Digest of recent discussions on ISSM mail (May 2009 - Aug 2009)

IX

CAROL FEATHERSTONE

Female Pain                                                                                                     

14 August 2009: 8 messages                                                                                                              

1

A supervisee has presented with ‘pulling’ pain which can come on, say, halfway through intercourse and can stay on for 24 hours. It is located top of cervix and lower half of uterus. She has had GP and hospital assessment. Nothing physical. She thinks it’s psychological. Female had previous traumatic relationship but left that ≈15 yrs ago. Does anyone have any thoughts on this?  

Carol Featherstone (carol.featherstone@BTINTERNET.COM)

2

What are the specifics of her previous traumatic history? Anything about early sexual abuse/negative messages about sex? Clearly, if it is not physical, then there must be something in her emotional and psychological history that would cause her to manifest some tension in her genitals associated with arousal.

 Linda Banner (llbanner@EARTHLINK.NET)

3

Dear Carol: The most telling factor in your summary is perhaps the fact that the patient herself instinctively links her pain to her emotions, even though she may not understand why. The location of the pain may be an essential clue to her past experience: for example, might it have involved a termination? There are many possibilities and I would not rush to any conclusion. Rather I would take a psychotherapeutic approach and explore the patient's internal experience and understanding of her history. I am curious about the nature of her ‘traumatic relationship’. Although it was 15 years ago, the patient's body appears to have held the trauma, which gets re-enacted in sexual intercourse with new partners. The traumatic relationship of 15 years ago itself may well have been a re-enactment of much earlier experience.

Susan Pacey (susanpacey@YAHOO.COM)

4

Thanks Linda.   I will investigate.

Carol Featherstone (carol.featherstone@BTINTERNET.COM)

5

Dear Susan: Thank you so much.  This makes so much sense.  I shall communicate to my supervisee.

Carol Featherstone (carol.featherstone@BTINTERNET.COM)

6

Dear Colleague, A pulling pain is often indicative of UTI or more esoteric gyn problems. A routine exam by a physician unfamiliar with these syndromes will not necessarily diagnose it on a routine exam, but rather rule out gross pathology. Your patient should see a specialist in vulvodynia.

Elaine Kleinbart (elainekl12@AOL.COM)

7

Poor vascularity - reduces if EROS used regularly - check usual vascular and hormonal blood levels.  

Ruth Hallam-Jones (ruth.hallam-jones@VIRGIN.NET)

8

You should consider the possibility of interstitial cystitis as a cause of the pain. A simple challenge of intravesical lidocaine into the bladder would suffice (when pain is present).

                                                                          Matt T Rosenberg (matttoren@yahoo.com)