Question: Hi; I have vaginismus and I have tried dilators but I’m too scared. I’ve
had a look at your injections and i would like more information about it. F (UK)
Answer: I think I can safely assume that what you describe as ‘our injections’ are
the Botulinum injections described in this section. In addition to the details found
in that section, all I can say is that when deemed appropriate, the injection is
normally administered in a pelvic floor muscle called the Pubo-coccygeus. This is
administered through the vagina. It is not necessary to have a general anaesthetic
for this treatment but the nature of vaginismus is such that for most women, that
is the most practical option. In most cases, only one administration is required
but in some cases a repeat, usually a few months down the line, is required.
I need to point out that, before considering Botulinum injections, you need to ensure
you have had a thorough review by a specialist. It is important that the diagnosis
is confirmed to be correct. Moreover, it is ideal that you see a psychosexual counselor
before embarking on any form of treatment. A short-cut treatment for vaginismus is
never desirable and may not be in your best interest.
If you have yet to bring this to the attention of your GP, that should be your first
port of call. You are then likely to be referred to a specialist at your local hospital
where the usual process of careful evaluation will be set in motion. It may be the
case that you might indeed find solution in botulinum injections. Can I also refer
you to the answer given to a similar question earlier by another site visitor found
here: Good luck.
Canesten vaginal cream in pregnancy
Question: I have a yellow vaginal discharge. Is Canesten cream safe to use using
an applicator? I’m in my last trimester. N.M (UK)
Answer: There are two issues here: Is your discharge thrush? It probably is not.
Canesten vaginal cream, the generic name of which is Clotramazole is an anti-fungal
and that is specific for thrush. It is not effective for anything else.
The second issue is your specific question on whether using an applicator to administer
the cream vaginally is safe in pregnancy. The answer to this is a definite yes. There
is absolutely no risk either from the applicator or the cream itself. Having said
that, you may find that many doctors do actually recommend using the pessary which
appears to work better as the dose is delivered more efficiently compared to the
cream. Plus, it is convenient as it is a single dose (it is the same medication).
However, it is best that you get the diagnosis confirmed first.
Threatened miscarriage in very early pregnancy
Question: I am 5 weeks pregnant, I started bleeding 4 days ago, the blood is bright
red, there is no clots. I am really worried because I had a miscarriage earlier this
year when i was about 5 weeks. I phoned the EPU and they said to do another test
in 2-3 weeks and let them know of the outcome. However, I need peace of mind now.
Should I go to my doctor? Is there any tests that can be done so early into pregnancy
so I will know for sure? K.D (UK)
Answer: Yours is a difficult situation with no satisfactory immediate answers. Your
anxiety following your recent history is completely understandable. Trouble is, at
such an early stage, an ultrasound scan may not be able to show anything, something
may very well heighten your anxiety and that is never good.
The only way that you can have this assuaged immediately is maybe to have a blood
test to quantify the level of the pregnancy hormone beta-hCG. Even this entails a
delay because, to have any meaning, you have to have two blood tests performed two
days apart. Normally, in a normal viable pregnancy, the level of this hormone will
at least double every two days. If this is found to be rising modestly, not rising
at all or even falling, it almost always means trouble for the pregnancy. This test
is usually applied in a suspected ectopic pregnancy and in tracking progress following
IVF. However, the principle applies in your situation similarly.
In the end, it may be the case that the surest way to know where you are is to wait
until you are at least 6 weeks when a fetal pole and a fetal heartbeat should be
seen on a scan. The 2 - 3 weeks wait you have been advised is unnecessarily long
and uncalled for.
Low-lying placenta in early pregnancy
Question: I am 14 weeks and I’ve had 3 bleeds in the last 3 weeks. The baby is fine
but they did say my placenta is reaching down to my cervix but should move. They
said they did not know why I was bleeding. Is this something to do with the placenta?
Thank you. M (UK)
Answer: Vaginal bleeding at that stage of pregnancy is regarded as threatened miscarriage.
A low-lying placenta at this stage of pregnancy is not that uncommon. It is also
the case that this rarely causes bleeding so early in pregnancy. It is, in practise,
almost impossible to establish the exact source of bleeding in this sort of situation.
In any case, that is really academic as the management is the same and that is purely
expectant. You would have been advised to avoid sexual intercourse. You should observe
Using Subutex in pregnancy: To detox or not.
Question: Hi, my missus is 10 weeks pregnant and on a low dose of Subutex, 1.6mg.
She is no longer taking any other substances and hasn’t been throughout the pregnancy.
We want her to detox during her pregnancy by 0.4g a fortnight; a 2 months detox.
Is this safe considering she is on such a small dose rather than her continuing Subutex
throughout. Thanks . P (UK)
Answer: You will be aware that Subutex (generic name: Buprenorphine) is an opiate
similar to heroin. It is sometimes used as a heroin substitute in detox programs.
However, its use is not recommended in pregnancy . This advice is based on animal
studies which suggested possible neurological development delay in the offspring.
However, where it has been used, there are, so far, no known reported similar adverse
effects in humans.
Whilst Subutex would not be started for the first time in pregnancy, if the person
has been on it pre-conception, a careful evaluation is usually done to look at options.
These would include continuing on carefully regulated doses, gradually weaning her
off altogether as long as this is started early in pregnancy or substituting Subutex
with another opiate, namely Methadone, which is known to be safe in pregnancy in
The specialist team at your local hospital will need to look at your partner’s circumstances
and, on the face of it, it appears to me, a complete detox in pregnancy is feasible
in her case. However, she should definitely involve the expert team in whatever she