Gynecology

- 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 that are scraped from around the opening of the cervix and from the cervical canal are examined under a microscope. The cervix is the lower part of the uterus that opens in the vagina.

 

How is the Pap smear 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 the cervix in the vagina. Cells are gently scraped from the cervix area and from the cervical canal. The sample of cells is sent to a lab for examination and analysis.

 

Avoid scheduling your Pap smear while you have your period. 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 or not. 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 until age of 65. Most women who are from ages 21 - 65 need regular Pap smear screening.

 

Interpretation of Pap smear results:

Cervical cancer usually develops slowly. It starts as precancerous abnormal cell changes of the cervix called dysplasia. Those cell changes can be detected by a Pap smear and is nearly 100% treatable. It can take years for dysplasia to develop into cervical cancer. Most women who are diagnosed with cervical cancer didn’t have regular Pap smears, or they did not follow up on abnormal Pap smear results. 90% of all cervical cancers are caused by human papillomavirus (HPV).

A normal result means there are no abnormal cells present. The Pap smear test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly, and follow-up Pap smears should find any changes in time for treatment.

 

Abnormal results are grouped as follows:

 

ASCUS or AGUS

• This result means there are atypical cells, but it is uncertain or unclear what these changes mean

• The changes may be due to HPV

• They may also mean there are changes that may lead to cancer 

 

 

LSIL (low-grade dysplasia) or HSIL (high-grade dysplasia): 

• This means changes that may lead to cancer are present

• The risk of cervical cancer is greater with HSIL 

 

 

Carcinoma in situ (CIS): 

• This result most often means the abnormal changes are likely to lead to cervical cancer if not treated 

 

Atypical squamous cells (ASC): 

• Abnormal changes have been found and may be HSIL 

 

 

Atypical glandular cells (AGC): 

• Cell changes that may lead to cancer are seen in the upper part of the cervical canal or inside the uterus 

 

When a Pap smear shows abnormal changes, further testing or follow-up is needed. The next step depends on the results of the Pap smear, your previous history of Pap smears, and risk factors you may have for cervical cancer.

 

For minor cell changes, doctors will recommend another Pap smear in 6 to 12 months.

 

 

Follow-up testing may include:

 

• Colposcopy- directed biopsy

• An HPV test to check for the presence of the HPV virus types most likely to cause cancer.

 

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.

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- Colposcopy

Colposcopy is a procedure that uses an instrument with a magnifying lens and a light, called a colposcope, to closely 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.

 

Your doctor may recommend a colposcopy if:

• your Pap smear test has shown abnormal results 

• you experience bleeding after intercourse

• you have an abnormal growth visible on your cervix, vulva, or vagina

 

A colposcopy can be used to diagnose:

• abnormal cervical cells, or pre-cancer or cancer of the cervix, vagina, or vulva

• genital warts

• inflammation of the cervix (cervicitis)

 

 

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.

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- 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. They are effective from 5 years to 10 years. An IUD has 99% effectiveness to prevent pregnancy.

There are two types of birth control IUD available - Copper and Hormonal.

 

Both the copper and hormonal IUDs work mainly by affecting the way the sperm moves so they can't join with the egg. If the sperm cannot join the egg, pregnancy cannot happen.

Copper IUD:

The copper IUD works by releasing copper ions into your cervix. No hormones here. Copper makes your uterus a hostile environment for sperm for up to 10 years. They work by damaging sperm and disrupting their motility so they are unable to join the egg. Specifically, copper acts as a spermicide within the uterus by increasing levels of copper ions, prostaglandins, and white blood cells within the uterine and tubal fluids. The increased copper ions in the cervical mucus inhibit the sperm's motility and viability, preventing sperm from traveling through the cervical mucus, or destroying it as it passes through. 

 

Hormonal IUD:

Hormonal IUDs release a small amount of progestin continuously. The progestin released by hormonal IUDs primarily acts locally. They may prevent the egg from leaving the ovary. Pregnancy cannot happen if there is no egg to join with sperm. The primary mechanism of action is making the inside of the uterus hostile for sperm.  

Hormonal IUDs release the progestin levonorgestrel and prevent pregnancy by:

• Thickening your cervical mucus so the sperm can’t reach the egg. The mucus blocks sperm and keeps it from joining with an egg.

• Making your uterus a hostile environment for sperm and eggs, impairing any chance of implantation by inhibiting the sperm’s ability to swim toward the egg.

Making the endometrial lining of the uterus thinner, impairing implantation and also giving you lighter periods (or sometimes no period at all). As a result, they are used to treat menorrhagia (heavy menses), once pathologic causes of menorrhagia (such as uterine polyps) have been ruled out.

 

 

- 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 along with the superficial part of the endometrium.

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.

 

• Miscarriage or missed abortion

D&C is done in case there is no heart beat and the products of conception (placenta and embryonic tissues or gestational sac) are still in your uterus. The remaining tissue is aspirated from the vagina through the cervix to prevent infection and adhesions.

 

• 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.

 

 

 

- Laparoscopy - A one day surgical procedure in which the doctor uses a narrow fiber-optic camera inserted through an incision near your navel to look for problems and fix them. He might make 1 - 3 more small incisions to insert other needed instruments that will be needed depending on the operation. The doctor can see the entire abdominal cavity on a screen. Laparoscopy is mostly used for (adhesions, endometriosis, cysts, blocked or damaged tubes, and ectopic pregnancy...). The patient can leave the hospital 4 - 12 hours later. Most of the patients can continue their work the next day after the Laparoscopy.

