Disorders of cycle length:
Disorders of flow (abnormal uterine bleeding):
Other menstrual disorders:
Amenorrhea:
Menorrhagia:
Dysmenorrhea:
Premenstrual syndrome (PMS):
Amenorrhea and oligomenorrhea:
Menorrhagia:
Dysmenorrhea:
Abnormal uterine bleeding:
Dysmenorrhea:
PMS and PMDD:
Endometriosis is a painful disorder where tissue that usually lines the womb (endometrium) is found outside of the uterus and in other parts of the body. The tissue appears in the abdomen on the ovaries, fallopian tubes, and ligaments that support the womb. Other areas for these growths may include the bladder, bowel, vagina, cervix and vulva. In more complex cases, they are found in the lung, arm, thigh or other locations.
The cause of endometriosis remains unknown. Some experts suggest that endometriosis occurs due to a process called retrograde menstruation. The menstrual blood flows back through the fallopian tubes into the pelvic cavity instead of leaving the body through the vagina. Another theory for the cause of endometriosis is that hormones transform cells outside of the womb into cells similar to those lining the inside of the uterus (endometrial cells).
The symptoms of endometriosis can vary with some women are more affected than others. These can include:
A laparoscopy can help to diagnose endometriosis, which usually shows the location, size and extent of the growths. There is no cure for endometriosis but there are treatments that ease the symptoms. These treatments include:
Surgery for endometriosis can alleviate pain. There are two options of surgery:
The other option is radical surgery, which is considered if a woman has not responded to conservative surgery. This means either having a hysterectomy, which is the removal of the womb, or an oophorectomy, which is the removal of the ovaries.
Having either a hysterectomy or oophorectomy is a big decision as these procedures are irreversible and a woman might want to consider having a family.
Minimal access surgery (MAS) is a surgical approach that can be used within many areas of gynaecology, including reproductive medicine, urogynaecology, gynaecological oncology and benign gynaecological surgeries. MAS does not involve open surgical techniques, which with them require longer recoveries and chances of complication. MAS techniques used keyhole surgical methods such as laparoscopy and hysteroscopies. Often MAS can be carried out as a same-day or outpatient clinic procedure.
The following conditions might require MAS:
Diagnostic hysteroscopy –
Operative hysteroscopy –
Complex operative laparoscopy can be used to treat –
Hysteroscopy:
Laparoscopy:
Hysteroscopies are a day-case procedure and no stay at the hospital will be required. Before the hysteroscopy you will be tested to check for suitability (you cannot have a hysteroscopy if you are pregnant), you will be advised to stop smoking if you are going to have general anaesthetic. If you are having fibroids removed, then you might be prescribed medicine to reduce their size first.
As laparoscopies are carried out under general anaesthetic, you won’t be able to drink or eat up to 12 hours prior to surgery. You may need to stop taking certain medications and to stop smoking.
After a hysteroscopy, you can normally return home the same day, or at least until the anaesthesia has worn off. It is normal to feel cramps that are similar to menstrual cramps for a few days, and you might also experience some light bleeding. Most women feel they can return to work after a day or two.
Recovery from a laparoscopy varies and depends on why the laparoscopy was carried out. If the procedure was diagnostic, you can usually return to normal activities within a few days. If you had treatment during the laparoscopy, then recovery is likely to take up to 12 weeks.
Fibroids are benign growths found in and around the uterus, made up of muscle and fibrous tissue. Symptoms are uncommon, but one out of three women may experience pain in certain parts of the body or heavy periods.
A cyst is a closed sac which occurs in the body’s tissue – in the case of ovarian cysts, they are fluid-filled sacs which grow on the ovaries in women. They are common and usually are symptomless, but they can occasionally cause problems. Most cysts clear on their own and you are unlikely to need treatment for them.
The cause of cysts can differ, depending on the type. Functional ovarian cysts occur because of the menstrual cycle, and are common if you haven’t yet been through the menopause. In a woman’s body, eggs are formed inside the ovaries in something called a follicle. When the follicle doesn’t release the egg as it normally does each month, or if the fluid inside it is not released, it can swell – which causes the cysts. This type of cyst is benign, meaning it is non-cancerous.
Pathological cysts, on the other hand, can develop both before and after menopause as they are caused by abnormal cell growth. Sometimes these cysts can be cancerous.
Certain conditions can also cause cysts to form, including endometriosis and PCOS (polycystic ovary syndrome).
Ovarian cysts may not cause symptoms at all, but if they do, you may experience symptoms such as pelvic pain, bloating, and a feeling of heaviness within the abdominal area.
Most cysts go away on their own and your doctor will adopt a ‘watchful waiting’ policy, which means the cysts are monitored and checked at a later time to see if they have indeed gone. If scans show the cyst has gone, treatment is not necessary.
However, if cysts are causing symptoms, or if they are particularly large, then treatment may be necessary. Cysts can be removed through surgery, which is often performed as a minimally-invasive procedure. If the cyst needing removal is cancerous, then additional tissue may need to be removed, and in some cases, both ovaries and the womb.
If the cysts are caused by an underlying condition, then the condition itself will also be treated or managed.
Infertility is the inability of a couple to become pregnant through natural means. Infertility affects the couple, both the man and the woman, who cannot have a child naturally. There are two types of infertility: primary infertility, affecting couples who have not become pregnant after at least one year of unprotected sexual intercourse, and secondary infertility, affecting couples who were able to become pregnant in the past but are now unable to.
There are various symptoms of infertility in men and women.
In women, symptoms may be related to the menstrual cycle and ovulation: abnormal menstruation, with more or less bleeding than usual; irregular menstruation, when the number of days between each menstruation is different each month; amenorrhoea, i.e., no menstruation; or dysmenorrhea, very painful menstruation. There may also be symptoms unrelated to menstruation, such as pain during sexual intercourse.
In men, the symptoms of sperm-related infertility include small amounts of ejaculate. There are also symptoms unrelated to semen, such as changes in hair growth, changes in sexual desire and erection problems. Men may also have a low sperm-count, making the chance of conceiving naturally more difficult.
Common causes of infertility among men and women are:
In women, infertility may be caused by:
In men, the causes of infertility may include:
Generally, if the origin of the infertility is genetic or caused by disease, then nothing can be done. However, you can avoid certain factors that may cause infertility:
Methods to treat infertility in men and women include taking hormones to resolve the hormonal imbalance, supplements to improve fertility, and antibiotics in the case of infection.
For women, having minor surgery to remove blockages or scar tissue from the fallopian tubes, uterus, or pelvic area is another option.
If these methods are unsuccessful, assisted reproduction techniques can be tried.
Mr Parijat Bhattacharjee is an experienced gynaecologist and fertility consultant based in London, whose areas of expertise include infertility, polycystic ovarian syndrome (PCOS), ovarian cysts, menstrual problems, endometriosis and the treatment of fibroids. He provides a one-stop service in fertility management. He believes all women are different and therefore need individualised care and management plans. He does not believe in time-bound consultations and attempts at giving the best medical care where the woman feels comfortable.
Mr Bhattacharjee holds a special interest in gynaecology ultrasound, early pregnancy problems including recurrent and late miscarriages, poor obstetric history and ectopic pregnancies. He holds one-stop gynaecology clinics, particularly for pelvic pain and irregular or heavy vaginal bleeding. He does an ultrasound scan during the initial consultation and provides a comprehensive treatment and follow up plan, which may include surgery if necessary. He has extensive training in advanced gynaecological surgery including laparoscopic & hysteroscopic surgery and is a trainer of the British Society of Gynaecological Endoscopists.
He has had extensive experience in all aspects of gynaecology from his specialist training in the UK, including at Royal London & St Bartholomew’s, Royal Free, University College London, St. George's and University of Leicester hospitals.
Outside of his clinical work, Mr Bhattacharjee is actively involved in voluntary work in countries that are poor and lack resources, to help reduce maternal and infant mortality and organises and provides training in gynaecology ultrasound and gynaecological surgery.
Ultrasound is a diagnostic imaging test that allows the healthcare specialist to observe the body's structures and tissues. During pregnancy, 3D ultrasound allows you to see three-dimensional images of your baby in the womb (as opposed to the traditional 2D images), while with 4D technology the image is constantly updated in real time – you can see it moving in the form of a video.
4D ultrasound, like other ultrasound scans, uses high-frequency sound waves to generate images of organs and tissues inside the body. These sound waves are emitted by a probe or transducer, which is passed over the region to be scanned by the doctor.
Traditional ultrasound scans produce a flat 2D image, but modern technology can combine data from scans taken by the probe from different angles to create a 3D image. When this 3D image is refreshed in real time it results in a live video known as a 4D ultrasound (three spatial dimensions + time).
During pregnancy, this test is performed to observe the status and development of the foetus without exposing it to radiation. The doctor administers a small amount of cold gel in the belly of the pregnant woman, and uses a probe to capture the images of the uterus and project them on a screen.
Ultrasound scans are very important for many parents, since it not only serves to monitor the development of the baby, but also shows the first images of the foetus, which can be retained as a memory or souvenir. The advantages of 4D ultrasound are that in showing the developing baby in three dimensions and in motion, it is not only much clearer to see the baby, but also makes it easier for doctors to diagnose any developmental problems, such as a cleft lip, which may be harder to spot on a standard 2D ultrasound.
The best time for a 4D ultrasound scan is usually between weeks 24-30 of pregnancy as this is the perfect time to see the baby fairly well-developed, but before it has grown so large that it cannot be seen well on the scan.
Ultrasound is a totally painless and non-invasive test. This is a special moment for the parents, in which they see the first images of their child moving within the womb of the mother and establish a stronger bond.
Adenomyosis is condition in which the uterine lining (the endometrium) protrudes through the muscle wall of the uterus (the myometrium). As a result, women suffering from adenomyosis can experience problems with their menstruation and discomfort. This is not a life-threatening condition, it is considered benign, however, the symptoms can have a significantly negative affect on the quality of life of those suffering from it.
Although sometimes there are no symptoms experienced with adenomyosis, common ones include:
Symptoms are normally first noticed after women have had children, or if not, in the later childbearing years.
The cause of adenomyosis is unknown, however, it typically goes away after menopause, which suggests that the cause is hormone-related.
As adenomyosis usually goes away after menopause, treatment options depend on how old you are or if you have finished having children.
For women nearing menopause, anti-inflammatory medications such as ibuprofen can be given to help manage pain. If these are taken in the days leading up to menstruation, bleeding should be lighter. Milder symptoms can be dealt with using over-the-counter pain relief and heat packs to help with cramps. Certain hormone contraceptives can sometimes help too with symptoms of heavy bleeding and cramps.
Endometrial ablation, which destroys uterine lining can help manage symptoms as well. Uterine artery embolisation, which blocks certain blood vessels leading to the uterine lining can help relieve pain too. This is because the blood supply gets cut off to the affected area, which shrinks as a result.
Finally, if the pain experienced is severe, and menopause is a long way off, sometimes a hysterectomy will be recommended. However, this is a serious decision that only an expert would recommend on careful consideration.
Amenorrhoea is the absence of a menstrual period in a woman of reproductive age. It may be physiological in the following moments of a woman’s life:puberty, menopause, pregnancy and breastfeeding. Other than that, amenorrhoea can be caused by various gynaecological conditions.
Amenorrhoea can be divided into two categories:
The prognosis for secondary amenorrhoea largely depends on what causes it. If the underlying cause can be treated, the outlook is generally positive. On the other hand, if the underlying cause cannot be treated or it is a particularly severe condition (womb cancer), the outlook is more negative.
Based on the cause of amenorrhoea, some of the symptoms may be:headache, vision disorders, hirsutism (excessive facial hair growth), acne, pelvic pain, vaginal dryness, hair loss, hot flushes, night sweats, sleep disorders, and excessive weight loss or gain.
To formulate an accurate diagnosis of what is causing amenorrhoea, you may have to do one or more of the following: going through your symptoms, pelvic examination, breasts and genital organs exam, pregnancy test (to confirm or exclude a potential pregnancy), FSH, LH, TSH and prolactin hormone levels, pelvic ultrasound (to see if there’s any anatomical anomalies), CT scan and/or head MRI scan (to determine whether or not there is a tumour of the hypothalamus or of the pituitary gland), hysteroscopy or hysterosalpingography (in case the pelvic examination and pelvic ultrasound are not enough).
There are many potential causes for amenorrhoea, which can be associated with:
Amenorrhoea can only be prevented if what causes it can be kept under control or prevented, such as anorexia nervosa, overtraining, malnutrition, stress or obesity.
Possible treatments include:
To accurately diagnose and treat amenorrhoea, you will have to see a specialised gynaecologist.
Anatomy is the structure of the human body. It looks at the organs and tissues which make up the body, how they are positioned, their size, and how they relate to one another.
Anatomy can be distinguished from physiology, which is the study of the functions of different parts of the body. However, medical students often study both interchangeably.
Anatomy can be divided into two types, corresponding to the methods involved:
Anatomy is one of the “basic sciences” studied by medical students and the most important in clinical application. Knowledge of the organs, tissues and cells which make up the body is essential for:
Antenatal care or prenatal care is the care a woman receives while pregnant to ensure that both mother and baby are as healthy as possible. It involves regular check-ups with a doctor or midwife, with scans, screenings, and blood tests to check on the development of the baby and identify any health problems in either mother or child that could cause problems. Pregnancies that are considered high risk may require additional tests or more frequent check-ups.
Mothers-to-be are also offered antenatal classes to prepare them for looking after their baby, such as workshops on breastfeeding.
Antenatal care is carried out because it is important for the wellbeing of the mother and the baby. During pregnancy, a number of complications can occur for the baby and the mother that can be prevented and avoided by monitoring the development of the foetus.
Regular visits with a doctor or midwife is also useful for providing the expecting mother with useful information about pregnancy, labour, and having a baby, along with advice on how to stay healthy while pregnant. Antenatal care may also involve discussing options for when the baby comes, including making a birth plan.
Antenatal care consists of a series of check-ups, which involve a number of tests. Tests that all pregnant women are offered in England include:
Other aspects of the mother’s health, such as blood pressure and weight will be checked regularly, and gynaecological examinations are also performed.
Asherman’s syndrome or Asherman syndrome is a rare, acquired condition that refers to the presence of scar tissue in the uterus or cervix. This scar tissue causes the uterine walls to be thicker, reducing the size of the uterus, and in severe cases, the walls can sometimes fuse together. Asherman’s syndrome is also known as intrauterine adhesions (IUA).
Asherman’s syndrome is not life-threatening, however, some women with this condition cannot conceive or will experience recurrent miscarriages. The risk of miscarriage and stillbirth are both higher in women with Asherman’s syndrome. Women with this condition are also more at risk of suffering from bleeding during pregnancy. However, if it is treated fertility can be restored.
The following are the common symptoms of Asherman’s syndrome:
A thorough medical history will be taken and a physical examination performed, however, it is very uncommon that adhesions are found in a physical examination. A first test will usually involve a blood test to rule out other possible conditions. You will also have an ultrasound to assess the uterine lining. The most reliable method of diagnosing Asherman’s syndrome is hysteroscopy. This involves inserted a hysteroscope through the cervix to see the uterus. You may also have a hysterosalpingogram (HSG) which uses contrast dye to show blockages on an X-ray.
Most cases of Asherman’s syndrome result after a dilation and curettage (D and C) procedure which is usually carried out after an incomplete miscarriage, as a means of pregnancy termination or if the placenta is retained after delivery. The risk of developing this condition increases with the number of D and C procedures had. Other causes of Asherman’s syndrome include severe pelvic infections and other forms of pelvic surgery (e.g. caesarean section and fibroid or polyp removal).
The main way to prevent Asherman’s syndrome is to avoid having a D and C procedure. Instead, medical evacuation can be had instead following an incomplete miscarriage, retained placenta or a post-delivery haemorrhage. If a D and C is needed, then an ultrasound should be used to guide the surgeon and to reduce the risk of damage to the uterus.
Asherman’s syndrome can be treated surgically, cutting and removing the adhesions or scar tissue. This can be done with a hysteroscopy to avoid invasive, open surgery. This requires general anaesthesia and after surgery, oestrogen may be given to improve the quality of the uterine lining. Adhesions can recur following surgery, so it may be necessary to wait for up to 12 months before trying to conceive.
Obstetricians and gynaecologists treat Asherman’s syndrome.
This treatment is undertaken when a couple is not successful in getting pregnant. It can be intrauterine insemination (IUI) or in vitro fertilisation (IVF).
Assisted reproduction is a technique in which, through medical assistance, the egg is fertilized by the sperm. This technique is used when there is a medical problem that prevents the couple from getting pregnant.
Assisted reproductive technology aims to help women who want to become pregnant but may have had some difficulties in doing so. Some of these techniques include artificial insemination or in vitro fertilization (IVF).
Bacterial vaginosis, or BV, is a type of bacterial infection in the vagina. It occurs when the balance of bacteria in the vagina is upset, and one type of bacteria grows more than the others.
Bacterial vaginosis is generally a harmless condition but can cause uncomfortable symptoms.
In rare cases, it may lead to pelvic inflammatory disease. Bacterial vaginosis may also slightly increase your risk premature delivery or of sexually transmitted infections.
