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An episiotomy is a surgical incision into the perineum, the area between the bottom of the vaginal opening and the anus, in order to increase the size of the vaginal opening during childbirth. If it is done as part of gynecologic surgery, it's called a perineorrhaphy.

What could possibly be worse than struggling with a painful condition and feeling ashamed to discuss the problem because of its intimate nature? Such is the case for many suffering with pudendal neuralgia, a little known disease that affects one of the most sensitive areas of the body. This area is innervated by the pudendal nerve, named after the Latin word for shame.

0) No Pain1) Slight Pain, slight ache, pain comes and goes very mild. Able to perform all tasks normally and pain is easily forgotten while attending to something else. No pain medications required.2) Slight pain which lasts a bit longer, still able to perform usual tasks and again, if concentration is shifted away from the pain, the pain is forgotten about. No pain medications required.3) Pain is more noticeable and it comes and goes more frequently. Still able to perform usual tasks but it takes a bit of effort. Mild analgesic usually will help with this type of pain.4) The pain lasts for longer periods, it is much more noticeable and it is starting to bother and interfere with concentration and tasks requiring more effort and concentration. Mild analgesia should alleviate this type of pain, maybe more doses than one single dose may be required. A hot pack or ice pack may also help alleviate the pain.5) The Pain is now very noticeable, it is interfering with everyday tasks and a pain reliever is now required at 4 to 6 hourly intervals. Depending on the patient, someone with acute pain, may still respond well to mild analgesia probably at 4th hourly, maybe with added codeine (if the patient is able to take it) and even heat or ice may help with some relief of this level of pain.6) The Pain level is medium heading towards strong now and it is becoming more constant and it is not easily forgotten about. Pain relief is now required and it may need to be stronger than just mild analgesia, added codeine may help with the level of pain relief, this all depends on whether the pain is acute or chronic and on the patient's actual level of pain tolerance. A chronic pain patient may still have this level of pain even with strong pain relief.7) The pain level is now medium to strong and the pain is continuous. It is not relieved by mild to medium analgesia. Stronger narcotics are now required for pain relief. Chronic pain patients may still be at this level, even with strong narcotic pain relief. Heat may also aid with relief. Its becoming harder to concentrate due to the strength of the pain.8) The pain is becoming unbearable, strong narcotic pain relief is required. The chronic and acute pain patient will be irritable, hot and may be flushed, perspiration may be noticeable. Blood pressure may also be elevated. Patient may start to shake a bit if the pain has been going on for too long.9) The pain now is unbearable, only strong narcotic pain relief for the acute patient will help with the pain. The chronic pain patient will be irritable, the patient may be flushed and their palms are usually sweaty, blood pressure usually raised, pain relief needs to be increased and re-assessed. Nausea or vomiting may be present. The patient may be trembling or shaking due to the amount of pain, moaning and groaning may be present. Whether the pain is acute or chronic, the patient is usually unable to sleep or concentrate on the smallest task.10) The pain level is totally unbearable, the patient maybe vomiting or can even lose consciousness. The patient may also become delirious, moaning and groaning without making any sense. The blood pressure may still be elevated or by now may have dropped and the patient may go into shock. The patient must be treated by his/her symptoms, if cold, then the patient should be kept warm and if hot they should be cooled down. Pain relief is needed urgently. The patient may even become incontinent.

For those of us involved in the field of weight control, there is no greater reward than helping someone overcome their struggles with weight. Too often, people with weight issues feel they are weak, lack willpower, or have a psychological “block” that makes taking off just a few pounds seem like a task of Herculean proportions.

In November of 1996 (at the age of 25) I was diagnosed PCOS, and about 2 weeks later I started having very intense pelvic pain that I thought was due to a pulled muscle. The pain continued for several months, and after an examination and discussion with my family doctor, we believed it was ovarian cysts.

Oral and topical pre-exposure prophylaxes are successful in preventing the transmission of human immunodeficiency virus via sexual intercourse, according to a presentation at the 13th European AIDS Conference of the European AIDS Clinical Society (EACS). Established in 1991, the EACS is a leading scientific society composed of clinicians that aims to educate, train and compose guidelines for those clinicians in Europe treating patients with HIV and AIDS.

Now open for public comment, the US Preventive Task Force (USPTF) has drafted a recommendation statement that updates their 2003 recommendations for screening for cervical cancer. Based on research examining benefits and risks associated with screening across various groups of women, the new draft recommendations note which women most benefit from cervical cancer screening.

