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Has This Ovarian Cyst Wrecked My Desire?

For the first few months of our relationship, my boyfriend and I enjoyed a healthy sex life, despite unexplained pains which were developing in my stomach. As these pains worsened over the months and brought with them symptoms such as nausea, my desire to have sex decreased rapidly.

Eventually, after many months of arguing and frustration, I was diagnosed with having a benign ovarian cyst, and had an operation three months ago to have it removed. However, I still feel like I don't want to have sex and it's causing real problems. Even when I sort of feel like I'm in the mood, once we start it feels wrong and I don't know why.

I always used to enjoy this strong bond with my boyfriend and now I feel like this cyst has ruined everything. Why do I feel like this? Is the operation to blame or is it something else? What can I do to stop myself from feeling this way forever? My boyfriend's tried to be supportive but he just feels like I'm not attracted to him anymore.

Linda, Kent

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Ovarian Cysts And Prolapse

Ovarian cysts

Causes: A cyst is a fluid-filled sac that develops inside the ovary. They are very common, especially in women in their thirties and forties, and almost always harmless. In fact, they can occur - and disappear - from one month to the next without you even noticing. But if they have reached a certain size, they are unlikely to shrink naturally. Occasionally, a cyst can cause the ovary to twist or it may leak into the abdominal cavity. In rare cases, an ovarian cyst may be cancerous (see Ovarian Cancer).

Symptoms: Pain during intercourse and painful, heavy periods. If a cyst twists or ruptures, it causes stomach pain, nausea and fever.

Treatment: This depends on the size of the cyst, whether it involves one or both ovaries and your age. An ultrasound operation will generally determine the nature of the cyst, though a twisted ovary will cause such intense pain that it requires emergency surgery. In younger women, smaller cysts are often removed via keyhole surgery. In older women who have had all their children, sometimes the entire ovary will be removed.

Prolapse

Causes: This occurs when the group of muscles and ligaments in the pelvis, which hold in place the pelvic organs - uterus, bladder, rectum, urethra, and others - weaken, allowing organs in the area to push down into the vagina, causing it to prolapse. The most likely organ to fall is the uterus.

A prolapse is very unlikely to occur in a woman under menopausal age, but though the muscles weaken with age, they will have probably been injured years earlier, in pregnancy, during a long labour or through having a large baby.

Symptoms: A prolapse is described according to the part or parts of the uterus and vagina that are involved. If the front wall of the vagina is prolapsing, it is called a cystocoele. If the back wall is involved, it is called a rectocoele. The first is associated with stress incontinence, the second with constipation and bowel discomfort. Other symptoms include severe backache, pain during intercourse and sometimes a 'dragging down' feeling in the pelvis.

Treatment: The best cure is prevention - by doing pelvic floor exercises on a daily basis to strengthen the muscles. These can be done anywhere and at any time by simply tightening the pelvic floor muscles as if trying to stop your urine flow.

It is particularly important to do this if you are pregnant or have just had a baby. Once you have had a prolapse, exercises are usually not enough to rectify the problem and you need surgery. The operation, to tighten the muscles with stitches, is usually performed under general anaesthetic.

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Ovarian Cysts: An Expert Explains

What is an ovarian cyst?

Generally an ovarian cyst is a fluid collection in one or both of the ovaries.

In women who have not gone through the menopause (when periods stop permanently) the ovaries make eggs regularly as part of the menstrual cycle. The eggs form in small fluid areas called follicles which look like small cysts so generally we only call a fluid collection over 3cm across a cyst. These small fluid collections are present in many women even if using hormonal contraception such as the pill and we can see them on scans. This is a normal finding.

In women who have gone through the menopause cysts are still common and we need to make sure these cysts are not serious or have a cause such as ovarian cancer so we investigate these cysts with blood tests and scans as outlined below.

So the answer is that cysts are found in many women and it takes care to decide whether they may be serious and need further investigation or not, much of this depends on your age and what the cyst looks like on a scan (see below).

Are ovarian cysts common?

Ovarian cysts are very common in women before the menopause and one in ten women undergo surgery for an ovarian cyst however most women who have an ovarian cyst diagnosed will not end up needed an operation to treat it. Only one in a thousand ovarian cysts in women under the age of 50 is a cancerous cyst.

