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smjpain posted:
Hi Jane well just got back from the ER I was trying all day to get in with my GYN and also my Primary Doctor, but no luck I have been having severe pain during urination and vaginal discharge that is Yellow and very smelly I was tested for STD'S before but there wasn't full pentration and he didn't ejaculate plus a condom was used then this time it wasn't my GYN's nurse said that I would need to get tested, he was on-call but couldn't see me so I went into the ER again very scared but I saw a male Doctor who I had seen before he didn't do the Exam because there was an ARNP GYN who has seen me before in my GYN's office who wanted to do the exam because I saw her coming into the room and I looked very scared so it was better that way anyways first she did the spec which was bad she said I was so swollen she couldn't believe it she almost was going to call my GYN but she took the test for STD's then she said she had to do the internal exam because of all the outer pain Jane I am telling you it was so painful when she pushed on my stomach and on the inside she said that she would be talking with my GYN and that I needed to try to get in with him right away. I was given roshrin and zithromycin to treat possible clymida and gonreha I am so scared she also said I might have PID and or BV again but will not get most of the results till monday. I was glade that she was so nice to come see me I told her thank-you and she told me that if I couldn't get in with my GYN on monday that she might be able to see me. She said no sex and also I might have to have surgery because of the old inscion hurting my GYN is going to tell me what he is going to do on monday anyways so will see what happens I just want to know why they treated me for something before they even get the results back.
Jane Harrison Hohner, RN, RNP responded:
Dear smjpain: The usual reason is, if a woman has pelvic pain the first assumption is that she is likely to have a pelvic infection (ie "PID"). So they "shoot first and ask questions later." It is relatively low risk to give a woman Rocephin (covers for gonorrhea) then Zithromax (covers for chlamydia) if there is a possible pelvic infection. Should your cultures come back positive for either of these your partner will need treatment as well. If a pelvic infection was the source of the pain the symptoms should start to improve about 72 hours after starting the medications.

When you see the GYN's office on Monday they should be able to share the lab results and do a follow up exam. Dang, I wish that the incision at the vaginal cuff would stop being tender. That could add to the pain of a pelvic exam when fingers are inserted.

In Support,
smjpain replied to Jane Harrison Hohner, RN, RNP's response:
Hi Jane thanks for responding so quick the incision I am talking about is my outer incision on my stomach pelvic hairline that has been causing severe pain. I also should mention that I have been spotting alot since I have had sex, which was last sunday and wed sunday was when it was not protected and then since then I haven't had sex. I am going to be really made at my Boyfriend if he gave me anything. I will be trying to get in with my GYN or the ARNP there on monday.
Jane Harrison Hohner, RN, RNP replied to smjpain's response:
Dear smjpain: Oh, I see the incision is the one at the pubic hair line--not inside the vaginal cuff. Some POSSIBLE causes of hysterectomy scar pain, once infection is excluded, can include:

1. Adhesions--filmy bands of scar tissue inside the abdomen. Adhesions arise from inflammation (eg endometriosis, infection).

2. Nerve entrapment or injury may follow a GYN surgical incision (eg laparoscope or C-section scar). The pain may be described as burning, or aching and like myofacial pain follows the shared pathway of a nerve ("dermatome"). Abdominal tightening or exercise can make the pain worse, and treatment includes injection with a local anesthetic at the specific site of pain on the outside of the abdomen.

3. Neuroma is a mass, or thickening, of nerve tissue. Often these can arise where there has been trauma to a nerve. In pelvic pain a neuroma can occur in the area of a hysterectomy scar (including inside the vagina), or other surgical scars.


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