Symptoms can include:
If you get the symptoms mentioned above, you can visit your GP or nearest sexual health clinic. They will ask you about your symptoms and may use a swab to take a sample of your discharge and test it for BV or other infections.
Bacterial vaginosis occurs when the natural balance of bacteria in your vaginal is disrupted. This can occur if you:
Bacterial vaginosis is more common if you have multiple sex partners or a new sex partners – but doctors don’t yet understand why this is the case.
Bacterial vaginosis is treated with a prescription of antibiotics for about a week. You’ll receive a prescription if you visit your GP or sexual health clinic; alternatively you can visit the pharmacist for a prescription.
It is common for bacterial vaginosis to come back. If this is the case, you’ll need to take antibiotics for a longer period of time.
You can help prevent bacterial vaginosis by making sure that you:
A bicornuate uterus is a congenital abnormality in which the uterus is heart-shaped, with a deep indentation at the top. This can affect a woman’s reproductive system, but not their fertility. A bicornate uterus does increase the risk of miscarriage later in pregnancy, and if you are pregnant but have a bicornate uterus, the pregnancy will be treated as high risk.
Women are born with a bicornate uterus, which means they may not know until later in life when an ultrasound or visual imaging test shows the abnormality, as it may not cause any symptoms whatsoever.
Sometimes, however, symptoms can present, such as:
It is important to have any irregular symptoms investigated, and attend regular check-ups with your doctor or gynaecologist.
Imaging tests can be used to diagnose a bicornuate uterus, such as an ultrasound, MRI, or hysterosalpingogram. The condition is often detected during a pregnancy ultrasound or other imaging tests which can be performed to check on unusual symptoms.
A bicornuate uterus is a congenital abnormality, which means it cannot be prevented.
Surgery can be used to correct a bicornuate uterus, although the majority of women do not need surgery to correct it. Surgery can be performed in those who have a history of miscarriage. The surgery performed to correct bicornuate uterus is called a Strassman metroplasty, which is generally performed laparoscopically. It removes removing any abnormal tissue separating the cornua (the uterine horns) of the uterus, and using stitches to correct the shape.
Bladder problems can include urinary incontinence, infection, or more serious conditions like cancer.
Breakthrough bleeding is vaginal bleeding that occurs between a woman's monthly menstrual periods.
The causes of breakthrough bleeding can include:
In rare cases, stress can causes breakthrough bleeding.
Because there can be many causes, the best way to determine the cause is to undergo a gynecological examination.
Depending on the cause, breakthrough bleeding sometimes cannot be prevented. However, in some cases it can be prevented by taking the following measures:
The treatment will depend on its cause, but usually, the following therapies are used:
A caesarean, or C-section, is a surgical procedure performed in order to delivery a baby. This type of delivery is used when it is thought that a vaginal delivery would lead to medical complications, putting the mother or baby at risk. The operation is relatively safe for the mother and child but the recovery period is longer than through natural birth.
Cervical cancer is the cancer originating in the cervix. The vast majority of cervical cancers are caused by the human papilloma virus (HPV). Additionally, there are other factors that can cause this cancer:
- Not being vaccinated against HPV.
- Engaging in sexual intercourse at an early age.
- Having multiple sexual partners.
- Having multiple children.
A cervical cerclage is a small operation to reinforce the cervix with stitches and keep it closed during pregnancy.
The cervix normally remains closed during pregnancy until the baby comes to term and the mother’s waters break. However, the pressure caused by a growing baby can sometimes cause the cervix to shorten and widen. If the cervix is weak, it might open too early, causing a miscarriage or a preterm birth.
A cervical cerclage is carried out if doctors think there might be a risk of this occurring. You may be considered at risk if you have a history of second-trimester pregnancy loss, or if the obstetrician has detected a shortening of your cervix during a routine pregnancy scan.
Cervical cerclage is not generally recommended if you’re carrying more than one baby, of if you have vaginal bleeding or an intrauterine infection.
Before the operation you’ll have an ultrasound and a swab taken to check for infection.
Cervical cerclage is an outpatient procedure so you can usually go home on the same day. Most of the time the procedure is carried out via the vagina, but in some cases you may need a transabdominal cervical cerclage, which involves making an incision in the abdomen.
After the operation you’ll have another ultrasound to check that everything has gone well, and you’ll be advised on any activity to avoid for the next few weeks.
If you had a transvaginal cervical cerclage, this will be removed at around 36-37 weeks into pregnancy. If you had a transabdominal cervical cerclage, this is not generally removed before labour, and you’ll give birth via a caesarean.
Because of the risks of bleeding, infection, or cervical damage, a cervical cerclage is not always recommended. The main treatment alternative is to take high dosages of progesterone to prevent an early labour.
Finally, some UK hospitals are trialling alternative method of reinforcing the cervix, called the Arabin pessary .
Cervicitis is an inflammation of the cervix caused by either an infection or irritant. The cervix is the opening to the uterus, located at the top of the vagina. Cervicitis often results from STIs, but can also result from non-infectious causes. To treat cervicitis, it is important to determine the specific cause first.
Women with cervicitis may not notice any symptoms. However, some women may notice the following symptoms:
If you are experiencing any of the above in combination, you should see a doctor.
There are several causes of cervicitis, but infection is the most common. Cervicitis can result from:
To avoid cervicitis certain measures can be taken, such as avoiding chemical irritants, such as douching and scented feminine hygiene products. It is also important to practice safe sex using condoms to lower your risk of contracting an STI.
Cervicitis is usually treated with antibiotics if it is caused by bacterial infections, such as chlamydia and gonorrhoea. Herpes infections can be treated with antivirals. If your cervicitis is caused by an allergic reaction then eliminating the irritant should cause your cervicitis to go away on its own. If you have cervicitis that has resulted from infection, it is often recommended that your partner is also treated. Additionally, if this type of cervicitis is not treated in time, an STI could affect the fallopian tubes and the uterus, but it is important to perform a pelvic examination at the onset of symptoms.
Chlamydia is one of the most common sexually transmitted diseases (STDs) caused by bacteria. It is passed from one person to another through unprotected sex and is particularly common in sexually active teenagers and young adults. Most people with chlamydia do not notice any symptoms and do not realise that they have it.
Chlamydia is caused by sex without the use of a condom and unprotected oral sex. Penetration is not the only way to catch chlamydia as the touching of the genitals together may transmit the bacteria. Chlamydia can also be passed on during anal sex. It can also spread if infected semen or vaginal fluid gets into the eye, although this is less common. Infected pregnant women can also pass this onto her baby.
Symptoms of chlamydia for women can include:
Men may experience:
When seeing a doctor about chlamydia, they will ask about the patient’s symptoms. If the patient does not have any symptoms they will ask how they think that they have been exposed to chlamydia.
To be diagnosed with chlamydia, women will be swabbed in the vagina and men are tested through a sample of their urine. If there is chance of an infection in the anus or throat then these areas may be swabbed also. A physical examination by a nurse or a doctor is not always necessary.
Anyone can have a free and confidential chlamydia test as a sexual health clinic, a genitourinary medicine clinic or at a GP surgery. People under the age of 25 in England can also get tested by the National Chlamydia Screening Programme (NCSP). This is often found in pharmacies or colleges.
There are also chlamydia home testing kits although the accuracy of these tests vary.
Chlamydia is easy to treat. The bacteria is treated with a course of antibiotics. Some tablets are required to be taken all in one day, or there is a longer course of capsules to take for a week.
Patients are advised not to have sex during treatment time as if they are exposed to chlamydia again the infection will reoccur even if the previous infection has been treated.
It is important that both partners in the relationship are tested and treated to stop the spread of the infection.
A person is most likely at risk of chlamydia if they have a new sexual partner. It is highly recommended that a condom is used every time during vaginal, anal and oral sex. Sex toys should not be shared and if they are, they should be washed and covered with a new condom.
Contraceptive methods prevent or reduce the possibility pregnancy. They prevent pregnancy and help to plan the optimal time to have a child. Currently, there are multiple types of contraceptives administered orally, vaginally, as an injection, by subcutaneous or physical implant. Common contraceptives include the pill, patch, implant, IUD, IUS and condoms.
Regarding their effectiveness, not all are classified in the same way and will depend on how well they are used for example. In addition, the use of certain contraceptive methods, such as condoms, can prevent the contraction of sexually transmitted infections (STIs). Many forms of contraception do not protect you against STIs so make sure you know which of those do and don't.
Contraceptive methods are used to prevent unwanted pregnancies. There are couples who want to enjoy sex but do not want to have children. Therefore, it is important to use contraceptive methods to help avoid them and thus be able to plan the best time to have them.
Among the different contraceptive methods, the most common are:
Barrier methods:
Hormonal methods:
Intrauterine device (IUD) – a plastic and copper device inserted into the vagina which kills sperm and prevents eggs from becoming fertilised.
Permanent methods:
Some contraceptive methods can cause side effects such as mood swings, loss of libido, weight gain and headaches. It is important to choose the best method for yourself. It is not uncommon to try different forms of contraception throughout your reproductive years. Additionally, some people are allergic to latex, so they should be careful when choosing a condom. Some women are unable to have certain hormones, so seek guidance from a GP or specialist.
Cystitis is a urinary tract infection (commonly referred to as a UTI), and is an inflammation of the bladder. This inflammation usually occurs as a result of a bladder infection. Cystitis is more common in women than it is in men. It usually goes away in a few days, but in more complex or recurring cases, it may need long-term treatment.
Symptoms include:
In children:
Cystitis is most frequently caused by a bacterial infection, which happens when bacteria from other areas of the body (e.g from in the bowel or on the skin) get into the bladder. Bacteria are thought to come through the urethra, which carries urine out from your body. Women have a shorter urethra, which is closer to the anus and means that they more commonly experience cystitis.
Bacteria can get into the bladder in several different ways:
Cystitis can also be caused by a damaged or irritated bladder.
Frequent cystitis infections can be difficult to deal with, but there are some measures which can help prevent it from re-occurring or occurring frequently. Showering, rather than bathing, is recommended as well as avoiding the use of perfumed bubble bath or shower gel. Keeping good sanitary habits, and wiping the bottom from front to back are also used as preventative measures. Cotton underwear, and wearing trousers which are not too tight can help as well. Keep hydrated and drink enough water, but make sure to go to the toilet when you need to pee rather than holding it in. You should also make sure to empty your bladder after having sex.
If you use a diaphragm, you may want to consider using a different method of contraception if you frequently get cystitis.
Usually, cystitis goes away on its own in mild cases and can be treated from home using self-help methods to ease symptoms. A hot water bottle, placed on the stomach or between the thighs can help to relieve pain or soothe, along with over-the-counter painkillers. Avoid sexual intercourse until the infection has passed.
In some cases, antibiotics may be prescribed, especially in recurring cases of cystitis. A doctor may prescribe a longer course of antibiotics, or continuous antibiotics for a number of months as a preventative measure.
Cysts are closed sacs in the body’s tissue that may be filled with fluid, air, or other substances. They have a membrane, or “shell”, to divide them from the surrounding tissue, and the cells that make up this membrane are abnormal compared to the surrounding cells.
Cysts can appear almost anywhere on the body, including on bones, organs, and the skin. There are hundreds or types of cyst and many possible causes.
Most cysts are benign and some resolve on their own; others may require surgical removal and a small proportion are cancerous.
There are many types of cyst, including:
The vast majority of cysts are benign (non-cancerous) and cause few problems for the patients. Many cysts simply go away on their own. However, if a cyst fails to resolve by itself, if it is causing particular discomfort or pain, or if its size and appearance bother the patient, it may require surgical removal, although this may also depend on the location of the cyst in the patient’s body.
If a cyst becomes infected, it can become sore and red, and may develop into an abscess (filled with pus).
A small proportion of cysts are cancerous, with the sac being formed by the body as an immune response to try to contain the cancerous cells and prevent them from spreading. However, if the cancer already has its own blood supply, the cyst will be ineffective. It is important to have any cyst that does not disappear quickly checked out by a doctor and monitored to make sure it is not cancerous.
Cysts on the skin or close to it may be visible as lumps on the body. Cysts on the internal organs may be more difficult to spot, unless they cause symptoms such as pain in that area or affect the function of the organ. For example, kidney cysts caused by polycystic kidney disease (PKD) can lead to frequent urination or blood in the urine.
A number of things can lead to cysts, including blocked ducts or glands, infections, inherited conditions, chronic inflammation, parasites, injuries, and tumours.
The treatment will depend on the type, size, and location of the cyst. Some common treatments include:
Cysts can be treated by doctors and surgeons from a number of different specialties, depending on the type and location of the cyst. For example, sebaceous cysts and other cysts affecting the skin may be treated by a dermatologist, while ovarian cysts may be treated by an obstetrician/gynaecologist.
A smear test, now more commonly known as cervical screening, is an exam aimed at analysing cells from the cervix in order to identify anomalies, infections or lesions which could develop into cancer. It is a routine test that all sexually active women or women aged 25 or above should take at least once every three years.
The test is not an invasive procedure and it can be carried out at your local GP clinic – there’s no need for anaesthesia. During the gynaecological examination the doctor uses an instrument called a speculum to help to dilate the vaginal opening. The doctor will then gently use a small brush to collect cell samples from the cervix. The samples are then placed on glass slides and sent to a laboratory.
The purpose of the test is to gather cervix cell samples and to determine your cervix’s state of health. With this test it is possible to identify infections (such as the Human Papillomavirus), sexually transmitted infections, or lesions which could develop into cancer.
The test should be taken periodically, at least once every 3 years, or once a year if there’s a family history of cervical cancer. You can’t take the test during your period or in the days immediately before or after menstruation, because that would affect the results. Being on the pill does not affect the test.
Pregnant women or women who have never been sexually active can take the test, but it is always best to talk to the gynaecologist beforehand. For women who have never been sexually active the test could be harder to take or the results might be less accurate due to possible anatomical peculiarities.
In the days before the swab it is recommended that you abstain from sexual intercourse as well as from using any spermicide, vaginal douche or washings, as those may affect the results of the test. If you are allergic to latex, let the gynaecologist know beforehand.
The smear test isn’t considered to be a painful procedure, but you may feel a slight discomfort. To help with the discomfort, it can help to take slow, deep breaths: this will help relax the muscles in your pelvic area. The test doesn’t take more than 5-10 minutes and you can go home straight afterwards.
If the test results come back positive it means that the cervix is inflamed, which could be due to different reasons. The test results are an indication of the degree of possibility of developing cancer. Based on the results the gynaecologist may refer you to other, more comprehensive tests, or suggest that you take the smear test more frequently.
Dyspareunia (painful sex) is a recurrent or continuous pain in the genital or pelvic region, during or after sex. It is quite common in both men and women and can be caused by a variety of things, including an infection, or physical and psychological problems.
A recent survey has found that 1 in 13 women in the UK experiences painful intercourse. It is important that those who have recurrent pain during sex should speak to a specialist. Men can also experience dyspareunia but it is more common among women.
In women
Female dyspareunia may cause the following symptoms:
In men
The symptoms of dyspareunia in men include:
The causes of dyspareunia can vary and there are numerous potential reasons. There can be pain upon entry during penetration, which may be associated with a lack of lubrication. Injury or irritation from an accident, pelvic surgery, circumcision, or a cut made during childbirth to make the birth canal larger, may also cause painful intercourse.
Other factors associated with dyspareunia include inflammation, a urinary tract infection, sexually transmitted diseases such as chlamydia or gonorrhoea, eczema on the genitals or vaginismus in women.
Deep pain caused by certain conditions such as endometriosis, pelvic inflammatory disease, uterine prolapse, uterine fibroids, cystitis, cysts and piles can also lead to dyspareunia. Other medical treatments such as a hysterectomy or chemotherapy for cancer may also lead to painful sex.
There are emotional factors, such as anxiety, depression and fear of intimacy that can contribute to lack of arousal, which results in discomfort when trying to have sex.
Preventing painful sex depends on what the cause is. There are a few things that can be done to prevent some cases, such as:
The treatment will vary depending on each patient and the individual case. A medical evaluation with a gynaecologist or urologist consists of a pelvic examination, where the doctor can check for pain, skin irritation or anatomical problems. There may also be a pelvic ultrasound. Some patients may need to have counselling or sex therapy if there are emotional reasons behind dyspareunia.
Others may need to take medications to clear any infections, such as antibiotics to treat chlamydia or to change some medications that they are already taking, which may be affecting the patient’s natural lubrication.
Ectopic pregnancy is a problem with the implantation of a fertilised egg cell. In a normal pregnancy, the fertilised egg attaches itself to the lining of the uterus. Ectopic pregnancy involves the fertilised egg implanting and growing outside the uterus, in places such as:
Just over 1% of pregnancies are ectopic. Unfortunately, the fertilised egg cannot survive in an ectopic pregnancy.
The severity of the condition depends on where the egg is growing. If the egg is growing in the fallopian tube and isn’t detected early enough it can lead to fallopian tube rupture and heavy bleeding, which can be life-threatening.
An ectopic pregnancy can cause:
Not all people with ectopic pregnancy experience symptoms and it might only be diagnosed during a routine pregnancy scan.
