In my last newsletter I discussed the concept that "health" is a state of body, mind, and spirit. In future editions I will continue discussion of many topics affecting women's health. In this newsletter, I am discussing pelvic pain since it is one of the more common reasons for a visit to the gynecologist's office. Some of the causes of pelvic pain are commonly know by most women, while others are much less recognized, even by physicians. Most of this discussion is in the format of definition and treatment. If you or a friend or relative have questions, please do not hesitate to contact our office. For more detailed information online about these and many other health issues for women, visit my websites www.womensdoctor.com and www.endometriosistherapy.com

Dysmenorrhea or menstrual cramping may be primary or secondary. Primary dysmenorrhea implies there is no pathology (abnormal findings such as endometriosis) and usually responds to birth control pills and NSAID's such as ibuprofen. Secondary dysmenorrhea is usually caused by endometriosis, a condition in which the tissue that lines the uterus and causes menstrual flow gets on the outside of the uterus and causes pain with menses and frequently with sex. Treatment is removal of this tissue at the time of laparoscopy (so-called laser surgery).

Labial hypertrophy is one of those less well known causes of pain. Labial hypertrophy (enlargement of the labia minora or "inner lips") can cause pain with strenuous physical activity, with sex, or with every-day activity such as standing; labial hypertrophy can even make it uncomfortable to wear tight-fitting clothes. The labia minora enlarge during puberty at the same time breast development occurs. Many women with labial hypertrophy do not realize it is abnormal to have this condition; after-all, it is the way they have always been. The best treatment is surgical reduction in the size of the labia, done as an outpatient procedure in the operating room.

Vulvodynia literally means vulvar pain and is commonly described as burning, stinging, irritation, pain, and/or rawness. The diagnosis is made by a physician when the symproms have been present for 3-6 months and when the symptoms are not associated with infection such as a yeast infection, neurologic disease, tumor such as skin cancer, or inflammation such as a condition call lichen sclerosis. The cause(s) of vulvodynia is unknown. The treatment is with medicaiton individualized for the patient by her physician.

Vaginismus is a spasm of the muscle at the entrance to the vagina when something touches the muscle, wither with sexual activity or pelvic examination. Vaginismus is a conditioned response to something unpleasant. For example, if a woman has intercourse when she has a yeast infection, this may cause pain (due to the infection). Up until this time there was no pain with sex. The next time she has sex, the muscle at the entrance to the vagina may go into spasm in an unconscious attempt to prevent penetration. Trreatment of vaginismus involves getting rid of whatever is causing pain and sometimes a conditioning exercise to eliminate the reflex spasm.

A Bartholin cyst or abscess, at the entrance to the vagina, is another common cause of pelvic pain. On either side of the entrance to the vagina there is a gland (Bartholin's gland). If the duct leading from the gland becomes clogged, a cyst or abscess can develop. If there is no pain and if the cyst does not become too large, no treatment is needed. If necessary, the cyst or abscess can be drained in the physician's office or, in some cases, in the operating room.

Vaginal pain or discomfort is most commonly caused by an infection and treated appropriately.

Dyspareunia is pain with sex. Dyspareunia may be caused by labial hypertrophy, vaginismus, Bartholin's gland abscess, vulvodynia, or vaginitis (see above). Endometriosis is a common cause of deep thrust dyspareunia or pain on deep penetration with intercourse. Other frequent causes of this condition are ovarian cysts and pelvic adhesions (scar tissue). Alternatively, inadequatee stimulation during foreplay may be the cause of deep thrust dyspareunia. When there is no (or inadequate) stimulation, muscles in the vagina are contrated, causing the vagina to be smaller in both diameter and length. Without adequate stimulation, deep penetration is more likely to hit the cervix and cause pain. Treatment of endometriosis, cysts, and adhesions frequently requires laparoscopy. Pain due to inadequaate stimulation during intercourse obviously requires adequate foreplay.

Pelvic pain not associated the the menstrual cycle or sex may be caused by endometriosis, adhesions, or cysts. This type of pain may also come from other causes such as bladder infections, kidney stones, diverticulitis, and many other non-gynecologic origins.

Diagnosis and treatment of pelvic pain requires a careful history, examination, and sometimes procedures such as ultrasouns and occasionally surgery. You should discuss any concerns about pelvic pain with your physician. We at Advanced Healthcare for Women are currently accepting new patients and would be happy to see you, your family, and friends.

In The Kitchen With Dr. B. - Easy Vegetable

This recipe is quick, easy, and does not require multiple pots and associated clean-up. It goes well with almost any entre. Before I get into the recipe, I would like to comment about food and, in fact, life. We live in a world in which we are going "90-to-nothing." We all need to slow down and enjoy the food, and life. When was the last time you took time to savor what you were eating? Food should look good, colorful when possible, smell good, have interesting textures, tase good, and in most cases be good for us. If what we are eating has these characteristics, whay not take time and use awareness to enjoy what we are eating? Scoffing down a hamburger and fries is not my idea of health and enjoyment. Slowing down a little to savor what we are eating not only provides pleasure but is also healthier.

Many years ago when my wife and I were attending a cooking class, our instructor did something I had never seen before - she salted what she was cooking based on smell rather than taste. As salt combines with food, the food cells burst and release good smells.

Back to the recipe. Anytime good, fresh ingredients are available, they beat anything else hands down. In this recipe, I use frozen corn and edmame (also spelled edammame) but would use fresh if available. As fresh tomatoes become available, I add them for flavor and color. If good tomatoes are not in season, I leave them out of the recipe. You can substitue red bell pepper which would give the color and will change the taste somewhat. If you use red pepper, chop and saute in a little butter before preparing the rest of the dish, reemove from the pan, set aside and add to the dish at the same time you would add the fresh tomato. A word about edamame, these are green soy beans, high in fiber and protein, low in fat, and having a moderate amount of complex carbohydrate - good for you.

1 1/2 cups frozen edamame
1 1/2 cups frozen white baby corn or fresh silver corn when available
1 medium to large tomato, medium ripe, seeded and chopped* or red bell pepper
Water
Butter
Kosher salt and pepper to taste (or smell, if you prefer)

Cook the edamame as directed on the package. My "taste" favors food to be on the "al dente," or slightly firm side rather than mushy, so I teend to barely undercook the edamame and corn. Drain the edamame and save to add at the end of the recipe. Cook the corn in a little water (and maybe a little butter) for seeverla minutes with salt added. I use just enough water so it has evaporated when cooking is finished and drain any left in the pan. My wife prefers to saute the corn in just a little butter for several minutes. Add the cooked edamame and chopped tomato, taste for seasoning, and enjoy!

*To chop and seed a tomato, cut in quarters or eight's if large, cut off the fibrous attachment to the stem, remove the soft inner part and seeds with your fingers, and chop.

Dr. B.