Q: My 29 years old wife has pain in her lower back for several months now, especially after insertion of an intrauterine device (IUD). The pain increases just before and during menses. She also has some discomfort during intercourse. She has seen a gynaecologist, who told her she has a vaginal ulcer, took some scrapings from it and told her it was not a sexually transmitted disease (STD). What causes the pain then? How can we prevent this from recurring?

A:Ulcer is not a diagnosis. It simply means that there is a break in the surface lining. There has to be some reason. It is true that STDs are not the only cause of an ulcer. The clinical appearance of the ulcer can sometimes give a clue to its probable cause. Investigations help to confirm a particular disease and rule out the others. Only after a proper diagnosis is made can one think of preventing it in future.