However, you should seek emergency help if you get a sudden intense pain in your abdomen, accompanied by dizziness or nausea, as this can be an indication of a ruptured fallopian tube. In this situation you will need emergency surgery to repair or remove the tube and control the bleeding.
After an assessment of your symptoms, the doctor will order some blood tests and a vaginal ultrasound. The blood test can help not only with diagnosis but with treatment, as you may need a blood transfusion.
In some cases, a form of keyhole surgery called a laparoscopy might be recommended if it’s still difficult to make a diagnosis. If an ectopic pregnancy is found, the fertilised egg can be removed during the same procedure.
The following can increase your chances of an ectopic pregnancy:
You’re also more likely to experience an ectopic pregnancy if you are between the ages of 35 and 40.
Tubal pregnancy (where the egg attaches itself to the lining of the fallopian tube) is caused by a blockage that stops the egg travelling to the uterus. This may be the result of fallopian tube surgery or damage due to inflammation.
You can reduce your risk of ectopic pregnancy by stopping smoking and reducing your chances of sexually transmitted infections.
Treatment for ectopic pregnancy depends on how early it has been detected.
If the diagnosis was made early and you don’t have unstable bleeding, ectopic pregnancy can be treated with an injection of methotrexate, which should dissolve any existing cells. You’ll be monitored with follow-up blood tests and you may need to continue taking contraceptive medication for the next few months.
If medication doesn’t work, or if the pregnancy is more advanced, surgery is generally recommended. A laparoscopy is performed under general anaesthetic and involves inserting small surgical tools to remove the ectopic pregnancy. If your fallopian tube is damaged and the other one is healthy, the surgeon might also remove the damaged fallopian tube.
After treatment you might have a follow-up appointment with a fertility specialist to discuss your chances of getting pregnant and get advice on when to start trying again.
Egg donation is the procedure of giving eggs, anonymously and altruistically, to help women who wish to have a child and cannot for different reasons. The requirements to be able to donate are to be between 18 and 34 years old, be in good health, be free of sexually transmitted or hereditary disease and have legal capacity to grant authorization. Prior to performing this procedure, the patient must undergo a medical check-up to assess physical health status, with a medical examination that takes into account family history, and a gynaecological, and psychiatric examination.
Egg freezing, or oocyte cryopreservation, is a method of preserving a woman’s eggs, enabling her to have the chance of having a baby in the future. As women get older, they typically produce fewer eggs, and often the viability of the eggs also falls, meaning that the chances of conceiving naturally also decrease. Freezing eggs at a younger age, and using them later can provide a better chance of conception.
Freezing your eggs is a good option for patients who have a medical condition or are taking medication which affects fertility, such as cancer. You might also choose to freeze your eggs (elective egg freezing) simply because you are concerned that your fertility is declining, but you have not found the right partner or are not currently ready to have a child, but think you may want one in the future.
Other possible candidates include members of the Armed Forces, or similar situations where severe injury or even death is a risk, and those planning to have a sex change operation.
Egg freezing begins the same way as IVF – this normally involves the patient taking fertility drugs to temporarily boost egg production and maturation. The eggs are then collected by doctors while the patient is sedated. Around 15 eggs are taken from most patients, but it may be less, depending on fertility.
Instead of mixing the eggs with sperm, they are mixed with a cryoprotectant (freezing solution). This will protect the eggs during the freezing process. The freezing itself is done either by fast freezing (vitrification) or slow cooling, after which they are stored in liquid nitrogen.
The maximum storage time is normally 10 years, but in certain situations the eggs can be stored for up to 55 years, or, if the patient wants, less than 10.
When the woman wants to use her eggs, they are thawed, and then fertilised. Standard IVF is not usually used, as eggs that have been frozen tend to have a tough outer coating, which sperm find more difficult to penetrate. Instead, a procedure called intracytoplasmic sperm injection (ICSI) is often used, which involves a skilled embryologist injecting a sperm directly into each egg, maximising the chance of fertilisation.
It is difficult to say how successful egg freezing is, as the number of women who do it is currently very low. Oocyte cryopreservation is a relatively new and quickly changing field, with new advances being made all the time, but with few studies into its reliability. If you are considering freezing your eggs, choose an experienced clinic with a high success rate with patients.
This is a full evaluation that tests the hormone levels produced in both men and women. These hormones have influence over many physiological aspects, including secondary sexual characteristics, fertility, growth, metabolism and sleep.
Endometrial polyps, otherwise known as uterine polyps, are tissue growths in the inner lining of the uterus. While these polyps are usually benign (non-cancerous), they can sometimes be cancerous or develop to be cancerous. Polyps can vary in size and shape, and you can also have multiple polyps. Most polyps are contained within the uterus, but on occasion they can also be found coming through the cervix into the vagina.
Polyps can increase the risk of miscarriage in women undergoing IVF treatment, and can also cause difficulties in getting pregnant. If the polyps are removed, it has been suggested this may successfully improve fertility, though data is inconclusive.
While no specific cause of polyps is known, it is believed that hormone levels have some effect on growth, as they are oestrogen-sensitive. This means that polyps may grow in response to oestrogen circulating in the body.
Certain people are also more at risk of developing endometrial polyps, including those who have hypertension (high blood pressure) and those who are obese. Endometrial polyps are also more common in postmenopausal women. Up to 10% of women are estimated to be affected by endometrial polyps.
Some polyps may not cause symptoms at all, and some may cause light spotting. However, general symptoms include:
Some polyps resolve on their own, meaning your doctor may recommend ‘watchful waiting’. This means the polyps are monitored but they are not immediately treated, to see if they go away on their own.
If treatment is necessary, then you may be prescribed medication. Hormonal medication may help to reduce symptoms, but generally medication is a short-term solution and the polyps may return if you stop taking it.
Your doctor may recommend surgical removal of the polyps. A hysteroscopy, where an endoscope (a long thin tube with a camera and light on the end) is inserted can help in both the diagnosis and treatment of uterine polyps.
Obstetricians and gynaecologists are the specialists who treat endometrial polyps and perform surgery to remove them.
Endometriosis is a painful disorder where tissue that usually lines the womb (endometrium) is found outside of the uterus and in other parts of the body. The tissue appears in the abdomen on the ovaries, fallopian tubes, and ligaments that support the womb. Other areas for these growths may include the bladder, bowel, vagina, cervix and vulva. In more complex cases, they are found in the lung, arm, thigh or other locations.
The cause of endometriosis remains unknown. Some experts suggest that endometriosis occurs due to a process called retrograde menstruation. The menstrual blood flows back through the fallopian tubes into the pelvic cavity instead of leaving the body through the vagina. Another theory for the cause of endometriosis is that hormones transform cells outside of the womb into cells similar to those lining the inside of the uterus (endometrial cells).
The symptoms of endometriosis can vary with some women are more affected than others. These can include:
A laparoscopy can help to diagnose endometriosis, which usually shows the location, size and extent of the growths. There is no cure for endometriosis but there are treatments that ease the symptoms. These treatments include:
Surgery for endometriosis can alleviate pain. There are two options of surgery:
The other option is radical surgery, which is considered if a woman has not responded to conservative surgery. This means either having a hysterectomy, which is the removal of the womb, or an oophorectomy, which is the removal of the ovaries.
Having either a hysterectomy or oophorectomy is a big decision as these procedures are irreversible and a woman might want to consider having a family.
Endometriosis is a condition in which uterine cells grow elsewhere in the body. This condition can cause pain, heavy periods and sometimes can lead to infertility. This condition can affect all women and girls of childbearing age. Although there is no cure for endometriosis, treatment can help reduce pain and avoid infertility. Treatment options depend on the level of pain experienced and whether or not the patient wants to become pregnant at some point. Surgery aims to remove the scar tissue and endometrial growths, but sometimes involves removing the uterus and ovaries in more severe cases.
If hormone therapy treatments or medicines have not worked, then surgery will be recommended, particularly if the pain associated with the endometriosis is severe or it is affecting other organs.
If you are hoping to become pregnant, then conservative surgery will be carried out. This involves removing scar tissue and growths laparoscopically. A small incision is made in the abdomen, usually near the belly button and a laparoscope is inserted. This option preserves the reproductive system and can help reduce pain, however, the endometriosis can return. If growths are more extensive, then sometimes open surgery will be performed to carry out the same procedure. Both are carried out with general anaesthesia.
In more severe cases, or if pregnancy is not a concern, then a hysterectomy (removal of the uterus) and an oophorectomy (removal of the ovaries) might be performed, both require general anaesthesia. Performing a hysterectomy alone is not effective as the production of oestrogen in the ovaries will stimulate growth of the remaining endometrial tissue which can cause pain to return. Following this procedure, you can no longer get pregnant and early, irreversible menopause will be experienced.
Choosing your form of endometrial surgery is a big decision that should be made very carefully, as certain options mean you would no longer be able to get pregnant. Additionally, the side-effects of having a hysterectomy and removing the ovaries can be challenging, with early menopause requiring hormone replacement therapy (HRT) until the age of around 50.
Following laparoscopic surgery for endometriosis, there will be some pain and tenderness around the incisions, which can feel similar to period pain. There can also be some bruising and swelling. Any discomfort can be managed with painkillers. Some patients can return home the same day of surgery, but some will stay overnight in hospital. Most feel well enough to return to work after two weeks. Incisions should be kept clean. Slight bleeding from the vagina is normal.
Following a hysterectomy, you will stay in hospital for 2-3 days and you will have a catheter tube for the time immediately following surgery. You will also have a drainage tube from the wound. Both are normally removed the day after surgery. You will then be asked to move around to avoid blood clots and to get your blood circulating. Slight bleeding from the vagina is normal for 2-3 weeks after surgery. Pain is similar to intense period pain. Most women can return to work 4-12 weeks after a hysterectomy.
The term ‘endoscopic surgery’ encompasses various techniques, such as hysteroscopy and laparoscopy, in which an optical instrument (a tube with illumination connected to a video camera and a monitor) is introduced inside the body via the rectum or through the abdominal wall, permitting visualisation of the inside of an organ or cavity. Endoscopic surgery, as minimally invasive surgery, has represented an advance over traditional open surgery as it is a lot more reliable and precise, and is associated with less trauma and better aesthetic outcomes. It is usually done under general anaesthesia.
Endoscopy is performed for diagnosis and observation as well as treatment and surgery. Specifically, endoscopic surgery is used in several fields of medicine: in gynaecology, endoscopic surgery, called hysteroscopy, is very common for treating uterine pathologies, such as cysts, endometriosis, myomas and also for performing tubal ligation, studying infertility, or hysterectomy (removal of the uterus). However, these pathologies are also frequently treated using laparoscopy, which differs in that the surgery is performed via a small incision made in the abdominal wall. It is also used in other fields, such as otorhinolaryngology, in which sinonasal endoscopic surgery is very common for treating lesions or problems of the nose that impair normal breathing, affect the sense of smell or cause face or head pain. Also, in general and gastrointestinal surgery endoscopy or laparoscopy may be used in surgery for obesity. Endoscopy may also be performed in emergency situations, for example in neurosurgery to treat brain haemorrhage or a cerebrovascular accident (stroke).
During endoscopic surgery an endoscope, which is an optical instrument in the form of a tube with a light source and a video camera at its tip, is introduced inside the body via the rectum or through an incision, thereby allowing the surgeon to observe the organ or area to be treated on a monitor. Furthermore, different tools for performing surgery can be introduced via the endoscope.
Before surgery, you will have to tell your physician about your health and any medications you are taking. Your medical history will be reviewed and various tests performed to determine whether you are fit to undergo the operation. Generally, these diagnostic tests will include clinical analyses; however, depending on the surgery and your characteristics, the specialist may require further specific tests. Given that endoscopic surgery is performed under general anaesthesia, patients are usually asked to fast for 8 hours before the intervention.
The main advantage of endoscopic surgery versus other surgical techniques is that it’s of a less invasive nature, which permits a faster recovery. So, you will remain in the hospital for only a few hours, sometimes being discharged on the same day as the intervention. Generally, you can resume work 48-72 hours after the intervention. Postoperative discomfort is also less, so absolute rest is not required and you can pursue your life as normal.
The alternative to endoscopic surgery is conventional open surgery, which is associated with a higher risk of complications, a longer and more complicated recovery period, and large, more-visible scars. Robotic surgery refers to minimally invasive techniques performed by the surgeon with the aid of a high-precision robotic system which permits better visualisation of the area to treat and surgical manipulations impossible to achieve without the aid of a robotic system.
Endoscopy is the use of cameras to relay images from inside the body. The device used, known as an endoscope, is a long thin flexible tube with a camera at one end and a light source.
Endoscopes are inserted in to the body via a natural opening such as the mouth or the anus. There are different types of endoscopy depending on the site and function of the procedure – if the bowel is to be investigated for example, it is referred to as a colonoscopy. If the airways are to be examined, the procedure is referred to as a bronchoscopy.
Endoscopy can also be used for surgery, as in the case of laparoscopic surgery – in this situation the laparoscope (a specific type of endoscope) is inserted through small incisions. Once inserted, the endoscope is able to send images from the inside of the subject’s body back to a TV screen.
Endoscopy is most commonly used to investigate symptoms and help to diagnose conditions relating to the digestive system, although it can be deployed to produce images and aid with many other parts of the body, including the respiratory system, the urinary tract and the female reproductive system. An endoscope can also be used to assist with surgery.
An endoscopy is commonly used to investigate symptoms such as abdominal pain, nausea and vomiting, unexplained weight loss, diarrhoea, blood in the stool or vomiting blood.
You may be required to avoid food and liquids for a period beforehand, depending on what type of endoscopy you are undergoing. In the case of a colonoscopy, you might be given laxatives to help you evacuate any stool beforehand. You may also be required to stop taking certain medication such as blood thinners to prevent excess bleeding from the procedure.
The procedure usually only causes mild discomfort although a local anaesthetic is also sometimes used. It is normally performed with the patient conscious, although sedatives can be deployed to help you relax. Antibiotics are sometimes used to reduce risk of infection.
An endoscopy can be used to diagnose a wide range of conditions and the results are interpreted by a specialist. Whether the results are good or bad clearly depends on what symptoms are being investigated and on which part of the body the endoscopy is being performed.
Family planning is a wide topic that involves taking steps to control when a pregnancy occurs. It can refer to both fertility treatments for couple trying to have children and contraceptive methods to prevent pregnancy.
The reason depends on the type of family planning.
Family planning is important to avoid unwanted pregnancy. There are different contraceptive methods available to achieve this end, and this kind of family planning is often done between the couple. However, a consultation with a doctor may be necessary to weigh up what kind of contraception is best for you. For example, some women may be unable to take contraceptive pills for medical reasons, or condoms may not be an option due to latex allergies, etc.
On the other hand, if a couple is trying to conceive, they may consult a fertility specialist to find out why they are having difficulties getting pregnant or to plan how to optimise their chances of having a baby. It may be that one or both partners are infertile and may need assistance in getting pregnant.
Family planning to conceive a child involves consulting a doctor, usually a fertility specialist or gynaecologist, who may run tests to find out why a couple is having trouble conceiving. This could involve:
Depending on the results of the tests, the doctor may advise different methods to maximise the chances of the couple having a baby, and will plan with the couple how they should proceed.
In some cases natural family planning will be advised. This simply involves having the woman monitor the signs of fertility in her menstrual cycle to know when she is ovulating, and therefore when is the optimal time to have sex.
In other cases, some sort of fertility treatment may be necessary or the couple may be advised to try options such as IVF.
Conversely, family planning to avoid unwanted pregnancy largely involves contraceptive methods, such as condoms or similar barrier devices, the contraceptive pill, or, again, using the natural family planning method to determine when the woman is ovulating and avoid having sex at that time.
Family planning carries several advantages:
As fertility treatment is a complicated process, counselling is an opportunity for couples to discuss any emotional difficulties, fears and anxieties that they may experience during their journey in becoming parents. Fertility counselling enables couples to talk about their problems and feelings. It may also support couples in helping them to understand the process, especially during critical cycles, such as if IVF treatment has so far been unsuccessful, or in cases where it has worked and they are finding it difficult to adjust to their new lifestyle.
Couples are most likely to seek fertility counselling:
The Human Fertilisation and Embryology Association (HFEA) was set up by legislation as an independent body who work on behalf of the government and considers fertility counselling as a key element of fertility services for all patients. The HFEA Act 1990 requires counselling to be offered to both partners before treatment starts.
Couples are entitled to have sessions with their partner, individually or in a group, which depends on the needs, treatment and referral made by the consultant. Many clinics have fertility counsellors and support groups for couples to talk to. The registered charity British Infertility Counselling Association (BICA), is the only professional association for infertility counsellors in the UK, which also helps couples find the right counsellor for them.
Fertility problems can affect both men and women. The most common causes of infertility in women include lack of regular ovulation, damaged fallopian tubes or endometriosis. In men, infertility is mostly caused by poor quality semen.
There are a number of factors that may also affect fertility in men and women, which include age, weight, sexually transmitted diseases (STDs), smoking, alcohol and stress.
Counsellors are professionals who are trained to help others cope with emotional issues. Infertility is known as a distressing experience for couples who are trying to plan a family. Sometimes, relatives and friends may not understand or know how to deal with the grief that couples may be experiencing. A fertility counsellor works with couples to help them to make sense of their life-changing situation.
