My fiancee's unmentionable bits...

Factual Questions
21

I’m a doctor with a different opinion.

What kind of doctor are you Peace? Half a world away, you have no business to be scaremongering like that. In fact, chances are the problem is not gynecological at all. Relax. There is no urgent need to see a gynecologist. And little reason to be concerned.

80% of women have uteruses with a body pointing anteriorly. Thus, one in five women has a uterus whose body faces the lower back. Usually the cervix is normally positioned, it can also be retroflexed, however. Positions of the uterus and cervix can change throughout life, especially after pregnancy.

Your doctor said, in passing, that the uterus was sideways. Fewer than 5% of women with retroverted uterus experience any symptoms. Most of the women who do experience symptoms are premenopausal, which I assume includes your wife. The symptoms that do occasionally occur are pelvic pain, back pain, infertility and disruption of the menstrual cycle. Constipation in uncommon. Problems with the urinary tract due to a change in position are very uncommon (according to Pernoll, LANGE Current Obstetrics & Gynecology 8th ed).

Emergency surgery? WTF? The uterus isn’t incarcerated here; not like your wife is pregnant and unable to pee which is a gyneologial emergency. Benign muscle tumours in the uterus are common, sure, but don’t cause these symptoms. Peace, I assume, made his comments since he knows the abdomen can indeed be difficult to diagnose. But for crying out loud, if the doctor thought it was an ulcer or stomach infection, presumably the pain was above the belly button. It went away, perhaps due to the medication. Why would this point you towards a gynecological diagnosis? On what basis? Family doctors are not a “weak temporary alternative” in this case. I will be happy to continue this in the Pit if you prefer.

I would be intersted to know more about peeing “every five minutes” which seems exaggerated. But I think your tipped uterus is nothing to lose sleep over. And it is plain silly to think you have to see a gynecologist SOON. Relax. Tell me more about the peeing and the stomach pain.
Don’t hear hoofbeats and expect to see a zebra when horses are more common.

22

Umm yeah Dr Paprika, I gotta join you in wondering just why peace is all over threads giving odd medical advice.

So peace? are you a doctor or do you just play one on the net?

Astroboy - I cannot get my head around a uterus being sideways ::pause for bizarre visual::. I guess if there have been no problems in the past then it is likely there won’t be probs in the future. Is she using an IUD? If she is, then maybe asking the doctor who fitted it would be a source of info. The diaphragm just needs to fit over the cervix so I don’t think retroverted uteri are a prob with diaphragms. Condoms and the pill are just fine of course :slight_smile:

What we really need here is for someone to bug the doctor’s office so we can get a decent translation. Is it totally culturally inappropriate for you to go with her and ask the doctor what this might mean in the future? Could you pretend that you desperately need to breed?

23

Here’s just one woman’s story. My own tipped uterus has never interfered with sex or childbirth or led to any other female problems. It’s as insignificant to me as if my doctor had noticed that I have a crooked little toe. To my doctor it may have more meaning, such as whether or not to prescribe an IUD or predicting difficulties during birth.

Get a second opionion, heed the advice given by the physician on the board, do research on the internet. Above all don’t freak over something that is shared by so many women.

24

Paprika seems to have the situation well in hand. But my sister the pediatrician did bother to respond to my query, so I may as well print it. Here it is:

“More than likely it is just retroverted where the fundus (or top) is folded over backwards. It looks like it is “sideways” on some of the ultrasound views, so maybe that was it.”

Just one more vote for the “it’s not a huge deal” side of the discussion.

25

Whoa! Damn this whole “going to work so that I miss all of the answers to my post” thing!

OK, first: thank you everyone for your help!! (and don’t pick on peace, please… he’s only trying to help, and I like him!! And I’m not easily scare-mongered… or I’d do something about the rest of my pathetic life!)

second: I need to clarify a bit… the stomach issue that Hyun Jeong (my fiancee… or just “HJ” as no one who grew up speaking English can pronounce her name, 'cepting me of course! I had to learn as part of the “wooing” process) went to the doctor about was not related to the uterus mis-alignment… the uterus issue was something that he, apparently, just mentioned to her during the exam (but stuck in my head, because…I mean, WTF??? I have a very strong interest in HJ’s naughty bits, and everything attached to them…). The stomach issue was diagnosed (we looked up the word, but I don’t remember the name of the condition), treated, and is over…

third: I am not all that worried about this! Just curious… and getting HJ to see a male doctor (female ones are rare here) is virtually impossible due to her reluctance to take off her clothes ('cept for me! :smiley: I AM A VERY LUCKY BASTARD!!!)

