Gynecology Q & A

  • Robotic Assisted surgery with the Da Vinci system
  • Thanks to a breakthrough surgical technology, there is a new category of minimally invasive surgery for which you may be a candidate. It is an effective, minimally invasive alternative to both open surgery and laparoscopy. Through the use of the da Vinci Surgical System, surgeons are now able to offer a minimally invasive option for complex surgical procedures.
    >> Learn more about the Da Vinci system

  • Dysfunctional uterine bleeding
  • Dysfunctional uterine bleeding is irregular vaginal bleeding that is not caused by a serious medical problem, such as miscarriage or cancer. In most cases, dysfunctional uterine bleeding is related to changes in hormone levels. Dysfunctional uterine bleeding is:

    • Menstrual bleeding that occurs more often than every 21 days
    (a normal menstrual cycle is 21 to 35 days long).
    • Menstrual bleeding that lasts longer than 7 days
    (normally 4 to 6 days).
    • Blood loss of more than 80mL each menstrual cycle
    [normally about 30mL].

    Treatment options include:

    • Waiting to see if symptoms get better on their own.
    • Hormone therapy.
    • Surgery, such as hysterectomy or endometrial ablation.

    Women with dysfunctional uterine bleeding should be examined for other causes of symptoms and tested for anemia (low red blood cell count).

  • Endometrial Ablation
  • Endometrial ablation is the removal or destruction of the endometrium (lining of the uterus). It does not require hospitalization, and most women return to normal activities in a day or two. Ablation is an alternative to hysterectomy for many women with heavy uterine bleeding who wish to avoid major surgery. After a successful endometrial ablation, most women will have little or no menstrual bleeding. Patient selection and physician experience is essential to a good outcome. (Links to her option and therma choice)

  • Abnormal Vaginal Bleeding
  • Many women experience abnormal vaginal bleeding or spotting between periods sometime in their lives. Vaginal bleeding is considered to be abnormal if it occurs:

    • When you are not expecting your menstrual period.
    • When your menstrual flow is lighter or heavier than what is normal
    for you.
    • At a time in life when it is not expected, such as before age 10, when you are pregnant, or after menopause.

  • Urinary incontinence

  • • The main symptom of urinary incontinence is a problem controlling urination. The circumstances and type of problem affecting urination vary with the cause.
    • Symptoms of stress incontinence involve the involuntary release of urine, especially when coughing, sneezing, or laughing. It is the most common type of urinary incontinence in women. It usually results in a small to moderate amount of urine leaked.
    • Symptoms of urge incontinence include the need to urinate frequently and a sudden, urgent, and uncontrollable need to urinate. It can result in a moderate to large amount of urine leaked, although it often occurs when the bladder contains only a small amount of urine.
    • It is common for a woman to have mixed incontinence, usually a combination of stress and urge incontinence.


    • Tension-free vaginal tape (TVT) surgery. TVT surgery is commonly used for stress incontinence. During this surgery, a meshlike tape is positioned under the urethra like a sling or a hammock to support it and return it to its normal position. The surgeon inserts the tape through small incisions in your vagina and pubic hair line. TVT surgery takes approximately 30 minutes and is usually done under local anesthesia. This surgery can also be done to correct incontinence that has come back after having another type of incontinence surgery. Another surgery called transobturator tape (TOT) surgery is like TVT surgery.
    • Retropubic suspension. The Marshall-Marchetti-Krantz (MMK) and Burch colposuspension procedures are the most common types of retropubic suspension. Retropubic surgeries provide lift to the sagging bladder neck and urethra by attaching their supporting tissues to the pubic bone or tough ligaments. These surgeries require hospitalization.
    • Urethral sling. The surgeon fashions a piece of muscle, ligament, or tendon tissue or synthetic material into a sling that lifts the urethra back into a normal position. This involves abdominal surgery, so hospitalization is required.