If you have been trying to conceive for over a year but have been unsuccessful, it is recommended to have some tests to determine your fertility. These tests can then indicate whether assisted conception measures will help to achieve pregnancy. Fertility tests are carried out on both women and men.
Fertility tests will usually begin by confirming the following:
You will also have a thorough physical examination to rule out infections, fibroids or endometriosis. A physical examination of men will rule out any testicle lumps or other physical abnormalities.
Women will undergo the following tests:
Men will have the following tests:
Fertility tests are needed to determine why a couple who have tried for at least year to conceive have been unsuccessful.
Depending on the fertility test being carried out, the preparation varies. In each case, the specialist will indicate what care should be taken.
Abnormal results may indicate the following:
Fertility treatment is typically given by a fertility specialist or fertility doctor, often an obstetrician/gynaecologist specialising in the issues and treatment surrounding infertility. The sub-specialty is often referred to as 'reproductive medicine', dealing with the prevention, diagnosis and management of reproductive problems.
Fertility specialists consult for and are able to diagnose all manner of conditions surrounding infertility and related problems. These specialists may consult for both male and female infertility, making an initial assessment either for an individual or a couple. Fertility specialists typically use three main methods of treatment for fertility issues, being medication, surgical procedures, and assisted conception. Depending on the treatment, fertility specialists may refer to other specialists, such as surgeons or endocrinologists.
Surgical procedures may be used for conditions such as endometriosis (where the womb lining grows outside the womb), fibroids, and polycystic ovary syndrome (PCOS). In men, surgery may be used to correct epididymal blockages, and retrieve sperm.
Fertility medication is more commonly issued to women in order to help with ovulation issues. However, medication may be issued in some cases of male infertility or related problems.
Many people visit fertility specialists for assisted conception, typically through IVF (in vitro fertilisation), IUI (intrauterine insemination), or egg/sperm donation.
There are many reasons to visit a fertility specialist. For women under 35, visiting a fertility specialist is recommended when pregnancy has not been achieved after one year of unprotected intercourse. Women 35 and older are recommended to visit a fertility specialist after 6 months of trying.
Other reasons for visiting a fertility specialist include:
In those with a thyroid condition, or who are overweight, or have a known reproductive issue such as PCOS, visiting a fertility specialist is advised before trying to get pregnant. In addition, some may wish to visit a fertility specialist and consult for the following reasons:
Fibroids are benign growths found in and around the uterus, made up of muscle and fibrous tissue. Symptoms are uncommon, but one out of three women may experience pain in certain parts of the body or heavy periods.
Genital warts (also known as condyloma) are a common type of sexually transmitted infection (STI), manifesting as small growths or lumps, usually pink in colour, around the genitals. They frequently occur in clusters, although sometimes there may be only a single wart. Spread by skin-to-skin contact during vaginal, anal or (occasionally) oral sex, genital warts are the most obvious symptom of infection by the human papilloma virus (HPV).
Genital warts rarely cause serious pain or discomfort themselves, but certain strains of HPV are associated with causing cancer, particularly cervical cancer, so it is important for women who have found genital warts to have regular cancer screenings.
Genital warts are themselves symptoms of HPV. They affect the moist tissue of the genitals and can vary in appearance. They may appear as small, flesh-coloured bumps or pale, cauliflower-like structures. They can be either hard or soft, and although they are usually painless some may cause irritation or even bleed.
They can appear anywhere on the genital or anal area, including the tip and shaft of the penis and the scrotum in men; the vulva, the walls of the vagina, and the cervix in women; and around the anus in both sexes. Sometimes, infection will not be immediately obvious because the warts are too small to see, and may even be inside the vagina, the opening of the urethra or the anus.
If you experience the following symptoms, you should get yourself checked out by a doctor:
If your sexual partner is showing any of these symptoms, it is also worth visiting a doctor in case you have been infected.
Genital warts are caused by the human papilloma virus (HPV). There are more than 40 strains of HPV that can affect the genital area, which can be spread through skin-on-skin sexual contact, although in most cases, the immune system kills the virus before you develop symptoms of the infection.
The virus can be passed from person to person regardless of whether or not there are visible warts.
Genital warts can be passed on by:
Genital warts can’t be passed on by:
The best way to prevent the spread of HPV and avoid genital warts is to practice safe sex, using latex condoms, as well as avoiding sexual contact with infected people. However, even using condoms is not a guarantee that there will be no contact with infected skin, because warts can appear in unprotected areas around the genitals such as the scrotum.
There is also a vaccine that protects against some strains of HPV that cause genital warts and the strains that are associated with cervical cancer.
There are several treatments for genital warts, depending on the nature of the warts and what the doctor recommends:
In some people, treatment is ineffective, while in others the warts return while the virus is still present in the patient’s body. There is no definitive cure, but in time the immune system may clear the body of the virus by itself.
A gynaecological examination is done to assess the overall health of the female reproductive system. During the exam, the gynaecologist will look at the external and internal reproductive organs, as well as at the breasts, to determine whether there are any problems or conditions present.
During a gynaecological examination, you will be lying down with your knees up and spread wide apart. The gynaecologist will inspect your vulva and vagina. With both a physical examination and a transvaginal ultrasound, the doctor will also check your uterus and ovaries.
It is very common to also do a smear test during the examination, to determine whether there are precancerous cells in your cervix. The sample taken is sent for examination in a laboratory with results shared, usually in a couple of weeks after the appointment.
The last part of the examination consists of a breast exam, where the gynaecologist checks for lumps or abnormalities. You will also be taught how to do a breast self-exam, so that you can do them at home periodically. The whole examination does not last more than 20-30 minutes.
A gynaecological examination is helpful to assess the general state of health of the female reproductive system, as well as to identify potential infections or problems. The very first examination should be done after the first menstrual cycle or after you become sexually active, even if there are no obvious problems or red flags. Should you have any itching, a burning sensation, abnormal vaginal discharge, as well as irregular menstrual periods or abnormalities or lumps on your breasts, you should go for a gynaecological examination as soon as possible. Even if you do not have any issues, you should go for a check-up at least once every three years (or more often if you have a family history of uterus or breast cancer).
You do not need to do anything before a gynaecological examination. However, you should schedule your examination away from your menstruations and remember to empty your bladder before the visit to avoid any potential discomfort.
A gynaecological examination is not painful at all. The feeling you will have during the internal examination is like that of using a tampon.
There are many potential anomalies that could be found during an examination. By going for your check-up, the gynaecologist can identify potential tumours, conditions, infections or even small irritations and determine the best treatment for you.
Gynaecological infections is a term that encompasses a number of conditions affecting the vagina and genital tract caused by pathogens (bacteria, viruses, fungi, or microscopic parasites that cause disease). Some common types of gynaecological infection include:
Symptoms vary depending on the type of infection, but may include one or more of the following:
If you notice the above symptoms affecting your vagina or pubic area, you should consult a gynaecologist immediately.
It can sometimes be difficult to know if you have particularly heavy periods because what is normal changes from person to person. However, the followings signs would suggest your periods are heavy:
It’s worth seeing the doctor if this applies to you, or if you’ve simply noticed your periods getting heavier. You should also see a doctor if you’re having period pain or bleeding between your periods. Left untreated, heavy periods can lead to iron deficiency anaemia.
Common causes of heavy periods include fibroids (non-cancerous growths in the womb) or endometriosis. Less common causes include:
Almost half of cases of heavy bleeding have no underlying cause.
When you visit the doctor they will ask you about your medical history, symptoms, and any medication you’re on, and you might need to keep a diary of your bleeding. You might also have a number of tests depending on the suspected cause, including:
There are many treatment options for heavy periods and it’s important that you and the doctor discuss in detail your personal preferences and future childbearing plans.
Conservative treatment options include:
If these treatments are unsuccessful, or if you have fibroids or endometriosis, there are a number of procedures available aimed at removing the tissue causing the problem, including:
If you are getting lots of fibroids or severe endometriosis, and you are no longer planning to have children, endometrial ablation or hysterectomy may be recommended treatment options.
A high-risk pregnancy is one that involves complications or associated factors that pose a risk to the health of the mother and the foetus. Currently, around 10% of pregnancies are considered high risk.
The main factors that can identify a pregnancy as high-risk include:
Pregnancy proceeds differently in each woman, but there are some warning signs to go immediately to the doctor:
If a pregnancy is identified as being high risk, it should be monitored closely by the mother’s doctors, with regular prenatal check-ups.
The mother should try to avoid any factors within her control that could cause complications, such as avoiding alcohol and tobacco consumption and maintaining a healthy body weight.
Menopausal hormone therapy involves taking medication to replace oestrogen lost during the menopause.
Menopausal hormone therapy is one of a many types of hormone replacement therapy. Hormone replacement can also be offered to:
As women approach the menopause their levels of oestrogen fall, leading to a number of uncomfortable symptoms such as:
Hormone replacement can help to maintain the levels of oestrogen in the body, and combat some of these symptoms.
It is particularly recommended in women who experience an early menopause, as they are at a higher risk of heart disease, anxiety, depression, or parkinsonism if their oestrogen levels are too low.
Finally, hormone replacement has also been found to help prevent bone loss and reduce the risk of fragility fractures.
Hormone replacement therapy is not likely to be recommended if you have a history of womb, ovarian or breast cancer, or if you have a history of blood clots.
Hormone replacement therapy involves taking medication on a regular basis.
There are different ways to take the medication, including as a pill, cream, or skin patch. You can also take the medication continuously or in cycles.
Unless you have had a hysterectomy, it’s likely you will need to take progesterone in addition to oestrogen, to reduce your risk of developing uterine cancer.
It’s important to discuss the risks and benefits of hormone replacement thoroughly with your doctor before making a decision. While there are many benefits (as described above), hormone replacement therapy can increase your risk of breast cancer and stroke. Side effects can include:
If you ultimately feel that the risks and side effects for you outweigh the benefits, there are alternative ways of tackling menopause symptoms you can consider:
Human papillomavirus (HPV) is a group of viruses that can infect the skin and mucous membranes in humans. There are more than 100 different types, most of them harmless, but some types are associated with an increased risk of cancer or cervical dysplasia (abnormal changes in the cells of the surface of the cervix). These are acquired through sexual contact with an infected partner and can be low or high-risk. Low-risk strains can cause genital warts. Conversely, high-risk strains can cause cancer of the cervix, vulva, vagina and anus in women; and cancer of the penis and anus in men.
In many cases, HPV infections produce little to no symptoms and the infection will go away without treatment. However, whilst that person may not experience symptoms of HPV, they are still carriers of the virus and can transmit it to any sexual partners they have. However, HPV infections can produce genital warts or warts in the throat. High-risk strains of the virus can also cause cell abnormalities in the cervix, which can develop into cervical cancer if untreated. Unfortunately, symptoms of cervical cancer do not usually become apparent until the cancer is in its later stages. This is why regular cervical screening is so important for women after the age of 20-25.
There are several factors that increase your risk of suffering from human papillomavirus infections. Most people who become infected with the virus will do so from direct sexual contact, including oral sex. The risk is increased if you are not practising safe sex (i.e. using a condom), because HPV is transmitted by skin-to-skin contact. Another risk factor is having a depressed immune system.
It is possible to get vaccinated against the human papillomavirus to reduce your risk of being infected by the high-risk strains. This vaccine is offered to girls in school from the age of 12 and is highly recommended. Using condoms is also advised to reduce your exposure and risk of contracting HPV during sex. To prevent HPV infections from developing into cervical cancer, women should also have frequent cervical screening from when they become sexually active.
There is no cure for the human papillomavirus. Treatment of cervical abnormalities that result from HPV can be removed surgically. Genital warts that result from HPV may be treated with topical creams, surgery or cryotherapy.
The human papillomavirus (HPV) vaccine is a vaccine that protects against certain strains of this virus, which can cause cervical cancer in women and genital warts (both in men and women). In the UK the vaccine is given to girls from age 12. To enquire about the HPV vaccine, visit your GP or a specialist gynaecologist.
HPV is a group of viruses that have been linked to the development of cervical cancer. HPV can be caught through sexual contact with someone who already has the virus. Whilst HPV infections are common, when someone is infected with a high-risk type of HPV, abnormal tissue growth in the cervix can result which, if untreated, can develop into cervical cancer. By giving the HPV vaccine to girls before they are sexually active, they should be protected from these high-risk strains of the virus, and hence their risk of developing cervical cancer from HPV is much reduced.
The vaccine stimulates the body to produce antibodies that, in future encounters with HPV, will bind to the virus and prevent it from infecting cells. The vaccine is given as two separate injections in the upper arm. These are usually spaced a few months apart, and both injections are required to be protected. If girls receive the vaccine after the age of 15, then three injections are required. The vaccine is shown to protect recipients against HPV for at least 10 years, but experts expect it to last longer than this.
The HPV vaccine does not protect against all types of the virus or other STIs, so it is important that women have regular cervical screening from the age of 25. The HPV vaccine may have some side effects. The most common are fainting, nausea and skin reactions in the area where the vaccine was applied. Your arm may feel a bit stiff for a few hours after the injection is given.
Hymenoplasty, also known as hymen restoration surgery, is a surgical procedure that aims to reconstruct the skin membrane, known as the hymen, located in the lower half of the vagina. This fibrous and elastic tissue is usually torn with the first sexual penetration of women, but it can also break after a physical accident, sudden movements or even using tampons. Hymen repair is a simple procedure that involves stitching the torn edges together with dissolvable stitches. Generally, it is performed with just local anaesthesia and performed as a day case procedure.
Generally, patients who request this type of operation wish to recover the original status of the hymen for cultural or religious reasons. This is because, in some cultures, the hymen is seen as symbolic of virginity. However, it is important to note that hymens can tear from non-sexual causes, such as tampon-use or certain sports activities (e.g. horseback riding).
The surgical procedure is quite simple and consists of the reconstruction of the hymen by means of fine, dissolvable sutures. The duration of the surgery is approximately thirty minutes to one hour. The newly formed hymen will also bleed when torn. The new hymen is constructed from the original torn hymen tissue.
In the days leading up to your hymenoplasty, you should avoid smoking, and certain medications may need to be stopped, depending on the advice of your surgeon.
You can expect slight pain after surgery, but you should be able to return to normal activities within 24 to 48 hours. It is important that during these 48 hours the patient must rest. The stitches are dissolvable, so they do not require later removal. Complete healing takes up to three months, in which time, sexual intercourse should be avoided.
A hysterectomy is a surgery that involves removing the uterus (womb), meaning you are no longer able to get pregnant post-surgery. There are different types of hysterectomy, and the type that you would be recommended would depend on why you require a hysterectomy.
The procedure is a big operation using general anaesthetic with extensive recovery periods, and is recommended after other less invasive procedures have been tried.
There are a number of different reasons why a woman would have a hysterectomy which include:
For non-cancerous illnesses a hysterectomy would only be offered if all other treatment options had been tried first.
There are different types of hysterectomy, and the type you have depends on why the surgery is needed.
The types of hysterectomy include:
If you have a total or radical hysterectomy, immediately after surgery you will experience what is called surgical menopause, no matter what age you are. This is because your ovaries will have been removed, and the hormones they released will no longer be present.
Symptoms of menopause include:
There are three ways for a hysterectomy to be carried out:
Compared to open surgery, a vaginal and laparoscopic hysterectomy require shorter hospitals stays and result is less pain and scarring, as well as a decreased chance of infection. However, not all women are suitable candidates for these less invasive procedures, and sometimes open surgery is the best option. This may be due to a presence of scar tissue from prior surgeries, or obesity.
Prior to undergoing a hysterectomy it is important to make sure that you are well-hydrated, have eaten lightly the day before, and usually have stopped consuming food and drink after midnight the night before surgery. Most hysterectomies will require a stay in the hospital, but it is recommended that transport home is pre-arranged as you would be unable to drive for up to two weeks post-surgery.
As a hysterectomy is a big procedure, it is important that you feel comfortable and have asked as many questions as possible to address concerns you might have. The doctor will have set expectations and given a thorough explanation of the procedure too.
Once you have woken up from the effects of the anaesthetic it is normal to feel tired and experiencing some pain. Painkillers will be given to reduce any discomfort.
Your wound will have dressing over it, and if you have had open surgery, a drainage tube will be inserted beneath the wound to drain any blood from the wound for a day or two.
A few days after surgery, you will be encouraged to try and walk, as this helps to get the blood flowing normally around your body.
Hospital stays and recovery times for the different types of hysterectomy are as follows:
Patients are advised not to drive until it is comfortable wearing a seatbelt and can perform an emergency stop safely. Heavy lifting and sexual intercourse should be avoided too until scars are healed.
It is also important that patients are reminded of the fact that contraception is no longer required, however, barrier methods such as condoms still need to be used to be protected against sexually transmitted infections (STIs).