 

- Hysteroscopy - A procedure in which your doctor uses a narrow fiber-optic camera inserted into the uterine cavity through the vagina and the cervix to examine the cavity and fix problems including the shape, septum, size, polyps, and fibroids or make a biopsy... The patient can leave the hospital or the clinic 2 - 4 hours after the hysteroscopy. All the women can continue their work the next day after the Hysteroscopy.

 

 

- Vaginoplasty and Labiaplasty and Hymenoplasty

 

Vaginoplasty: 

Vaginoplasty is a procedure that is done to "tighten up" a vagina that's become widened or lose because of vaginal childbirth or aging. Vaginoplasty improves the outer look of the vagina and removes the wrinkles and can even improve the sensitivity of the vagina because of increased friction when the vagina becomes tighter.

Normal vaginal delivery can result in widening of the vagina by stretching the tissues and separating the adjacent muscles. Postpartum vaginal laxity can create a gaping perineum and reduce friction sensation, diminishing sexual satisfaction. 

While the vaginal tissues can stretch, surgically tightening the vaginal tissue improves sexual response for the woman, as well as arousal, and orgasm.

During a vaginal examination, while the patient bears down and tightens, the surgeon can assess the vaginal width and the rectal muscles.

 

Labiaplasty:

Labiaplasty is a plastic surgery on the “lips" surrounding the vagina, and 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.

 

 

Hymen reconstruction or Hymenorrhaphy:

Hymenoplasty or Hymen reconstruction is the surgical restoration of the hymen. Thus it restores virginity. It is a procedure to restore the ability of the hymen to bleed at intercourse on the wedding night, thus protecting the women socially and psychologically. 

 

 

Vaginal Hymeno plasty: Hymen repair, Hymenorrhaphy, or Hymen reconstruction.

It is the surgical repair of the hymen to restore virginity. Using a surgical technique, the edges of the hymen are put back together leaving a small opening to allow the blood of the menstrual cycle to get out.  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 as usual.

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 invisible 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 on the 2nd day and complete healing takes approximately 6-8 weeks.

The purpose of this Hymenoplasty is to eliminate your anxiety and bring self-confidence as well as happiness to your life

 

- Hymenoplasty, Hymen reconstruction, and Hymen Repair Surgery (restore virginity)

The purpose of this Hymenoplasty is to eliminate your anxiety and bring self-confidence as well as happiness to your life.

Hymenoplasty is the surgical reconstruction of the hymen in a woman to bring her back to the virgin state after her hymen has been ruptured. The hymen is a ring like skin membrane in a girl’s vagina and when it ruptures this means the end of her virginity status. In lots of communities, virginity is considered the honor of a girl, and her family and her hymen has to remain intact before marriage. Hymen reconstruction is usually done for moral, cultural or social reasons. Hymenoplasty is to restore the hymen as it was before the rupture. 

Hymen reconstruction can be done months or years after a woman loses her virginity.

 A specialized Gynecologist performs hymenoplasty or hymen repair.

In general it can be done in less than an hour, depending on the degree of difficulty. 

Usually it is a 1 day surgery performed under local anesthesia or general anesthesia. You can leave the clinic 2 – 3 hours after the surgery and continue your life as usual.

 

There are mainly two kinds of techniques of hymenoplasty operations.

The 1st operation is the simple hymen repair if we don’t have much time before marriage.

1. Hymen Repair or Hymenorrhaphy:  For short term results, done 7-10 days before marriage. Simple hymen repair surgery and is based on suture approximation of the hymen edges or remnants (Hymenorrhaphy) without vaginal tightening and which allows the penetration causing some bleeding. Stitches dissolve after 4 - 5 weeks and hymen remnants again become separate like before the surgery. The most important point in hymen repair surgery is the use of invisible sutures that will not be detected by the partner. 

The 2nd operation is hymen reconstruction and if given sufficient time it heals to give you natural hymen, which will serves its purpose.

 

2. Hymenoplasty for Natural Looking Hymen: Hymenoplasty or hymen reconstruction also includes vaginal tightening and should be done at least 3-4 weeks before marriage, or before. After proper healing hymen and vagina looks, feels and behaves like natural hymen (means breaks & bleeds with penetration with no evidence of hymenoplasty surgery). The Hymen heals well with proper Hymenoplasty surgery and if given proper time and care. Surgical time (30-40 minutes), recovery time (few hours, may be little pain or discomfort) and relative bed rest (2 hours). The advanced Hymenoplasty technique has to be done at least 3-4 weeks; best if 6 weeks, before marriage. After the hymenoplasty operation, the patient can return back to work on the 2nd day and complete healing takes approximately 6-8 weeks.

After such a Hymen reconstruction you may maintain the resultant Hymen for the whole life if you want. 

 

Both Hymenorrhaphy & Hymenoplasty are done under anesthesia, operative time is 30-40 minutes, discharge from the clinic after 2 hours. You may walk normally, climb stairs gently, only straining and vigorous activity should be avoided for about 3 – 4 weeks. Good hygiene is important to decrease the risks of infection. Swelling of the vulva and discomfort will disappear in the few days following the surgery. Pain killers will help you with pain control following the surgery for 2 – 3 days.