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Diagnosis in case of chronic pain in the pelvic area. Neoyu Women's Urology Clinic

Nowadays, the number of patients with recurrent and refractory cystitis and vaginitis resisting general antibiotic treatment continues to increase, and patients with chronic pain observed in pelvic areas such as chronic vulva, dyspareunia, and pelvic pain are getting younger. However, this chronic pain is difficult to treat unless the root cause is found.

For example, women with severe menstrual pain, at risk for uterine myoma, endometriosis, and adenomyopathy visit the gynecologist. It is common to treat degenerative disc diseases at orthopedic clinics. However, if no abnormal findings are found in gynecological or orthopedic examinations or if general treatment does not improve the disease due to suspected lesions, it is necessary to visit the urology to diagnose whether the root cause of the disease is a disorder of pelvic muscles on the genital side.

Patients who are young, are in their 20s and 30s (sexually active) visit Neoyu Women's Urology Clinic for recurrent cystitis, vaginitis, and dyspareunia while women in their mid-40s and 50s, visit for treatment of vaginosis based on atrophic vaginitis, chronic vulva discomfort, and dyspareunia. Finally, elderly people in their 70s or older visit the hospital due to urinary disorders such as frequent urination, night urination, urinary incontinence, and chronic vulva.

Director Kim Joo-nam, who runs the Neoyu Women's Urology Clinic, is a urologist who graduated from Yonsei University's Wonju University and opened the U&I Women's Clinic with three specialists in 2006, and became independent in 2014.

The hospital is in charge of women's urology, so most patients have problems with urination or complain of chronic discomfort or pain observed in the pelvic area, the area between the navel and thighs, including genitals. These symptoms appear across all ages, but young people often visit the hospital because they do not heal well in treating cystitis and vaginitis, and urethral syndrome and vulva transmission are often mixed.

Among them, vulva metastasis refers to a chronic pain condition for months observed in the vestibular area, a mucous membrane that makes up the female vulva, without clinically observing trauma, deformity, infection, or other chronic skin diseases. These diseases have a high prevalence in countries with westernized lifestyles.

The main causes of pathophysiology of this disease are abnormal inflammatory reactions and peripheral neuralgia formed inside the tissue. In order to treat these diseases, it is common for general hospitals to prescribe antibiotic ointment or stade ointment, but in fact, the effect is insufficient. Women's hormone ointment is often prescribed for menopause women, but there is a limit to improving symptoms because the ointment does not improve inflammation or correct neuralgia.

Kim Joo-nam, director of the Neoyu Women's Urology Clinic, said, "The treatment of vulva transmission can be treated with local anesthetics or neuralgia, but the treatment effect is limited. Instead, most of them can be treated with topical injection therapy that injects therapeutic drugs into the affected area. "Some hospitals investigate approved vaginators for urinary incontinence and vaginal wall contraction to try cell regeneration, but the tissue itself often reacts to inflammation and lacks hormones. In other words, the regenerative ability is significantly reduced, so the tissue becomes worse and symptoms often worsen after laser treatment. In addition, some hospitals try vestibular resection to resect the painful mucosa, but after surgery, the pain may worsen in the resected mucosa section or cause complications such as tissue fibrosis, adhesion, and dryness, so care should be taken."

In addition, in the gynecological domain it is common to explain and treat frequent trauma, bleeding, and pain in sexual intercourse as vaginal dryness. However, in fact, in most cases, the vestibular region constituting the vulva mucosa is mixed with chronic inflammatory reactions and peripheral neuralgia.

In addition, menopausal symptoms experienced by women aged 45 to 55 appear as ovarian function decreases and female hormone secretion decreases rapidly. These menopausal women develop menopausal symptoms such as facial flushing, sleep disorders, emotional changes such as depression or nervousness, and osteoporosis due to female hormone deficiency.

Representative diseases of menopausal women are atrophic vaginitis, which thins the epidermis of the mucous membrane due to a lack of female hormones, and chronic dryness, discomfort, smallness, vulva pain, smallness, and bleeding after relationship are observed. As a result, urination symptoms such as night urination, desperate urination, urination pain, and recurrent cystitis are also common.

These menopausal symptoms are due to hormonal deficiencies, so it is common to control symptoms with hormone supplement therapy. However, Kim Joo-nam, director of the Neoyu Women's Urology Clinic, avoids hormone supplementation therapy, judging that there are many concerns about breast cancer, endometrial cancer, and cardiovascular risk. Most patients with atrophic gastritis are often mixed with vulcanitis, so treatment is performed to improve the symptoms of vestibular inflammation to improve various symptoms related to genital and urination problems.

Kim Joo-nam, director of the Neoyu Women's Urology Clinic, said, "Commonly, bladder inflammation is cured with antibiotics, irritable bladder is treated with anticholinergic drugs that suppress bladder, and urinary incontinence is cured with urinary incontinence surgery. However, a differentiated treatment is used for chronic diseases such as recurrent bladder inflammation or vaginitis that resists general antibiotic treatment, frequent urination, night urination and non-surgical treatment, atrophic vaginitis that does not improve dyspareunia, and pelvic pain that without major problems. In addition, with sincere counseling and detailed explanations to patients, many patients are steadily visiting and improving their understanding of the treatment method.

Meanwhile, Kim Joo-nam, director of the Neoyu Women's Urology Clinic, will continue to engage in activities of the domestic urology, obstetrics and gynecology, and beauty society. In addition, he plans to participate in overseas conferences with industry officials who share the same goal, and plans to share treatments with overseas medical staff. In addition, after COVID- 19, he plans to attract overseas patients from China, Japan, and Southeast Asia, and is taking a step further to explore the possibility of overseas branches in China, Japan, Thailand, and Vietnam.


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