Topics of Interest
- How to prepare before minimally invasive surgery (and what to expect after)
- Painful sex
- Heavy periods
- Painful periods
If you and your physician decided that surgery is the way to go to treat your condition, here are a few pointers to remember before the operation. Most of these will most likely be discussed with you in-person during your preoperative visit. These recommendations are for educational purposes only: Always follow the instructions that your doctor gives you.
Eating well the day before surgery is important in order to not deplete your body’s nutritional status. You will be fasting the day of surgery, so having nutrients built up is helpful. Most surgeries require an eight-hour fasting period. This is mainly because the stomach needs to be empty before anesthesia. Sips of water or medications during this fasting period is usually considered to be OK.
Light exercise in the weeks preceding the operation (stretching or walking) can also help make recovery easier. This should be under your physician’s guidance, especially if you have mobility issues.
There are some medications that may also need to be suspended. Examples of over-the-counter meds that should be avoided include ibuprofen, naproxen, ketorolac and aspirin. It is usually recommended that these be discontinued a week before the surgery. However, do not stop taking anything without your doctor’s instruction.
If you are a diabetic, it is very important that your sugars are well controlled before the surgery. This will allow for the tissues to properly heal and decrease the risk of infection. Your doctor will help you modify your medication regimen to achieve this. A healthy diet is also paramount.
Make sure you bring a list of all the medications you take to your preoperative appointment. This will allow your physician to carefully review them and let you know if there is anything that should be modified.
After the surgery, the first thing you will most likely remember is waking up in the recovery area. Here, you will have a nurse that will closely watch you as the effects of anesthesia wear off and will help keep you comfortable. With minimally invasive surgery, the majority of patients are discharged home the same day. You will likely receive scripts for pain medication to take as needed. Your surgeon will give you instructions regarding what restrictions you’ll have, but in the majority of cases after a hysterectomy, it is recommended to avoid heavy lifting and avoid intercourse. Driving should also be avoided if you are in pain or taking strong narcotic medications.
You will have a postoperative visit (usually two weeks after the surgery), where your doctor will check on how you’re doing, discuss decreasing restrictions and give you the results of what was seen under the microscope from anything that was taken out during the surgery. Make sure you write all your questions in advance so you don’t forget what they are during your appointment! You can call our number 24/7 if any questions.
Pain during sex is not normal. Unfortunately, many women suffer from this condition but never seek care. Modern medicine has made great strides in identifying the causes of painful intercourse, and we live in a time where multiple treatment options are available.
Painful sex can have several sources. One of the most common is endometriosis. Endometriosis is a condition where implants of inflammatory tissue grow on the pelvic lining and muscles. Depending on their location (if they’re close to a nerve or sensitive area), they can be very painful. Treatment can be hormonal, to decrease the inflammation from these implants, or surgical, where the small implants are resected, or “peeled off,” allowing for healthy tissue to grow in its place.
Another common source of pain during intercourse is pudendal neuralgia, which is a condition where the nerves that give feeling to the vaginal area become inflamed and are constantly sending pain signals to the brain. This condition can sometimes be treated with simple nerve blocks using medications that decrease pain and inflammation. This is something that can be done in the office.
There are also chronic conditions where the muscles around the vagina are involuntarily tense, resulting in marked discomfort. Again, this can be relieved with medications, local injections or pelvic floor physical therapy.
On some occasions, pain during sex can be a result of vaginal mucosa irritation, caused by autoimmune conditions or a disturbance in the vaginal acidity level, which promotes yeast infections and bacterial vaginosis.
In some patients, past emotional trauma can lead to a subconscious reflexive tensing of the pelvic floor, which results in painful intercourse. This creates further anxiety during the next encounter, in a never-ending vicious cycle.
An appointment to discuss painful sex usually would entail a detailed history regarding the characteristics and location of the symptoms and a physical exam, searching for potential “trigger points.” A specialized ultrasound may also be ordered to look for implants of endometriosis or internal scaring. Based on the findings, a personalized treatment plan is formulated. Follow-up visits are scheduled to ensure that the treatment is working, and if not, make modifications as needed.
Our team of experts is happy to guide you through the process.
Do you bleed for more than seven days?
Do you bleed through your tampon/maxi-pad, soaking your pants?
Do you feel dizzy, weak and light-headed during your periods?
Do you miss school, work and/or social functions because of your period?
A normal period cycle happens every 21-45 days, and the period could last up to seven days. The amount of bleeding changes from day to day, and usually it is heavy the first one to two days and then lightens up. Your periods may also change at different points in your life.
Heavy menstrual bleeding is defined as excessive menstrual blood loss that interferes with your physical, social, emotional or material quality of life. Heavy bleeding can also be quantified an amount more than 80 milliliters, which is similar to a small perfume container.
If you continue to bleed, you may begin to feel dizzy and light-headed, and have headaches. These are all symptoms of anemia, which means your blood count is low. This is very concerning, because you can damage your body if your blood count is low. You may need iron supplements to help your body build up the blood, or you may even need blood itself.
Based on the reason why you have heavy bleeding, after thorough investigation which can involve imaging and blood test, you may need hormone treatment and/or surgical management.
Do you take more than 10 tablets of acetaminophen and ibuprofen in a day?
Do you use more than acetaminophen and ibuprofen for pain during your period?
Have you ever been to the ER for painful periods?
Have you ever had to stay home from work? School?
Do you feel frustrated?
Painful periods can happen to everyone; it becomes a problem if it interferes with your physical, social, emotional or quality of life. It can happen at any age from your first period to your last. There are many causes for painful periods, which can be related to the pelvic organs such as the ovary, fallopian tube and uterus, or nearby structures like your bladder or bowel, which is also known as secondary dysmenorrhea.
Painful periods can also be related to a medical condition. Sometimes there is no pelvic pathology or medical condition related, which is called primary dysmenorrhea. You may be started on treatment to see if your painful periods resolve. If you are started on treatment for your painful periods and still have not found improvement in three to six months, you need to be reevaluated. You may also need physical therapy to work through it.
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are also causes of painful periods. They are usually associated with some degree of behavioral and emotional symptoms. PMS is quite common, and about three in four menstruating women will experience some form of PMS, which includes symptoms of fatigue, breast tenderness, food cravings and irritability. About 2% of women will meet criteria for PMDD, which is a severe form of PMS. There are conservative measures, like lifestyle modifications, that can help you. If necessary, you may need to be started on medication.