Gynecology

Annual Gynecological Exam:

Women should begin annual gynecological exams at about 18 years of age or earlier if they become sexually active and find

themselves in need of birth control . Of course, a visit should also be scheduled earlier if any problems are encountered with the menstrual cycle or if pain or abnormal discharge occurs.

A typical gynecological exam should include a full physical or at the very least should involve an assessment of the thyroid, breasts, heart, lungs, abdomen and pelvis.

A thorough history is taken prior to the exam and the woman should be instructed in how the exam will be conducted, the collection of specimens, the sensations she may experience and what follow up might be necessary.

Contraception:

Contraception is any process used to prevent pregnancy. Contraceptives may be used at the time of intercourse (e.g., condoms, diaphragms, spermicides) or regularly (e.g., birth control pills, intrauterine devices). Surgical methods are available for women (tubal ligation). Other methods range from natural family planning to the morning after pill.

Some of the most popular temporary contraceptive options include:

Birth Control Pills
Condoms
Contraception
Diaphragm
Intrauterine Device
Morning After Pill
Tubal Ligation

Infertility

A person is infertile when he or she is unable to perform the function of reproduction. Infertility is considered a disease and affects more than six million men and women in the United States, according to the American Society for Reproductive Medicine (ASRM).

Infertility disorders in men include azoospermia, in which no sperm cells are produced; and oligospermia, in which few sperm cells are produced. Although the number of cases is rare, infertility can be caused by a genetic disorder. Typically, male infertility rests with the testes, responsible for the production of sperm. Disorders of the thyroid, adrenal and pituitary glands, liver, and kidneys—as well as infections and trauma to the testes—can contribute to male infertility.

Osteoporosis

Osteoporosis is a disorder that causes bones to become porous, weak and brittle. It usually affects older adults and occurs when low levels of calcium, phosphorus and other minerals cause bones to lose mass. The early stage of decreased bone density is called osteopenia.

In most cases, osteoporosis does not cause pain. However, it can lead to fractures – most often in the spine, hip or wrist - that cause sudden, searing pain. Falls or minor events such as coughing, bending over or sneezing can break osteoporotic bones.

There are two main types of osteoporosis, according to the National Institutes of Health:

Primary. Caused by aging (senile osteoporosis) or by unknown factors (idiopathic osteoporosis)
Secondary. Caused by another disease, a medical treatment or lifestyle factors.

Osteoporosis is most common in women during and after menopause because lower levels of the hormone estrogen weaken bones. However, the disease also affects men and – in rare cases – children. In addition to aging, other contributors to osteoporosis include endocrine and many other disorders, a diet low in calcium and vitamin D, lack of weight-bearing exercise and use of certain drugs, such as corticosteroids taken by mouth for extended periods.

Urinary Incontinence:

Incontinence is the inability to control the passage of urine (urinary incontinence) or feces (fecal incontinence). Both are symptoms of an underlying medical condition, not a disease in themselves. The term “incontinence” alone is most commonly used in reference to urinary incontinence.

Treatment for incontinence depends on the type of incontinence, the severity of the problem and the underlying cause. Often, a combination of treatments is used and most people treated for incontinence experience improvement.

Treatment options can be divided into four categories – behavioral techniques, medications, medical devices and surgery

Vaginal Discharge:

Vaginal discharge is any fluid or material that leaves a female’s body through the vagina. Some vaginal discharge is normal for all women, especially those in their reproductive years (ages 15 to 44). When the amount, quality or consistency of vaginal discharge changes, it may be a sign of disease or other irritation.

The fluids, chemicals and organisms of the vagina have a natural balance. When in balance, they help to clean the vagina and protect it from outside organisms. Any change to that natural balance can affect the characteristics of vaginal discharge. Changes may originate from both internal factors (e.g., hormonal changes, stress) or from external factors (e.g., infection, poor hygiene).

Normal vaginal discharge is clear or white with no bad odor. It has regular fluctuations that result from hormonal changes occurring throughout the menstrual cycle. The normally clear and thin fluid becomes a bit thicker and heavier at the time of ovulation. Sexual excitement increases vaginal discharge. It also changes during pregnancy, at menopause and when a woman uses birth control pills .

Ectopic Pregnancy

Ectopic pregnancy (also known as tubal pregnancy) is any pregnancy implanted outside the uterus. It usually occurs in the fallopian tubes, but may occur in the ovary, cervix, abdomen or the site where the fallopian tube and the uterus join.

Ectopic pregnancies result from an embryo’s inability to make its way through the fallopian tube to the uterus. Conditions that may block or slow this passage include fallopian tube abnormalities, such as those caused by sexually transmitted diseases (STDs), endometriosis and pelvic inflammatory disease (PID).

