Women's Health Community

Dear butterflydc: Congrats on finding a relationship that made sex seem worth trying again. That must be some wonderful person!

I would concur with your GYN that your vaginal estrogen should help internal vaginall tissue thickness and lubrication abilities. Your massage therapist's idea of using a small dilator (to "exercise" the site) might be helpful as well. Yet I am hearing you say that there is a very specific site (site of old surgical scar) which seems to be refractory to all attempts to have non-painful penetration. If this very specific pain site persists despite all your treatments (including use of numbing agents such as viscous Lidocaine) you MIGHT have a vaginal neuroma. Here is some informaiton about this uncommon condition from teh Natioanl Library of Medicine site:

Obstet Gynecol. 2006 Sep;108(3 Pt 2):809-11.
Severe vaginal pain caused by a neuroma in the rectovaginal septum after posterior colporrhaphy.
Millheiser LS, Chen B.
Source

Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94301, USA. sempre@stanford.edu
Abstract
BACKGROUND:

Traumatic vaginal neuromas are a rarely documented finding in the setting of vaginal pain after posterior colporrhaphy. They arise as a result of trauma or surgery and are often mistaken for scar tissue.
CASE:

After a total vaginal hysterectomy and posterior colporrhaphy, a 32-year-old woman presented with debilitating vaginal pain, presumed to be secondary to scar tissue formation. Excision of the tissue from the rectovaginal septum revealed a traumatic neuroma. After the removal of the neuroma, the patient's vaginal pain resolved.
CONCLUSION:

Traumatic neuromas may be a cause of significant point tenderness and thickened tissue after vaginal surgery or repair of obstetric lacerations. If conservative treatment methods have failed, surgical excision of the neuroma can be considered.

Yours,
Jane

Hi Jane. Thanks so much for taking the time to respond to my query. Really. I am not sure about the guy at this point, but you can say he certainly helped open the Pandora's box.

I have not tried Lidocaine but see the MD again 9.10.12 so will ask about that as well. Am not familiar with vaginal neuroma--and will consider surgery again if Lidocaine does not work. What seems to be helping is a Chinese creme (really) that my acupuncturist uses with people who have ports for chemo--it relieves the burn area and allows for tissue regeneration. I am trying this for 3 weeks. Hopefully throw some nookie in the mix and will go from there. Will keep you posted Jane. PS. The estrogen creme has not worked.
How curious about a neuroma.....

Thank You Jane.

Dear dcbutterfly: We'll look forward to your updates. It would be interesting to know what is in the Chinese cream. There are some citations at the National Library of Medicine web site about Chinese medicine products which were analyzed in a US chemistry lab. These products were advertised as herbal preparations but some actually contained western medicine pharmaceuticals. Your acupuncturist sounds wonderful so hopefully her medication and body work treatments will do the trick.

Yours,
Jane

Dear Jane:

I wanted to give you update re. vaginal tear, chinese creme and premarin. Well tear healed okay, and area felt looser, softer. So I had intercourse and tear tore-like a split of skin. Pain is not as bad but made another appointment to see Gynecologist Monday 24th.
Not a happy puppy. Used lubricant (Emerita), but somehow position, or the size of the shaft or pure luck. This tear is bigger than original in 2007. Options at this point?
If I have surgery again, can run into scar tissue I think which defeats purpose. How do women accommodate themselves to chronic tear situation?
Please note in advance that I truly appreciate as a reader, and a woman the time you take to talk with us.

Rhona

Dear Rhona: We all appreciate your willingness to share your progress with us. As you know, other women with the same concern will find your information via Google search, and that can be VERY helpful to them.

Given what you have shared (area healed, no pain until re-tear) a neuroma seems less likely. Neuromas tend to hurt any time pressure is applied--and a skin tear is not a typical outcome.

I went back to review the literature about perineal tears, much of it is in the obstetric lit. There are no studies specific to repair of vaginal tears in the non-obstetric patient. Several contributing factors seemed to be:

1. Type of suture material & suture technique---unsure if this is relevant to you as most of the problems were with older techniques and materials.