A hysteroscopy is a clinical procedure that allows the specialist to view the cervix, the inside of the uterus and the openings of the fallopian tubes to study the functions and shape of the endometrium. There are two types of hysteroscopy:
A hysteroscopy is performed in the following cases:
The patient lies down and is placed in the gynaecological examination position. An instrument is inserted into the vagina to widen it (a speculum), and the vagina and the inside of the uterus is cleaned using an iodine solution. The cervix is then held in place with a clamp. The specialist adapts the hysteroscope to the size of the vaginal canal and slowly inserts it. The hysteroscope is a lighted tube connected to a video camera and a screen. In some cases, gas or fluid may be introduced into the uterus to expand it so that the inside of the uterine cavity can be seen better. Local anaesthetic may be applied to the cervix, if necessary. To remove abnormal growths or tissue for testing, tools may be placed inside the hysteroscope.
Prior to a hysteroscopy, the specialist may prescribe medication that opens the cervix, which should be taken 8 to 12 hours before the procedure. It is important that you tell your doctor about any medication you are taking, including vitamins, herbs, or dietary supplements, and also if you have health problems, if you are pregnant, or if you smoke. On the day of the surgical hysteroscopy, you should not eat or drink anything in the hours prior to the procedure, and the indicated medication should be taken only with a small amount of water.
You can return home on the day of the procedure; hospital admission is necessary only in a few cases. You will be able to return to normal daily life within two days of the procedure, but it is very important to abstain from sex until the specialist tells you that you are well enough to do so. You might experience menstrual-like cramps and some slight vaginal bleeding for a couple of days afterwards. For cramps, ask your specialist if you can take pain medicine. During the following few weeks, you may notice some watery discharge.
Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization technique where sperm is directly injected into the egg. In some cases, the sperm needs to be extracted from the man first with surgery.
ISCI is carried out to treat cases of male infertility, including cases of:
The steps to follow are:
After the transfer of embryos, the patient has to rest in the clinic for 30 minutes and then she can return home, although it is recommended to avoid intense physical exercise.
It is also advisable to drink plenty of fluids, restrict salt intake, avoid sexual intercourse until the pregnancy test, and avoid immersion baths in hot water.
In vitro fertilisation (IVF) is a procedure in which an egg is combined with sperm outside the body, in a laboratory. Once fertilised, the egg is transferred to the woman’s uterus, with the goal of successful pregnancy. It is a common fertility treatment.
This treatment is an option which can help a woman to become pregnant, in the case of infertility problems, such as:
IVF requires several steps to achieve ultimate success:
The first step when considering any fertility treatment is to visit your GP, who can refer you on to a specialist, or to visit a private fertility specialist or clinic. Once at the clinic, the specialist will speak to you about your fertility history and conduct an examination if necessary.
If IVF is deemed to be the best treatment, you will then be referred for assisted conception. At the clinic or assisted conception unit you and your partner will need to have blood tests, screening tests for sickle cell anaemia and thalassaemia, and your egg count will be investigated.
Once the embryo transfer has been made, you should rest for the remainder of the day.
Generally, you’re advised to wait for 2 weeks before a pregnancy test can be carried out. This time can be stressful and the clinic may offer counselling or support. If the treatment has been successful (and it is important to remember that IVF is not always so), you will be offered regular antenatal care and monitored throughout the pregnancy.
Infertility is the inability of a couple to become pregnant through natural means. Infertility affects the couple, both the man and the woman, who cannot have a child naturally. There are two types of infertility: primary infertility, affecting couples who have not become pregnant after at least one year of unprotected sexual intercourse, and secondary infertility, affecting couples who were able to become pregnant in the past but are now unable to.
There are various symptoms of infertility in men and women.
In women, symptoms may be related to the menstrual cycle and ovulation: abnormal menstruation, with more or less bleeding than usual; irregular menstruation, when the number of days between each menstruation is different each month; amenorrhoea, i.e., no menstruation; or dysmenorrhea, very painful menstruation. There may also be symptoms unrelated to menstruation, such as pain during sexual intercourse.
In men, the symptoms of sperm-related infertility include small amounts of ejaculate. There are also symptoms unrelated to semen, such as changes in hair growth, changes in sexual desire and erection problems. Men may also have a low sperm-count, making the chance of conceiving naturally more difficult.
Common causes of infertility among men and women are:
In women, infertility may be caused by:
In men, the causes of infertility may include:
Generally, if the origin of the infertility is genetic or caused by disease, then nothing can be done. However, you can avoid certain factors that may cause infertility:
Methods to treat infertility in men and women include taking hormones to resolve the hormonal imbalance, supplements to improve fertility, and antibiotics in the case of infection.
For women, having minor surgery to remove blockages or scar tissue from the fallopian tubes, uterus, or pelvic area is another option.
If these methods are unsuccessful, assisted reproduction techniques can be tried.
Cystitis is the inflammation of the bladder. The term interstitial cystitis (also known as painful bladder syndrome) is used to designate cases that are considered a chronic condition.
People affected by cystitis have the bladder wall completely swollen and is painful, they can even expel blood when urinating. This is due to scars or stiffness that are created in the bladder, which causes the inability to enlarge when it is filled with urine. Therefore, the symptoms usually include a strong urge to urinate, urinary frequency, and pain during sexual intercourse.
The exact cause of these infections are unknown at the moment, although it is known that it is not a bacterial or viral infection. Interstitial cystitis is much more common in women than in men, as it usually happens from the age of 20 to 30 and it is quite common to develop after having sex or during the menopause.
The main way to prevent chronic cystitis is to prevent cystitis from occurring. Therefore, some guidelines to prevent or avoid cystitis are:
There is no permanent cure for interstitial cystitis, although the initial treatment of cystitis is usually a course of antibiotics. In interstitial cystitis treatments are usually focused on improving the symptoms: diet, exercises to control the bladder, medication, physiotherapy, etc.
An intrauterine device, more commonly known as an IUD, is a contraceptive device. It is a small copper device that is T-shaped and inserted into the uterus. No hormones are released by this device, as copper changes the cervical mucus, making it difficult for sperm to reach an egg and survive. This change in mucus also stops a fertilised egg implanting itself. An intrauterine system (IUS), releases progesterone to prevent pregnancy.
It is a highly effective contraceptive method, which is more than 99% effective when inserted correctly. Once it is implanted, it remains effective for 5-10 years, depending on the type used. It is not necessary to have any rest period and once it is removed, your fertility returns to normal immediately. It is important to note that whilst the IUD is a form of contraception, it does not protect you against STIs.
The IUD can be inserted at any point in your menstrual cycle and will protect you from pregnancy immediately. An appointment to insert an IUD takes just 30 minutes and can be done by either a trained nurse, GP or gynaecologist. The vagina is opened using a speculum, through which the IUD is inserted into the uterus. Once the IUD is placed in the uterus, the specialist removes the speculum leaving two small cords that hang inside the vagina. The goal of the cords is to verify that the IUD is in the right place, as well as to help extract it when the time is right.
Before having an IUD inserted, it is important to understand your options for contraception. IUDs are often used when you want to avoid the risks of birth control hormones, when they cannot be used, or when you want long-term protection against pregnancy.
The day of your consultation to insert the IUD, it is advisable to be accompanied so that later they take you home. Some women may have mild cramping, back pain in the lower back and spotting for a couple of days. It is important to have a check-up by a GP 3-6 weeks following the insertion to ensure it is placed correctly. If you have your period when it is inserted, you should avoid using tampons for the first 48 hours.
Advantages:
Disadvantages:
Artificial insemination is an insemination method in which the sperm is deposited in the vagina through mechanical means at a time close to ovulation. In this way, the journey of the sperm to the fallopian tubes is shortened, and therefore, there are more chances of the sperm getting closer to the ovum. The goal is to increase the chances of pregnancy in couples who have difficulties in conceiving. The technique consists, first of all, in collecting a semen sample that is treated in the laboratory to concentrate the sperm. The doctor inserts a speculum into the vagina to see the cervix and injects the semen into the uterus. In general, it is not a painful procedure and it is usually accompanied by ovarian stimulation techniques.
Labiaplasty is a surgery that involves remodelling and resizing the labia minora which are the flaps of skin on each side of the vaginal opening. This can either be performed for cosmetic purposes, but sometimes it is for functional reasons. In most cases, local anaesthesia is used for a labiaplasty procedure. Labiaplasty should not be performed on girls aged less than 18 years of age because the labia minora may still be growing and changing.
Women might choose to have a labiaplasty because they are self-conscious of the size and appearance of their labia minora. Some women’s labia minora can cause physical discomfort, as they are larger than average and can suffer from twisting or tugging, causing pain.
A labiaplasty can be performed with either local or general anaesthesia. During the procedure, the labia minora are shortened and reshaped, with any unwanted tissue cut away with either a scalpel or a laser. Incisions are closed with small, dissolvable stitches. A labiaplasty can take up to two hours and most patients are able to return home on the same day.
Before your surgery, it is important to follow your surgeon’s instructions about fasting and stopping any medications. It is also important to stop smoking in the months leading up to your surgery. On the morning of the surgery, you should carefully shave, as hair can be obstructing.
You can expect to have some soreness, swelling and slight bruising for up to two weeks. Some patients will find they need a few days off work to recover. Full healing can take up to two months, and during this time you will need to keep the area clean, avoid sexual intercourse, use sanitary towels rather than tampons and wear loose underwear and clothing. Over-the-counter painkillers can be taken to manage any pain as sitting and peeing can produce some discomfort.
Laparoscopy is a minimally invasive surgical technique which allows the surgeon to operate without the need for deep or large incisions in the skin. This means the recovery period is generally shorter, there is less pain after the operation, and scarring is reduced significantly for the patient. This technique is also known as keyhole surgery.
Laparoscopy can be used to both treat and diagnose a range of conditions across specialties such as surgery, gynaecology, gastroenterology, and urology. Laparoscopy may be used in investigation, to check symptoms and attempt to reach a diagnosis, for example in cases of ovarian cysts, fibroids, pelvic inflammatory disease, and appendicitis. Laparoscopy can also be used to take a biopsy (a small sample of tissue) meaning it can be used to investigate certain cancers, e.g liver cancer, ovarian cancer, pancreatic cancer, and many more.
As a surgical technique, laparoscopy is especially useful as it allows for minimal scarring and a shorter recovery period, which is advantageous to the patient. Laparoscopy can be used as a surgical technique in many situations, such as:
Laparoscopy is performed under general anaesthetic. The surgeon makes small incisions in the abdomen and inserts a laparoscope, which is a small camera attached to the end of a thin tube, allowing the surgeon to see inside the abdomen through a projection on a TV monitor in front of them. The surgeon uses small instruments to perform surgery, looking at the TV monitor for a clear view of the area they need to operate on.
Generally, you will be asked not to eat or drink anything for 6-12 hours before the procedure. You will also be asked to stop taking blood-thinning medication a few days before the procedure takes place. If you are a smoker, your surgeon may advise you not to smoke for a few days before the procedure, as smoking can delay the healing process.
As laparoscopy is a minimally invasive procedure, you can generally go home either on the same day or the day following surgery. Someone will need to accompany you home as you will be advised not to drive for the 24 hours following the procedure.
Recovery from laparoscopy depends on the type of procedure performed. After diagnostic laparoscopy, for example, you may be able to resume normal activity after five days. If surgery is more minor, for example ulcer repair, normal activity may be resumed in around three weeks. Major surgery, such as hysterectomy or organ removal (e.g kidney) typically takes longer – up to 12 weeks. Your surgeon or doctor will advise you on how to clean your stitches and keep wounds clean.
Expect to feel tired or somewhat drained after surgery for a few days, but this should pass as your body uses less and less energy as the recovery process goes on. If you experience any pain, you can take over-the-counter medication pain relief to reduce it.
Laparoscopy is a minimally invasive technique which is used as an alternative to traditional open surgery. Open surgery may be necessary in certain situations and your surgeon will speak to you regarding your options before making a decision as to which type of surgery will be performed.
Laparotomy is a surgical incision into the abdominal cavity. It is carried out to examine the organs and structures of the lower abdomen, such as the appendix, intestines, kidneys, liver, pancreas, gallbladder, bladder, uterus, etc. It is performed under general anaesthetic and may be merely exploratory or may include another surgical procedure if necessary, as in the case of intestinal obstruction, for example.
A general surgeon or gastroenterologist makes an incision in the abdomen to examine the organs. If necessary, they will remove a sample of tissue (biopsy) for laboratory examination, especially in cases of suspected cancer. The surgeon will then use stitches or staples to close the incision.
Laparotomy is performed in the operating room under general anaesthetic.
Exploratory laparotomy is recommended when it is impossible to obtain an accurate diagnosis using medical tests such as X-rays and CT scans. It is useful for the diagnosis and treatment of medical problems such as:
Before surgery, the specialist will study your medical history and tell you what medication you will not be able to take. They may also request various diagnostic tests to be performed in order to assess whether you can safely have surgery under anaesthetic.
You may need to follow a special diet rich in fibre and fluids, or even take laxatives to empty the bowels before the procedure to reduce the risk of bowel infection after surgery.
The procedure is painless since it is performed while you are asleep under general anaesthetic.
After the operation, you will stay in hospital for a few days, during which time the doctors will monitor your progress and make sure there is no infection, blood clots or any respiratory or intestinal problems.
The risk of blood clots forming must be monitored, as these could break off and result in a fatal vascular accident, such as a heart attack or a stroke.
The main alternative and advancement to laparotomy is laparoscopy, which is a less invasive technique that allows the specialist to examine the area using a camera and lighting system.
Laparoscopy is a safer procedure that presents less risk of complications or bleeding. It also requires a shorter hospital stay and post-operative period and is less painful. In addition, the scars resulting from laparotomy are larger and more visible. Laparoscopy is therefore used more often than laparotomy whenever possible.
Male infertility is a health condition where a male’s chances of getting his partner pregnant a reduced. Infertility is classed as being unable to conceive after frequent, unprotected sex, with around 15% of couples unable to conceive when having unprotected sex, approximately 40-50% of these cases are due to male infertility.
The most common cause of infertility in men is either the production of low amounts of sperm, the sperm being damaged or of low quality, such as not being able to move properly, making it difficult to swim to the egg, or finally due to abnormal sperm, such as sperm that are an abnormal shape, again, making it difficult to swim to the egg.
It is not fully understood why the sperm becomes damaged or low in number, but it is believed that incorrect temperature regulation, such as the testicles being too hot from tight clothes, or from having a source of heat such as a laptop close to the genitals for long periods.
Other reasons for male infertility may be as a result of infection or damage to the testicles, testicular cancer, or testicular surgery may reduce sperm production.
Some men may have problems ejaculating during sex, causing further difficulty in causing pregnancy. A condition known as hypogonadism, where males have an abnormally low level of testosterone can often be a cause of low levels of sperm.
There are many other factors that can have a detrimental effect on the quality and quantity of sperm produced by a man, and numerous conditions that can have an affect. Lifestyle choices that are known to cause low sperm count, or abnormal sperm include recreational drug use, smoking and drinking excessively, obesity, and high levels of stress.
Many of the causes mentioned above are unavoidable, and the next course of action for couples wanting to get pregnant may be to explore other options such as IVF treatment, or egg freezing. Making changes to the lifestyle will also help the chances of producing healthy sperm. Avoiding smoking, cutting down on alcohol intake and eating healthily will likely have beneficial effects, along with reducing stress levels where possible.
Mastalgia is the medical term for breast pain. There are two main types of mastalgia – cyclic and non-cyclic.
Cyclic pain is connected to the menstrual cycle and, as such, usually occurs monthly. It usually manifests in both breasts, but can be limited to just one, or can also radiate to the armpit and/or arm.
Non-cyclic pain is not linked to the menstrual cycle. It most commonly occurs in women in the 30-50 age range. It is usually limited to one part of one breast and is usually present all the time.
Mastalgia is a symptom rather than a diagnosis, and presents in different ways depending on the type.
Cyclic mastalgia:
Non-cyclic mastalgia:
Mastalgia is more common before the menopause.
Cyclic mastalgia is thought to be caused by the normal monthly changes in hormones, but the reasons why this should cause pain, or why it affects some women to different degrees, while not affecting others at all are not fully understood. Research is ongoing, with various theories regarding hormone levels.
Non-cyclic mastalgia may be caused by trauma (a blow to the breast), pain in the chest of neck (perhaps caused by arthritis) radiating to the breast, or possibly a cyst or fibroadenoma (a firm, noncancerous tumour).
It is unusual for breast cancer to cause breast pain, but in some cases painful lumps may be cancerous.
Sore breasts may also be a sign of pregnancy, or brought on by breastfeeding.
You cannot prevent all causes of breast pain, but it is possible to prevent some tenderness and discomfort caused by exercise by wearing a well-fitting sports bra.
Treatments vary depending on the cause of the mastalgia.
For cyclic mastalgia, dietary changes, such as cutting out caffeine, reducing fat intake, and taking vitamin E are sometimes recommended. In some cases, medication in the form of hormone supplements, or conversely, hormonal blockers may be prescribed to try to correct a hormone imbalance, but due to possible side-effects, these options should be thoroughly discussed with your doctor. Painkillers may also be recommended, depending on the case.
Non-cyclic breast pain could have a number of different causes, so treatment is very much dependant on the diagnosis. Painkillers, anti-inflammatories, and compresses are often ways to manages the symptoms, but if the cause is a cyst of fibroadenoma, surgery may be necessary. The treatment always depends on the individual case, so you should always consult a doctor when confronted with mastalgia.
