Gynecology

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•    Vaccination against cervical cancer:
Most cervical cancers are caused by the sexually transmitted infection human papillomavirus (HPV). The HPV vaccination will reduce the impact of cervical cancer worldwide.
How does the cervical cancer vaccine work?
Various strains of HPV, transmitted through sexual contact, cause most cases of cervical cancer. The vaccines can prevent most cases of cervical cancer if given before girls or women expose to the virus.
The vaccine can prevent vaginal and vulvar cancer in women, and can prevent genital warts and anal cancer in women and men. Vaccinating boys against HPV might also help protect girls from the virus by possibly decreasing transmission.
Who needs the cervical cancer vaccine and when should it be used?
The cervical cancer vaccine is recommended for girls and boys ages 11 to 12, although it can be given as early as age 9 up to the age of 45. It's important for girls and boys to have the vaccine before they have sexual contact and exposed to HPV. Once infected with HPV, the vaccine might not be as effective. Response to the vaccine is better at younger ages than it is at older ages.
The vaccines are given as a series of three injections over a six-month period. The second dose is given one to two months after the first dose, and the third dose is given six months after the first dose.
Who doesn’t have to do the cervical cancer vaccine?
The cervical cancer vaccine isn't recommended for pregnant women or people who are moderately or severely ill. If you have any severe allergies, including an allergy to yeast or latex inform the doctor. Also, if you've had a life-threatening allergic reaction to any component of the vaccine or to a previous dose of the vaccine, you shouldn't get the vaccine.


Are there any benefits of the cervical cancer vaccine if you're already sexually active?
Yes, even if you already have HPV, you could still benefit from the vaccine. Because the vaccines will protect you from specific strains of HPV to which you haven't been exposed.
Does the cervical cancer vaccine have any health risks or side effects?
The effects are usually mild. The most common side effects of HPV vaccines include soreness at the injection site (the arm), headaches and low-grade fever. Sometimes dizziness or fainting occurs after the injection. Remaining seated for 15 minutes after the injection can reduce the risk of fainting. They might also cause nausea, vomiting, diarrhea or abdominal pain.
Is the cervical cancer vaccine required as a routine vaccine?
The cervical cancer vaccine is part of the routine childhood vaccines schedule.
Do women who received the cervical cancer vaccine still need to have Pap Smear tests?
Yes. The cervical cancer vaccine doesn’t replace Pap smear tests. Routine screening for cervical cancer through regular Pap smear tests remains an essential part of a woman's preventive health care.
•    Pap Smear Test
A Pap smear test is a screening test to collect and microscopically examine cells taken from the cervix and cervical canal. The Pap smear is a screening test for cervical cancer. Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus that opens in the vagina.
How is it done?
You lie on a table and spread your legs apart. The doctor gently places an instrument called a speculum into the vagina to open it slightly. This allows the doctor to see inside the vagina and cervix. Cells are gently scraped from the cervix area. The sample of cells is sent to a lab for examination.
Avoid making your Pap smear while you have your period (are menstruating). Blood may make the Pap smear results less accurate. If you are having unexpected bleeding, do not cancel your exam. Your doctor will determine if the Pap smear can still be done. Empty your bladder just before the test.
A Pap smear may cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam. You may bleed a little bit after the test.
The Pap smear is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap smears.
Screening should start at age 21.
Abnormal Pap smear
Initial Pap smear results reported as abnormal indicate cell changes of the cervix. After an abnormal Pap smear, your doctor may ask you to repeat Pap smear or a colposcopy to determine the significance of these cell changes. A colposcopy requires use of an instrument called a colposcope, which has a series of lenses that magnify the tissues of the cervix. It is from this instrument that the procedure gets its name.
Colposcopy
Colposcopy is a procedure that uses an instrument with a magnifying lens and a light, called a colposcope, to examine the cervix (the opening to the uterus), vagina and vulva for abnormalities and signs of disease. The doctor will recommend colposcopy if your Pap smear test has shown abnormal results. If the doctor finds an unusual area of cells during colposcopy, a sample of tissue can be collected for laboratory testing (biopsy).
Colposcopy feels similar to a Pap smear collection. Instead of taking a sample of cervical cells, the doctor will put the colposcope at the vaginal opening to more closely examine your cervical tissue in order to detect any abnormalities. In areas where cervical tissue may appear suspicious, the doctor will use another instrument to obtain a small tissue sample. You may feel a slight pinch or cramp and there might be some minor bleeding from the biopsy site, or temporary pelvic pain. The tissue will then be sent to the lab for analysis.
Depending upon the biopsy results, various treatments can be performed in your physician office. These treatments may include observation, cryosurgery or “freezing” of the cervix, laser removal or “burning,” and LEEP procedures.

