Dear Dr Mitchell,
I am 21 years old and I have a two-year-old daughter. Since the birth, I have been feeling pains in the right side. Before I had my daughter the doctor told me that I had a cyst that was mild. Now I'm feeling some strange pains in my side even during sex. What could be happening?

The pain that you experience in your right side may be due to one of several factors. It is not unusual to have a simple or mild cyst in the ovary. This usually occurs after ovulation when the remnant of the sac from which the egg is released forms a corpus luteum cyst. This is a functional cyst and usually goes away after the menstrual period.

The pain associated with this tends to occur mid-cycle and lasts for two to three days at most. Once you have done an ultrasound to ensure that this is a simple cyst then all that is required is for you to go on a low-dose oral contraceptive pill for at most three months and this will help the cyst to shrink quickly and reduce the painful discomfort that you now experience.

The pain that you experience during intercourse could be due to the fact that the cyst has increased in size or is being irritated by sexual activity. A condition called endometriosis may also present with deposits in the ovary and cause pelvic and abdominal pains. Endometriosis is a condition in which the similar tissues to that which normally line the inside of the uterus is present outside of the lining of the uterus.

These tissues bleed each month since they respond to the hormones produced by the ovaries and shed in a similar fashion to the lining of the uterus. This causes blood to accumulate in the pelvis or in the ovary, depending on the site at which deposits occur and this result in pelvic pain and long-term adhesions and scarring.

In some cases this may even result in infertility. This condition is usually diagnosed by doing a diagnostic laparoscopy since ultrasound is not usually helpful in detecting this unless of course there are deposits in the ovary resulting in the usual "chocolate cysts" formation.

The chocolate cyst is due to collection of old blood. Endometriosis may be treated by doing a surgical operation or by using hormonal treatment. In some cases the continuous use of the low-dose contraceptive pill without taking the usual seven days break is effective, especially if taken for at least six to nine months continuously.

Alternatively, the contraceptive injection depo provera may offer some relief. The use of other drugs such as Zoladex or Lupron is significantly more expensive, but is quite effective. These drugs create a false state of the menopause and suppresses the periods completely allowing for the deposits to "dry out".

However, they should only be used for six to nine months at most because of significant side effects on the bones and the heart due to the low oestrogen levels that result from taking these drugs. Endometriosis tends to recur despite adequate treatment and only disappears completely after menopause.

Other possible causes of the pelvic pain you experience could be chronic pelvic inflammatory disease (PID) or problems related to the bowels, kidney or bladder.

You need a detailed gynaecological check-up including a pap smear. Other investigations such as a pelvic ultrasound or CT scan of the pelvis may be necessary depending on the finding of your family doctor or gynaecologist. Specific treatment can then be undertaken depending on the outcome of the investigations.
Consult your family doctor or gynaecologist for further evaluation.
Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via e-mail to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.

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