QuestionHi there,
I am one year post-TAH for chronic pelvic pain associated with endometriosis. I retained my ovaries, and am not exhibiting the menopausal symptoms of hot flashes, mood swings, etc.
I recently moved, and was referred to a new gyne for evaluation of my unresolved pelvic pain. The hysterectomy addressed a good portion of the pain, but much of it still remains.
I was very flustered, when on consultation with this new gyne on January 28, he suggested a right adnexectomy. He said that if my hormones levels (E2 and FSH) are normal and suggestive of healthy ovaries, he would put me on monophasic contraceptives for one month to suppress ovarian function. He said after the one month, he would suggest the adnexectomy. He said, "Let's not delay the inevitable."
In his consultation letter he states that "[o]n bimanual examination...slight fullness in the right adnexa which on speculum examination appears to be due to a slight degree of ballooning of the vaginal vault on the right side over a 2 x 3 cm dimaeter."
During the office consult, he stated that he felt a bulge at the top of my vagina and said that if it were worse, he would have called it cystocele. I understand that there are various grades of cystocele, but I do not understand how one can have "borderline" cystocele. The only symptom I have of cystocele is a full feeling in my abdomen -- similar to the "fat lip" feeling one has when given local anaesthetic at the dentist.
Further, if I consent to having the right adnexectomy, I am wondering if it would be reasonable to repair any cystocele that may be present during that time.
I am scheduled to see this gyne again on Thursday, and expect to ask him a lot of questions during this appointment. If I am not satisfied, I will ask my GP for a referral to another gyne. I am finding the combination of an older (graduated from medical school in 1963) and patronizing gyne and a GP with a lack of interest in women's health, difficult to work with. As I am in a small town, I am limited. Further, I am seeing the ONLY GP who is taking new patients.
I have a referral to a clinic at Vancouver General Hospital, but their wait list is 12-18 months IF they decide to see me for consultation.
Thank you for your time!
Carmen
AnswerIt is all well and good for the exam to have shown a fullness or ballooning of the vaginal vault, and you may have the beginning of a cystocele. However, before having any surgery, you should first get a pelvic sonogram to assess your ovaries and the pelvis post-hysterectomy. If you are not having urinary symptoms (stres incontinence, UTIs, etc) I would not repair the cystocele or remove it. If you have normal ovaries, at this time, I would not have any oophorectomy or adnexectomy. Put yourself on the list for the consult at Vancouver General. Perhaps you may be seen earlier. Good Luck.
