Mens Health Blog. Medical Blog

A man in Oregon wrote to Dr Obama after Elizabeth, hit wife, asked him to read about endometriosis. Jonathan, a twenty-seven-year-old administrator at a large company in Texas, was searching for an answer that made sense, Elizabeth seemed to be suffering terribly, and it was getting worse. What he read about endometriosis seemed to correlate with Elizabeth’s symptoms and life-style. He hoped Dr Obama might assist him further.

His letter is a touching one. It is a love note for Elizabeth as well as a sad tale of all-too-common experiences with misdiagnosis and improper treatment of the “career woman’s disease.” It goes, in part, this way:

“I’m writing at a point of desperation in my wife’s life. She has learned after five years of pain that she has endometriosis. Elizabeth has seen twenty doctors since 1982, when they began having chronic pain in her vulva following an abortion. Doctors couldn’t find any condition that corresponded to her pain and either dismissed her as neurotic or prescribed creams that irritated the area.

“Then, a few months ago, a general practitioner diagnosed endometriosis based on her symptoms: painful urination, history of bad menstrual cramps, and abdominal pain. We heard that Danocrine would help over other treatments, but he insisted she take Norlutin. A synthetic progesterone, which created terrible side effects. Elizabeth then went to a top gynecologist on whom she’d pinned all her hopes. He told her that she had problems ‘accepting a normal sex life’ (we’ve been unable to make love for months because intercourse was so painful for Elizabeth) and that nothing else was wrong with her!

“I’m not a doctor, but I think I’ve unearthed every available medical journal on endometriosis. I feel pretty confident that Elizabeth has this disease and no other.

“I never would have believed how a woman can suffer and still be ignored by those with the power to heal if 1 had not seen it myself. This is why I’m writing a letter like this. Please give our problem your attention. We trust your opinion and hope you can answer us, no matter how briefly. What should we do next?”

Endometriosis can dramatically alter the daily rhythms of a woman’s life, and Elizabeth is a good example of this. Often, intimate relationships change when pain becomes a demanding third party. In these cases, coping with the disease not only requires fortitude of spirit but needs the understanding of others.

Of the many points Jonathan raised in Elizabeth’s case, the most significant was his description of two of the three symptoms (the “triad”) that most typify endometriosis: a history of bad menstrual cramps and dyspareunia (or painful intercourse). The third, infertility! is, in my opinion, a good probability for Elizabeth, although getting pregnant is not relevant to her now. Although a laparoscopy; or “Band-Aid procedure,” performed by a good diagnostician can help reveal the truth about Elizabeth’s condition, it’s a fairly good bet based on her symptoms that she has endometriosis and that a laparoscopy is not necessary in her case. As mentioned earlier, a standard suction abortion is rarely responsible for the onset of the disease. A badly performed abortion, however, may have caused some damage to the uterus. The doctor might have accidentally wrenched it in some way, tearing it slightly so that endometriotic tissue spread to the cervix and vagina. It is worth noting that the disease very rarely implants itself and grows in the vagina. However, during an internal examination a doctor can see very small brown-black (“powder burn”) spots of endometriosis on the cervix.

Unless there were actual lesions or indication of infection, we would say that the pain an Elizabeth’s vulva was not due to a localized problem, but radiated down from another source. Most likely, the pain originated in pelvic organs inflamed with actively growing endometriotic tissue. Such growths would alto account for frequent urination, since the bladder is commonly involved in this “glue-stick” disease.

Partnership of any kind, but especially partnership in health care, requires harmonious goals. You and your doctor must be able to exchange information freely and decide on the wisest course of action.

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Comments (0) May 08 2009

There are several sites for cancer that prompt women to consider a hysterectomy. Cancer of the cervix, also called cervical cancer, develops in cells that line the cervix. The abnormal changes usually occur over a period of years, although in some women the changes seem to happen much faster. Abnormalities of the cells of the cervix, thought to be precursors of cervical cancer, used to be called dysplasia; but nowadays the term cervical intraepithelial neoplasia (ON) is used.

Cervical cancer is diagnosed in about 1100 Australian women each year. Although most diagnoses are made in women aged over fifty-five, it seems that increasing numbers of women in their twenties and thirties are now being affected. Tell-tale signs include bleeding between periods in pre-menopausal women, bleeding after sexual intercourse or at any time after menopause, and a smelly vaginal discharge.

