Biomedical subjects

M F Goetsch

Publications and source records attributed to M F Goetsch.

3 recordsLinked to original sources

PubMed1999

Postpartum dyspareunia. An unexplored problem.

OBJECTIVE: Postpartum dyspareunia has been attributed by authors of obstetric texts to episiotomy tenderness or vaginal atrophy. The nursing literature attributes it to low estrogen levels. This study attempts to examine these assumptions, to clarify the incidence of postpartum dyspareunia and the length of time it is likely to last. STUDY DESIGN: Sixty-two women in a private practice were examined between two and eight weeks postpartum and followed prospectively. RESULTS: Forty-five percent of parturients developed entry dyspareunia, but only 6% had pain at the sites of vulvar repair. The median length of symptoms in the 39% with nonfocal introital dyspareunia was 5.5 months, and tenderness lasted up to 1 year. Such dyspareunia developed in women having a first (42%) or second (47%) infant, delivering vaginally (42%) or by cesarean section (29%), and lactating (41%) or not lactating (22%). One-third of those affected had severe sexual dysfunction. CONCLUSION: Postpartum dyspareunia is quite common and can be a significant source of difficulty in the months after delivery. It is an underdetected problem and deserves more study.

Adolescent↗

PubMed1996

Simplified surgical revision of the vulvar vestibule for vulvar vestibulitis.

OBJECTIVE: The prototype of surgical treatment for vulvar vestibulitis has been the Woodruff vulvoplasty. A simpler surgery could be less morbid, technically easier, and equally effective. STUDY DESIGN: Twelve patients underwent vestibular revision, nine with local anesthesia. They were followed up for between 6 months and 6 years. Outcome was judged by ease of healing and relief of tenderness. This was a feasibility study. RESULTS: Ten of 12 patients had complete resolution of vestibulitis. Two others had improvement. Other causes of dyspareunia remain in 2 subjects. Issues of patient histories, postoperative healing, and functional outcome are reported. CONCLUSION: A simple surgery seems well suited to this problem. Additional causes of dyspareunia need to be recognized preoperatively and clarified. Development of granulation tissue in areas of wound separation can create sites of continued pain. Postoperatively, reflex vaginismus should be expected and needs therapy to complement the surgical treatment.

Adult↗

PubMed1991

Vulvar vestibulitis: prevalence and historic features in a general gynecologic practice population.

All gynecologic patients seen by the author during a 6-month period were questioned and examined by means of a swab test to determine the prevalence of vulvar vestibulitis and the normal variation in sensitivity of vestibular skin. Of 210 patients, 78 (37%) had some degree of positive testing. A total of 31 patients (15%) were found to fulfill the definition of vulvar vestibulitis. A questionnaire was administered to these patients as well as to seven patients in whom vestibulitis had been previously diagnosed. A total of 50% had always had pain, most since their teenage years. Their history was not suggestive of a cyclic or remittent pattern of symptoms. Those with secondary dyspareunia or resolution of pain were usually either in a post partum phase or had group B streptococcus or human papillomavirus. The two most severe cases of vestibulitis occurred after use of fluoroucil cream. A total of 32% had some female relative with dyspareunia or tampon intolerance, raising the issue of a genetic predisposition.

Adult↗