Sometimes at Atlantic Coast Aesthetics, we receive a question that has even our highly trained staff raising their eyebrows and shrugging their shoulders. One example of this is our ACA Question of the Week, which came in from West Palm Beach. The patient asks, “Do I see a gynaecologist, a plastic surgeon or a urogynaecologist? Willing to travel overseas if need be.” Dr. Thomas A. Pane, our Chief Medical Officer and founder, chose to take on this question as a way to showcase the limitations of even good photographs in explaining what the problem is or what can be done to address it.
The patient reports “tightness” around the perineum, or the sensitive area of skin between the anus and vulva. Additionally, unspecified bladder and bowel problems and a feeling of “blockage” and numbness were reported in the vaginal canal. However, the patient did not say what the procedure was that led to the situation, but did mention that the patient has never given vaginal childbirth. This brings up the first obstacle, Dr. Pane says. Without a complete medical history to understand what procedure was done and what it was intended to correct, it is difficult to be certain how the patient’s reportage links back to the original procedure.
The second problem is that while the patient sent good-quality photographs of the vaginal area, a picture is highly limited in demonstrating “feeling” without a clearly apparent blockage, scarring or deformity in the genital area. To diagnose and understand the problem and determine what the best corrective measure might be, Dr. Pane says there is simply no substitute for direct clinical examination. Photographs are fine for some issues, such as skin problems or explaining why a patient feels breast implants are appropriate in a certain case, but in this case, they just don’t illuminate the right information, a situation compounded by the lack of detailed medical history.
Another issue is that while this may well be a problem which is correctable through cosmetic surgery, the bladder and bowel problems the patient reports seem to indicate that more drastic surgical intervention may be needed. Whether this is the province of a gynecologist, urogynecologist, plastic surgeon or another type of surgeon altogether would again depend upon what direct clinical examination in-person revealed. However, an additional drawback to this is that some gynecologists may not be sufficiently skilled, confident or willing to get involved in what may prove to be major reconstructive or amendment surgery of the genital area. Depending on what needs to be done, the gynecologist or urogynecologist may well refer the patient to a surgeon with a subspecialization in pelvic reconstruction, a class of surgeons to which Dr. Pane belongs.
The greatest overall concern is the lack of medical history in this case. The patient’s best bet in this case is to obtain opinions from at least one specialist in the female genitalia, which will require an in-person examination with a complete medical history. However, no doctor would expect the patient to be able to describe the physical appearance of their own genitalia in detail, nor would it be expected that the patient could give a precise before and after explanation of exactly how the genital area has changed visually, simply because of the type and apparent complexity of the procedure in question.
In situations like this, it is very difficult to “overshare” with a surgeon. The more medical history information the patient can provide, including who did the procedure, when it was done, what the procedure was and why, the better the doctor will be able to understand, assess and make an informed decision as to how best to proceed. Likewise, photographs are wonderful tools, but they do have some limitations that simply cannot be gotten around without a clinical evaluation, which naturally requires the patient’s presence. It is always better to give more information and risk giving extraneous detail than to omit something that may completely alter the treatment approaches available.
If you have a cosmetic surgery-related question and are unsure who to ask, Dr. Pane and the staff of Atlantic Coast Aesthetics are always glad to take a few minutes to discuss your questions and concerns. Simply follow us on Facebook and Twitter, email us at https://acplasticsurg.com or call us at (561) 422-4116. It’s possible that your question may be ACA’s next Question of the Week, answered live in an on-air Google Hangout by Dr. Pane personally. Remember, at Atlantic Coast Aesthetics, we believe the only bad question is the one you don’t ask!