How do I go about bringing this up to my doc... Never completely healed after birth of my son - Mothering Forums
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#1 of 26 Old 02-10-2009, 05:11 PM - Thread Starter
 
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This is humiliating to me... I feel mutilated . It's something I've been trying to ignore but I can't do it anymore. I have to get it out... I don't know how to deal with it.

When my son was born almost 5 years ago I had a 3rd degree lateral tear and a 2nd degree tear downwards. I required a blood transfusion and dozens and dozens of stitches. It took a LONG time for everything to heal and I'm just destroyed down there. I look with a mirror and it's just a mess... Nothing resembles normal anatomy anymore . I literally have no perineum anymore and the lateral tear did not heal properly so things just gape? open... I'm disgusted with myself ... I feel like I'm less of a woman. It's horrible...

My husband and I have been unable to DTD normally since his birth because of this and it's putting a HUGE strain on our marriage. It's a wonder we were able to conceive our daughter. It's bad...

I'm terrified to go talk to a doctor about it. I know I probably need reconstructive surgery but I'm told that my insurance (military, Tricare) will not cover it . We can't afford it right now but my marriage cannot afford to continue like this.

Advice... please...

Val, Mama to Aidan (5 years) and Autumn (almost 2)
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#2 of 26 Old 02-10-2009, 05:21 PM
 
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Mama, I'm so sorry this happened to you. I know you don't want to bring this up with your doc, but you must. Just lay it out on the table, as plainly for the doc as you just have for all of us reading your post. Trust me- docs have heard things that are waaaaay more embarrassing than what you're describing.

There may be a way to tweak the insurance codes for the reconstructive surgery so that it classifies as a necessary medical procedure instead of a cosmetic one. (And IMHO, it is necessary. A repair that was botched as badly as you describe needs to be repaired, especially since it is clearly impacting your sexual function and sense of self-worth.)

Please, please, please talk to your doc about this!
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#3 of 26 Old 02-10-2009, 05:59 PM
 
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I assume you're considering going to a *different* doctor than the one who botched the repair so badly, right? Because I can't imagine trying to talk to the guy who botched it, but maybe someone else.

Honestly, I'm wondering if maybe going and talking to someone (a counselor or therapist of some sort) would help - getting past the emotional is going to be a huge step in helping you talk to a doctor about it. It'll probably help with the birth this time, too...

Maybe you are already, though...

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#4 of 26 Old 02-10-2009, 06:02 PM - Thread Starter
 
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I assume you're considering going to a *different* doctor than the one who botched the repair so badly, right? Because I can't imagine trying to talk to the guy who botched it, but maybe someone else.

Honestly, I'm wondering if maybe going and talking to someone (a counselor or therapist of some sort) would help - getting past the emotional is going to be a huge step in helping you talk to a doctor about it. It'll probably help with the birth this time, too...

Maybe you are already, though...
We're military so unfortunately we're at the whim of whatever doctor they want me to see . It won't be the same as when I gave birth. Unfortunately I was nearly unconcious and DH says it was an intern that did the stiches! UGH. Nobody said anything when I had my daughter last January but I'm betting they were afraid to? DH has insisted I go speak with someone ASAP. I guess I can't ignore it anymore.

Val, Mama to Aidan (5 years) and Autumn (almost 2)
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#5 of 26 Old 02-10-2009, 06:04 PM - Thread Starter
 
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Mama, I'm so sorry this happened to you. I know you don't want to bring this up with your doc, but you must. Just lay it out on the table, as plainly for the doc as you just have for all of us reading your post. Trust me- docs have heard things that are waaaaay more embarrassing than what you're describing.

There may be a way to tweak the insurance codes for the reconstructive surgery so that it classifies as a necessary medical procedure instead of a cosmetic one. (And IMHO, it is necessary. A repair that was botched as badly as you describe needs to be repaired, especially since it is clearly impacting your sexual function and sense of self-worth.)

Please, please, please talk to your doc about this!
Thank you for the info.. I'm hoping there is some way to get it covered. I really cannot live like this any longer. Should I go see my regular care manager or try to make an appointment with the OBGYN that delivered my daughter?

Val, Mama to Aidan (5 years) and Autumn (almost 2)
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#6 of 26 Old 02-10-2009, 06:09 PM
 
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We're military so unfortunately we're at the whim of whatever doctor they want me to see . It won't be the same as when I gave birth. Unfortunately I was nearly unconcious and DH says it was an intern that did the stiches! UGH. Nobody said anything when I had my daughter last January but I'm betting they were afraid to? DH has insisted I go speak with someone ASAP. I guess I can't ignore it anymore.
I wonder if they thought that if it was bothering you, you would have told someone or had it fixed? I assume you had a vaginal delivery the second time and no tearing?