2. Tissue integrity--the use of the estrogen cream should hopefully help this. There are also cases of women with connective tissue disorders (eg Ehlers-Danlos syndrome, lupus) who have more problems with skin healing. There is also data to suggest an increased risk of perineal tears in women with increased amounts of stretch marks. This is attributed to different characteristics of collagen in the skin.

Your GYN, after the exam, is in the best position to advise whether an extended time of healing (best skin effects with local estrogen can take up to six weeks) combined with non-penetrative sex is to be tried again--or whether another focused surgical repair is next. Do let us know what happens next.

In Appreciation,
Jane

Hi Jane:

I am glad to share my journey with others. Since I started talking about vaginal tear with friends, all kinds of great conversations ensue about dryness, tissue thinning, fear, etc...and that's just what happens with women.

Using both estrogen creme and the ointment recommended by my Chinese acupuncturist. Will see my doctor tomorrow afternoon.
My concern about surgery is the scar tissue, but will report my update Monday 9.25.
I am using Lidocaine as well for some relief.

Thank you Jane for your support and encouragement.

Rhona

Glad my relationship is still in beginning stages...as I have a hard time saying no....when

Dear Rhona: Yes, it is very true that dryness, tissue thinning are MUCH more common than realized. While we usually associate these conditions with menopause they can also arise during other times of lowered estrogen levels such as breastfeeding, elevated prolactin levels from pituitary adenomas, or even in some DepoProvera users. As mentioned above, some autoimmune conditions can prompt skin thinning (eg lichen sclerosus of the vulva and vaginal opening). Connective tissue disorders, while less common, can have vaginal consequences.

So do keep us appraised of what you find out. It will be interesting to hear what your examining GYN decides.

Yours,
Jane

Dear Jane and Other readers with Vaginal Tears:

I went to my doctor yesterday (10/11) as I incurred another vaginal tear with same partner. Seems as soon as area heals, we fool around, and it tears again. I have used both the Chinese herbal medicine and Estrogen creme 3x4 times a day for the past 2.5 months since I started having sex, and am now using Neosporin too.

My options include:
1. Dump the lover (possibly a great idea).
2. Live with tearing situation. Not a great idea.
3. Have surgery.
4. Wait on surgery till area heals. Start practicing with inserting smaller objects into area to keep area malleable. Then use real deal penis. If skin tears again, get surgery.
5. Encourage or build upon alternative sexual pleasure that does not include intercourse. And when skin tears, deal with it.
6. Avoid intercourse. Not a great option. One I have tried and will not do again.
----------------
I am disappointed because I am fearful of another surgery, Nor is my doctor real keen to do it, as we both know there is no guarantee area won't tear again despite her best effort.
I think Jane, that we don't know whether the choice(s) we make will be good or bad. We just make the best choice we can in the moment.
If you have any other ideas or sites I can check for alternative solutions please advise. Your input is valued by me and other readers.

Thanks,
Rhona

Dear Rhona: One other thought, as pertinent to option #4. Given that you have tried many topical products, and waiting until the area heals, I would wonder if a second opinion from a pelvic floor surgeon might be worth your time. These are GYNs with expertise in repairing rectal-vaginal fistulas, anal sphincter tears. They have an excellent knowledge of those tissues. It is a distant possibility but perhaps you have lichen sclerosus, or some type of collagen /connective tissue condition.

Also pertinent to option #4 would be a consult visit with a pelvic floor physical therapist (PT). She would have even more training than your superb massage therapist if dilators are really the best option.

One final question to you. Is the 3-4 times per day usage of the estrogen cream from you GYN having any effect on your vaginal tissues in general? If not you should let your GYN know so another product/formulation might be tried.

Thanks for staying in touch with us so we can follow your progress.

In Gratitude,
Jane

Jane:

If you were closer, I'd hug you. I scheduled an appointment with the top dog at USF uro/gyn department for next month.
Possibly he will vote surgery (surgeons like to operate) or not.
The first surgeon was also a Uro guy. Not gynecologist.

I have old tissue no issues-- cause I'm 61, post menopausal, and have already done 1 surgery on the area. Dr. Hoyt may say the same thing, my current MD says. Estrogen is not really working, but the Chinese liniment for burns is doing great. I heal fast, but tear easily. I also use an E RING.

