Brief Answer:
Its not endometriosis ...explained

Detailed Answer:
Hello,

Thanks for contacting health care magic.

After going through the history, it is evident that you are suffering from recurrent urinary tract infection especially symptomatic at the onset of your periods. The burning sensation in the urine while passage indicates infection. This is though sometimes common in women during menses when the frequency of urine tends to increase under progesterone withdrawal.

The very fact that you mentioned that you start bleeding from urethra and then your bleeding starts, its kind off unlikely as bleeding per urethra is seen in cases of chronic cystitis or much later in cases of bladder cancer only. Menstrual bleeding with urethral bleeding is a possibility in cases of severe endometriosis where the endometriotic tissue has invaded through the walls of bladder and invaded the mucosa. In that case the bleeding through urethra has to be continuous and had already taken the form of a endometriotic cancer, which is not the case with you. It is likely that on the first day of menses some collected blood in the vagina may come out with the stream of urine and would give you a perception that you are bleeding from urethra.

Your ultrasound, pap smear, I believe even urine test are all normal, so there is no need to worry. There may be asymptomatic bacteuria which may be causing those burning sensation for which you can opt for a urine culture test done.

The whitish discharge during or before menses, during the premenstrual phase is physiological and can get accumulated sometimes around the creases of groin and may give foul odour. If the discharge is not itchy or coloured, its normal. So rest assured, you seem to be fine.

But get an urine culture done and get a gynaecologist consultation for a checkup during day 1 of your cycle just to allay your anxiety.

Regards,
dr XXXXXXX XXXXXXX

---

Brief Answer:
get a cystoscopy done.....

Detailed Answer:
Hello.
thanks for the follow up.

if that is the case and you are sure about bleeding through urethra then you must undergo a cystoscopic examination to see the urethra and bladder through a scope few days prior to your menses and get a urine sample for culture before cystoscopy.
This would help clear all doubts.
I suggest seek an appointment with an urologist and ask him for cystoscopy.

regards
dr.samerr XXXXXXX

---

Brief Answer:
cystoscopy is gold standard. possibilities explained

Detailed Answer:
Hello.
thanks for follow up.
Well that's the most logical diagnosis but then it should be confirmed and urethral diverticulum should bleed even otherwise when menses don't start.
Hence cystoscopy is indicated.
Another likelihood is probable bladder injury during cesarean section and while repairing it accidental implantation of endometrial tissue into bladder which bleeds only during menses secondary to progesterone withdrawal. this would be endometriosis bladder in situ.
But then it should be accompanied by pain as well.
IF cystoscopy is problem though it would be gold standard, you can undergo multislice CtScan and evaluate the bladder for any growth. But sensitivity is less.

If its diverticulum still it would require a cystoscopic resection and same for endometriotic tissue.

My advise is it's not bladder CA , so you may wait for the time being for cystoscopy or get a ctscan done.

regards.
dr XXXXXXX XXXXXXX

---

Brief Answer:
possible post op adhesions ..reason for pain..

Detailed Answer:
Thanks for the follow up again.

I would like to see your reports , if you can attach them for me through the site. if this bleeding continues , then there is no option but to get a cystoscopy done.

Your right sided pain could be because of post operative adhesions which are formed between the scar tissue and anterior abdominal wall sometimes and can cause you discomfort in one particular position usually. If there is no acute pain or severe discomfort , then its fine and can be attributed to adhesions. PELVIC inflammatory disease is ruled out as it always have a bilateral presentation.
likely cause for your pain on right side is post-op adhesions for which no intervention is required at present as the pain is mild discomfort only.

Did your urine culture show blood cells ...or red blood cells in it when it was done?
it would also be wise to get it repeated now that you are off menses and no bleeding per urethra. An element of chronic UTI or urinary tract infection may also have a similar presentation. I hope local hygiene is duly taken care off and local area kept dry.

regards,
dr XXXXXXX XXXXXXX

---

Brief Answer:
get the cystoscopy done...for sure

Detailed Answer:
Thanks for the follow up.

Well if your urine culture is clear then it is unlikely to be a urinary cause or endometriosis. I think mostly you may be confusing it with menstrual blood mixed with your initial morning urine when passed.

Is all tests are normal , then only cystoscopy is left to prove that the cause if within urethra or bladder. unfortunately you have to go through it sooner or later.

With the cultures coming negative, i feel the cause is no more organic. please dont be worried.
regards
Dr.Sameer XXXXXXX

---

Brief Answer:
its not urethrovaginal fistula

Detailed Answer:
Thanks for the follow up.

Well i dont see nay such possibility of urethrovaginal fistula because if it would have been then there would have been regular leakage of urine through vagina during urination and you should always be smelling of urine throughout the day. so this possibility is a good thought but unlikely.

regards,
dr XXXXXXX XXXXXXX

---