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Gynecology (Expert Forum)
Can't get a straight answer
Answered by
Elaine Brown, MD - Pregnancy, Gynecology
Elaine Brown, MD - BLOG
Billings - MT
Can't get a straight answer
by tweety7663, Jun 25, 2009 01:01PM
I can't get a straight answer from anyone. I am 45 years old. Ten years ago I had a hysterectomy, but I still have my ovaries. I am have slight vaginal bleeding, (I am sure blood is coming from vagina), bladder infection with blood, and a possible Bartholin cyst. Dr. has not biopsied it. Any ideas?
Doctor's Answer
by Elaine Brown, MD, Jun 28, 2009 02:14PM
, Jun 28, 2009 02:14PMTo: tweety7663
Hi!
If my patient came in with your complaints, we would do the following. First, treat the bladder infection. Once the urine is clear we can be certain the source of the blood is NOT the bladder. In fact, if you are having vaginal bleeding, it might be important to use a catheter to obtain the urine to be certain the blood in the urine is actually coming from the bladder. Next we would lance the Bartholin's cyst--that is if it is large and bothersome. If it is small and stable over time, we could just keep an eye on it. It is very important to watch it carefully though, as sometimes the Bartholin's glands can develop malignancies--though this is very rare. Finally, after having taken care of the easier matters, we would address the source of the vaginal bleeding. IF there is any obvious lesion, it should be biopsied.It can be very difficult to find the source in the cases that I have seen. We also have to rule out any GI source too. If we could discover what is bleeding (some things I have seen include a prolapsed fallopian tube, and endometriosis implants ) we would take the necessary steps to correct it. If not, I would do a pap smear from the vaginal cuff and an ultrasound of the ovaries and possibly a laparoscopy to check them if necessary.
Hope this was helpful. Make sure your MD knows why you had your hysterectomy too--especially if there were any malignant cells in any part of the uterus or cervix!
Good luck!
Dr B
If my patient came in with your complaints, we would do the following. First, treat the bladder infection. Once the urine is clear we can be certain the source of the blood is NOT the bladder. In fact, if you are having vaginal bleeding, it might be important to use a catheter to obtain the urine to be certain the blood in the urine is actually coming from the bladder. Next we would lance the Bartholin's cyst--that is if it is large and bothersome. If it is small and stable over time, we could just keep an eye on it. It is very important to watch it carefully though, as sometimes the Bartholin's glands can develop malignancies--though this is very rare. Finally, after having taken care of the easier matters, we would address the source of the vaginal bleeding. IF there is any obvious lesion, it should be biopsied.It can be very difficult to find the source in the cases that I have seen. We also have to rule out any GI source too. If we could discover what is bleeding (some things I have seen include a prolapsed fallopian tube, and endometriosis implants ) we would take the necessary steps to correct it. If not, I would do a pap smear from the vaginal cuff and an ultrasound of the ovaries and possibly a laparoscopy to check them if necessary.
Hope this was helpful. Make sure your MD knows why you had your hysterectomy too--especially if there were any malignant cells in any part of the uterus or cervix!
Good luck!
Dr B