•    LEEP or Loop Electrosurgical Excision
Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current to remove cells and tissue as part of the diagnosis and treatment for abnormal or cancerous conditions in a woman’s cervix and vagina.
•    Cervical Biopsy
Cervical biopsy is a procedure done to remove tissue from the cervix to test for abnormal or pre-cancerous lesions, or cervical cancer.
•    Intra Uterine Device or IUD
Is a Small, "T-shaped" device inserted into the uterus to prevent pregnancy
  It is safe, effective, and long lasting. It has to be inserted by a doctor.
IUDs are small, "T-shaped" devices made of flexible plastic. A doctor inserts an IUD into a woman's uterus to prevent pregnancy.
There are two types of birth control IUD available - Copper and Hormonal

 

 
They are effective from 5 years to 12 years.
Both the copper and hormonal IUDs work mainly by affecting the way which the sperm move so they can't join with the egg. If the sperm cannot join with the egg, pregnancy cannot happen.
Hormonal IUDs may prevent the egg from leaving the ovary. Pregnancy cannot happen if there is no egg to join with sperm.
Hormonal IUDs release a small amount of progestin continuously.
Progestin also prevents pregnancy by thickening a woman's cervical mucus. The mucus blocks sperm and keeps it from joining with an egg.
An IUD has 99% effectiveness to prevent pregnancy.


•    Dilation and Curettage (D & C) for medical reasons:
A dilation and curettage procedure, is a surgical procedure in which the cervix is dilated so that the cervical canal and uterine lining can be scraped with a spoon-shaped instrument to remove abnormal tissues.
It is performed to obtain samples of the endometrium, the lining of the uterus to evaluate abnormal uterine bleeding or abnormal cells that may be from the uterus that was found during routine screening for cervical cancer.  D&C is typically performed when an endometrial biopsy is not possible or if the sample of the tissue was inadequate.
•    Endometrial Ablation
Endometrial ablation is a procedure to permanently remove a thin tissue layer of the lining of the uterus to stop or reduce excessive or abnormal bleeding in women who will have no more children.
It is done by using either heat or cold energy to destroy the endometrial lining of the uterus. Bleeding tends to be significantly less than before the procedure.  An endometrial ablation should only be considered for women who no longer wish to become pregnant and permanent treatment is desired.
•    Endometrial Biopsy
The biopsy is performed to obtain a small tissue sample from the lining of the uterus.
This procedure obtains a sample of the endometrial tissue. It involves the insertion of a plastic small flexible tube, through the opening of the cervix, into the uterus. Using suction, it plucks off a sample of tissue from the uterine lining and it is removed for laboratory examination.
•    Hysteroscopy
Hysteroscopy is the visual examination of the canal of the cervix and interior of the uterus using a camera in a thin, lighted, flexible tube called a hysteroscope. It is done vaginally. The doctor takes a look inside the uterus using a camera in the scope.  The physician can see the lining of the uterus (endometrium) and the openings of the fallopian tubes.  It allows direct view of the uterine lining and the ability to take samples of tissue.  This procedure is minimally invasive. Operative Hysteroscopy – While the physician is seeing the uterus and endometrial lining, he may remove polyps, fibroids or perform a D&C or remove a septum to increase the size of a cavity or remove adhesions to improve the success of pregnancy. The doctor can fix any abnormalities of the cavity while seeing and during the procedure.
•    Laparoscopy
Laparoscopy is a procedure that uses a camera in a laparoscope, a thin flexible tube containing a video camera to examine the organs of the abdominal cavity. The camera is inserted through small incisions done under the umbilicus and on left and right flanks and maybe above pubis. A thin telescope like instrument that allows the physician to visualize and operate on the uterus, fallopian tubes, ovaries and surrounding tissue. It can be diagnostic or operative. It can help us verify if the tubes are open or not. If there are any adhesions, they can be removed during the procedure….
•    Vaginoplasty and Labiaplasty and Hymenoplasty
Vaginoplasty: Is a procedure that is done to "tighten up" a vagina that's become slack or lose because of vaginal childbirth or aging. It can even improve sensitivity of the vagina because of increased friction when the vagina becomes tighter. While it's true that vaginal tissues can stretch, surgically tightening the vaginal tissue in itself cannot guarantee a heightened sexual response for the woman, since desire, arousal, and orgasm are complex and highly personal responses.
Labiaplasty: Is a plastic surgery on the “lips" surrounding the vagina, can be performed alone or with vaginoplasty. Surgery can be performed on the labia major (the larger, outer vaginal lips), or the labia minor (the smaller, inner vaginal lips). Labiaplasty changes the size or shape of the vaginal lips, making them smaller or correcting an asymmetry between them.
Vaginal Hymeno-plasty: Hymen repair, Hymenorraphy, or Hymen reconstruction are all the same.
It is the surgical repair of the hymen. Using a surgical technique, the torn edges of the hymen are put back together. There is no apparent scarring and the hymen appears intact. After this hymen surgery which is without any complication, intercourse will typically tear the membrane causing pain and bleeding.
The hymenoplasty is usually a 30-45 minute procedure and can be done as a 1 day surgery using general or local anesthesia in any equipped clinic. The doctor uses dissolvable stitches to reconnect the skin membrane that once partially covered the opening of the vagina. After the hymenoplasty operation, the patient can return to work in a day or two and complete healing takes approximately 6-8 weeks.

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