Solve the Medical Riddle: She Has Embarrassing Symptoms “Down There” After Making Love, First Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

We’ll start this week by letting you know what the patient told her gynecologist and how the doctor proceeded with the examination. Next week, the doctor will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!

The Patient Reports Her Symptoms

Sybil, a 62-year-old widow, started a relationship with a man she met through a good friend. However, she had some embarrassing symptoms after making love with the new man in her life.

As always in ThirdAge Medical Riddles, the doctor uses the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

This week, we’ll learn what Sybil told the doctor:

“I was devastated when my husband died of a heart attack at the age of 60, right after our 37th wedding anniversary. I thought I could never get back into the dating scene, but this year my best friend introduced me to a wonderful guy from her church. We clicked right away. My friend said I needed to give myself permission to love again, and I said I would try. My son and daughter encouraged me as well. They said their father would want me to be happy and they said that if the relationship worked out for Cliff and me, the grandchildren would have a step-grandfather. I thought they were kind of rushing things, but I was touched by their enthusiasm.

“Anyway, Cliff and I started with a coffee date and moved on to drinks and dinner. Then I invited him over to my house for a home-cooked meal. We ended up in bed, and I felt myself come alive again! We didn’t need to use any birth control since he had a vasectomy and I’m post-menopausal. I kept a lubricant handy because I had vaginal dryness after menopause that made sex painful with my husband, but Cliff understood and took a long time kissing me and getting me aroused. Wow! Who knew sex could be so great at this stage of life?

“Unfortunately, though, the day after the second time Cliff and I made love, I woke up with a burning and itchy feeling down there. I also noticed a smelly odor and some discharge even though after menopause I have had almost no vaginal discharge, which was a good thing – no more soiling my underwear, and no more need for minipads to absorb the normal discharge. Right away, I douched to get rid of that smell. I was relieved that Cliff, who’s younger than I am by six years and still working, was leaving on a two-week business trip. I hope I can get this condition cleared up before he comes back. I don’t know if it’s related to lovemaking or not, but it’s definitely uncomfortable and embarrassing!”

The doctor did a complete physical exam and asked Sybil about her general health, whether she was using hormone replacement therapy, and what her vaginal hygiene habits are. Sybil said she feels great overall. She does not have diabetes or any autoimmune condition including rheumatoid arthritis or MS, so she’s not taking any immune modulating drugs.

She’s not using any HRT. She also said she douches every so often and that she uses toilet paper following urination or bowel movements. The doctor, a woman herself, suggested that Sybil should try moistened baby wipes because they are less irritating than paper, and that Sybil should not douche. The doctor also mentioned that perfumed soaps can cause allergic reactions, especially if Sybil soaks for a while in hot baths. Sybil said she does do that and that she also uses the hot tub in her backyard.

Next the doctor asked whether Sybil had a history of any sexually transmitted infections, and Sybil said she didn’t. She said she had one partner before she married her husband and that she had never had an affair. She believed her husband had never cheated either. She never took the birth control pill. They relied on condoms until she went into menopause. She also never used topical estrogen creams since there’s a family history of beast cancer and her first gynecologist had therefore warned her against the creams.

The doctor suggested that Sybil should get screened for STDs and HIV since her new partner didn’t use condoms, and she also recommended a blood test and vaginal smear.

To be continued . . .

Come back to ThirdAge.com next Thursday to learn how the doctor continued the quest for a correct diagnosis of Sybil’s condition . . .

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.