Common signs and symptoms of ectopic pregnancy include pain in the pelvis or lower abdomen, as well as common signs of early pregnancy, such as amenorrhea (absence of menstruation) and breast tenderness. Signs and symptoms of a ruptured ectopic pregnancy are often more severe. They can include sharp and sudden pain in the lower abdominal area, fainting with low blood pressure and shock.

Cystectomy

Ovarian cysts are very common, particularly in women between the ages of 30 and 60. They may be single or multiple, and can occur in one or both ovaries. Most are benign (non-cancerous), but approximately 15 percent are malignant (cancerous).

Myomectomy

Myomectomy is the removal of fibroids (noncancerous tumors) from the wall of the uterus. Myomectomy is the preferred treatment for symptomatic fibroids in women who want to keep their uterus. Larger fibroids must be removed with an abdominal incision, but small fibroids can be taken out using laparoscopy or hysteroscopy.

There is a risk that removal of the fibroids may lead to such severe bleeding that the uterus itself will have to be removed. Because of the risk of blood loss during a myomectomy, patients may want to consider banking their own blood before surgery.

Hysterectomy

The surgical removal of a woman’s uterus (womb) is called a hysterectomy . This procedure is the second most common operation for women in the United States after Caesarean sections, according to the American College of Obstetricians and Gynecologists (ACOG).

The female reproductive organs include the uterus, vagina, fallopian tubes and ovaries. A woman’s uterus is an organ located in the pelvic region and its opening is called the cervix.

Some of the most common reasons for a hysterectomy include:

Uterine fibroids
Endometriosis
Menorraghia (heavy menstrual bleeding)
Cervical and endometrial (uterine) cancers

Hysterectomies are typically performed by gynecologists (physicians who specialize in the female reproductive system). The four most common types of hysterectomy include:

Abdominal hysterectomy
Vaginal hysterectomy
Laparoscopic assisted vaginal hysterectomy
Laparoscopic supracervical hysterectomy
Total laparoscopic hysterectomy

Laparoscopy

Laparoscopy is a minimally invasive procedure used as a diagnostic tool and surgical procedure that is performed to examine the abdominal and pelvic organs, or the thorax, head, or neck. Tissue samples can also be collected for biopsy using laparoscopy and malignancies treated when it is combined with other therapies.

Laparoscopy can also be used for some cardiac and vascular procedures

Laparoscopy is performed to examine the abdominal and pelvic organs to diagnose certain conditions and—depending on the condition—can be used to perform surgery. Laparoscopy is commonly used in gynecology to examine the outside of the uterus, the fallopian tubes, and the ovaries—particularly in pelvic pain cases where the underlying cause cannot be determined using diagnostic imaging (ultrasound and computed tomography). Examples of gynecologic conditions diagnosed using laparoscopy include endometriosis, ectopic pregnancy, ovarian cysts, pelvic inflammatory disease [PID],

Treatment of PMS and PMDD

Premenstrual syndrome (PMS) is characterized by emotional and physical symptoms that can be troubling and cause moderate discomfort for women the week or two before the onset of their menstrual cycle. PMS is estimated to affect up to 40 percent of reproductive-aged women. Approximately 5 to 10 percent of these women experience symptoms so severe that it totally impairs their everyday lifestyle. This severe form of PMS is known as premenstrual dysphoric disorder (PMDD).

Premenstrual dysphoric disorder (PMDD) is a condition marked by severe depression, irritability, and tension before menstruation. These symptoms are more severe than those seen with premenstrual syndrome (PMS.

Perimenopause

Perimenopause, or menopause transition, is the stage of a woman's reproductive life that begins several years before menopause, when the ovaries gradually begin to produce less estrogen. It usually starts in a woman's 40s, but can start in the 30s as well.

Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, this decline in estrogen accelerates. At this stage, many women experience menopausal symptoms.

The average length of perimenopause is four years, but for some women this stage may last only a few months or continue for 10 years. Perimenopause ends the first year after menopause (when a woman has gone 12 months without having her period).

Menopausal Care

Menopause occurs for most women between the ages of 45 and 55 (average age in the United States 51), when the production of hormones (estrogen and progesterone) declines. These hormonal changes will usually cause irregular menstrual periods before they stop altogether. Once the menses have stopped for a year, it is called “menopause,” and the time of menstrual changes before and after the stop is referred to as the “perimenopause.” During this time, women commonly experience hot flashes, vaginal dryness, and mood changes. Other women may have an increased number of urinary tract infections, fatigue, and frustrations with short-term memory changes. Some women have only irregular periods.

Women respond to menopause individually, depending upon their own expectations, their physical and emotional feelings, and information from friends, family, health care providers, and the media. All perimenopausal women should talk with their health care provider about maintaining healthy bones, getting annual mammograms, dealing with menopausal changes, and assuring a birth control method if applicable (women over 40 are second only to teens under 14 in the number of unintended pregnancies).