Brief Answer:
Advice to see neurologist is reasonable

Detailed Answer:
Good morning Ms. XXXX. My name is Dr. XXXXXXX Saghafi and I am a neurologist from XXXXXXX Ohio, USA. I will do my best to give you an answer to your question which you previously posed to another colleague on this network even though there is very limited information.

You state that you have the sensation about the anal and vaginal regions which causes "inflammation around pelvic and abdomen which affects vein to stiff." You appear to have been placed on antibiotics for a urinary tract infection.

I take it you are not feeling any particular relief from that regimen of medication.

As a neurologist I cannot say very much about your sensation in the anovaginal territory which is referred to as the perineal region except that it is possible that a nerve or nerve branch which supplies the skin and underlying pelvic structures may be impinged or otherwise irritated giving you these odd sensations.

I note that you are not truly complaining of classical symptoms that we could easily ascribe to a nerve problem such as a burning or tingling type of pain, a numbness, or an uncomfortable irritation of soft sort. Your complaints are more vague and involve swelling sensations.

Please excuse the next few questions but these are necessary in order to gain insight into possible causes for your discomfort in the anal/genital region as you describe.

Are you overweight by chance? Have you had recent vigorous or even traumatic types of sexual encounters that could've affected that region, do you use sex toys or apparatuses of any sort that could've played a role in overly irritating this region of the body? Have you recently given vaginal birth?

As I said, there are several nerves which do run through this region, however, your symptoms are rather vague and do not suggest irritating these structures but then, anything is possible.

Has someone visually inspected this region? Have you tried looking with a hand held mirror to see the underside region yourself to note any pustules, redness, or swelling physically?

I tried looking at the file you sent but it is not clear exactly what you were sending.

So ultimately, I believe the utility of seeing a neurologist for your condition would be to assess you more closely for symptoms that could be interpreted as having to do with specific nerve irritation in the region of complaint and to look at other things that are typically assessed in blood work and so forth when evaluating these sorts of cases. I don't think I would want to see you undergo invasive testing for any reason unless absolutely necessary or the symptoms somehow progressed or got worse which then, might lead to one to get something like an MRI of the region or at least a CT scan along with an EMG and nerve conduction study looking specifically at the nerves that run through that region.

If you had any blood work done and would like to post this then, I would be happy to look at it, however, in general things such as thyroid, B12, folate, vitamin D, CBC, electrolytes, glucose, HbA1C (looking for high sugar in the past) liver and kidney function tests, and a few other miscellaneous things could be obtained in order to fully assess your situation.

If this information answers your question to a satisfactory extent given the limited information you've provided then, could you do me a favor of providing some written feedback on the quality of the response and give a STAR RATING? Also, if you have no further questions or comments to make on this conversation I'd appreciate it if you'd CLOSE THE QUERY so that the system can properly process, archive, and credit this conversation for future reference.

If you would like to ask me or post more information so that I should specifically look at it then, please use the DIRECT QUERY function on this network and look for me, XXXXXXX SAGHAFI, MD and I will be sure to get the information and respond to you. Alternatively, if you would like to have a real time web conference and even by videocamera connection then, you may look me up at:

www.healthtap.com/drsaghafi

My hours on duty through that service are Wed-Sat's from 3a-6a (New York City time) and Sunday evenings 11p-3a (NYC time). This may be another option for you as we can then, converse or simply text back and forth in real time and I can obtain more data to work with or know.

I hope all goes well for you and that you have a splendid day.

This query required 60 minutes of physician specific directed time for review, research, and final draft documentation for envoy.

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Brief Answer:
What was placed in your vaginal area?

Detailed Answer:
Thanks for that information.

Could this be the smoking gun? What is the timing of your symptoms compared to when they put this stuff in your vaginal area? If this happened afterward by a few days or even a few weeks then, I think we've got a possible explanation. Have you had a good vaginal examination and exploration using a colposcope to make sure there isn't anything left behind from that screening visit such as a small piece of gauze, small piece of a swabbing stick that could be caught or stuck within the vaginal wall itself? You may wish to have an OB/GYN specialist just do a great exploration of the vaginal vault and the vulvar region (the outer portion of skin, the lips, etc.) to check for anything.

If nothing is found then, can you discover what was placed in the vagina to see if it would become irritated? Find out the name of the chemical or test agent or material. It may have been something that ultimately irritated the perineal or pudendal nerve branches which innervate the vaginal wall, the labia, etc. Perhaps, some of that material was inadvertently placed in the perineal area (region between anus and vagina) which could be causing some residual skin irritation?

If nothing is found in the vagina is it possible that something could've been inadvertently stuck into the cervix and lodged in the uterus? Ultrasound may not be sensitive to pick it up if it is certain material or smaller than a certain size. A uteroscopic exploration may be necessary. This would have to be done under some form of anesthesia. Perhaps an MRI would be worth doing since it tends to pick up objects that are as small as 1 mm. in diameter.

If this information has been useful to you would you please leave some written feedback and a STAR RATING of the responses I've given. And if there's nothing further to ask or comment on please don't forget to CLOSE THE QUERY on your end so the question is processed, archived, and credited. My sincerest appreciation.

This query required 17 min. of physician specific directed time to review, research, and document the final draft for envoy.

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