A new procedure for diagnosing Dyspareunia


OBGYN.net Conference CoverageFrom American Association of Gynecological LaparoscopistsLas Vegas, Nevada, November, 1999

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Dr. Marshall Smith: "Good afternoon, we're back at the 1999 AAGL meeting in Las Vegas. We have Dr. James Carter with us today, who has been instrumental in developing a newer procedure for dyspareunia. I'm going turn it over to him, he's well-known to all of you, and let him discuss it a little bit - Jim."

Dr. James Carter: "Thank you, Mark. You know the problem that we've faced in evaluating women who have pain with intercourse - dyspareunia - has been first determining whether it's at entry or deep. If it's at entry, of course, we look for our common problems with infection, problems with vulvodynia, problems with mild fascial difficulties, say with levators. If it's deep, we're always concerned about the possibility of endometriosis. If we feel nodularity in the cul-de-sac, that's our first and primary diagnosis, but in addition, if we feel that the uterus is retroverted and we can reproduce the pain that that individual experiences with intercourse by movement of that retroverted or "malpositioned," as we call it, uterus - then a procedure for uterine suspension has been found to be very helpful. What we've developed is a technique we've titled the "uplift uterine positioning by ligament investment, fixation, and truncation." What all those words mean is that we place the suture within the round ligament, and we invest the round ligament with the suture, and shorten and truncate the round ligament as a way to position the uterus in its more normal anteverted fashion. In this way, we're able to very easily through a laparoscopic procedure, reduce the incidence of pain from intercourse from that retroverted uterus, and patient satisfaction has been very high. The procedure takes between 10-15 minutes to perform after the laparoscopy has been initiated, and is a very nice procedure to add to your armamentarium."

Dr. Marshall Smith: "It sounds akin to a type of uterine suspension, is that correct?"

Dr. James Carter: "This is exactly what we're doing. It's a uterine suspension procedure but by utilizing the round ligaments in a technique that strengthens and shortens them and attaches them to the lateral side wall in their natural and normal anatomic position. So what you see when you're done is not suture in the field but simply stronger, more permanent round ligament structures."

Dr. Marshall Smith: "Ten to fifteen minutes is a great time for getting a procedure like that done and providing a lot of relief for our patients."

Dr. James Carter: "In the first seventy-five patients in whom I performed this procedure, the average level of pain with intercourse was reduced from what they ranked as a 8.4 on a scale of 0-10, down to a 1.7 on a scale of 0-10, where 10 is the worst pain they'd experienced. In addition, my average time was actually twelve minutes, and this has been reproduced by Jim Presthus in Minneapolis, Paul Perry down in Birmingham, and Insu Kong out in New York."

Dr. Marshall Smith: "It sounds very promising."

Dr. James Carter: "Thank you very much."

Dr. Marshall Smith: "Thank you very much, Dr. Carter, for being with us."

Dr. James Carter: "My pleasure."



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