Sunday, February 14, 2010

South African Husband Concerned: Is Wife's Abnormal Bleeding Caused By Cystourethrocele?


Good day, I am writing from South Africa. My spouse has recently been having blood discharge and discomfort after intercourse. After consulting a local gynae, he advised that her bladder muscles seem to have collapsed pushing the bladder more into her vagina. He has recommended constructive surgery by insertion of some sutures.

Could you please advise what causes this (she works long period as a scrub sister in theatre), possible treatments? Also, please advise what effects having intercourse would have before the surgery is performed. Thanks. J.


Hello J. from South Africa,

I understand the problem that your wife's gynecologist identified. It is called a cystourethrocele. It is a condition whereby the upper vagina becomes weakened and the bladder sags into the vagina. It is usually a result of childbearing, which causes the muscles to stretch out, and they never return to their normal tensile strength. The upper vagina supports the base of the bladder.

However, although this may be an identified problem, I am not sure that this is the reason for the post-coital/intercourse bleeding. Cystoceles don't usually bleed, unless over vigorous intercourse causes the vaginal skin to tear, which is hard to do. The other possibility is if your wife is menopausal, the vaginal tissues can become thinned and brittle and intercourse can cause an abrasion, leading to some bleeding. In any case, an evaluation needs to be done to identify the cause of the post-coital bleeding. The most common source of bleeding is from the cervix or uterine cavity. Disorders such as cervical polyps, endocervical polyps, cervical lesions/cancer, endometrial lesions/cancer, can cause post-coital bleeding. I would not assume that it is from the cystocele if these things have not been evaluated.

Cystoceles are repaired by opening the vaginal layer, pushing the bladder up and bringing the muscle back together to hold the bladder up, then closing the vaginal skin. The formal name for it is anterior vaginal repair or anterior colporrhaphy. If there is bladder leakage, called stress urinary incontinence, this procedure can also be combined with a bladder neck suspension to lift the bladder neck with sutures on either side.

Please have your wife evaluated further for some of the possible disorders I named above if she hasn't been already before proceeding further.

I hope this answers your question,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

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