Your Doctor Speaks to You — What Is the Cause of This Pain?

What is the cause of this pain??

For a long time I have felt a pain in my right side, and my husband persuaded me to have my body examined, to make sure whether the cause of this pain is the appendix — for he felt the very same pain a year ago from an inflamed appendix — or whether my trouble is of that kind?

The woman speaking to me was twenty years of age. I looked at her with interest and asked her to explain her problem to me further; and I asked her whether the pain was continuous, or came from time to time. She answered:

— It comes at a certain period, but it is enough to wear me out!

— Has anything happened to you that has prevented pregnancy? Or have you yourself tried to postpone it?

— No, doctor, I have never experienced pregnancy, and I long to have a child!

— Then have you tried to cut off the course of the pain with any treatment?

— No; the pain comes and goes without cause or treatment, and I pass through this torment every month.

— So it has a fixed time?

— Not exactly by the monthly reckoning, but it occurs between the two menstrual periods.

— And what of the menstrual cycle? Does it come every twenty-eight days?

— Yes!

— How would you describe this pain to me?

— It is continuous for forty-eight hours, on one side; a pain I would not call severe, and yet it is thoroughly troublesome. Then, before it begins, I feel light prickings three days earlier, which I take as a warning of what is to follow!

— And do you notice any bleeding during this time?

— No! That has happened only once or twice!

— And when was your last menstrual period?

— Ten days ago, and this morning I began to feel the light prickings.

The lady went on talking as the nurse led her to the examination room:
It is not the appendix that causes my pain, is it?

— I do not believe so, although this pain is very often taken for the result of an inflamed appendix, and so leads to an unnecessary operation.

— But you have not told me what the cause of my pain is, doctor?

— The fact is that this is the period in which the ovum is formed, and five percent of women suffer pain during this time. In the ovary there is a cluster of small ova, connected to one another by fine filaments, and activity continues among them all following the menstrual period; but one of them outstrips the rest in growth and ripening, then forces its way through the ovarian membrane, which swells and stretches and finally splits, sometimes causing internal bleeding.

It happens in some women that conception occurs outside the wall of the womb and the vaginal canal after menstruation, and this kind of pain may also be attributed to the swelling of the ovary itself.

— I am fortunate, then, that my pain comes from this! But there is one point I have not understood: why does the outward bleeding occur, so long as the pain is inside the organs?

— The seepage of blood you mentioned does not count as heavy bleeding; it may be some blood that escapes into the vaginal canal upon the release of the ovum; and it can be stopped by means of certain hormones. You told me that you long for motherhood — you are fortunate a second time, since you now know the period when the ovum ripens. Conception takes place within a week after the pain, and this is known as the fertile period. So if you wish to conceive, the best time is the period following the pain — and I foresee success for you in what you hope!

— Nothing could make me happier; thank you, doctor!