Screening for cervical cell abnormalities that could develop into cancer is available using the Pap smear technique. A small sample or biopsy of cells from the cervix is obtained using a special brush and a fine wooden spatula. The cells are smeared onto a piece of glass and then sent to a laboratory for examination. From the appearance of the cells, it is possible to identify cancer at a stage early enough to permit its complete removal and cure. Australian health authorities recommend a Pap smear every second year from the time women start to be sexually active.

Over 400000 women in the State of Victoria, Australia, had a Pap smear during 1990, but seven out of ten women considered to be most at risk of cervical cancer did not come forward for testing. Of every ten smears done, eight were completely normal or showed insignificant changes. Less than four in every 100 smears showed CIN changes and only one in every 2000 was suggestive of possible cancer. If the results of a Pap smear raise concerns or if a woman experiences any unusual bleeding or cervical discharge, the cervix is examined for suspicious-looking tissue using a magnifying instrument called a colposcopy. A biopsy is usually taken and the tissue sample removed from the cervix is sent to a laboratory for microscopic examination. If the examination indicates severe CIN or pre-invasive cancer, any areas of the cervix which look abnormal are treated by cryosurgery (which destroys tissue by freezing), diathermy (which achieves the same end using an electric current), or else by heat or by laser. Diathermy or electrocoagulation entails using an electric current to produce points, loops or small balls of heat that burn the tissue while also closing blood vessels. Lasers are high-density beams of light energy that can cut tissue precisely and, at the same time, close off blood vessels. All these techniques have a high cure rate, and they do not interfere with a woman’s sex life or prevent her from having children in the future. Occasionally, a procedure called conisation is performed in which a cone-shaped sample of tissue about a centimetre thick is removed from the cervix using a scalpel, diathermy or laser. Once again, it is rare for the technique to damage a woman’s sex life or impair her ability to have children. If, however, there is any evidence that the disease has spread inside or beyond the cervix, a hysterectomy should be discussed. Radiation therapy or chemotherapy may also be suggested in a bid to ensure the complete destruction of cancer cells.

Although scientists do not know the exact cause of cervical cancer, there appears to be an association with sexual activity. Research suggests that certain strains of the human papilloma virus (HPV), which may be transferred during sexual contact, are involved in the disease process.

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Comments (0) May 08 2009

A hysterectomy for endometriosis is surgery which involves the removal of the uterus and as many remaining endometrial implants and adhesions as possible. It may also involve the removal of one or both ovaries and fallopian tubes.

A hysterectomy is often said to be the only cure for endometriosis apart from the natural menopause. However, it does not always cure endometriosis, especially if the ovaries are not removed.

A hysterectomy in which the uterus and cervix are removed is known as a total abdominal hysterectomy (often abbreviated to a TAH). Sometimes all or part of an ovary and/or fallopian tube will be removed at the same time if they are diseased but at least part of one ovary is always left.

Following a total abdominal hysterectomy a woman will no longer menstruate but she will continue to ovulate until the time of her natural menopause.

A hysterectomy which involves the removal of the uterus and cervix as well as both fallopian tubes and ovaries is known as a total abdominal hysterectomy and bilateral salpingectomy and oophorectomy (often abbreviated to a TAH and BSO). It is also sometimes known as a radical hysterectomy.

Following a radical hysterectomy a woman will no longer menstruate or ovulate and she will undergo the menopause almost immediately.

To simplify matters and avoid confusion we will refer to a total abdominal hysterectomy as a total hysterectomy; and a total abdominal hysterectomy and bilateral salpingectomy and oophorectomy as a radical hysterectomy. We will use the term hysterectomy if we are referring collectively to both types.

Hysterectomy is usually only used as a last resort to treat women whose endometriosis is so chronic and their symptoms so severe that their quality of life is intolerable. The most common reasons that women with endometriosis have a hysterectomy are the persistence of intractable and incapacitating pain or severe and persistent heavy bleeding. It should not be used, except in a few rare life threatening situations, until a range of other hormonal and surgical treatments have been tried without success.

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Comments (0) Apr 22 2009