Ovarian cysts are found in up to one in five women who have gone through the menopause and again these frequently will not need any treatment but usually need careful monitoring.

How are ovarian cysts diagnosed?

Ovarian cysts are found in two ways generally. They are found either during a gynaecological investigation due to symptoms such as pain, infertility or period problems. The other way ovarian cysts are found is during scans such as ultrasound scans or CT scans that have been organised to investigate something not related to the ovaries, these ovarian cysts have been found by chance. Just because a cyst has been found by chance does not mean that is is less important than one that has been found because of a gynaecology symptom. 

The diagnosis of an ovarian cyst really means deciding what type of cyst of the ovary it actually is. Once an ovarian cyst has been found this usually means the need for a further scan called a vaginal scan. This may be uncomfortable as a small ultrasound probe needs to go into the vagina to perform the scan. However this type of scan is the most accurate way to diagnose an ovarian cyst and these are usually done by, or reviewed by, a gynaecologist. There are many features of a cyst that can be seen during the scan that help decide the next step.

In women who have not gone through the menopause most cysts have a specific appearance on a scan and this will allow your doctor or gynaecologist to decide if anything further needs to be done. Most cysts need no treatment or follow up. If a cyst has the appearance that means it will not resolve without treatment then an operation may be needed and usually this can be planned without the need for any more investigations. These cysts may be benign non-cancerous cysts such as dermoid cysts, mucous-filled cysts or cysts related to endometriosis (as in the previous article). If a cyst appears to be unusual in some way then more investigations may be done.

In women who have gone through the menopause then the same rules apply to the scan results with lots of specific features looked for during an ultrasound scan. However  all ovarian cysts in women of this age or older need more investigation.

What investigations are needed if i have an ovarian cyst?

Once all the information needed has been found from the scan above then the next steps for investigation can be decided. This is not complicated and most women before the menopause will need no further investigations to recommend a treatment. Sometimes if the scan results are not clear or if the cyst appears unusual (even if not suspicious of cancer) this may mean hormonal blood tests such as CA125 blood test or infrequently further hormone blood tests for rare causes of ovarian cysts.

In women who have gone through the menopause a CA125 blood test is always needed to help decide the next step of management. 

Sometimes a CT scan or MRI scan is used to give more information about an ovarian cyst or to look at other organs within the abdomen but usually these are not needed.

Do ovarian cysts need to be treated?

Fortunately many ovarian cysts do not need any treatment. In women who have not gone through the menopause most smaller ovarian cysts under 5cm across will resolve on their own over 2 to 3 months. This is because most cysts this size are related to the menstrual cycle and will therefore usually not need treatment. Usually we do not even need to do any further scans. Larger cysts should be looked at again by scanning but this should usually be delayed by up to a year to see if a cyst is growing or not. 

Many cysts that are larger have been found on investigations due to them causing some pain so these may need to be treated by operation. They are also less likely to resolve without any treatment. If a larger cyst is left in place it may cause sudden severe pain by causing the ovary to twist, this would require emergency surgery if it occurred.

In older women who have gone through the menopause all cysts need to be carefully monitored by a gynaecologist with scans and ca125 blood tests to check that the cyst has not changed in any way or grown significantly.

If I need to have surgery for my ovarian cyst what does it involve?

If an ovarian cyst needs treatment then this usually means surgery. Surgery obviously varies widely depending on what kind of cyst has been diagnosed or is suspected. It also depends on a woman's age and wishes for further family.

Ovarian cysts are usually treated with keyhole surgery to remove the cyst, repairing the ovary if needed, or by removing the ovary itself if this is a better option. Either way this means less than a day in hospital and three or four cuts in the tummy about a centimeter across. The recovery should take in the region of a couple of weeks. Any stitches are usually absorbable. These cysts should not be treated by draining them alone at an operation as they just come back.

In older women who have  an ovarian cyst that needs to be removed this may mean similar keyhole surgery or may mean surgery to remove the womb and both ovaries depending on the investigations that are described above.

Any cyst tissue removed at an operation is sent for microscopic analysis and you would receive the results of this test.

For more information

enquiries.Rosshall@bmihealthcare.Co.Uk or telephone 0141 303 1405

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