PREGNANCY-BIRTH Messages for August, 1999: Re: Painful episiotomy scar

Re: Painful episiotomy scar

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Mon, 30 Aug 1999 20:11:57 -0500 (CDT)

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At Sun, 29 Aug 1999, Julie wrote:

Julie-

Regarding your post about pain after episiotomy repair. This is actually fairly common, although without doing an exam anything I say here is speculation. It can happen after a 2nd, 3rd, or 4th degree repair, and can happen regardless of the skill of the doctor doing the repair. Sometimes tiny nerves get "bunched up" in the incision line that trigger pain. Sometimes scar tissue forms. If your pain is mostly at the very bottom of the entrance of the vagina (at the 6 o,clock position) then the above is the most likely cause. Here are some thoughts:

snip He had the nerve to tell me I had >Chronic Vulvar Vestibulitis Syndrome.

This is a very tricky diagnosis to make. If you are tender in certain areas on the exam but not others, then this is a very reasonable diagnosis. Remember, doctors need to look at every possible diagnosis, not just the obvious ones. However, since the pain only developed since the episiotomy, it is more likely due to that.

snip He had the nerve to put me on >antidepressants and said the get rid of the pain fibers.

This actually works for many patients, and for many types of pelvic pain. However, if the pain is due to the incision site, then this usually will not work.

So now, I need >to find another dr (preferably a woman) so I can get this resolved.

Julie, please take care when making statements like this. I am a male physician and I am very experienced in dealing with post-episiotomy pain. Many female gynecologists in my area refer patients with such pain to me. I refer to other doctors who have experience in things I don't see very often. Being a bad or good doctor has nothing to do with being male or female. It's much more a function of compassion, training, hand skills, common sense, etc.

Here is what I would suggest:

If there is a nearby medical school, try to get an appointment with someone in the gynecology department for a thorough exam. This is the best chance to find out what the problem is. If it's caused by pain only at the incicion, they might consider a steroid/novocaine injection, which is very effective for incisional pain. Usually one or two injections does the trick. However, if the anatomy is distorted by scar tissue or infection, then it might require a trip to the operating room to revise the incision (kind of like starting over from scratch).

I sincerely hope everything turns out well for you.

Best wishes,

-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://home.mpinet.net/dahmd

The above is intended for general medical education, and is not for specific medical advice. I apologize, but I am unable to answer personal e-mail due to time constraints.

Next message: Nancy: "Re: Painful episiotomy scar"
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