  • Interstim
  • The neurostimulator is placed in the upper buttock

    Neurostimulation was FDA-approved in 1997 for urge incontinence and in 1999 for urinary retention and significant symptoms of urgency-frequency

    How It Works

    Neurostimulation is a reversible treatment that can be discontinued at any time by turning off or removing the device. It sends mild electrical pulses to the sacral nerves.

    Located near the tailbone, the sacral nerves control the bladder and the muscles related to urinary function. If the brain and sacral nerves don't communicate correctly, the nerves can't tell the bladder to function properly. This communication problem can lead to symptoms of overactive bladder. Neurostimulation targets these symptoms by stimulating the sacral nerves with mild electrical pulses.

    Neurostimulation may help you resume normal activities, and help you avoid frustrating experiences associated with overactive bladder. (Medtronic link)

  • Hormone Imbalance
  • Hormone Imbalance Hormones! From PMS to menopause, these messengers of womanhood can affect your mood, your weight, your food cravings - even your desire for sex. For many women, it's smooth sailing, but for others, it's a shipwreck at every turn of the hormonal bend


    -Bioidentical hormones

    Bioidentical hormones are made in the laboratory and are based on compounds found in plants (usually soy beans or wild yams). Unlike supplements containing soy or wild yam extract, a bioidentical hormone product has been processed by a specially trained compounding pharmacist.

    After the plant-based hormone is processed, its structure is said to be identical to the estrogen, progesterone, or androgen hormone your body produces. (Well-designed studies have yet to prove this theory.1) A compounding pharmacist can offer you a custom-made formulation in one of many forms, such as a capsule, skin cream or gel, tablet to dissolve under your tongue, suppository, or nose spray. Some commonly prescribed estrogens and progesterones are bioidenticals, such as Estrace (estradiol).

    Just like synthetic HRT, bioidentical hormone replacement is prescribed to increase or stabilize a woman's hormone levels. This is generally done during perimenopause, when hormone levels change unpredictably, and after menopause, when the hormones drop to low levels

  • Decrease Libido
  • Sexual desire is a normal and natural feeling for women and men. However, sexual desire can change over time, and can increase or decrease depending on the situation... To understand changes in sex drive, which is called libido in medical terminology, one must understand that every person, and every couple, has a different level of desire. Sexual desire often changes in response to outside forces, like stress. Plus, libido can decrease with certain medical conditions and by many medications.


    Localized estrogen therapy. Placing estrogen directly into the vagina soothes vaginal tissue, and allows the secretions necessary for comfortable sex and possibly even an increase in sexual desire.

    Compounded testosterone cream. Many compounding pharmacies offer testosterone creams and gels, but you'll need a doctor's prescription.

    Vitamin E. When used locally in the vagina it can help rehydrate tissue and may possibly increase sensation. No need for a prescription here.

  • Premenstrual syndrome
  • Troubling physical and emotional symptoms that occur between the time of ovulation and the first days of the menstrual period are called premenstrual symptoms. Premenstrual symptoms that interfere with relationships or responsibilities are called premenstrual syndrome (PMS).

    PMS has a wide variety of physical, emotional, and behavioral symptoms that vary greatly from woman to woman and from cycle to cycle. Symptoms may range from mild to severe. The most common physical symptoms of PMS are water retention, breast tenderness, and weight gain. Common emotional and behavioral symptoms include depression, irritability, and mood swings.


    While there is no cure for PMS, many women can improve their symptoms by getting regular exercise, eating a healthy diet, limiting alcohol and caffeine intake, and reducing stress. Nonprescription pain relievers can help reduce some symptoms. Prescription medications may be necessary for women who have severe PMS that significantly interferes with their lives on a regular basis.

  • Premenstrual dysphoric disorder (PMDD)
  • Premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS), causes physical and mood-related symptoms that seriously disrupt a woman's life and relationships. PMDD symptoms develop during the latter half of each menstrual cycle, after ovulation, and go away during the first few days of each menstrual period.

    PMDD symptoms are related to hormone changes during the menstrual cycle. Emotional symptoms include feelings of sadness, hopelessness, anxiety, irritability and sensitivity, anger, being overwhelmed, and the need to withdraw from others. Physical and behavioral symptoms include lack of energy, problems with concentrating, sleep problems, food cravings or binge eating, breast tenderness, bloating and weight gain, headaches, and joint or muscle pain.