Mastitis is an inflammation of the mammary glands caused, usually, by an infection. Common symptoms include swelling, pain, redness and sometimes a mild fever.
The usual symptoms of mastitis are:
One of the main causes of mastitis is the lack of hygiene. However, this condition often occurs when a woman is breastfeeding. During breastfeeding, the skin of the nipples can crack and allow the bacteria that live on the skin to penetrate the fatty tissue of the breast. The proliferation of bacteria produces a blockage that makes it difficult for milk to exit through the mammary ducts.
Breastfeeding helps prevent mastitis. When the baby sucks, the ducts are emptied and cleaned of possible infections or obstructions that may occur.
To eliminate the infection, you will usually be prescribed antibiotics and analgesics to relieve pain. Other recommendations are the application of local heat through damp cloths for 15-20 minutes four times a day, good hygiene, avoiding prolonged periods without breastfeeding or using a milk pump. It is also essential to get enough rest and drink plenty of fluids. If mastitis is not treated properly and the infection gets worse, an abscess may occur. The abscesses must be drained, either through outpatient treatment or surgery.
The term “medicolegal” refers to both medicine and law. It can refer to two things:
The two should not be confused, although some legal cases can involve both, for instance, if a doctor is called as an expert witness for a malpractice case against another healthcare provider.
There are many potential cases where medical and scientific expertise may be important in law. Examples can range from disputes over paternity to criminal proceedings. A doctor may be called to produce evidence about the case or appear in court as an expert witness.
As an expert witness, the doctor may use their scientific knowledge and expertise to give the court insight into the available evidence, which may prove valuable in ascertaining the truth about the events of the case.
Forensic medicine is one particular specialist field, which involves collecting and analysing samples from a criminal case to produce objective evidence for the court.
Medical law sets out the proper code of conduct, the responsibilities of healthcare providers and the rights of patients. If a healthcare provider is suspected of having committed medical malpractice and caused unnecessary harm to a patient, they risk legal action from said patient. Criminal law also applies to the medical world to ensure that healthcare provides do not engage in criminal activity in their practice.
The menopause refers to the process which naturally occurs in women as a result of ageing, meaning they no longer have periods and are unable to conceive. The menopause usually happens between the ages of 45 and 55, with the average age in the UK for women being 51. It is a new stage in a woman’s life and brings a number of both physical and emotional changes.
During the menopause, a woman’s oestrogen levels naturally decrease. This can cause menopausal symptoms, which vary from being mild to severe. Occasionally, women experience early (or premature) menopause, which happens before the age of 40.
Symptoms of the menopause can begin months, or years before periods finally cease, and typically go on for around four years after periods have stopped. Common symptoms include:
As we get older, our sex hormones change, with the ovaries not producing as much oestrogen as they once did. This means that eggs are no longer released from the ovaries. The menopause is a natural part of ageing, but it sometimes occurs earlier than expected, without clear cause.
In some cases, the menopause can be caused by medical treatments, such as treatment for breast cancer (e.g chemotherapy or radiotherapy). Surgery removing the ovaries can also cause menopause to happen, and medical conditions such as Down’s syndrome may be the reason behind early menopause.
Hormone replacement therapy (often called HRT) is one of the most effective treatments for menopause symptoms, and it is also able to maintain bone strength, thus helping in the prevention of osteoporosis. Hormone replacement therapy can be applied through hormonal coils, tablets, patches, and pessaries. Gels can also be used, for example in topical application to the vagina, to relieve dryness. However, before using HRT, it is important that the GP or gynaecologist explains the risks and benefits of the therapy, so the patient can make an informed decision.
Symptoms of the menopause can also be managed through lifestyle changes, e.g eating healthily, and exercising regularly. Being at a good level of fitness can help to relieve some of the symptoms of the menopause. Some types of therapy can also help women to deal with low mood, or anxiety.
If menopause symptoms occur before the age of 45, consult your GP and talk to them about the symptoms you are having. They may order a blood test to see if the symptoms are indeed related to the menopause. Blood tests can also be ordered for those under 40 if the doctor wishes to confirm a suspected early menopause after evaluating symptoms.
Disorders of cycle length:
Disorders of flow (abnormal uterine bleeding):
Other menstrual disorders:
Amenorrhea:
Menorrhagia:
Dysmenorrhea:
Premenstrual syndrome (PMS):
Amenorrhea and oligomenorrhea:
Menorrhagia:
Dysmenorrhea:
Abnormal uterine bleeding:
Dysmenorrhea:
PMS and PMDD:
Minimal access surgery (MAS) is a surgical approach that can be used within many areas of gynaecology, including reproductive medicine, urogynaecology, gynaecological oncology and benign gynaecological surgeries. MAS does not involve open surgical techniques, which with them require longer recoveries and chances of complication. MAS techniques used keyhole surgical methods such as laparoscopy and hysteroscopies. Often MAS can be carried out as a same-day or outpatient clinic procedure.
The following conditions might require MAS:
Diagnostic hysteroscopy –
Operative hysteroscopy –
Complex operative laparoscopy can be used to treat –
Hysteroscopy:
Laparoscopy:
Hysteroscopies are a day-case procedure and no stay at the hospital will be required. Before the hysteroscopy you will be tested to check for suitability (you cannot have a hysteroscopy if you are pregnant), you will be advised to stop smoking if you are going to have general anaesthetic. If you are having fibroids removed, then you might be prescribed medicine to reduce their size first.
As laparoscopies are carried out under general anaesthetic, you won’t be able to drink or eat up to 12 hours prior to surgery. You may need to stop taking certain medications and to stop smoking.
After a hysteroscopy, you can normally return home the same day, or at least until the anaesthesia has worn off. It is normal to feel cramps that are similar to menstrual cramps for a few days, and you might also experience some light bleeding. Most women feel they can return to work after a day or two.
Recovery from a laparoscopy varies and depends on why the laparoscopy was carried out. If the procedure was diagnostic, you can usually return to normal activities within a few days. If you had treatment during the laparoscopy, then recovery is likely to take up to 12 weeks.
Miscarriage, or pregnancy loss, is when an embryo or foetus is naturally lost before being able to independently survive, in the first 23 weeks of the gestation period.
Sometimes the cause of miscarriage is unclear, and miscarriages can happen for many reasons. Most miscarriages are not affected by the woman herself, and most miscarriages are one-off events. Having a miscarriage does not necessarily mean you will not be able to have a successful pregnancy in the future.
Miscarriages which occur in the first trimester (i.e the first 3 months of the pregnancy) can be caused by abnormal chromosomes, which mean the baby does not develop properly. There may also be a problem with the development of the placenta, which can also lead to miscarriage.
After the first trimester, a miscarriage may occur because of health issues in the mother, or because of an infection which causes the waters to break. Food poisoning and certain medications can also increase the risk of miscarriage.
The commonest sign of miscarriage is vaginal bleeding. The bleeding may occur over several days, and can come in the form of spotting, heavy bleeding, or passing bright red clots. This bleeding can come and go, and because vaginal bleeding can occur lightly during the first trimester of pregnancy, it doesn’t necessarily indicate miscarriage. Speak to your healthcare provider or GP if you experience vaginal bleeding during pregnancy.
You may also feel:
Most miscarriages cannot be prevented, however there are certain activities or states which can increase the risk of miscarriage. Risk factor is increased if:
After a miscarriage, it is normal to feel an emotional impact. The miscarriage can affect not just you, but family and friends around you. Support is available for those who have lost a baby in miscarriage. Speak to your GP for advice, and you may be able to find a counselling group or counsellor who can help you and your family through what can be a difficult time. The NHS can help you to find bereavement support services in your area, or you may choose to visit a private qualified therapist or psychologist.
A multiple pregnancy is a pregnancy that involves the development of more than one foetus in the womb, resulting from the fertilisation of two or more ovules. Children who are the result of a multiple pregnancy can be identical twins (sharing the exact same set of genes) or non-identical twins (born from two eggs released at the same time).
The rate at which identical twins occur is the same across the world, but the rate of non-identical twins varies from country to country, due to the age and ethnicity of the mother. In the UK, 16 in 1,000 births involve multiple pregnancy , 98% of which are twins.
The symptoms that distinguish a multiple pregnancy from a normal pregnancy include:
The main factors related to multiple pregnancy are:
Fertility treatment in the form of IVF is a major risk factor for multiple pregnancy – with 24% of successful IVF procedures resulting in multiple pregnancy.
Treatment is based on a more controlled consultation throughout pregnancy since it is a type of pregnancy that carries more risks than normal. This check-up may involve:
Multiple pregnancy carries the greater risk of a range of conditions including:
A myoma, commonly known as a fibroid, is a benign growth that forms on the uterus. While some women demonstrate symptoms such as abdominal or back pain, many women experience no symptoms at all.
Prenatal testing are a series of screening tests done to assess the risk of chromosomal abnormalities or birth defects for the baby. These tests are usually carried out from 10 weeks, or between 14 and 18 weeks. Prenatal testing include:
Depending on the test done, it may be done via ultrasound (to check size, structural abnormalities, signs for Down syndrome), blood tests (to check for chromosomal abnormalities or foetal protein deficiencies), CVS (a small sample of placenta tissue is taken to check for genetic abnormalities), glucose screening (to check for gestational diabetes), amniocentesis (amniotic fluid is tested to check for genetic abnormalities) and lastly group B Strep screening (bacteria from the mouth, throat, intestinal tract and vagina are tested as GBS can be harmful to babies on birth).
These tests can determine if there are any chromosomal abnormalities present. Most are non-invasive, however, CVS and amniocentesis are invasive. CVS requires a sample of placenta being taken either through the cervix or through the belly. Amniocentesis involves taking a sample of amniotic fluid from the uterus using a needle inserted through the belly or vagina.
There is no need for any special preparation for most prenatal screening.
Most prenatal screening does not cause pain or discomfort, however, during an amniocentesis you may feel menstrual-like cramps after the procedure. This is the same for CVS with side effects of cramps and slight spotting.
If your tests have positive results, then you may be required to have further diagnostic tests which can be slightly more invasive.
Osteoporosis, meaning “porous bone”, is a disease in which the bones become weak and brittle due to the body either losing too much bone or making too little. On a microscopic level, the structure of healthy bone resembles a honeycomb, with hollows and spaces. In bones affected by osteoporosis, these hollows and spaces are much wider, meaning the bones are less dense, and therefore weaker than they should be. This makes them susceptible to breaks and fractures.
Most of the time, a person will not realise they have osteoporosis until they break or fracture a bone. The hip and wrist are the most common places that fractures occur, while spinal fractures are also relatively common.
Stooped posture (in older people) and particularly significant loss of height (>2 inches) should always prompt investigation for osteoporosis.
The DEXA or DXA scan is a reliable method to measure bone mineral density using a low-intensity X-ray. It is painless, straight-forward, and involves minimal radiation – in fact, the operator sits in the same room as the patient. After the scan is done, the results are compared to that of a young, healthy individual, and based on accepted criteria a diagnosis of osteoporosis may be made.
Losing bone is a natural part of getting older, but some people will lose bone density faster than others. In general, women have a higher risk of getting osteoporosis than men, especially in the years following the onset of the menopause, when bone density is lost more rapidly.
Things that can increase the risk of osteoporosis include:
While it is impossible to prevent a condition like osteoporosis with 100% certainty, you can lower the risk of getting the disease by taking steps in your lifestyle to keep your bones healthy:
Treating osteoporosis revolves around treating fractures caused by the condition and trying to improve bone strength, which may involve medication. Your doctor will advise you on treatment depending on the results of your DXA scan and the cause of your osteoporosis.
Most of the therapies available slow down the rate of bone loss and decrease fracture risk except for parathyroid hormone analogues which effectively stimulate bone formation.
Possible treatments include:
Endocrinologists and rheumatologists treat osteoporosis.
The ovary is the organ which produces eggs in women. These eggs then travel to the uterus through the fallopian tubes during ovulation. Sometimes epithelial cells or germ cells inside the ovaries multiply excessively, generating a tumour mass inside the ovary itself.
There are several kinds of ovarian cancer:
The symptoms of ovarian cancer can be difficult to recognise, particularly early on, since in the early stages this kind of tumour is asymptomatic, and symptoms are similar to a number of other conditions. Symptoms can include:
The most common tests to make a diagnosis are:
It is not clear yet what exactly causes ovarian cancer, but the following factors may increase your risk of getting ovarian cancer:
Compared to the general female population, women who have had children, women who have breastfed and women who take the combined contraceptive pill have a lower risk of getting this kind of cancer.
Although you cannot prevent ovarian cancer, the best way to minimise the impact of the condition if it develops is to get an early diagnosis. If you think you may be at a higher risk of ovarian cancer, an annual gynaecological check-up may increase your chances of detecting it early on.
The most common treatments for ovarian cancer are:
You’ll see a gynaecologist for your first examination. If you are diagnosed with ovarian cancer, the doctor will advise you to see an oncologist.
A cyst is a closed sac which occurs in the body’s tissue – in the case of ovarian cysts, they are fluid-filled sacs which grow on the ovaries in women. They are common and usually are symptomless, but they can occasionally cause problems. Most cysts clear on their own and you are unlikely to need treatment for them.
The cause of cysts can differ, depending on the type. Functional ovarian cysts occur because of the menstrual cycle, and are common if you haven’t yet been through the menopause. In a woman’s body, eggs are formed inside the ovaries in something called a follicle. When the follicle doesn’t release the egg as it normally does each month, or if the fluid inside it is not released, it can swell – which causes the cysts. This type of cyst is benign, meaning it is non-cancerous.
Pathological cysts, on the other hand, can develop both before and after menopause as they are caused by abnormal cell growth. Sometimes these cysts can be cancerous.
Certain conditions can also cause cysts to form, including endometriosis and PCOS (polycystic ovary syndrome).
Ovarian cysts may not cause symptoms at all, but if they do, you may experience symptoms such as pelvic pain, bloating, and a feeling of heaviness within the abdominal area.
Most cysts go away on their own and your doctor will adopt a ‘watchful waiting’ policy, which means the cysts are monitored and checked at a later time to see if they have indeed gone. If scans show the cyst has gone, treatment is not necessary.
However, if cysts are causing symptoms, or if they are particularly large, then treatment may be necessary. Cysts can be removed through surgery, which is often performed as a minimally-invasive procedure. If the cyst needing removal is cancerous, then additional tissue may need to be removed, and in some cases, both ovaries and the womb.
If the cysts are caused by an underlying condition, then the condition itself will also be treated or managed.
Ovarian stimulation is a treatment used before other assisted conception procedures to both induce ovulation and to increase the number of eggs released. This can increase the chances of a pregnancy happening. Ovarian stimulation can be done either with medications, or it can be done using injections. Ovarian insemination may precede artificial insemination or in vitro fertilisation (IVF).
Ovarian stimulation is performed to increase the number of eggs released in ovulation. If done before artificial insemination, this increases the chances of the inseminated sperm of reaching the fallopian tube and fertilising an egg. It is done before IVF so that more than one egg is retrieved during egg retrieval. This allows more than one egg to be mixed with semen in a laboratory setting to increase the chances of a viable embryo forming for transferring.
The treatment consists of putting an injection of follicle stimulating hormone (FSH) and/or luteinising hormone (LH), given usually 8-10 days after the end of the last period. The goal is to help the ovaries produce one or more eggs for release. Ovarian stimulation may also consist of taking medication orally instead. Once ovulation occurs and one or more eggs are released, either egg retrieval for IVF can take place, or artificial insemination can be carried out.
Ovarian stimulation does run the risk of ovarian hyperstimulation syndrome occurring (OHSS) where the ovaries become painful and swollen. This is more common when ovarian stimulation is being performed with injected hormones. Symptoms of OHSS can include nausea, vomiting, tenderness around the ovaries and abdominal pain.
Pelvic congestion syndrome (PCS) is a chronic condition in women that causes a persistent dull pain in the pelvic area. It is thought to be caused by varicose-type veins that have developed in the pelvic area. It is these dilated ovarian and pelvic veins that are thought to contribute to chronic pelvic pain in some women.
PCS is not life-threatening, but it can affect your quality of life if you are having to deal with chronic pain and the resulting symptoms. However, the symptoms of PCS do vary in severity, so being diagnosed with PCS does not mean you will definitely experience the range of symptoms and pain. Treatments are available to make the symptoms more manageable.
The main symptoms of PCS include:
PCS can be hard to diagnose, but an ultrasound is often first used if it is suspected. CT and MRI scans may also be used to assess the pelvic region for enlarged veins. A laparoscopy may be required to examine the pelvis.
The exact cause of PCS is unknown but a hereditary element is thought to be important, and women whose mother experienced PCS are more likely to develop this condition. Women who already have children are also more likely to develop PCS and it is thought that pregnancy could play a role in the development of pelvic congestion syndrome. This is because during pregnancy hormone changes and alterations in the woman’s pelvis are thought to weaken surrounding blood vessels, increasing their likelihood of becoming swollen and dilated.
Treatments for pelvic congestion syndrome aim to provide relief and to alleviate the symptoms. Chronic pain can be alleviated with certain pain medications and NSAIDs (nonsteroidal anti-inflammatory medications), however, long-term these aren’t always appropriate. Embolisation of the pelvic veins has also shown promise in alleviating the symptoms of PCS. Embolisation blocks the veins thought to be causing the most pain and discomfort.
