QUESTION: Hi Michael,
I have found a lot of comfort reading the answers you give to people's questions so I wanted to ask my own.
I am a 25 year-old relatively healthy married female; I have never been pregnant but hope to be some day. I have a history of ovarian cysts since about age 17, but they have all resolved themselves... sometimes with excruciating pain and weeks of bedrest, but nonetheless they have resolved themselves.
I started having some pain during intercourse and some general pelvic discomfort about a month ago... including very sharp stabbing vaginal pain for the past 2 or 3 cycles. Similar time frame I started having trace amounts of rectal bleeding occasionally after bowel movements and some upper abdominal pain right under my ribs (kind of like gas) after eating/drinking. About 2 weeks ago, I had what I would consider equivalent to a light menstrual period for about 24hours from my bum after a bowel movement... and now have little bits of bleeding (only on the toilet paper when wiping) after each bowel movement. I went to the doctor and she said she suspects that the bleeding is internal hemmroids. I used Anusol HC for 5 days but the bleeding is still happening after each bowel movement. She also referred me for an ultrasound and to a GI specialist for the bleeding and "acid pain" as she called it.
I had the ultrasound and the doctor shared the report with me yesterday. They found "a complex right ovarian cyst measuring 1.4 x 0.9 cm. It contains a few thin septations. There is no evidence of vascularity. A simple cyst is present within the left ovary measuring 1.4 cm. There is no free pelvic fluid." And, the opinion given was to have a follow-up US in 6 weeks.
I am seeing the GI specialist today for a consultation regardarding a possible colonoscopy for the rectal bleeding and to get some insight on the "acid pain"...
I guess what I am asking for is some more clarification on the cysts... What does "complex" mean? I thought that cysts were only complex if they were larger? Are they something to be worried about? Are they what is causing the pain during intercourse and the sharp stabbing vaginal pains? Could this at all be related to the rectal bleeding and "acid pain"?
Any insight you can share is very much appreciated.
ANSWER: Hello Natalie,
Firstly, you definitely need rectal bleeding addressed asap. In all likelyhood it is nothing and just some hemorroidal veins along the rectal wall. Hope you get this resolved after your appt with the GI doctor today.
Regarding US and cysts. Given the size of the cyst, I doubt it has anything to do with painful intercourse and vaginal pains. Small cysts may be complex as well. Complex means it is more than a sphere filled with fluid...and can have septaions in it, blood vessels going to it, or may contain blood. Most of the time these resolve. The reason for 6-8 week follow up is to see the cyst at a different menstrual cycle. Given your age, I would expect them to resolve completely or go down in size. No vascularity is a good thing as tumors like to be vascular. If the cysts are the same on the next US, you will likely need another follow up. If the cysts grow (which I do not expect) then you may need to see GYN. Given your age, these findings are common and are worked up with several US. You should be fine.
Regarind pain with intercourse and vaginal pain. Do you have any discharges that are unusual? did the pain start recently and getting worse? if so you need to be check out for infection. May be your doctor already sent some tests. If this is not infection, that see if the pain with intercourse is better or worse with certain positions, during deep penetration, varies depending on menstrual stage. If so then perhaps you and your husband need to modify accordingly so not to have you in pain.
Let me know if you have any other questions.
I hope this is helpful.
---------- FOLLOW-UP ----------
QUESTION: Hi Michael,
I just wanted to say thank you for your response.
The GI Specialist has scheduled me for a colonoscopy. He said he suspects Irritable bowel and possibly hemmroids. We'll see once the colonoscopy happens, I guess.
As for the cysts - Thank you for the reassurance. I hope you are right. I was hoping the cysts could be the cause for the pain... I don't know what else it could be then :( I do not have any unusual discharge but the vaginal pains have been getting progressively worse in the past few cycles.
My husband and I are each others' only sexual partners but we were tested before marriage and having intercourse for the first time anyway. We have only been married just over a year, so perhaps the pain during intercourse is like you said because of the angle/etc. as we are definitely still learning. I did not know that the time of my cycle can affect that so I will try to keep that in mind.
I have had regular paps and no concerns in the past other than UTIs in reaction to prescription medications and cysts on my ovaries that have resolved themselves as mentioned previously and a Nabothian cyst on my cervix about a year ago that I saw a GYN for and she did a biopsy that came back fine. I did have another pap done this week though - just in case.
Is there anything else you can suggest for figuring out the cause of the sharp vaginal pains that have been happening? When the doctor gave me the US report she alluded to the fact that the cysts would be the cause and her only suggestion was to continue taking Naproxen that she has prescribed to me. However, this isn't very practical... especially because I am sensitive to the drowsiness that Naproxen causes and so I can only take it at night.
Any other light you can shed would be much appreciated.
Thank you again.
I am certainly not a GYN expert re vaginal pains so I think I exausted my knowledge. The only I would say is to see your doctor specifically regardin that. Again, I think the cysts are too small to be a culprit. There are severeal options for the pain medicine, so I would ask about that as well.