Re: dyparunia after vaginal reconstruction
From: rchudacoff (rchudacoff@mylinuxisp.com)
Fri Oct 10 07:21:27 2003
My thoughts exactly, however if I try telling this to her husband (a tincture
of time) who is 6'8", 300#, I'm afraid it may be the last thing I tell
anybody. TIC
Richard Chudacoff, MD
>---------- Original Message -----------
From: "Braun, R. Daniel" <rbraun@iupui.edu>
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
Sent: Fri, 10 Oct 2003 06:27:00 -0500
Subject: Re: dyparunia after vaginal reconstruction
> Time.
> additional surgery runs a significant risk of making it worse.
>
> Dan
> -----Original Message-----
> From: Richard Chudacoff, MD [mailto:rchudacoff@mylinuxisp.com]
> Sent: Thursday, October 09, 2003 4:11 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: dyparunia after vaginal reconstruction
>
> 4 months ago I performed a vaginal reconstruction on a 38 yo.
> with uterovaginal prolapse. Prior to the surgery I asked and was told
> her husband was extremely large and intercourse was important to
> them. With this in mind, the introital and luminal diameter of the
> vagina was
> >2.5 fingers (around 6 cm) after the reconstruction, as it remains
> today. She returns today with significant posterior dyspareunia.
> Dyspareunia is worse if she is on top or in knee-chest, and only
> slightly less if she is supine. She denies pain with bowel movements.
> There is no deep thrust pain.
>
> Evaluation notes that there is minimal pain with downward
> traction of the perineal body. (For discussion sake proximal is referred
> to as closer to the cuff, distal is closer to the perineal body.)
> Pain increases just proximal to the perineal body, at about the
> level of the hymeneal ring, and extends three cm proximal. There is
> no pain of the most proximal half of the vaginal. There is excellent
> suspension of the vaginal cuff, no granulation tissue, and no pain
> with palpation. There is neither adnexal pain nor masses. Anteriorly
> there is an absence of pain as well. Of note, the uterosacral
> ligaments were used for vaginal suspension
>
> Rectovaginal exam notes a supported, but thin rectovaginal
> septum. No palpable suture, granuloma nor retention of the septum.
> The pararectal space is free of scar, contraction or involvement of levator
> ani muscles. It feels very pliable. The sulci also seem to be without
> tension. There is also no pain with ventral movement of the rectovaginal
> septum.
>
> The only option I can think of is to make a window in the
> rectovaginal fascia and put a pliant mesh.
>
> Does anyone have any other suggestions?
>
> Richard Chudacoff, MD, FACOG
> Chudacoff Obstetrics & Gynecology, PLLC
> 15200 Southwest Freeway, #270
> Sugar Land, TX 77478
>
> Tel: 281-277-3900
> Fax: 281-277-3901
>
> rchudacoff@mylinuxisp.com
> Richard.Chudacoff@obgyn.net
>
> http://www.mdhub.com/281-277-3900
> http://www.chudacoffobgyn.yourmd.com
>
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------- End of Original Message -------
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