I still think you should see a counselor about it, if you can. It sounds like you have issues to get past so you can get to the point of asking for it to be fixed, no? do you think some of your issues with your husband are from just the traumatic birth itself and not necessarily about the way the repair turned out or do you think having it repaired, alone, will make it better?

This must be so hard. I can't even imagine what you're going through, but I hope you figure out how to move on this!

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#7 of 26 Old 02-10-2009, 06:17 PM - Thread Starter
 
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I wonder if they thought that if it was bothering you, you would have told someone or had it fixed? I assume you had a vaginal delivery the second time and no tearing?

I still think you should see a counselor about it, if you can. It sounds like you have issues to get past so you can get to the point of asking for it to be fixed, no? do you think some of your issues with your husband are from just the traumatic birth itself and not necessarily about the way the repair turned out or do you think having it repaired, alone, will make it better?

This must be so hard. I can't even imagine what you're going through, but I hope you figure out how to move on this!
That was probably the case. I was too humiliated about it to say anything. Yes, I had a vaginal delivery with my daughter. I didn't even have to push, so no tearing... she literally fell out.

It's probably a little of both... My son's birth was really traumatic in a lot of ways and part of me thought I was over it after the easy delivery of my DD but I don't know. Part of it may be the way that my husband has (perhaps subconsciously) treated me since. It's really like a roomate situation over here... I suspect that's partly due to his inability to see me as a sexual being any longer. Heck, I can't even see myself in that light. It hardly feels like there's a point.

I have tried counseling for other issues here... but my options through the military base were lacking. I haven't felt comfortable with either of the counselors they refered me to and I'm kind of scared to try again.

Val, Mama to Aidan (5 years) and Autumn (almost 2)
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#8 of 26 Old 02-10-2009, 06:29 PM
 
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Even with Tricare Prime, there is a way to get outside referrals - the paperwork is just tricky. I've seen threads about it. You could search for info here. Are there any Attachment Parenting of LLL groups in your area? They probably know of counselors who specialize in birth trauma. Even if you have to pay for it, seeing one of them might be worth it. I'm so sorry!
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#9 of 26 Old 02-10-2009, 06:37 PM
 
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That was probably the case. I was too humiliated about it to say anything. Yes, I had a vaginal delivery with my daughter. I didn't even have to push, so no tearing... she literally fell out.

It's probably a little of both... My son's birth was really traumatic in a lot of ways and part of me thought I was over it after the easy delivery of my DD but I don't know. Part of it may be the way that my husband has (perhaps subconsciously) treated me since. It's really like a roomate situation over here... I suspect that's partly due to his inability to see me as a sexual being any longer. Heck, I can't even see myself in that light. It hardly feels like there's a point.

I have tried counseling for other issues here... but my options through the military base were lacking. I haven't felt comfortable with either of the counselors they refered me to and I'm kind of scared to try again.
Maybe couples therapy would be the route to go, then...

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#10 of 26 Old 02-10-2009, 06:59 PM
 
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First, many many hugs to you Mama. I had many tears in my birthing career (two 3rd degrees with first two and a 4th with a post birth stitch up with my third). I'm crazy enough (and loving enough) to think about getting knocked up again!

I just had to say, in my experience, how bad it was in my mind and from my limited viewpoint was waaaaay worse than what was actually wrong. Could you find a nice female trusting caring GYN to do a look see? I think you need someone with knowledge to take you through what reconstruction you need and if it is advisable during this pregnancy.

I thought my 4th degree was horrible - and in some ways it was (I had a piece of skin hanging) but then when I read the post op notes it was considered superficial. I hope this is the case with yours.

Many healing vibes to you Mama!
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#11 of 26 Old 02-10-2009, 10:44 PM
 
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Thank you for the info.. I'm hoping there is some way to get it covered. I really cannot live like this any longer. Should I go see my regular care manager or try to make an appointment with the OBGYN that delivered my daughter?
I'd go straight to the OB. Your primary care provider- I'm assuming that's what you mean by "regular care manager"- probably isn't an OB, and would probably just refer you to your OB. So save yourself the step and go straight to the specialist.