Whew!

OK: now to the issue of her peeing… “peeing every 5 minutes” was an exaggeration, but not by much! We’re talking about a woman who goes to urinate, on average, about once every hour or so… and if the evening includes beer, as it often does, once every 10-15 minutes (no exaggeration, no joke!). When she does go, she does it SO fast that she has to (again, no joke, no exaggeration) slowly count to 10 before coming out of the bathroom so that her friends don’t tease her about how quick it was… when we are at my house, and she goes to the bathroom, she’s out so fast it’s hard for me to believe that she had time to stop, drop, sit, pee, wipe, stand, and adjust her clothes(if any)!

So… there you have it!

I’m going to try to persuade her to see an OB/GYN eventually (as far as I know, she has never seen one, and I’m not optimistic about my chance of convincing her to see one!)

Does that help? Dr.Paprika, I’d appreciate any further input…

26

BTW: peace, Dr.Paprika… Please don’t take this to the Pit! I’d feel bad if my innocent little post started a bitter argument!!

27

All other issues aside… it IS a good idea for all women to see an OB/GYN for an annual check-up, especially if they are sexually active. This is not meant to scare anyone; it’s just good health maintenance.

I can understand that your fiancee is uncomfortable going to a male doctor for this; by the same token, I don’t know many guys who’d be comfortable going to a woman proctologist. :wink: But please encourage her to go.

28

Astroboy, you defended me, I will try to explain my motifs and my rational.
I do not approve of giving long distance medical advice, patient unseen. Such advice may work 10 or even 100 times. Then the doctor hits shit and the patient… I do not want to be that patient.
In your case the matter is more complicated because of translation. In order to deal with it, I have to assume that we are talking indeed about the uterus. If a doctor, a GP at that (nothing against your brethren, Dr. Paprica, just limited experience is implied here), could diagnose something on external examination, something very wrong must be with the uterus or with the doctor, or with…
Normally, uterus cannot be palpated (felt with examining hand), let alone a diagnosis can be made. Retroflexion is not rare and is not dangerous. But it cannot be diagnosed like it was, if it was. His diagnosis does not make sense at all. He could feel that the uterus was “sideways” in one case only: if the uterus is very enlarged and distorted. In which case it must be a large fibromyoma (leiomyoma). But he did not mention anything about “big tumor”. So, at this point I suggested to see a gynecologist. The urinary frequency could be “natural”, or symptomatic and unrelated or related to the pressure caused by a huge tumor. A benign tumor of this size can be asymptomatic, other than urinary frequency, and be diagnosed incidentally.
I always thought, that the most important thing, when consulted in such manner, is to tell the patient about all eventualities. For instance, if you told me that she got a zit on her forehead which has been there since the Labor Day, I’d said: “I wouldn’t worry much in a 29 yo, but, just in case, show it to a skin doctor. Once in a million times these things may be cancerous”. Next week you, guys, would have beer and recall the hole episode with a smile, saying: “Oh, this Peace! He always sees cancer behind every zit!” But once in a million times you’d say: “Oh, this Peace! How did he know it was cancer! Brilliant guy!” I do not need this compliment, I’d rather be a cautious idiot.
So, returning to HJ: if better translation is not possible, she should see a gynecologist. At the most, it will cost some money and nerves. You will recall the whole episode with a smile. It’s better than to recall my name all your life, I will not get any kicks out of it.
P.S. Fillet’s advice is good, regardless. Especially after certain age, when a Pap smear will come into play.

29

Hey I just wanted to say that, even if you have to search long and hard to find a female ob/gyn, even if you have to drive across the %$#@! country to find one, even if it take 1 or 2 or 5 or 10 hours for her to work up the nerve and walk in, it is really important, especially for a sexually active woman who might, someday wish to have kids. Not the most fun way to spend an afternoon, but important. Plus, I don’t know about Korea, but in the US you can’t get birth control pills without a pelvic exam (isn’t that a nice euphemism?). Perhaps a consideration.

Not a doctor, just my opinion. (and has she read “Our Bodies, Ourselves?”)

