The questions answered in this podcast are listed below.
They were compiled by GPs and health professionals around Australia.

1. Why is endometriosis so common these days? Is it because of tampon use and backflow of blood?
2. Is there any genetic link or family history that’s associated with endometriosis?
3. Is there any connection between pelvic pain and chronic vaginal candidiasis?
4. How do you examine for obturator internus spasm in males?
5. Do you think that excessive sitting could possibly be relevant to operate a spasm?
6. Any advice on how best to manage obturator internus muscle pain in a primary care setting?
7. Advice for a patient who’s got long standing vulvodynia. The woman’s gynaecologist recommended stopping breastfeeding when she developed vaginal atrophy postpartum. The question is whether it’s okay to prescribe vaginal estrogens so that she can continue breastfeeding, which is really what she’s keen to do.
8. Some women, appear to develop vulvar symptoms, either numbness or burning pain, after episiotomy, or a vaginal tear during childbirth. Do you have any tips for managing that in a GP setting.
9. A participant writes that she has a number of patients with long standing depression or anxiety, who’ve been reasonably well controlled on SSRIs or SNRIs. Some of these women will also have chronic pelvic pain, which has been refractory to the usual gynaecological treatment like hormones, surgery etc. The suggestion for one specialist was to change the SSRI to a tricyclic. The questioner says I’ve tried this a few times, but reemergence of the depression and anxiety is common. Do you have any tips on how best to manage a transition from an SSRI to a tricyclic and what makes it even worse for these patients is if they present endometriosis with pain, they tend to come back to me having been prescribed endone. What’s your advice?

Host: Dr Terri Foran, Sexual Health Physician

Guests: A/Prof Susan Evans, Gynaecologist and Laparoscopic Surgeon

Total time: 17 mins

Recommended resources:

• Pelvic Pain Foundation of Australia
• Access to ‘Easy Stretches to relax the Pelvis’
• Pelvic Pain Foundation of Australia Shop (which has access to Susan Evans book ‘Endometriosis and Pelvic pain’ and pelvic floor relaxation audios recorded by Patricia Newman)
• Endozone