Obstetricians and gynaecologists, vascular surgeons and interventional radiologists would treat pelvic congestion syndrome.
Pelvic floor reconstruction is a surgical procedure involving the repositioning of the internal organs of the female pelvis.
The goal of pelvic floor reconstruction is to position pelvic structures in a manner that corrects urinary and/or faecal incontinence, pelvic disease and pelvic symptoms while preserving sexual function.
Pelvic floor reconstruction is performed to achieve correct positioning of the internal organs of the female pelvis: uterus, bladder and rectum. The procedure involves placement of a polypropylene mesh.
There are different ways to perform it: vaginal route, abdominal route, laparoscopically (minimally invasive) or a combination of these.
The vaginal route is the most common.
Before undergoing pelvic floor surgery, it is advisable to undergo a course of vaginal physiotherapy to strengthen the musculature of the area for the intervention.
When performed as minimally invasive surgery, the surgical procedure is shorter and recovery is faster. You can resume your normal routine one week after the operation. If the surgery is performed through the vaginal or abdominal route, your surgeon will advise what type of post-operative care is necessary and how long you will need to rest.
Pelvic floor rehabilitation , or pelvic floor therapy, involves strengthening the muscles around your bladder, vagina or penis, and back passage. It is performed by physiotherapist with specialist training in bladder, bowel and pelvic problems.
Pelvic floor therapy is often recommended as a treatment for women who have given birth and as a result experienced a tear or weakening in their pelvic muscles. However, pelvic floor therapy can also be helpful for men and women experiencing:
It may also be recommended if you have had surgery on your pelvic floor and the muscles have been weakened as a result.
Pelvic floor therapy is carried out by a specialised physiotherapist and generally involves a series of appointments.
The first appointment will include an assessment. This takes place in a private setting, where the physiotherapist carry out an examination of your pelvic floor to get an idea of the strength of your muscles.
In women, this involves putting a finger into the vagina and feeling the vaginal walls near the bladder. You should let the physiotherapist know if you might be pregnant, have any form of vaginal infection, or have an allergy to latex.
You will only have an examination if you have given your consent.
Following the assessment, there are a number of treatment options:
You don’t need to bring anything or wear any special clothes, but it is always helpful to have a list of any medication you take.
Pelvic inflammatory disease is an infection of the female reproductive organs, including the womb, fallopian tubes and ovaries.
Most women with pelvic inflammatory disease experience mild symptoms, such as:
In severe cases, pelvic inflammatory disease can cause:
If you are experiencing severe abdominal pain or a high fever, you should seek emergency medical treatment.
Diagnosis of pelvic inflammatory disease is complex. At first, your doctor will ask you about your symptoms and may carry out a pelvic exam.
Swabs may then be taken from your vagina and cervix to be tested in the laboratory.
Finally, you may be referred for an ultrasound or laparoscopy for further examination.
Pelvic inflammatory disease is a common disease mainly affecting sexually active women under the age of 25. It occurs when bacteria enter the upper genital tract through the cervix.
The most common way to become infected is through unprotected sex with someone carrying a sexually transmitted infection (STI) such as chlamydia or gonorrhea. However, it can also occur when bacteria which normally live in the vagina spread to the organs higher up, which can happen after childbirth or a miscarriage.
It’s possible to reduce your risk of pelvic inflammatory disease by always using condoms with a new sexual partner, unless you know they have had a sexual health check and are free from an STI.
If you are at risk of an STI, it’s important to visit your local sexual health clinic for a test. The earlier any STIs are treated, the more likely you are to avoid PID.
Treatment involves taking antibiotics to fight the infection. This is generally effective, providing you complete the entire course of antibiotics. In cases where you have more severe symptoms or the antibiotics aren’t working, you might need to stay in hospital to have antibiotics given to your intravenously.
The earlier you treat pelvic inflammatory disease, the less likely it is to damage your womb or ovaries.
Pelvic pain occurs in the lower abdomen. In women can occur during menstruation or during intercourse. It may be a sign that there is a problem in the pelvic organs such as the uterus, ovaries, fallopian tubes or the vagina. To discover the cause of the pain suffered by the patient, several clinical tests must be performed, and the treatment of pelvic pain depends on the results. Women may also experience an infection of the lining of the uterus, fallopian tubes or ovaries called pelvic inflammatory disease (PID), which is caused by bacteria that cause chlamydia and gonorrhea.
Pelvic pain syndrome is considered chronic if it lasts for more than six months, and must be assessed by a specialist as it can have multiple causes and possible treatments.
Period pain is a normal part of the menstrual cycle and most women experience it at some point in their lives. It is felt as painful muscle cramps in the lower abdomen that can sometimes spread to the back and thighs.
Period pain usually starts on the first day of the period, although many women experience pain a few days before. It normally lasts between 48 and 72 hours, but this can vary.
The cramps can vary in intensity with each monthly period. Sometimes the pain can come in intense spasms, while other times it can be dull and constant. Many women experience less pain with age and after having children.
The most common symptoms include:
Sometimes women experience:
Normally period pain is light to intense muscle cramps every month around the time of the period. However, if periods become irregular, heavier and other symptoms present, like foul-smelling vaginal discharge and bleeding between periods, your GP may want to carry out a pelvic exam to rule out other conditions.
Period pain occurs when the muscular walls of the womb or uterus contract. When the wall of the uterus contracts, it compresses the blood vessels in the lining of the womb and this cuts off the oxygen and blood supply to the womb. When the tissues in the womb have no oxygen, they release chemicals that cause pain and inflammation. These chemicals are called prostaglandins.
The contractions occur to allow the lining of the womb to shed, which causes monthly bleeding.
Period pain is a normal part of the menstrual cycle, however, sometimes the pain can be accompanied by an underlying medical condition. These can include:
If period pain is caused by an underlying medical condition, the following symptoms may be experienced:
If you experience any of the above symptoms, it’s important that you make an appointment with your GP.
Painkillers such as ibuprofen and aspirin and paracetamol can help. However consult your doctor if you have stomach, kidney or liver problems. Aspirin should not be given to anyone under the age of 16. If cramps are very bad, your doctor may prescribe stronger painkillers.
A combined contraceptive pill may be prescribed, as this thins the lining of the womb, leading to fewer contractions and lighter periods. Contraceptive injections or implants are also an option.
Natural measures that help to relieve the pain:
If period pain is caused by an underlying medical condition, then the treatment will depend on the condition. Fibroids may require surgery, or a bacterial infection may require antibiotics.
If your periods are heavier or more painful than normal or you experience symptoms of an underlying medical condition, as mentioned previously, consult your doctor for correct treatment.
Polycystic ovaries is a condition that occurs when there is an imbalance in the female ovaries or adrenal glands so they produce more male hormones than normal. The result is the development of cysts (tiny fluid-filled balloons) in the ovaries. Women can develop the syndrome during the teen years or reproductive age, being more common in obese women. Although sometimes there are no symptoms, some symptoms the patient may experience include irregular, infrequent or absent menstrual periods, infertility, pelvic pain, excess hair on the face, chest, abdomen and fingers, hair loss or weak hair, acne, oily skin or dandruff. Birth control pills can help regulate the period and reduce male hormone levels, so this is the treatment usually prescribed for polycystic ovaries. When the ovaries produce multiple small cysts (no more than 1 cm in diameter), it is micropolycystic ovaries syndrome, which usually has the same symptoms. Likewise, the treatment for micropolycystic ovaries may also be based on the administration of the contraceptive pill.
Polyps are abnormal tissue growths. They can form in different parts of the body:
Polyps are a common problem and most of them are benign, although some types have been linked to cancer.
What is postpartum haemorrhage?
Postpartum haemorrhage is the heavy bleeding that occurs following the birth of a baby and is considered an emergency complication of childbirth. It is estimated that 1 to 5 percent of women may experience excessive bleeding, which is more common following a caesarean birth.
A minor postpartum haemorrhage is defined as a loss of 500ml to 1000ml of blood, whilst a major postpartum haemorrhage is defined as over one litre of blood, and if there is a blood loss of over two litres it is severe. It can lead to anaemia and is a leading cause of maternal death. Postpartum haemorrhage usually happens just after birth but it can occur up to 12 weeks after giving birth.
What causes postpartum haemorrhage?
Normally once a baby is delivered, the uterus continues to contract and tighten and expels the placenta. Once the placenta is delivered, the contractions help compress the bleeding vessels where the placenta was attached. If the uterus does not tighten strongly enough, the blood vessels bleed freely, which create the haemorrhage. Bleeding is also likely if small pieces of the placenta remain attached. Some women are more at risk than others.
What are the symptoms?
The most common symptoms include:
• Uncontrolled bleeding
• Drop in blood pressure
• Increased heart rate
• Decrease in red blood cell count
• Swelling and pain in the tissues inside the vaginal and perennial area, if the bleeding is due to a hematoma.
What conditions make some women more prone to the risk of postpartum haemorrhage?
The following conditions may increase the risk of postpartum haemorrhage:
• Placental abruption
• Placenta Previa – the placenta covers the cervical opening.
• Excessive enlargement of the uterus due to too much amniotic fluid or a large baby.
• Multiple pregnancies
• Preeclampsia
• Prolonged labour
• Infection
• Obesity
• Medications that were used to induce labour.
• General anaesthesia
How is it diagnosed?
The tests used to diagnose postpartum haemorrhage include:
• An estimation of how much blood loss has occurred – this is done by counting the number of saturated pads used to absorb blood.
• Heart pulse and blood pressure are measured.
• Red blood cell count is made.
• Examining of clots in the blood.
How is postpartum haemorrhage treated?
The treatment is to find and stop the cause of the excessive bleeding immediately. This may include:
• Medication
• Manual massage of the uterus, which stimulates contractions.
• Removing the remaining placental pieces in the uterus.
• Examining the uterus and pelvic tissues.
• A Foley catheter to compress the bleeding inside the uterus.
• Uterine compression sutures.
• Laparotomy surgery, to open the abdomen and find the cause of the blood loss.
• Hysterectomy, this surgical procedure to remove the uterus is a last resort.
Pre-eclampsia is a condition that causes high blood pressure in women, usually from the 20th week of their pregnancy.
Normally, a pregnant woman with pre-eclampsia may not initially feel ill, but will show signs such as:
If the pre-eclampsia is severe, the following symptoms may be present:
The exact cause is not known, but it may be related to the following factors:
There are no proven strategies for preventing pre-elampsia. However, it is thought that taking aspirin in low doses, calcium supplements and products with vitamins E and C helps to reduce your risk. If you suspect you might have pre-eclampsia you should see your doctor to ensure you are monitored properly and any complications if they occur are managed.
A diagnosis of pre-eclampsia is made on your blood pressure levels and the presence of at least one other symptom (listed above). You may be referred for tests such as blood tests or urine tests to gather the necessary information.
The only current “cure” for pre-eclampsia is delivery, through an induced pregnancy or ceasarean.
In order to avoid a delivery too early, your doctor will consult with you about how the condition can be managed temporarily. In the case of mild preeclampsia, you may only need medication to lower your blood pressure. In more severe cases, corticosteroids may be offered to improve your liver and platelet function, as well as anticonvulsant medication to prevent seizure. In the most severe cases, you may need to stay in hospital to receive regular monitoring of your own health and the health of your baby.
Pregnancy is the physiological condition of a woman, starting from the moment of conception of the foetus and goes on with the baby’s growth, until birth. Pregnancy is usually categorised by weeks (for a total of 40) and lasts around 280 days. Under particular circumstances, the baby can be born before (premature birth) or after the estimated due date.
Conception is the result of the semen entering the woman’s reproductive system. The spermatozoa in the semen then travel through the cervix to the Fallopian tubes. The ovum or egg, which can be found in the Fallopian tubes, is then fertilised by a sperm and undergoes a series of cellular divisions while it travels to the uterus.
Once it has reached the uterine cavity, the fertilised egg adheres to and penetrates into the uterine lining (the endometrium). From that moment on, the foetus starts developing.
Women’s fertility reaches its peak during ovulation, when the egg moves towards the Fallopian tubes. This time frame can last up to six days and it is known as ‘fertile window’.
Gestation usually lasts 40 weeks, which is the time it takes for the baby to develop. The first eight weeks are really important because at that time the baby is developing the organs he or she needs to survive. The mother will have symptoms such as nausea, irritability, fatigue and enlarged breasts.
Between weeks eight to 13, the mother’s body will start changing; the baby’s genital organs will differentiate and the vocal cords will be formed. At that time, the most critical part of the pregnancy is over, leaving behind most risks of abortion or health problems for the baby. So, the second trimester of pregnancy begins.
From week 13 to 17, the mother will feel less tired and the nausea will go away; the baby is now fully formed.
From week 17 to 21, the mother will start feeling the first movements of the baby.
Between weeks 21 to 26 the mother’s belly will become more evident and she will start feeling the first uterine contractions; at the same time, the baby’s weight will increase, the eyelids will start opening and closing and he or she will start trying to breathe.
Week 26 is the beginning of the last trimester. The baby will keep on growing and between weeks 30 to 35 he or she will change position in order to get ready for birth; the mother will start suffering from intense back and abdominal pain and the uterine contractions will become more frequent.
During the last month of gestation (weeks 35 to 40), the baby will be fully developed and will start turning upside down, with the head towards the pelvic cavity.
Labour is when the baby leaves the mother’s body. It can happen in several ways:
Natural: also known as vaginal birth or spontaneous birth;
Caesarean section or C-section: carried out if baby is in the breech position (feet first), if the mother has a low-lying placenta (placenta praevia), if the baby is in distress, if it’s a twin pregnancy, if the mother has had uterus surgery before or if either the mother’s or the baby’s health is in danger. A C-section can be planned, or it can be chosen as an emergency measure;
Induced birth: if it is two weeks past the due date and the baby is not out yet, and either the mother’s or the baby’s health is in danger, delivery can be induced manually or by administering oxytocin and giving an epidural to the mother.
Pregnancy is a very delicate period both for the future mother and for the baby: that is why they both need to be assisted throughout this whole journey. It is important to see a specialised obstetrician/gynaecologist, who will be able to give you more information about pregnancy, what are the related risks and symptoms and what to do so that both you and your baby will be perfectly healthy.
With any pregnancy, whether it is planned or unplanned, there is an element of expected stress and anxiety. It can be normal to experience some stress during a pregnancy, however, in some cases these feelings can manifest as antenatal depression or other mental health issues. Pregnancy counselling can help expecting mothers with these feelings, and make their pregnancy more manageable. Pregnancy counselling will also be offered to women who have had miscarriages or abortions, or who have had traumatic births.
The following are the most common reasons why pregnancy counselling would be recommended:
Pregnancy counselling will involve talking to a specialist in a private setting. The specialist will help talk through the patient’s concerns and offer support and coping mechanisms.
Preimplantation genetic diagnosis is a technique used in in vitro fertilisation treatments that allows the selection of embryos in order to avoid of genetic and chromosomal diseases. This technique is authorised for the detection of serious hereditary diseases which show early in embryonic development and for which there is still no cure. In these cases, the preimplantation diagnosis allows the selection of fertilised ovules where the embryo is exempt of genetic diseases before being transferred to the uterus. The diagnosis is made from the analysis of one of the cells of the embryo to determine if it is a carrier or not of a mutation of a particular gene; it can then be selected or discarded for implantation. In this way, the chances of success of in vitro fertilisation treatments are improved and the risk of abortion is reduced.
Any labour and birth that occurs before the 40th week of pregnancy is considered to be premature or preterm. Usually a pregnancy lasts around 40 weeks. If labour and delivery happen between the 20th and 37th week of gestation, it is considered premature.
There are several kinds of premature birth:
Babies born before full term tend to have a low birth rate and other symtoms depending on how early they are born.
It is important that the foetus stays in the uterus as long as possible, so that the organs will develop correctly (especially the lungs, brain and heart). The earlier the baby is born, the more severe the consequences will be. The baby, once born, may have respiratory problems, heart conditions, neurological conditions, gastrointestinal tract conditions, metabolic or immune system disorders.
From the 37th week on, the baby has everything he or she needs to be considered a fully developed foetus. However, this doesn't exclude the possibility of complications.
The possibility of premature birth is linked to some elements in your pregnancy and medical history:
It is important to go to all your scans and checks during the pregnancy - especially those during the 31st and 32nd week, such as the transvaginal ultrasound, which can detect whether you have cervical insufficiency (your cervix is smaller than 2.5 or 2 centimetres). Cervical insufficiency is one of the main causes for spontaneous premature birth.
Premenstrual syndrome, more commonly known as PMS, is the name for the symptoms that women experience before getting their monthly period. Many women experience PMS, and symptoms vary from women to woman, though in some it can be more severe, affecting their daily life to the extent where they must seek medical help.
The causes of PMS are not fully understood. It is thought that it may be due to changes in the hormone levels which occur at some point over the menstrual cycle. However, it is not clear why this affects some women more than others.