And definitely go and see a counselor as well, both a couples counselor and one just for you. Not only would it be helpful, but sometimes a doc from a different specialty can figure out an unconventional way to get past insurance hang-ups. For example, sometimes women who want breast reduction surgery can get it covered by insurance by going through a back specialist instead of a plastic surgeon: if their back pain is severe enough, the back specialist will recommend surgery as medically necessary.
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#12 of 26 Old 02-10-2009, 11:00 PM
 
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Although most insurances do not cover cosmetic surgery to the vulva, I've never ever heard of one that didn't cover post birth reconstruction.
Many military families qualify for medicare (I think the compensation for military members is shamefully low). Medicare standards are different in each state, so if not your current state, maybe then next station?
One option is to seek out physical therapy for your pelvic floor. Perhaps strengthening the muscles can help repair the function of your vagina and vulva before surgery? Also, physical therapists who specialize in the pelvic floor will know about reconstruction and can steer to you someone great!

I would go strait to your OB, but do bring up physical therapy with him/her.

There is so much variation in physical anatomy, it's possible that your providers didn't know that you didn't always look that way, or that you had poor function. Function is really important. You deserve to get some answers on what can be done.

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#13 of 26 Old 02-10-2009, 11:30 PM
 
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im so so sorry this happened to you, mama. sounds like trauma on top of trauma on top of trauma. i second the suggestion that insurance codes can ALWAYS be tweaked. a good doc would totally work with you to help you find a way to get this covered. im betting whomever told you that this type of reconstructive surgery isnt covered was mistaken. i have my fingers crossed for you that you find a lovely doc who is empathetic and kind and talented. you deserve that. big hugs.

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#14 of 26 Old 02-14-2009, 04:58 PM
 
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I'm so sorry. Is there anyone who loves you and you trust who could go with you to an appointment or appointments, to hold your hand and help you talk to the doctor? To be there as support and to cut in if the doctor says something hurtful or stupid? To help talk if you start crying? I have had some minor issues since the birth of #2 and I get paralyzed and start crying pretty hard if I start talking about it. So I would definitely need someone with me to help me get through the conversation.

I would be bringing my husband along, but I know that he may not be your best support on this particular issue. Do you have a sister, or maybe your mother? I hope that you can get the care that you need.
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#15 of 26 Old 02-15-2009, 01:03 AM - Thread Starter
 
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I'm so sorry. Is there anyone who loves you and you trust who could go with you to an appointment or appointments, to hold your hand and help you talk to the doctor? To be there as support and to cut in if the doctor says something hurtful or stupid? To help talk if you start crying? I have had some minor issues since the birth of #2 and I get paralyzed and start crying pretty hard if I start talking about it. So I would definitely need someone with me to help me get through the conversation.

I would be bringing my husband along, but I know that he may not be your best support on this particular issue. Do you have a sister, or maybe your mother? I hope that you can get the care that you need.
I keep thinking about this... and none of my close friends (any that I'd feel comfortable discussing this with, at least) live anywhere near me here . I'm on the opposite end of the country from my mother (who I'm sure would like to go on believing I'm still a virgin somehow) and I have no sisters . I do feel like I need someone to go with me and hold my hand... You're right about that.

The last time I went to the doctor to request a round of Diflucan for a bout of thrush I just could not kick. The male doctor made a comment about my weight and said "surely your husband must tease you about it." UHHH NO?! So I'll definitely be requesting a female doctor. Surely my vagina is a mess because I'm a little overweight after birthing my children . The military male mentality sure gets to me sometimes :.

I've been doing a little bit more research and am feeling a little more confident about bringing it up. I adored the OB practice I had my daughter with so I'm going to call Tricare and see if I can somehow be covered for a visit with them instead of going to the military clinic. I'm pretty sure I'm coming up on a routine pap here soon anyway.

Thank you for all the comments and support. It's nice not to feel like a total freak show.

Val, Mama to Aidan (5 years) and Autumn (almost 2)
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#16 of 26 Old 02-15-2009, 01:17 AM
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The last time I went to the doctor to request a round of Diflucan for a bout of thrush I just could not kick. The male doctor made a comment about my weight and said "surely your husband must tease you about it." UHHH NO?! So I'll definitely be requesting a female doctor. Surely my vagina is a mess because I'm a little overweight after birthing my children . The military male mentality sure gets to me sometimes :.
I just want to remind you that you are not a military member who has to keep quiet when a military officer behaves in an insulting manner.

