Questions I Am Frequently “Axed”

I often discuss common medical conditions with patients and questions come up on multiple occasions. I have recorded these questions and will answer them periodically on this blog site. If you have any questions you like me to answer, please let me hear from you, nbaum@neilbaum.com.

I am 31 years old and have just had a baby. When can I resume sexual intimacy with my husband?
Whether you give birth vaginally or by C-section, your body will need time to heal. Many health care providers recommend waiting four to six weeks before having sex. This allows time for the cervix to close, postpartum bleeding to stop, and any tears or repaired lacerations to heal.
The other important timeline is your own. Some women feel ready to resume sex within a few weeks of giving birth, while others need a few months — or even longer. Factors such as fatigue, stress and fear of pain all can take a toll on your sex drive. If you have any questions contact your obstetrician.

I have loss of urine when I cough or sneeze or do any kind of exercise. My doctor said I have stress incontinence and he recommended a vaginal sling using mesh material. Is this safe?

Surgery to decrease or prevent urine leakage can be done through the vagina or abdomen. The urethra or bladder neck is supported with either stitches alone or with tissue surgically removed from other parts of the body such as the abdominal wall or leg (fascial sling), with tissue from another person (donor tissue) or with material such as surgical mesh (mesh sling).

Surgical mesh in the form of a “sling” (sometimes called “tape”) is permanently implanted to support the urethra or bladder neck in order to correct SUI. This is commonly referred to as a “sling procedure.”

The use of surgical mesh slings to treat SUI provides a less invasive approach than non-mesh repairs, which require a larger incision in the abdominal wall. The multi-incision sling procedure can be performed using three incisions, in two ways: with one vaginal incision and two lower abdominal incisions, called retropubic; or with one vaginal incision and two groin/thigh incisions, called transobturator. There is also a “mini-sling” procedure that utilizes a shorter piece of surgical mesh, which may be done with only one incision.

Complications of this type of procedure are rare but may occur. The most common complications include bleeding and infection, erosion or infection of the graft material (possibly requiring further surgery), injury to nearby structures, pain, inability to urinate (retention of urine), recurrent or worsening incontinence, new or worse vaginal prolapse, urgency or urge type-incontinence.

I am 65 years old man and had my prostate gland removed for prostate cancer three years ago. My PSA test is rising after several years being at an undetectable level. Is there anything else I can do?

First, I would get the test repeated. Although mistakes are rare, you need to confirm the results with a second test. Next a test has to be done to see if there has been any spread or recurrence of the cancer at the location of the surgical removal of the prostate gland. There are several tests that can be useful for this purpose including a bone scan to see if there has been any spread to the bones.

For men with less than five years life expectancy or with other medical conditions that may affect their longevity, then no treatment is needed and watchful waiting is an option.

For men with spread to other organs or to lymph nodes, hormone therapy is a consideration. This usually consists of medication to decrease the testosterone level which almost always results in loss of libido and erectile dysfunction.

Finally, if there is localized disease in the pelvis, radiation therapy is an option after surgery has failed to cure the disease.

The bottom line is that a rising PSA after surgery is usually treatable.

To Your Good Health,
Dr. Neil Baum

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