    Women diagnosed with PMDD are typically encouraged to use healthy lifestyle choices and prescription medication to manage their symptoms.

  • STD'S
  • Sexually transmitted diseases, commonly called STDs, are diseases that are spread by having sex with someone who has an STD. You can get a sexually transmitted disease from sexual activity that involves the mouth, anus, vagina, or penis. Sexual conditions, such as STDs and sexual problems, need a medical evaluation and treatment. Frequently, there are no STD symptoms, although there's sometimes a discharge from the vagina or the penis and burning or pain during urination. Doctors use STD tests to diagnose sexually transmitted diseases such as Chlamydia, gonorrhea, syphilis, and trichomoniasis. Whereas STD treatment can help resolve these sexual conditions, practicing safe sex can prevent STDs.


    There are many STDs out there, and the types of STD treatment are as varied as their symptoms. Remember, however, if you are diagnosed with an STD, that the only person who can tell you the appropriate STD treatment is your healthcare provider. Treatment is decided on between you and your doctor on an individual basis in order to adjust for any other issues that may be affecting your overall physical health.

    The HPV Vaccine

    HPV vaccines protect against a very common sexually transmitted virus called HPV or human papillomavirus. HPV infects at least 80% of sexually active people at some point in their lives. The virus often clears on its own. If it persists, it can lead to cervical and other cancers and to genital warts.

    One HPV vaccine, Gardasil, was licensed for use by the FDA in 2006. In September 2008, the FDA announced it may also be used to prevent some cancers of the vulva and vagina when given to females aged 9-26. (Gardasil link)

  • Birth Control Overview
  • Birth control is any method used to prevent pregnancy. There are many different methods of birth control including condoms, IUDs, birth control pills, the rhythm method, surgical sterilization, and tubal ligation.

    What Is Essure?

    Essure is a new form of permanent sterilization for women that can be performed without general anesthesia (being put to sleep).

    How Is Essure Placed?

    Essure is a tiny birth control device that looks like a spring. Doctors use a thin tube to thread an Essure device through the vagina, into the uterus, and then into the fallopian tubes. Thus, each woman receives two Essure devices to achieve sterilization.

    A mesh-like substance that's embedded in the Essure device irritates the lining of the fallopian tubes, causing scarring that over time permanently blocks the tube. (Essure link)

  • What is osteoporosis?
  • Osteoporosis is a common disease that weakens bones. As it does, your risk of sudden and unexpected fractures goes up. Osteopenia is the forerunner of osteoporosis. It is a silent but destructive condition that robs bones during a woman's -- even a young woman's -- most productive time.

    No matter what your age or sex, osteoporosis and osteopenia can affect you. Your bones might seem sturdy now. You may be very active and doing the things you want to do. But osteoporosis and osteopenia are quiet, accomplished thieves. In fact, there are usually no visible signs. You may notice a loss of height or a Dowager's hump over time. But chances are good the first sign that you have one of these conditions will be a painful fracture.

    Treatment & Care

    Osteoporosis treatments include the “basic CDE's” -- calcium(C), vitamin D (D), weight-bearing exercise (E), prevention of Falls (F), and bone-friendly medicines.

  • Liquid based cytology
  • Since the mid- 1990's, techniques based around placing the sample into a vial containing a liquid medium which preserves the cells have been increasingly used. The media are primarily ethanol based. Two of the types are Sure-Path(TriPath Imaging) and Thin- Prep (Cytic Corp). Once placed into a vial, the sample is processed at the laboratory into a cell thin-layer, stained, and examined by a light microscopy. The liquid sample has the advantage of being suitable for low and high risk HPV testing and reduced unsatisfactory specimens. Proper sample acquisition is crucial to the accuracy of the test; clearly, a cell that is not in sample cannot be evaluated.