30

Peace

answer the question please. Are you a doctor? Your last post certainly implies that you are. What’s the deal with the diagnosing and scaremongering over the net?

A simple yes or no would suffice

31

Primaflora, in all my respect, a simple YES or NO would not suffice. If I am, I can’t prove it to you, and I am not licenced in your state. What if I am an imposter? What difference would it make for you , anyway? I do not want to instruct anyone even about wart removal over the Net. One can either trust me, or take it with a grain of salt, or…
So, again: the Net is great, but I do not that think one should use it as an HMO, even if you think: “What’s the difference?”
Sorry for the long answer.

32

**

**

Does that answer the question Primaflora?
Didn’t think so.

33

Gaspode

It did ;). So did his reply. It kinda proved my idea that he was an evasive, posturing person.

Peace

If you won’t give advice on wart removal, it might be a damned fine idea if you stopped giving advice on more serious matters. Reading your posts does give a STRONG impression that you think you know what you are talking about.

Quote:I always thought, that the most important thing, when consulted in such manner, is to tell the
patient about all eventualities. For instance, if you told me that she got a zit on her forehead
which has been there since the Labor Day, I’d said: “I wouldn’t worry much in a 29 yo, but, just
in case, show it to a skin doctor. Once in a million times these things may be cancerous”. End quote

That says in no uncertain terms that you are a person who is consulted in the role of medical practitioner. If you do not wish to give this impression, then I suggest you either hone your writing skills or stop answering medical questions.

34

Astroboy, I have nothing against Peace. He posts a lot of medical advice and some of it is good. Diagnosing people over the net is obviously not ideal. But when he starts talking about tumours, emergency surgery, prognosis for fetility and need for an ultrasound or MRI, he is being very irresponsible. I don’t want to be the doctor in the 1:1000 case either. But his positions are untenable, and I think highly irresponsible.

I am a family medicine resident. Family doctors in my town run the emergency rooms. I moonlight in small towns where I am the only emergency doctor on call. Many family doctors in my town deliver 100 babies a year; several do unassisted Caesarians! 15% of all visits to family doctors are about gynecological problems, and to be honest the differential diagnosis in gynecology is not particularly expensive (OB/GYNs are well worth an annual visit and are particularly valuable because of their great skill in gynecological surgery and difficult obstetric cases). If you were to say my experience as a gynecologist was limited to three months of formal training, fine. To denigrate my profession in this manner is unfair. GPs are not gynecologists but they know the common and important conditions. They know there limts and whe to refer, as well. Obviously this limit depends on the GP.

Now to address peace’s points before discussing the peeing every hour.

But was it an external exam? This is an assumption Astroboy makes. It is very easy to diagnose this on a bimanual exam (with one hand external). If the uterus was grossy enlarged, don’t you think the doctor, who (unlike us) saw the patient would have made an urgent referral? Not given some acid medications or mild antibiotics? The doctor who saw the patient may be arrogant… doctors are all over the world. But a first year medical student can tell the uterus position! It is also possible the uterus position was already in the chart noted from a previous Pap. Does this make sense? None of us saw the patient. None of us are in a position to try to scare the patient’s family given what we know is normal in one in five women.

This is, with all due respect, impossible. The patient needs to know about problems which are common and problems which are serious and forseeable. One day, you may have a heart attack. Lots of people do. You don’t need to see a cardiologist TOMORROW and get triple bypass surgery.

A noble goal. I applaud it. But unfortunately none of the questions you asked were the relevant questions. What did you conclude from what you asked?

Immediate danger in this case would come from appendicitis, pancreatitis, ruptured peptic ulcer, ruptured abdominal aortic aneurysm, ectopic pregnancy, ovarian torsion ovarian cancer or acute renal failure. You did not ask about fever, rigors, night sweats, weight loss, anorexia, light headedness, rigid stomachs, change in bowel movements, chance of pregnancy, location of pain, character of pain, whether it was of sudden or gradual onset, where the pain radiates, change in bowel habits, dysuria or perhaps 20 other basic questions which may indicate an emergency. You did make some unfounded comments with no information. A doctor has already seen this patient, remember. You did give a lot of medical advice even if you don’t believe in it. If I tried, as a GP, to refer this patient urgently based on what I know, the OB/GYN would laugh in my face!