Hyperparathyroidism is a syndrome caused by excessive secretion of parathyroid hormone. Primary hyperparathyroidism results in raised ionized serum calcium with adverse effects on many organs. The effects particularly in pregnancy may be severe.

Botulinum toxin type A may be effective in reducing coital pain in vestibulodynia with levator ani tenderness, but has little effect on vestibular allodynia.

A Randomized Comparison of Group Cognitive-behavioral Therapy, Surface Electromyographic Biofeedback, andVestibulectomy in the Treatment of Dyspareunia Resulting from Vulvar Vestibulitis

Vulvodynia, also known as burning vulva syndrome, is characterised by sensory abnormalities of the vulva and the surrounding tissue, such as an unpleasant burning and itching sensation, or a painful response to a stimulus that is not usually painful such as sexual intercourse or the touch of a cotton swab.

The Web-enabled Glazer Surface Electromyographic Protocol for the Remote, Real-time Assessment and Rehabilitation of Pelvic Floor Dysfunction in Vulvar Vestibulitis Syndrome: A Case Report

Biofeedback is a self regulation training technique derived from well established principles of human learning. Biofeedback is a technique, not a stand alone treatment, which is one component of a behavioral training program to facilitate acquisition of pelvic floor muscle control and other continence skills.

Thirty-three women diagnosed as suffering from vulvar vestibulitis syndrome, marked by a significant history of long-term moderate to severe chronic introital dyspareunia and tenderness of the vulvar vestibule, were selected for treatment.

"What is the hardest of all to do? To see with our eyes what our eyes lay before us. (Paraphrased, with apologies from Goethe) That essentially is the message of the innovative efforts of Ms. Deborah Bush, Chairperson of the New Zealand Endometriosis Foundation. She has developed an interactive Menstrual Health and Endometriosis Education Program that has been presented to over 40,000 young women (ages 15-24), educators and clinicians.

Chronic pelvic pain is generally used to describe a condition of pelvic discomfort not solely associated with menstruation, of more than 6 month's duration, and of a severity sufficient to cause disability in some form.

A 26 year-old woman delivered her first baby, weighing 7 pounds, 6 ounces, without difficulty after 35 minutes of pushing. Although her doctor used perineal stretching (gentle stretching of the area between the vagina and anus) and lubricants during delivery, there was a small, second-degree tear of the vagina and perineum as the baby's shoulders delivered.

I’m just back from holiday which as all OBGYN’s know is never a complete break. The usual scenario at the beach/bar/restaurant; Interested person "Oh so you’re an OBGYN, I know you’re on holiday but what do you think about my/our periods/fertility problems/pelvic pain?"

Chronic pelvic pain, a common complaint in female adolescents, is defined as cyclic or noncyclic, intermittent or constant discomfort in the pelvic region for at least 6 months. It often frustrates the patient, her parents, and her physician, and it can lead to major functional problems such as changes in family dynamics or school absenteeism.

To evaluate and compare the safety and efficacy of leuprolide versus placebo in managing chronic pelvic pain in women with clinically suspected endometriosis.

Chronic pelvic pain can be defined as cyclic or non-cyclic pain of six or more months in duration that localises to the anatomical pelvis and is severe enough to cause functional disability and require medical or surgical treatment.

An interview with Paul D. Indman, M.D., Los Gatos, CA.

SB is an 18-year-old G0 female who presented with a long-standing history of perimenstrual pelvic pain and diarrhea thought to be due to endometriosis. Her menses are irregular (1-3 month intervals).

DB is a 26-year-old nulligravid female with dysmenorrhoea and a long-standing history of endometriosis. Dysmenorrhoea began at age 16 years and has become progressively worse. She describes two unique pain profiles.

Endometriosis is a disease in which endometrial glands and stroma implant and grow in areas outside the uterus . The most common place to find implants is in the peritoneal cavity, but they can be found in any other place.

A pain score is being used to monitor women with a history of chronic pelvic pain. The total score for each day of the month is plotted into a graph and is later correlated to patient's daily activities in order to help with the diagnosis of baseline gynecological conditions.

The basic research of visceral pain mechanisms does not explain the chronic pelvic pain phenomena a gynecologist confronts in the clinic. There is, however, a link between the basic research and the acute gynecologic pain processes observed in the emergency room.