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Cause of Painful Sex Should Be  Investigated

Dear Dr. Roach: This is a subject I am reluctant to discuss, but I am at my wits’ end and don’t know what to do. I am 61 years old. I had a vaginal hysterectomy two years ago because of prolapse. I also have had a bladder lift (about 15 years ago). Everything seemed to have gone well. Once I recovered and was allowed to resume sexual relations, I discovered that I could no longer tolerate penetration. It was extremely painful, and I felt like my vagina suddenly was too small or the muscles were clamped down. It feels like a burning, tearing pain, from beginning of penetration to end. The two doctors I have mentioned this problem to didn’t have helpful suggestions. I was fine before the hysterectomy.

I am able to orgasm with oral sex. We have tried using lubricants, but they don’t help much. A kit with stretchers of increasing size also did little to help.

I really would like to fix this problem and be able to enjoy sex again. I have been enduring painful sex since and have begun to avoid it. I am hoping that you might be able to offer a better solution. Thanks. — D.V.

Answer: Painful sexual intercourse is a very common problem for women, one that many are reluctant to bring up. The fact that your problems began after surgery naturally arouses suspicion that the surgery caused some problem that is now causing pain. There are several possibilities of damage that can happen during surgery — even a properly performed surgery can have complications. A trapped nerve, for example, can cause pain during sex that causes the vaginal muscles to “clamp down,” a condition called vaginismus. I wonder whether you might have vaginismus as a complication of the postoperative pain.

In any case, you aren’t getting the help you need from your doctors, and you need to see an expert. Fortunately, there are experts in pelvic pain. A sex therapist also may be helpful, and I would recommend seeing one before considering another surgery. Unfortunately, it is possible that another surgery will be required to fix the problem. Only a very careful examination will be able to tell what the problem is.

Dear Dr. Roach: I’m an 82-year-old male in generally good health. Several years ago my blood test results came back with the notation that I have Pelger Huet Anomaly. Interestingly, a grandson and great-granddaughter also have been diagnosed with this condition. Please give me details about the condition and its significance. Should I be concerned about the condition? Apparently I’ve had the condition for a long time. A previous doctor said only that my blood count is “different” but that that is just the way I am and there’s no need to be concerned. — P.H.

Answer: The Pelger-Huet anomaly is a benign, genetic abnormality of the neutrophil, the cell that first fights off infection in the blood. The cells function normally. Automated machines sometimes can misread these cells as immature neutrophils, called “band cells,” leading to confusion about whether an infection is present. Otherwise, there is no reason for concern.

Dear Dr. Roach: Could you help me with geographic tongue? A dermatologist has been trying steroid ointment. It helps but has not cleared up the problem. I have had this more than a year. The tongue gets very sore, and the patches come and go. — N.

Answer: Geographic tongue — also called benign migratory glossitis — is a very common condition, with as much as 2 percent of the world being affected. The patches come and go in most people, but pain isn’t common with this condition.

Geographic tongue occasionally can be misdiagnosed as an oral fungal infection, but treatment for fungus is ineffective. In addition to steroid gel, one treatment that works for some people is topical antihistamine used as an oral rinse. Your dermatologist can prescribe this.

Fortunately, most cases go away as mysteriously as they come.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, Fla. 32853-6475.