It wouldn’t. As long as what you say is credible. Lots of nurses, paramedics, counsellors and health workers give excellent advice which in their area of expertise is better than that of an MD. But they don’t see the big picture…

I’m not trying to chastize Peace. But if he is going to disparage my profession and then advise you as irresponsibly as he did, I cannot let that pass without comment. I have no wish myself to take this further.

OK. And sorry for the above rant.
Your wife pees a small amount every hour or so. More often if she drinks a lot.

A few more questions, please.

How much warning does your wife have between feeling like she needs to pee, and actually peeing?
Any history of accidents?
Does she lose urine when she coughs or sneezes?
Do you have any children?
Has your wife ever had abdominal surgery?
Is there any history of back injury?
Is there pain on peeing?
Does she often need to pee at night?
Is she more likely to pee if you turn on a faucet or tap?
How long has this been a problem?
How much of a concern is this problem to your wife?
Any fever, chills, weight loss, night sweats, change in appetite?
Ever had a kidney stone?
Ever noticed very dark urine?
Any change in the menstrual cycle?

35

Whoops! Not only is the differntial diagnosis in gynecology all that extensive, apparently it is not expensive either. Family doctors certainy have the training to make a diagnosis, they do NOT have the skills to treat many problems not solvable with a simple medicine. I would not want a GP doing laproscopic surgery on me!

Any women more comfortable seeing a women about these problems should. Visiting an OB/GYN once a year is probably a good idea especially given a history of breast or ovarian cancer, etc. Most male patients don’t really mind rectal exams from females; a few get off on it, unfortunately. Female patients generally are more comfortable dealing with female doctors about these problems; this is especially true for Moslem women.

36

Whew! OK, to answer a few Q’s about my fiancee (and byt the way, if she ever saw this thread and knew that I initiated it, I’d be a dead man!):

Warning time? Normal, I guess…
Accidents? No, except one time, very drunk, stuck in a taxi in heavy traffic…
Urine lose on coughing/sneezing? Nope!
Children? Nope!
Abdominal surgery? Nope!
Back injury? Nope!
Pain on peeing? Nope!
Peeing at night? Nope… she can usually sleep through the night without getting up…
More likely to pee if a faucet is on? Nope… but I am! :slight_smile:
How long has it been a problem? It’s not a problem, just weird! But it has occured all her life…
How much of a concern to the fiancee? None, really… it is sometimes a bit embarassing for her when we are out with friends, that’s all…
Fever, chills, etc.? Nope!
Kidney stone? Nope!
Dark urine? Nope!
Period change? Yes, occassionally… I have attributed this (in my non-doctoral way) to stress. Her job is occassionally very stressful!

Whew! Anyways, it’s not a problem, just something I wondered about…

Thanks again, all!!

Exactly when did this turn into a thread about peeing? :slight_smile:

37

Sorry. Guess I shouldn’t have told your wife about this thread :open_mouth:

Doesn’t sound too severe if she has no accidents or nocturia. Unlikely to be an infection if its always happened. Still a couple possibilities…

Small bladder. Not everyone has a bladder that can hold half a litre of urine.

Bladder hyperrlexia. A failure of the bladder to relax properly, hence a problem storing urine. Medications are available to relax the bladder, but if she honestly doesn’t think it’s a problem no one would probably treat it.

Flaccid urethra. Again, a storage problem.

Overflow incontinence. Generally a full bladder all the time which overflows periodically in small amounts, when the pressure in the bladder is higher than that in the urethra. This could be caused by a hypotonic bladder which is much more likely than autonomic dysreflexia.

Again, these are never treated if the patient does not think they are a problem. If it is, ask your doctor about medication. A urometry test or voiding X-ray (cystourethrogram) would make the diagnosis more obvious. But it does not sound all that concerning.

38

Dr. Paprica, I think I got more from you than I deserve. We have different philosophies, that’s all. I ain’t saying that mine is right. Or yours. Just different. I wonder where do you find the time to be here? Between your residency and moonlighting?
I do not give medical advice here. I post my opinions. Anyone can read them or skip them. That’s why I am not telling about my qualifications. They are simply irrelevant here.

