelvic support examination and bladder function testing.
Typically, women are advised to complete childbearing before undergoing reconstructive surgery for laxity, prolapse and stress incontinence, since pregnancy after said operation(s) may undo the results.
Thank you for sharing you story!
Best Regards, Dr R

Dear R from Alabama,
We are learning more every day about women’s sexuality, and we have found that a variety of hormones definitely contribute to sex drive. Some of these hormones are produced by the ovary, while others come from the adrenal glands (on top of your kidneys) and others come from your brain. Chances are your sex drive will be just fine, possibly better now that the source of pelvic pain is gone, along with the worry. The love and stability in your relationship trumps all, as this is the sexiest of sex drive factors.
Thank you for getting back to us and sharing your story.
Dr. R