YOU are a civilian, and you should go straight to the Patient Contact department when treated so poorly. That jackass should have been reported for his terrible bedside manner.
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#17 of 26 Old 02-15-2009, 01:22 AM
 
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The last time I went to the doctor to request a round of Diflucan for a bout of thrush I just could not kick. The male doctor made a comment about my weight and said "surely your husband must tease you about it." UHHH NO?! So I'll definitely be requesting a female doctor. Surely my vagina is a mess because I'm a little overweight after birthing my children . The military male mentality sure gets to me sometimes :.
Oh wow, what a UAV. I would have been furious.

Mama, there is hope! If you can find a doctor you trust to help you, they can work with you to get insurance to cover it. It might help if you remember to think of your vagina as an organ, which it is, a sexual organ. Just like any other organ in your body, it needs to be able to function properly and if it's not doing so, you have a medical reason to have a repair. If a doctor says it's medically necessary, insurance will cover it.

A friend of mine had some awful results after her first son was born (fourth degree tear all the way down *through* her rectum and all the way up to her clitoris, it was really REALLY bad) and the repair after the birth was less than stellar. She was basically sewn up with two layers of stitches, one set interior and another set exterior. Well, two weeks PP, the exterior set re-opened and when she looked with a mirror to see what was causing the pain, she could see all of the interior stitches zig-zagging back and forth like a laced-up shoe. At that point, they tried to restitch what they could, but it never went back together right and she was horrified with how everything looked. When she got pregnant again she discussed the issues with her OB. After the birth of her second son, they had an OB come in who specialized in reconstructive surgery, and he just did what needed to be done. She says things are still not perfect, but much MUCH improved, as in she feels like she actually has a pretty "normal" vagina/vulva now.

They chose to do it immediately after the birth because she would already have the effect of the epidural in place, but they told her that generally they wouldn't choose to do reconstruction at that time because of all of the swelling, and the need to address any other issues she might be having, like BP or blood loss, etc. So in your situation, it would probably be ideal to do it now.

Big hugs to you mama... maybe you could find a mama in your area in the Finding Your Tribe forum who you can trust to accompany you and advocate for you if you become overwhelmed. There are a lot of great mamas on this board. If you were in my area, I would totally go with you to hold your hand!

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#18 of 26 Old 02-15-2009, 01:33 AM
 
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I keep thinking about this... and none of my close friends (any that I'd feel comfortable discussing this with, at least) live anywhere near me here . I'm on the opposite end of the country from my mother (who I'm sure would like to go on believing I'm still a virgin somehow) and I have no sisters . I do feel like I need someone to go with me and hold my hand... You're right about that.

The last time I went to the doctor to request a round of Diflucan for a bout of thrush I just could not kick. The male doctor made a comment about my weight and said "surely your husband must tease you about it." UHHH NO?! So I'll definitely be requesting a female doctor. Surely my vagina is a mess because I'm a little overweight after birthing my children . The military male mentality sure gets to me sometimes :.

I've been doing a little bit more research and am feeling a little more confident about bringing it up. I adored the OB practice I had my daughter with so I'm going to call Tricare and see if I can somehow be covered for a visit with them instead of going to the military clinic. I'm pretty sure I'm coming up on a routine pap here soon anyway.

Thank you for all the comments and support. It's nice not to feel like a total freak show.
What a jerk!

You're not at all a total freak show, and you have nothing to be ashamed of!

I had an episiotomy with my first birth, and I've torn right down the scar with the second two births. The last time was the worst, then I popped open the stitches while picking up my toddler son w/the baby in the sling. This was at about 2 weeks post partum, and the midwife just told me to do lots and lots of Kegels, and I was lucky that it healed up pretty well. Definitely not perfect, and I don't know what will happen this pg, but it helped.

Anyway, I agree with thinking of it as an organ. Like if you tore your Achilles tendon, or needed sinus surgery.

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#19 of 26 Old 02-15-2009, 09:55 PM
 
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Big hugs to you mama... maybe you could find a mama in your area in the Finding Your Tribe forum who you can trust to accompany you and advocate for you if you become overwhelmed. There are a lot of great mamas on this board. If you were in my area, I would totally go with you to hold your hand!
This is what I was thinking after I read your response to my post. There are a lot of incredible women here, and in a way you might have the best of both worlds - someone who fully supports you and understands, but at the same time, a level of anonymity. It isn't someone you ever *have* to see again, and it isn't someone who knew you "when you were skinny" or whatever and also not someone who knows your other friends.