Astroboy told us about his problem. I doubt that there is a problem, but there are so many unknowns that I cannot be certain of anything. The story sounded very strange. A GP (again, no offence, that particular GP seemed eh, strange to me) casually mentions that young lady uterus is “sideways”. ON EXTERNAL EXAM. (Remember, she is so shy, she wouldn’t undress). Tell me how he palpated the uterus? So, I decided that if he could have palpated it, it was enlarged. You tried to impress me with your differential diagnosis. You are absolutely correct. I, on the other hand, even did not want to go through the differential. I suggested the statistically likeliest cause and “send” her to a gynecologist. Was it wrong with that?
Astroboy can skip my post(s), go to yours and follow it. If I ask a “personal” question here, I’d like to get as many answers as possible. Then I may study them, check them, etc. Perhaps, it may look wrong to you but at least, I am consistent. I naively though that other people take a similar approach. If they don’t, I feel sorry for them, but this is not my business. I might decide to open my own page on the Net and do consulting. But it would be set up differently. And, since I know next to nothing about it, I may ask people how to do it. But I won’t do anything on their advice alone: I do not know them.

39

Since you ask, most hospitals have the Internet. In a small town, some days are busy and I am very busy. Some days are slow, and I can easily access http://www.straightdope from the hospital. There does not seem to be much of a happy medium. I recently bought a used notebook and have fallen into the unfortunate habit of logging onto this board from home. %$#% addictions! But since I tend to be in the hospital for longer periods of time then you could imagine, and since things are either chicken or feathers, I log on when things slow down.

Medicine is a humbling profession. Diagnosing the most statistically likely thing is DANGEROUS. You need to know ALL of the things that reasonably explain the symptoms and then systematicaly eliminate the possibilities. This is the ENTIRE basis of medicine, especially emergency medicine – what are ALL of the things that could be causing this problem? What do I need to do to sort it out to fewer possibilities? You have to, because otherwise you are a DANGEROUS MENACE. The statistically likely possibility, statistically, is the wrong one. Over the net (half a globe away!), your approach is even more irrational, since you claimed earlier to be eliminating life-threatening conditions. Now you tell me this was not your goal or part of your philosophy. Your medical advice always involves seeing a professional quickly. That often makes sense. But in this case it really does not.

Your original post does not contain the most likely possibility either. However, if you use your philosophy, instead of being wrong 1:10 or 1:100 or 1:1000, you would be wrong at least 50% of the time. Which IMHO is abou your track record. Anyway, isn’t this just an excuse? I mean, tumours, emergency surgery, prognosis for fertility? I see your point about the external exam. But patients are people. When doctors see them, they are people under stress. They don’t remember the name of every pill, or when they had their last X-ray. They don’t describe their problems the way textbooks do. They don’t have all, even any of the classic symptoms. They mix up all sorts of details. They do this because they are people. I do this to when I visit the doctor. Fairly often, the patient lies intentionally or exaggerates to make their pain seem much worse or much less severe (lots of stoics out there). The art of medicine is distilling the patient’s history. What is useful? Unlikely? Any one with much experience taking histories would realize Astroboy is not (as he said) fully sure the exam was external, and in all probability wasn’t. Your conclusion that gross hypertrophy of the uterus is the most statistically likely explanation is surprising.

Medical advice is not entertainment. People are more likely to take the opinion of a doctor more seriously than that of a layman. I have seen others chastised on this board for giving harmful medical opinions. If I want a house built, I don’t ask my grocer for advice either. I don’t think you did get much more than you deserved, at least from me. I’m not saying you ever said you were a doctor, you just play one on TV. I disagree with a lot of the stuff many people say about health on the SDMB. But your tone is certainly meant to imply expertise. And you claim expertise as well saying that you are in a position to know. In this case, my opinion is that you do not. In my opinion, it is not just a difference in philosophy.

I don’t think your advice in this threat – see a professional quick-- was dangerous. Just uncalled for. The danger is telling a healthy person the most statistical likely cause for their problems is a tumour which will affect their fertility and needs emergent surgery. Tell a real-life patient that, they tend to get a low opinion of you if you are wrong.

40

You know, all I know about this GP is that he probably correctly diagnosed and treated the stomach pain, was somewhat arrogant or brusque and said the uterus was sideways. Which of the above strikes you as strange, in a GP?

I’ll assume you aren’t serious when you tell me the exam HAD to be external because the girl was shy and therefore would not undress. Shy patients are especially compliant with Confucian authorities.