Collision Dyspareunia

COLLISION DYSPAREUNIA

 

What is “Collision Dyspareunia”?

The diagnosis of collision dyspareunia can only be made if the patient still has her uterus and she experiences pain deep inside the vagina, pelvis or lower abdomen with penile thrusting.  This pain is elicited when the partner’s penis strikes the cervix and the uterus in a chain reaction collides with the nerves exiting the sacrum i.e. the tailbone. This condition is most common in women with retroverted uterus.  That means the uterus bends backwards i.e. towards the hollow of the sacrum or tail bone which is rich in nerves that come directly out of the spinal cord. When the penis collides with the cervix it pushes the uterus into the hollow of the sacrum where the rich nerve plexus resides.  Pressure on any never plexus can cause pain.

Does hysteropexy work for collision dyspareunia?

It certainly can especially if other reasons for painful intercourse such as infection, pelvic inflammatory disease, cervical cysts, endometriosis and fibroids, ovarian cysts and central chronic pelvic pain have been ruled out. Once other potential causes of painful sex have been ruled out and an examination by Dr Miklos & Moore confirms their suspicion of collision dyspareunia then the patient could consider surgery.   The success rate of stopping collision dyspareunia with a hysteropexy is > 90 %.  Drs Miklos and Moore believe the key to success starts with making the appropriate diagnosis.

How is the hysteropexy performed?

The uterine suspension ie hysteropexy is performed laparoscopically and requires approximately 30 minutes.  Drs Miklos & Moore attach mesh using permanent suture to the back of the uterus and then to the sacrum ligament.  Usually 8 sutures are required to attach the mesh to the uterus and then 2 sutures to the ligament i.e. presacral ligament of the tailbone. The technical name to this type of hysteropexy is the sacrocolpohysteropexy.  Please see:  https://www.miklosandmoore.com/uterine-prolapse-surgery-atlanta/hysteropexy/

What does sacrocolpohysteropexy mean?

“Sacro” = sacrum or tailbone, “colpo” = vagina, “hystero” = uterus and “pexy” means to support.  Reading this backwards it states:  support uterus & vagina to tailbone. If you understand the meaning of the words it tells you the surgical technique.

Sacrocolpohysteropexy means the same thing as hysteropexy however it distinctly delineates how the surgery lifts the uterus and vagina to the tailbone as a point of attachment.  There are other simpler surgeries called hysteropexies which require less skill to perform but have much lower chances of surgical success or cure.

What complications can occur during the surgery?

Remember the surgery is only as good as the surgeons performing the surgery all surgeons are not created equal.  In the hands of Drs Miklos & Moore the risks are as follows:

 

Bladder, bowel, rectal ureteral injury        (< 1/1000)

Blood transfusion                                           (<1/500 Dr M & M have not experienced this)

Large abdominal incision                              (<1/500 Dr M & M have not experienced this)

Hysterectomy                                                   (<1/500 Dr M & M have not experienced this)

 

What complications can occur after the surgery?

As you already know no surgery is without risk, however the hysteropexy surgery is one of the safest surgeries that Drs Miklos & Moore perform.  They have never seen a patient’s pain get worse after doing this surgery but it is possible.  Other risks include:

 

Bowel obstruction                                            (< 1%)

Infection (incision sites)                                 (1-2 %)

Uterus infection                                                (<1% Dr M & M have not experienced this)

Urinary tract infection                                    (5%)

Urine retention (temporary)                          (1-2%)

Urinary leakage post-operative                     (5%)

 

How much pain does a patient have from the hytseropexy?

Most patients getting a hysteropexy for collision dyspareunia form Dr Miklos & Moore have very little pain post-operative.  Most of the pain is in the abdominal incision sites.  Though every patient is different and there is no way of exactly tell a patient what she will experience, most patents will say their pain is <4 out of 10 (using a 0-10 pain scale) on their first day after the operation.

Drs Miklos & Moore attempt to minimize the pain of surgery by utilizing several techniques during and after surgery including:  heating and moisturizing  the gas going into your belly for laparoscopy, inject the incision sites with a numbing medication prior to surgery, operate rapidly and efficiently to minimize the time your body is traumatized from the surgery, start patients intraoperatively on anti inflammatory medicine (i.e. Toradol) as well as narcotics, and treat postoperative patients with the same.

99% of patients are discharged the next day after surgery and 30% of patients say they feel little or no pain, 70 % of patients are off narcotics with in 5 days and 95% within 10 days.

How do I schedule an appointment?

Drs Miklos & Moore can usually accommodate most patients with 2-4 weeks for a consultation in either Atlanta or Beverly Hills.  Please click here: https://www.miklosandmoore.com/cosmetic-surgeon-consultation-atlanta/ to see about scheduling an appointment for an evaluation for collision dyspareunia and hysteropexy.