There is one more compounded product suggested by current MD, but she said using it would still thin the tissue more so I have avoided purchase. It contains lidocaine and cortisone, thinning tissue even more. You definitely ask great questions. And are very knowledgeable.

Keep on trucking, I guess.

Be Well,

Rhona

Dear Jane:

I wanted to provide update regarding my vaginal tear and also ask a question.
Currently my tear is healing well. Skin is pink still but tissue is thicker and my current doctor wants to wait on surgery until/if skin tears again (via intercourse). No intercourse option in near future. So premarin creme (2x day) and Chinese burn ointment(2xday) workwed wonders.

I am interested in purchasing a SYBIAN--a saddle massage machine that has ability to stretch and exercise external muscles, tissues in vaginal area. Unfortunately machine is $1300.00. I have used machine in past and it is fabulous. Do you think it's worth my effort to find a medical doctor who might see value in having insurance pay or co pay such a machine?
We help men with Viagra (insured). What support machines or tools do we provide women who have chronic tears?

I have an appointment later this week with a pelvic floor specialist and am curious to see if it is worth my time to talk with him about this.

Appreciate your advice.

Rhona

Dear Rhona: Thanks for keeping us on your journey with the chronic vaginal tears. Honestly, I have never heard of the specific SYBIAN device. I could not find any citation for it (or similar machines at the National Library of Medicine site). A Google search did yield information that it was a "masturbation device" and showed some photos. Thus, if a MD did a search they may not be much impressed about the efficacy of the device--that is, no data. Some one needs to do a study on medical uses and get it published in the GYN or sex therapy literature.

What should you do? Among your option might be:

1. Contact the manufacturer and see if they are interested in doing a study. If so see if a USF faculty or student is willing to do a case report for publication. Or see if the manufacturer has unpublished data from product development and take that to your medical provider. Somehow the EROS CT manufacturer got enough data to get their device FDA approved for female anorgasmia.

2. Ask an MD for a referral to a pelvic floor physical therapist (PT). Most insurance will pay for this as and see if the PT can make a case for insurance billing. Also PTs may have other devices (beyond simple dilators) they can use .

3. Get your lover to pay for half the cost!

Please let us know what happens--especially if you can get the device reimbursed by insurance.

Yours,
Jane

Hi Jane and Vaginal Tear Readers:

As I walk this path I am learning so much about the body.

I am recommending Dr. Lennox Hoyt, USF Tampa as an excellent practitioner. Not to mention your awesome guidance, Jane for which I am truly grateful.

My tear has not healed due to its location outside the vaginal entrance--
Short version.
1. Blood flow from uterus/vagina stops just short of spot where tear is. And blood flow from anus back to vaginal area, stops just short of the tear. Condition identified as Dyspareunia.
He proposed that with limited blood flow to area increases pain, and inability for area to heal. He used migraines and heart attacks as similes.
2. How to increase blood flow?
Take hot baths 3x a day.
Use a creme that promotes blood flow (script). Will provide name once I get creme.
Keep using the Chinese burn ointment for burns (repairs tissues, promotes blood flow)
3. Get physical therapy on pelvic area.
4. No nookie for couple of months.
Call back in 6 weeks.

The meeting was beneficial as I thought I had only two choices. Surgery or live with chronic tears. Please let other readers know to get second and even third opinions.


Thanks,


Rhona

Dear Rhona: Your input is invaluable with very precise information. Do keep up what has evolved into a good resource on vaginal tears and a multifocal treatment regimen.

An aside, which may be helpful to other postmenopausal women, relates to genital blood flow issues. For both genders adequate blood flow improves sexual response/performance. Vasodilators (medications to dilate blood vessels which thus increases flow) also increase vasocongestion allowing for a more engorgement of the labia and clitoris. Nitric oxide is a vasodilator (eg nitro tablets under the tongue dilates blood vessels in the heart). Drugs like Viagra are nitric oxide enhancers (increasing blood flow to the penis). Estrogen is a nitric oxide enhancer as well. Additionally there are other classes of medications which work as vasodilators--you will likely be getting a prescription for one of these. Even taking a hot bath (or hot tub) will have the effect of increasing vasodilation in the genital area. So if one is an older woman, or has an older partner, bathing together is a good addition to foreplay.

Yours,
Jane