Re: Pearls Needed for Treating Intact Hymen(s) - Long!
From: art fougner, md (evsono@pipeline.com)
Thu Aug 17 09:56:37 2000
before surgery is attempted, perhaps a trial with graduated dilators may
be helpful here.
art
At Thu, 17 Aug 2000, babydoc wrote:
>
>I believe this describes the Fenton perinneoplasty--
>>----- Original Message -----
>From: Gibbons, John <JGibbons@stfranciscare.org>
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.medispecialty.com>
>Sent: Thursday, August 17, 2000 9:17 AM
>Subject: Re: Pearls Needed for Treating Intact Hymen(s) - Long!
>
>> Joanne:
>>
>> I use four principles:
>>
>> 1. Thorough evaluation including the psychological
>> dimension. Surgical solutions of psychiatric problems are notoriously
>> unsuccessful.
>>
>> 2. Estrogen pretreatment if clinically indicated.
>>
>> 3. The surgical "swing thought" is that a vertical incision
>> repaired transversely provides more room.
>>
>> 4. Use relatively fine absorbable interrupted sutures. 3-0
>> vicryl horizontal mattress stitches are commonly employed.a
>>
>> John Gibbons
>> > ----------
>> > From: jbulley@cheshire.net[SMTP:jbulley@cheshire.net]
>> > Sent: Wednesday, August 16, 2000 11:04 PM
>> > To: Multiple recipients of list OB-GYN-L
>> > Subject: Pearls Needed for Treating Intact Hymen(s) - Long!
>> >
>> > Looking for "How you would do it" suggestions:
>> >
>> > I currently have two women with intact hymens and one woman who scarred
>> > after vaginal birth as if she has a hymen - birth was 10 years ago.
>> >
>> > Patient A - 64 - now widowed - husband was an alcoholic, and in
>> > retrospect never able to maintain an erection enough for intercourse.
>> > She had no knowledge that they had never really had intercourse and was
>> > unhappy to have never had children. Her pelvics and paps had always
>> > hurt severly, but her doc never identified the cause nor referred her to
>> > a gyn... She had attempted to have intercourse with a new partner. It
>> > was unable to be completed - due to the intact hymen combined with lack
>> > of estrogen. I have had her massage some estrogen into the introitus -
>> > but that was psychologically hard for her to do. We are now doing oral
>> > HRT and plan a hymenectomy in the fall.
>> >
>> > Patient B - 30-ish, married 8 or so years - unconsummated. Had had 2
>> > pelvic exams prior to marriage - that left her feeling raped. Her
>> > sister came to her exam with her. She was initially beside herself over
>> > the prospect of the exam. I reviewed the plan with her and assured her
>> > that SHE was always IN CHARGE and that at any point that she said to
>> > stop, I would not proceed any further and we could return in the future
>> > to complete the exam. Both were surprised that I could work with her
>> > and manage a gentle full gyn exam without pain. She returned to me to
>> > discuss the intact hymen and options. After the 8 or so years of
>> > marriage, her husband is now refusing to do any joint sexual therapy -
>> > always reminding her that she will never be able to change and she will
>> > never find another man who will tolerate her abnormality and not have
>> > affairs or force himself on her. She is quite willing to work on her
>> > aversion with the therapist herself, but anticipates the marriage may
>> > not survive and wants to probably have a hymenectomy in the near future.
>> > She would also like to have kids and has been devastated every time a
>> > family member badgers them to start a family.
>> >
>> > Patient C - later 30's - has been unable to have intercourse since
>> > repair of vagina after child birth. On exam there is a taut band at the
>> > introitus located from about 6 O'Clock to 10 O'Clock - where the hymen
>> > was years ago. For what it is worth, she recalls her husband actually
>> > telling the doc to sew her up tight so she wouldn't gape. I have had
>> > her massage estrogen into the area and stretch it. She doesn't think
>> > there has been any improvement, but I am fairly certain she is more
>> > distensible than prior to the E. Again, she plans a trip to the OR this
>> > Fall for a plastic repair.
>> >
>> > So, folks - how would you treat these patients? All suggestions are
>> > welcome.
>> >
>> > And - as I have not done a hymenectomy since residency over 15 years -
>> > what are your preferred methods? Where would you cut, how would you
>> > repair and with what type of suture? Etc. What type of estrogen pre-op
>> > prep would you want them using?
>> >
>> > Thanks
>> >
>> > --
>> > Joanne Bulley, MD
>> > Keene, NH, USA
>> >
>>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
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