Re: Gyn: How do you approach this one?
From: art fougner, md (evsono@pipeline.com)
Fri Jan 13 05:33:38 2006
Why the hesitancy? Isn't sexual history a part of your routine GYN
evaluation?
Art
At Thu, 12 Jan 2006, Garry E. Siegel, M.D. wrote:
>
>45 YO P0001 (one adopted 7 year old) presented a couple of weeks ago for
>a second opinion. Her mother has had ovarian cancer, and the patient
>was undergoing twice yearly surveillance with Ca-125s and ultrasounds.
>The first ultrasound showed a 7 cm. unusual adnexal mass which was
>likely a pedunculated fibroid by MRI. This was barely palpable (more
>"sensed") on bimanual examination.
>
>Long story short, she came back and wanted a hysterectomy-BSO, and
>asked/preferred an LAVH-BSO so she could recover more quickly and go
>back to work.
>
>At her preop exam this week, I went to assess her pelvic arch (for
>vaginal surgery) and she was quite uncomfortable during the exam--like a
>virgin, frankly--and it made me think that even if I controlled the
>vessels from up top, that getting uterosacral and cardinal bites might
>be problematic at best. She was told that up front, and agreed to
>proceed.
>
>At exam under anesthesia today, her arch was a bit narrow, and her
>introitus was tight--again, almost virginal.
>
>I am starting to think that she may be virginal or perhaps not
>heterosexual, although we never explicitly discussed sexual function
>other than me discussing the influence of hysterectomy on sexual
>function. I believe she said "it has been years" or something similar.
>
>So. . .I want to ask her if she is indeed virginal, or homosexual, and
>am wondering how to do so.
>
>I am thinking:
>
>"Mary (not her real name), your vaginal opening was constricted and made
>me think that you've not had heterosexual (penis in vaginal) intercouse.
>Did I miss asking you something?
>
>Any thoughts welcome.
>
>Garry
>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
art fougner, md
"I knew I was going to take the wrong train, so I left early."
Lawrence Peter Berra
