Tuesday, December 16, 2008

How Pelvic Organ Prolapse Affects Women's Sexuality

I will be giving a talk on January 24, 2009 at Banner Desert Medical Center on this topic. It will review the types of pelvic floor disorders collectively termed "prolapse", and how these afftect female sexuality. It will review what prolapse is, how it occurs, in whom it occurs, how it affects women's intimacy and what can be done about it.

It is sponsored by the Spirit of Women's health series. The fee for whole morning, including two other talks, on boosting immunity and dietary supplements, is $5.

Follow the link here for more info and directions:


Call (602) 230-CARE to register, or call the Spirit office for more information at (480) 512-6205.

Monday, December 15, 2008

Urethral Diverticulum

More on urethral abnormalities.

A urethral diverticulum in women is usually an acquired condition. It is believed to be a gland along the urethra that pushes out and creates an out-pouching. This out-pouching, the diverticulum, may be asymptomatic if small, can contain pus, urinary stones, or even very rarely, a polyp. Regardless, they are believed to form from chronic infection, but remain a relatively uncommon entity.

When large they are palpable on pelvic exam. When present, however, thay usually present with the "Three D's" triad: Dysuria (burning with urination), Dribbling (of urine), and Dyspareunia (pain with sex). Not all three must be present, but a thorough history and physical exam will pick it up. Patients will complain of recurrent UTI's, burning with urination that is not alleviated by antibiotics, pain with sex, urinary stream issues, and the like.

On exam, they may mimic vaginal wall cysts which are congenital. It may simply look like a vaginal wall mass and can be tender. If compressed with a finger during exam, sometimes secretions, such as pus, can be expressed. This would be disgnostic.

If the exam is difficult, or when planning surgery, and x-ray should be obtained and cystoscopy performed.

Some other common symptoms include: irritative urinary symptoms such as frequency and urgency. Dyspareunia is noted in 12-24% of patients, and 5-32% of patients will complain of post-void dribbling. As mentioned, recurrent urinary tract infection is a frequent complaint in one-third of patients. In addition, women may experience pain, hematuria (blood in the urine), vaginal discharge, obstructive urinary flow or inablility to urinate (retention). Stress and urge incontinence may also occur. However, a urethral diverticulum can be asymptomatic in up to 20%.

Sometimes, but not always, during cystoscopy the opening to the diverticulum can be seen within the urethra. Several x-ray tests exist to visualize the diverticulum, but the most reliable is an MRI of the pelvis, which will show the size and location of the diverticulum.

When symptomatic, surgical removal is necessary and is peformed through the vagina.

Friday, December 12, 2008

Urethral Prolapse

It's not quite the same as pelvic prolapse. Pelvic prolapse is the abnormal descent of female pelvic organs into the vagina, or out the vaginal opening. This would include cystocele for the bladder, rectocele for the rectum, enterocele for the small intestine, vault prolapse for the vaginal apex after hysterctomy, or procidentia for uterine descent. It is an abnormal herniation of these organs due to intra-abdominal pressure pushing down on these organs as a result of poor pelvic floor support.

A urethral prolapse, also known as a urethral caruncle, is the mucosal lining of the urethra that protrudes and is visible at the urethral opening. It is not caused by pelvic floor weakness, rather, in women, it is caused by menopause and the low estrogen staus of the vagina and urethra. The prolpase will appear like a small red pimple on the urethral meatus (opening). It is usually of no significance, but its presence indicates hypo-estrogenization.

Uncommonly, it can bleed or cause blood spotting in the urine or cause pain if it gets large. If large, it can cause deflection of the urinary stream. If it doesn't bother the woman, then nothing has to be done. If the vagina is dry already, consideration can be given to applying local estrogen cream to help the prolapse retract and improve the vaginal health. If the urethral prolapse is spotting blood or painful, estrogen cream should be applied. Only when estrogen cream has not worked or if large and painful does the prolapse need to be removed in the operating room.

A urethral prolapse is NOT a polyp of the urethra. Most polyps of the urethra are benign and can be removed surgically. Tumors of the female urethra are rare entities, but present as polyps and are removed as well.