Your Pelvic Pain May not be Endometriosis

Question:

I am a thirty year old woman with 2 children. Over the past few years I have been battling pelvic pain with no help in sight. My gynecologist did a laparoscopy on me and found no endometriosis.

My symptoms include painful intercourse both at the entrance and deeper part of my vagina. I wake up at night many times to go to the bathroom. My doctor has treated me with antibiotics on many occasions for bladder infections without improvement. I have been scheduled to have hysterectomy with removal of my ovaries. What should I do?

Answer:
Your condition is not unique. I recently saw a 21 year old woman who has had hysterectomy with removal of her ovaries because of pelvic pain presumed to be pelvic endometriosis. I often see women in my practice who have been variously treated for pelvic pain without relief.

They tend to have pain with sexual intercourse, frequency of urination during the day and at night. They may have associated pain at the entrance of the vagina. Many would have been treated for pelvic endometriosis, diverticulitis or recurrent urinary tract infections without improvement of their condition. Usually these patients have Chronic Interstitial Cystitis. The pain may flare up during menstrual periods and mimic pelvic endometriosis.

We don't know the cause of the disease though some theories of its causation exist. It can affect men but it is more common in women with devastating consequences since it affects sexual activity and sometimes prevents the patients from working. Most patients I see at the office have been variously treated for pelvic endometriosis, recurrent urinary tract infections, pelvic inflammatory disease and diverticulitis.

My approach to diagnosis is to ask the patient about frequent urination, pelvic pain and painful intercourse. I then examine them specifically looking for tenderness at the entrance of the vagina and the bladder, backed by the Interstitial cystitis questionnaire (PUF). I obtain urine for culture and cytology to exclude bladder infection and cancer. I do not do the potassium sensitivity test which can be painful in the office setting. If the urine tests are negative, I treat the patient with 3 medications.

• The first is Elavil (Amitryptiline) that blocks the nerve endings and treat pain.
  
• Atarax (Hydroxyzine) that prevents allergies in the bladder.
  
• Elmiron that coats the bladder to treat the condition.
  

The last counseling I give to the patient is to draw their attention to certain foods that can cause allergies in the bladder and aggravate their condition. Most patients do well if they take their medications and avoid foods that can aggravate the bladder.