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Understanding vaginal adhesions, vaginal atrophy

Dear Dr. Cynthia

Tuesday, October 15, 2002

By Korky Vann, Special to The Hartford Courant

Dear Dr. Cynthia:

I have a problem. When I last saw my gynecologist, he told me that I have adhesions in my vagina. Are these a problem? They don't bother me and he told me not to worry about it. Could you give me some information on this? Thank you.

HELEN

Dear Helen:

I'm wondering if you have confused vaginal adhesions with vaginal atrophy or other types of adhesions. Adhesions are a type of fibrous scarring that results from trauma, infection or inflammation. Vaginal adhesions, which are extraordinarily rare, could in fact be a problem since they have the potential to cause a blockage.

Dr. Cynthia Napier Rosenberg

I'm inclined to believe that your gynecologist was actually talking about another condition. Let's start with adhesions. The two types of adhesions that gynecologists routinely manage are intraperitoneal adhesions and intrauterine adhesions. Intraperitoneal adhesions occur, just as the phrase implies, in the peritoneal cavity (the interior space of the sac that lines the abdominal cavity and covers the internal organs). Doctors don't agree whether or not these adhesions play a role in chronic pelvic pain. Nor do they agree on whether surgically cutting these adhesions can decrease chronic pelvic pain. Intrauterine adhesions occur inside the uterus and primarily cause problems with fertility.

Vaginal atrophy, on the other hand, is a very common problem for post-menopausal women and is probably what your gynecologist was referring to. Due to decreased estrogen following menopause, the tissues of the vagina, labia, urethra, and parts of the bladder undergo change. The vaginal walls become pale, thin and vulnerable to ulceration and infection. The vagina also can become shorter and less elastic.

Some women have no symptoms whatsoever from these changes. Others experience vaginal dryness, discharge and itchiness, painful sexual intercourse and urinary difficulties.

The standard treatment for these symptoms has been estrogen replacement therapy. Even though estrogen is no longer recommended as a preventive therapy for cardiac problems, it is still a treatment for these symptoms. In addition, these symptoms can be managed with topical estrogen treatment rather than by a daily pill.

In any case, since you are not having any clinical difficulties at this time, I wouldn't worry. If things change, you will need to see your physician.


DEAR DR. CYNTHIA:

My wife has sickle cell trait. Our family life is very stressful and three months ago she passed out and was in a coma for nine days.

She is only 33, but she frequently states that she will not live past the age of 35. I try to encourage her not to think those thoughts, especially since she only has the sickle cell trait. I know that neither my children nor I would be able to live happily without her.

Do you think that a high dosage of concentrated fish oil would help her by building up her red blood cells? If not, do you know of any other natural treatment?

I would truly appreciate your assistance in this matter.

HAROLD

Dear Harold:

I was very sorry to read about your difficulties. Maybe I can help with a few thoughts.

First, I do agree with you that your wife's loss of consciousness a few months ago was almost certainly due to something other than the fact that she carries one gene for sickle cell disease. The sickle cell gene causes hemoglobin (the protein that carries oxygen from the lungs to the rest of the body) to have an abnormal shape. Approximately 1 in every 12 African Americans has the trait for sickle cell anemia. But for a person to actually have the disease itself, he or she must inherit the sickle gene from both parents.

Although sickle cell anemia is a very serious condition causing breakdown of red blood cells and blockage of blood vessels, most people with the sickle cell trait (meaning that they have inherited one sickle gene and one normal gene) have no clinical symptoms and lead completely normal lives.

There are very rare cases of serious problems from sickle cell trait, but these are mostly in association with exposure to extremely high altitudes or extremes of exercise or dehydration.

Regarding the use of fish oil, I am unaware of any studies recommending the use of concentrated fish oil to treat sickle cell trait or sickle cell anemia itself. Large doses of omega-3 fatty acids (found in fish oils) can decrease the level of triglycerides in the blood. However, I would not recommend using these large doses indiscriminately and, in any case, triglycerides are not the culprit in sickle cell anemia.

My advice to you, first and foremost, is to find a good family physician who can go over all of this with you in more detail and who will take the time to help with the stressors in your family's life. It would be very important to understand why your wife suffered a loss of consciousness a few months ago and to take measures to treat that problem so that it doesn't happen again.

She might also be depressed, which could make it difficult for her to cope with other physical or psychosocial problems.

On the positive side, it sounds to me as if she is very much loved by both you and your children. That might be her biggest motivator in taking those first steps toward feeling better.


Dr. Cynthia Napier Rosenberg is Chief of Geriatrics and Executive Director of Senior Health Services at West Penn Hospital. Her column appears in the Health section on the third Tuesday of every month. If you have any questions on health and aging, you can write to her at P.O. Box 9190; Pittsburgh, PA 15224 or via her email address at drcynthia@wpahs.org.

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