  • If Abnormal Pap
  • Cervical Cryotherapy

    Cryotherapy destroys abnormal tissue on the cervix by freezing it. Cryotherapy destroys some normal tissue along with the abnormal tissue. During cryotherapy, liquid carbon dioxide (CO2), which is very cold, circulates through a probe placed next to the abnormal tissue. This freezes the tissue for 2 to 3 minutes. It may be allowed to thaw and then be refrozen for another 2 to 3 minutes. A single freeze treatment for 5 minutes may also be used.

  • Colposcopy
  • Colposcopy is a procedure that gives your healthcare provider a magnified view of the cervix. It is done using a lighted microscope called a colposcope. In most cases, a sample of cervical cells is taken during a biopsy. The sample can then be studied in a lab. If any problems are found, you and your healthcare provider will discuss treatment options. Problems with the cervix can be best when detected early.

    Loop electrosurgical excision procedure (LEEP) for abnormal cervical cell changes

    The loop electrosurgical excision procedure (LEEP) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP can:

    -Cut away abnormal cervical tissue that can be seen during colposcopy.
    -Remove abnormal tissue high in the cervical canal that cannot be seen during colposcopy. In this situation, LEEP may be done instead of a cone biopsy. (For more information, see cone biopsy.)

    LEEP is also known as large loop excision of the transformation zone (LLETZ).

    A vinegar (acetic acid) or iodine solution, which makes abnormal cells more visible, may be applied to the cervix before the procedure is done.

  • Pelvic Prolapse
  • Prolapse (or falling) of any pelvic floor organ (vagina, uterus, bladder, or rectum) occurs when the connective tissues or muscles within the body cavity are weak and unable to hold the pelvis in its natural orientation. The weakening of connective tissues accelerates with age, after child birth, with weight gain and strenuous physical labor. Women experiencing pelvic organ prolapsed typically have problems with urinary incontinence, vaginal ulceration, sexual dysfunction and/or having a bowel movement.


    Anterior Repair (colporrhaphy)

    This procedure is used to treat prolapse of the bladder (cystocele), urethra (urethrocele) or both the bladder and urethra (cystourethrocele).

    The operation is done through the vagina and you will be given a general anaesthetic. It involves making a cut in the front (anterior) wall of the vagina so the bladder and/or urethra can be pushed back into place. Once this is done, the surgeon stitches together existing tissues to provide a new support for the bladder and urethra. A small portion of the vaginal wall is removed to give the vagina more strength.

    The main complications of anterior repair are painful sex (dyspareunia) and incontinence. Your surgeon may be able to reduce the risk of painful sex by making sure the vagina is not narrowed too much or pulled out of place during the repair. Incontinence can usually be prevented when diagnosed before surgery (see Before Surgery, above).

    Posterior Repair (colporrhaphy/colpoperineorraphy)

    Posterior repair is used to treat prolapse of the rectum (rectocele) and small bowel (enterocele). The operation is done through the vagina and you will be given a general anaesthetic. The procedure is similar to an anterior repair (above) but the doctor may first make a small cut from the base of the vagina towards the anus (similar to an episiotomy during childbirth). This makes it easier for the repair to be done. A cut is then made in the back (posterior) wall of the vagina and the rectum and/or small bowel is pushed back into place. The doctor stitches together the existing tissues to create a new support for the prolapsed organ(s) and then removes some of the tissue from the vaginal wall to make it stronger. If a cut was made at the base of your vagina, it will also be stitched back together.

    Suspending the Uterus

    Treatments that suspend rather than remove the uterus are recommended for women who want to keep their uterus or have children in the future. Procedures can be done either vaginally or abdominally, and there is some evidence to suggest that abdominal repairs tend to have better long-term results.

  • Sonohysterogram
  • It's a simple ultrasound procedure that may be used to evaluate the endometrium. The technique involves placement of a catheter into the endometrial canal with subsequent instillation of sterile saline under US guidance. The sonohysterogram is completed after menstruation has ended and before ovulation occurs. The timing of the procedure allows for optimal viewing of the uterine walls, since they are at their thinnest at this point in a woman's cycle.

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