Just a thought. I'm glad you're feeling more empowered to do something about this. Sometimes the silence itself is paralyzing; we think we're alone or our needs are silly or our problems freakish when really, there is a whole warm community of people who understand.
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#20 of 26 Old 02-22-2009, 09:24 PM
 
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I just couldn't read this thread and not respond. I'm so sorry you were treated so horribly on so many occasions. I hope so much that you find the help you need.

Wife to the man I never expected, DS born at home '07, '08, baby girl born at home Oct '09!
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#21 of 26 Old 02-26-2009, 07:33 PM
 
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I've been doing a little bit more research and am feeling a little more confident about bringing it up. I adored the OB practice I had my daughter with so I'm going to call Tricare and see if I can somehow be covered for a visit with them instead of going to the military clinic. I'm pretty sure I'm coming up on a routine pap here soon anyway.
Oh hugs mama. I hope you don't mind my posting, but I just wanted to add-- You can always ask the OB you like how much it would be to just see him for cash. Many time's OB's reduce their fee for paitients who just pay upfront. It may not be as much as you are thinking for that initial consult.

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#22 of 26 Old 03-03-2009, 01:58 AM
 
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Here is a military moms thread:

http://www.mothering.com/discussions...6#post13280516

Perhaps they can help you with your tricare issues, and one of them may be in your area.

It seems important that you refer to the "fix" you are looking for as "reconstructive surgery" and not allow anyone to refer to it as cosmetic.

"It should be a rule in all prophylactic work that no harm should ever be unnecessarily inflicted on a healthy person (Sir Graham Wilson, The Hazards of Immunization, 1967)."
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#23 of 26 Old 03-03-2009, 06:19 PM
 
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I wish you the best of luck figuring out this sticky situation.

Remember that you can file ICE reports online for ANY bad and good experiences you have at any military facility (military doctor, the commissary, exchange, etc.). They will always follow up on your report and try to remedy the situation. I have filed a direct complaint about a doctor including her name and they followed up with me several times. The ICE system is done through DOD and stands for Interactive Customer Evaluation. You should be able to google it online and find it, although I still have a hard time getting to it sometimes.

Good luck in everything as you figure this all out. I know it's not easy.
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#24 of 26 Old 03-03-2009, 07:30 PM
 
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I had a major tear last year when my DS came rocketing out with a nuchal hand, delayed suturing/closure, and an infection that ruined the repair...I really empathize with your frustration and sadness over what happened. After talking with my gyn, I decided to delay final repair until I am done nursing, because the healing will likely be faster and easier with normal non-breastfeeding hormone levels. But not a day goes by that I don't think about it, and I am so, so, so ready to have my "normal" anatomy back!

I would bypass your PCP if you have the option, and go straight to a Gyn that you trust, because from your description this is a surgical issue. Ask in your Tribal area if necessary, for referrals. If you think you may have trouble explaining the problem without crying, write down what you want to say about the physical problem and how it has affected you, and just hand that to your doctor. Regarding the insurance issue, surgical repair should be a covered service even under TriCare. Often, a traumatic tear will be accompanied by other anatomic changes - cystocele, rectocele, uterine prolapse - and those conditions can cause medical problems like constipation, incontinence, dyspareunia (painful intercourse). Maybe you are having symptoms related to the tear - if so, be sure to let your doctor know - it will help with getting prior authorization and insurance coverage for the surgery you need.

Oh, and that male doctor you saw is a UAV who doesn't deserve to practice medicine.

Cindy, part-time family doc, full-time Mommy to Jared (2/04) and Connor (2/08) :
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#25 of 26 Old 03-09-2009, 01:18 AM
 
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So sorry you are dealing with this I tore thru my labia into my clitoral hood and then ripped the stitches out getting onto my bed. It really bothered me and my OB fixed it 15 months later. It looks a ton better,but not perfect.I would not have been able to cope with being intimate without the surgery, having deformed labia made me feel almost sub human, it was sad. FWIW. my surgery was considered medically necessary and covered 100% by insurance.
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#26 of 26 Old 06-07-2009, 05:26 AM
 
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OP - how are things with you right now? I'm feeling sort of the same way about my vagina right now. I have no perineum left either, and my repair was awful. I can't have sex - forget about it not being normal I just can't have it. My midwife isn't on my insurance anymore so I can't see her about it.

I'm trying to figure out if I need to look into reconstructive surgery, or if something else is the solution. I did a search on here and came up with this thread, so I hope you don't mind me asking if you went through with it? How was it? Feel free to PM me if you don't want to share publicly, I'm just looking for some advice. Thanks.
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