Wednesday, May 20, 2009

STI: Ask the experts

May 21, 2009

Ask the experts




Q: I did not realise that I suffer from vaginismus until after my marriage. Sex is almost impossible.


However, I was really fortunate to get pregnant and I thought the problem would be solved after a natural birth. Sex is still so painful that I avoid it.


I read that Botox can help, but is it a permanent solution? Are there alternatives?


A: Vaginismus is characterised by an uncontrolled, involuntary contraction of the muscle surrounding the vagina (called the pubococcygeus muscle), which makes intercourse either painful or impossible. Fear of penetration is the main emotional obstacle.


The causes may be psychological - such as previous sexual abuse, strict home upbringing that sex is immoral, fears and misconceptions about sex being painful; or physical - such as genital infection or childbirth injuries.


Treatment may be psychological or physical. Psychotherapy can help the psychological aspects while physical therapy involves vaginal exercises, lubricants and desensitisation with vaginal dilators.


Botox has been used recently with some success, especially when standard treatments fail. Minute amounts of the drug are injected directly into the pubococcygeus muscle (a hammock-like muscle which stretches from the pubic bone to the tail bone, controls urine flow and contracts during orgasm) under anaesthesia to paralyse the muscle, thereby eliminating the pain.


Once the element of pain is gone, psychological fears subside and normal coitus is possible as the brain readjusts to a new situation and feelings. However, repeat treatment (four to six months) may be necessary and side effects include headache and flu-like symptoms.


As every case of vaginismus is different, an individualised approach by a gynaecologist and a therapist working as a team is the best.


Dr Tan Yew Ghee is an obstetrician and gynaecologist at Raffles Hospital and a senior partner and consultant at Raffles Women's Centre





Q: I am a first-time mother and the sole caregiver of my son. About a month after giving birth, I felt a sharp pain from the thumb down to the wrist area. Wearing a wrist guard or using a heat pack does not help.


I went for a few sessions of tui na massage but the pain became worse. A few weeks later, I experienced the same problem in the other wrist. A few of my friends, who are mothers, also have the same problem.


Could it be that we are carrying our babies the wrong way? Is there any medication that will help? Will the pain worsen in my old age and lead to more problems such as rheumatism and arthritis?


A: The symptoms you described seem to fit that of de Quervain's stenosing tendonsynovitis, which is an inflammation of the extensor tendons of the wrist over the thumb side. There are tight tendon compartments that hold down the tendons over the wrist so that they can act over the hand. They also act as 'pulleys" to direct the tendons in the correct direction.


However, when the wrist is subjected to repetitive actions or placed at awkward angles, such as carrying children with the wrist flexed, the tendons in that area are stretched or compressed. This leads to painful and swollen tendons.


You can avoid aggravating the situation by changing the way you carry your baby.


The good news is that the condition in your circumstance is usually temporary and will go away once your child gets older.


Another treatment option includes wearing wrist splints to provide support. If these do not work, try a steroid injection in the area of pain. This will provide a strong anti-inflammatory medication to the site and, together with adequate rest, may cut down the inflammation. A single dose of steroid does not interfere with breastfeeding.


In severe cases, surgery to release or free the tendons will solve the chronic problem. This condition is not usually related to rheumatism or arthritis in old age.


Dr Tan Ter Chyan is a consultant at the department of hand and reconstructive microsurgery at National University Hospital

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