dyparunia after vaginal reconstruction_help from http://www.midwiferytoday.com
From: Emilio Porro (sanbonav@hotmail.com)
Sat Oct 11 12:36:43 2003
I think You can suggest the silicone ballon as described below
Yours faithfully
Emilio Porro
ObGyn.M.D.
Como
Italy
http://www.sanbonaventura.com
e-mail:sanbonav@hotmail.com
Question of the Quarter for Midwifery Today Print Magazine
Question of the Quarter: What does "instinctive birth" mean to you? How do
you facilitate it?
Our favorite responses will be published in Midwifery Today magazine,
December 2003. E-mail your response to: mgeditor@midwiferytoday.com.
Responses are subject to editing for space and style. Try to keep the word
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Deadline for submission: Sept. 15, 2003.
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I am an Israeli midwife practicing in homestyle hospital birthing rooms,
homebirth, and clinic. I am currently distributing an amazing product made
in Germany to prevent tearing (and for those backward places that still do
episiotomies). As a more naturally inclined midwife, and one who was quite
content with perineal massage and has low tear rates anyway, I was skeptical
of its benefit. However, after working with this device I must really urge
you to try it for your first birthers.
It is a small silicone balloon connected via tubing to a hand pump and
manometer (like a blood pressure machine). It is begun in the ninth month
and inserted after lubrication about three centimeters in the vagina. It is
slowly inflated to the point of minor discomfort and left inflated for l0-20
minutes. Then you practice pushing it out. It eventually inflates to the
size of a baby's head. The results are amazing. As a midwife, it makes a
first birth act like a second, and you don't work hard on the perineum, and
all the women I have birthed (six so far) didn't have a scratch. They all
had second stages of up to 40 minutes. Other midwives have also had good
results. Research shows that it greatly reduces tearing, shortens second
stage, improves apgars, lowers maternal anxiety, and there is less use of
epidurals and analgesia. It is also used to practice "kegel" exercises for
the regaining of pelvic floor muscle tone and preventing stress incontinence
and prolapse. Check out their site at: http://www.epi-no.com. Please pray for peace
in the Middle East and a stop to all this violence.
- Ilana
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Midwifery Today: Each One Teach One!
>----- Original Message -----
From: "rchudacoff" <rchudacoff@mylinuxisp.com>
To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net>
Sent: Friday, October 10, 2003 2:23 PM
Subject: Re: dyparunia after vaginal reconstruction
> 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
> >
> > *****HIPAA Confidentiality Notice*****
> >
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> ------- End of Original Message -------
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