Symptoms can vary from woman to woman, and even in the individual from month to month. Symptoms include:
PMS can be managed at home or through lifestyle changes. It’s important to get regular exercise and keep to a healthy, balanced diet. Symptoms of stress and anxiety can be managed through activities such as yoga or meditation. Pain caused by PMS can be reduced through over-the-counter painkillers, e.g ibuprofen.
You should see a doctor if your symptoms are affecting your daily life, and the measures you are taking to manage your PMS are not working. It helps to keep a symptom diary when you experience PMS, so you can show your doctor or specialist your frequent symptoms.
If symptoms are severe, you may be referred to a specialist. Recommended treatments and coping measures may include:
Prenatal diagnosis is a set of tests that are carried out during pregnancy and allow us to monitor the formation and development of the foetus.
There are different techniques, both invasive and non-invasive. Some of the tests are commonly performed on all women, while others are performed depending on the state and development of the mother and foetus.
In prenatal diagnosis, the gynaecologist will ask the mother several questions and review her medical history and family history, which may influence her health during pregnancy.
To control the health and development of the mother and the foetus, different clinical tests and diagnostic imaging tests will be performed. The main tests are:
The objective of prenatal diagnosis is to monitor the development of the foetus, as well as to detect and prevent possible diseases and deformities. Thanks to prenatal diagnosis tests and reviews, parents can anticipate what their baby's state of health will be like before birth.
Most tests to be performed during prenatal diagnosis are imaging tests such as ultrasound, which are painless. The tests are designed not to cause side effects or discomfort in the mother. In addition, it is a series of procedures that allow parents to know in depth the growth process of their future baby.
If any of the tests of the prenatal diagnosis provides abnormal results, it may be because the foetus is not developing correctly and may have some disease or deformity. In case any test indicates a risk of anomaly, more tests will be performed to rule out or confirm the problem and, if possible, prevent it.
The term “childbirth preparation” encompasses a range of tools that help parents-to-be prepare for the birth of their child from the start of pregnancy. They usually take the form of talks providing information about foetal development and medical check-ups; psychological aspects of pregnancy, birth and the postpartum period; what happens during childbirth; breastfeeding etc. In practical sessions, a specialised instructor shows pregnant women postures and exercises that will help make muscle structures more elastic in order to facilitate childbirth, as well as breathing and relaxation techniques to provide them with better self-control during labour contractions.
Pregnancy is a period of major adaptation for future parents, who should be aware that they are nurturing a new life and that they are responsible for their future child’s health and wellbeing, and they should be informed about the changes that the mother will experience and that pregnancy is ultimately an enriching experience. It also helps future mothers be better prepared during delivery, by working on elasticity, better postures for childbirth and control of contractions.
Childbirth preparation sessions are imparted by a specialist in obstetrics and gynaecology at hospitals, social and educational facilities or health centres. The pregnant woman can attend by herself or with their partner or companion. Sessions are usually between 1 and 2 hours. They are held over a period of 5 to 8 weeks, usually from the first trimester.
There are theoretical and practical sessions:
Pregnant women should obtain information about the various childbirth preparation courses available to them, as well as the techniques to be done in them. Childbirth preparation courses are based on several techniques, of which the most commonly used are:
Childbirth preparation is not compulsory. It is undertaken by future parents who want to be better informed and prepared for pregnancy and delivery. Alongside the childbirth preparation course, the pregnant woman must also be under the care of a specialist in obstetrics and gynaecology who will monitor her pregnancy and provide individualised care.
Psychosexual Therapy - Psychosexual Therapy involves the examination of the body and the mind to understand the physical and emotional factors that can sometimes cause sexual difficulty. It is brief interpretive therapy using history and examination to explore unconscious thoughts and feelings. 20% of women attending gynaecology clinics have psychosexual difficulties which can include painful sex, vaginismus (persistent involuntary contraction of vaginal muscles), pelvic pain, vulvodynia, persistent unexplained vaginal discharge, non-consumation and tokophobia (fear of childbirth).
What is rectocele?
Rectocele, also known as posterior vaginal prolapse, is a condition in which the tissue wall between the rectum and vagina weakens. This allows the vaginal wall to bulge. Childbirth and processes that put pressure on pelvic tissues can lead to rectocele. Self-care measures are often very effective but severe rectocele may require surgical repair.
What are the symptoms of rectocele?
A woman may notice pressure within the vagina, or that her bowels do not feel empty after having used the bathroom. In moderate cases, when trying to push the stool out through the anus may push it into the rectocele instead. This can cause pain and discomfort and creates a higher chance of having constipation. It could also lead to pain during sexual intercourse. More severe cases include vaginal bleeding and sometimes the rectocele bulge may prolapse through the vagina mouth or through the anus. Most of the time, many women have a rectocele but do not notice all of the symptoms.
What causes rectocele?
The commonest cause of rectocele is childbirth, especially if the baby is heavy, or if the birth happens quickly. The muscles, ligaments and tissues in the vagina become stretched and weakened during pregnancy, labour and delivery. If a woman has had more than one vaginal birth she is at a higher risk of developing rectocele. Women who have never given birth can also develop a posterior vaginal prolapse. Rectocele occurs as a result from pressure on the pelvic floor. Increased pelvic floor pressure can be caused by constipation or straining with bowel movements, chronic coughing, repeated heavy lifting or obesity.
What are the risk factors of rectocele?
The following factors may increase the risk of rectocele:
How can you prevent rectocele?
To reduce the risk of worsening rectocele, a woman can:
When should you see a doctor?
Rectocele is a common condition in both women who have had children and those who have not. It is recommended to see a specialist if suffering from chronic constipation and if there is a bulge of tissue that protrudes through the vaginal opening.
Recurrent or repeated miscarriages are when a woman has miscarried on three or more consecutive pregnancies.
Miscarriage (also referred to as pregnancy loss) can be devastating if it happens once; sadly some individuals miscarry on multiple occasions, and if three or more consecutive pregnancies are lost a diagnosis of recurrent miscarriage can be made. At this point, further tests are often conducted to find what is causing the pregnancies to be lost.
There are several factors that can lead to repeated miscarriages:
Most pregnancies are monitored to an extent, with most UK hospitals offering at least two ultrasound scans during a pregnancy, as well as regular prenatal check-ups. These measures often pick up irregularities in the pregnancy; however, if a woman suffers several miscarriages, a closer examination may be needed.
After recurrent miscarriages, certain tests and scans are usually offered to try to identify the problem. These tests include:
If a cause is discovered, the doctors and patient can work to counter it to try to prevent further miscarriages. For instance, some blood clotting disorders can be treated with medication, while a weakened cervix can be strengthened with a small stitch of strong thread (cervical cerclage) carried out once the patient is pregnant again.
Measures such as maintaining a healthy weight and avoiding harmful substances including alcohol and tobacco also lower the risk of miscarriage.
A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse.
Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease.
In addition, there are certain situations where a second medical opinion is sought after:
The aims of obtaining a second medical opinion are:
Possible disadvantages of seeking a second medical opinion include:
You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion.
Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals.
Sexual health in men and women is vital to overall well-being and can have pathological, physical, psychological, or lifestyle related components.
Sexually transmitted infections (STIs) are a set of infectious diseases that are transmitted from one person to another through sexual contact (vaginally, anally or orally). There are numerous types of STIs, including:
Sexually transmitted infections can cause symptoms, although not always. Some patients may experience the following symptoms:
The cause of sexually transmitted infections is either bacteria, parasites, fungi or viruses.
Abstinence is the only way to completely prevent STIs, however, making sexual contact safer will also reduce the possibility of contracting an STI. If used properly, condoms can provide effective protection against many STIs. However, whilst condoms protect you from contact with fluids (semen or blood), they may not protect you from skin-to-skin transmission. It is also a good idea to have regular STI health checks if you are sexually active, to allow for early diagnosis and treatment and to stop the spread of STIs among the population. It is also a good idea to have the HPV vaccine, which is currently offered to girls at school.
Not all sexually transmitted infections can be cured. Those that are caused by bacteria, such as chlamydia, are treated with antibiotics. However, those that are caused by a virus, such as genital herpes, treatment is limited to alleviating the symptoms. STIs such as lice or trichomoniasis can be treated with topical medications.
A hysterosonography (or sonohysterography) is a particular type of transvaginal ultrasound which allows the doctor to analyse the uterine cavity.
It is a minimally invasive procedure: you don’t need to do anything to prepare for it. The hysterosonography is usually carried out in two steps:
This technique can identify uterine abnormalities such as polyps, fibroids, uterine malformations, congenital anomalies, malignant tumours or endometrial adhesions.
What is a sperm bank?
A sperm bank, or cryobank, is found at a fertility clinic. It is a licensed facility where sperm is donated, frozen and stored so that it can be used to help women become pregnant through the process of artificial insemination, or intrauterine insemination (IUI). There are many fertility clinics in the UK that are licensed by the Human Fertilisation and Embryology Association (HFEA), both on the NHS and privately. The waiting list for donor sperm varies with each clinic. A separate license is needed if donor sperm is to be purchased from another country and these fertility clinics may charge more for this service.
What is the sperm donation process at a sperm bank?
The donor is to have screening tests, medical history checks and counselling before they are accepted as a registered donor. The potential donor must supply a sample of semen at the centre, which will be tested against its reaction to freezing and the overall sperm count that is generated each time. If the specimen meets the criteria, the potential donor is invited to another session, where they will be asked to provide another sample of urine and semen. All donors have a thorough assessment, which includes being tested for infectious diseases such as HIV 1 and 2, Hepatitis B and C, and sexually transmitted diseases. The process can take weeks but once completed and accepted they can then donate sperm.
How many times does a person need to donate sperm?
The donor is expected to donate several times over a period of months and maybe even regularly throughout a year. This allows the clinic or facility to build up a good supply of the donor’s sperm. Not all fertility treatments are successful the first time, which means that enough samples must be collected in case the recipient needs to use it more than once, if necessary. Qualified sperm donors are expected to donate at least once a week, but they are encouraged to visit the office two to three times per week.
Why would a sperm donor recipient use a sperm bank?
There a few reasons as to why people choose to use a sperm donor. Couples may use a donor if their partner has a poor semen analysis or if there is a genetic problem, which could be inherited from the male. Single women who want a biological child may also use a donor. LGBTQ couples may consider using a sperm donor in order to conceive.
Who can donate sperm?
A sperm donor must meet specific requirements in regards to their age and medical history. To qualify, the donor will need to meet the following criteria:
Thrush is an infection caused by the proliferation of the fungus candida. It is naturally found in the vagina, mouth, digestive tract and skin, often without causing infection. If the levels of candida get out of balance in the vagina, it can cause unpleasant effects like itching and soreness. Most women have a yeast infection throughout their lives.
Some causes of thrush are:
Directed intercourse or programmed coitus is a treatment consisting of administering a medication, usually by mouth, sometimes with injectable hormones in a very low dose, to induce ovulation.. In this way, the specialist is able to recommend the ideal time a couple should have sexual intercourse to coincide with ovulation.
An ultrasound is a type of scan carried out by a sonographer which uses high-frequency sound waves to create a picture inside your body. A transvaginal ultrasound looks specifically at female productive organs including the uterus, cervix, and vagina, by passing the scanner through the vagina.
A transvaginal ultrasound is an internal examination. Many people are familiar with an ultrasound scan which involves passing a microphone over the stomach to see inside the womb. With a transvaginal ultrasound, the microphone is gently fed through the vagina.
You’ll be asked to lie on your side or on your back with your knees drawn up for the procedure, and you might need to wear a hospital gown. You’ll be able to see the images in real time on a monitor, but the sonographer will also take some still pictures to analyse later. The examination should take about 15-30 minutes.
Transvaginal ultrasound is a safe procedure and there are no side effects.
In pregnancy, a transvaginal ultrasound can be used to:
A transvaginal ultrasound might also be ordered if you have:
You don’t need to do any special preparations for a transvaginal ultrasound, other than emptying your bladder before the exam.
The examination is not painful but might be slightly uncomfortable as the microphone is moved around. The microphone is much slimmer than those used in external ultrasound examinations. It is about the size of a finger, and it is covered with a condom and lubricating gel. You will be able to put it in yourself if you prefer to. After the exam you will be free to go home straight away.
If an abnormal growth is found within the ovaries or uterus, there are a number of things that this could be. Fibroids, a type of benign tumour that can cause abdominal pain, are extremely common. Ovarian cysts are also common, and most go away without treatment. In some cases, however, a tumour might indicate ovarian cancer.
Other issues that can be detected with a transvaginal ultrasound include ectopic pregnancy (see above) and a low-lying placenta, which may or may not need to be treated. The results of the scan should be available within 1 or 2 weeks, and you will be able to discuss them with the doctor who ordered the scan. If a tumour is found inside your ovaries, the doctor is likely to order a biopsy to find out what kind of tumour it is.
Trichomoniasis is a sexually transmitted infection (SIT) caused by a parasite. It can affect both men and women, but does not always caused symptoms.
Thrichomoniasis is the world’s most common non-viral STI, but in the UK there are few cases, and these tend to be clustered in urban areas, in particular London and Birmingham.
Many people with trichomoniasis will experience no symptoms at all. Where it affects women, it can cause:
In men, it can cause:
Finally, both men and women may experience pain when urinating.
In very rare cases, trichomoniasis can lead to complications in pregnant women such as premature birth or a low birth weight.
If you suspect you might have trichomoniasis or another sexually transmitted infection you can visit your GP or local sexual health clinic. They will ask you about your symptoms, examine your genitals and take a swab from the vagina or penis to test in the laboratory.
If you are diagnosed with trichomoniasis and you have a partner, they should also be tested.
Trichomoniasis is caused by a one-celled parasite called Trichomonas vaginalis.
The parasite is usually spread by having unprotected sex, or by sharing sex toys. It can take up to a month after exposure to the parasite to develop an infection.
However, the parasite does not seem to spread through oral sex, anal sex, kissing, hugging or using the same toilet seat.
You’re most likely to get infected if you have multiple sexual partners. If you are infected, your chances of being infected again in the future are higher.
You cannot prevent trichomoniasis if you have sex, but you can reduce your chances of infection by wearing a condom, and always washing sex toys after use.
The most common form of treatment is to take antibiotics for a period of about a wee, usually metronidazole. The dosage will depend on whether or not you are pregnant.
It’s important during this time not to have sexual intercourse or you risk becoming infected again.
Tubal ligation is a surgical procedure performed on some women to close the fallopian tubes which are the tubes that connect the ovaries to the uterus. This procedure is performed as a permanent method of birth control (sterilisation). By closing the fallopian tubes, eggs released from the ovaries are prevented from travelling down them and sperm are blocked from travelling up to meet the egg. This intervention can be performed on an outpatient basis and lasts approximately 30 minutes, or it can be carried out following childbirth. Anaesthesia can be epidural, local or general; depending on each case. This is a permanent procedure and generally cannot be reversed, however, fewer than 1 in 100 women will become pregnant after the procedure.
The goal of this surgery is to prevent access of the eggs to the fallopian tubes and to the uterus, making it a permanent form of contraception. It is usually recommended for women who know for sure that they do not want to become pregnant in the future. Whilst this works as a contraceptive method, it does not protect against STIs and does not affect the menstrual cycle. Another benefit of this method is that it decreases the risk of ovarian cancer.
The surgeon makes one or two small incisions in the abdomen of the patient. Once the surgical instruments are introduced, the fallopian tubes are sealed, either by cauterising them or by using special clips or rings. This surgery can be done right after having a baby or during a caesarean section.
Before surgery you must go on an 8-hour fast of solids and liquids. That day it is important to take the drugs that the doctor has recommended. If you are not having the procedure following childbirth, you will have to complete a pregnancy test to ensure you are not pregnant.
Like any surgical procedure there are risks to be aware of, including:
Tubal ligation does not usually require a hospital stay, but if you have the procedure after childbirth, you will remain in hospital until you are discharged. It is not uncommon to feel some pain, cramping, bloating or dizziness following tubal ligation. You are advised to bathe 48 hours after the procedure, taking care to gently clean the incision.
Ultrasound is a diagnostic imaging procedure that allows you to see organs and soft structures inside the body. At present, they can be 2D, 3D or four-dimensional images. Ultrasound is a non-invasive technique, in which radiation is not used and thanks to this, it is used to visualise developing foetuses.
It is carried out using high frequency sound waves emitted through a transducer that captures the echo of different amplitudes which occurs when they ‘bounce’ off the organs. These signals, once processed by a computer, give a series of images.
With this procedure you can clearly differentiate the shape and size of each structure inside the body. In medicine it is used to see the heart, kidneys, liver and blood vessels, among other organs. In addition, ultrasounds are also carried out on patients who are pregnant. Another function is the study of different tissues of the body such as the blood flow of arteries and veins to detect arteriosclerosis and blood clots. Ultrasounds also allow the analysis of the thyroid gland and other soft structures of the neck as well as tendons, ligaments, muscles and joint structures, and mammary glands.
Usually, you do not need any type of preparation for having an ultrasound. In cases where the area to be examined is the abdomen, the specialist may tell you to drink three glasses of water approximately one hour before the test.
During the ultrasound, the patient will lie on a table or stretcher with the area to be analysed exposed. The specialist will apply a transparent gel that will allow the movement of the roller built into the transducer. During the scan the expert will interpret the images and determine which shots are correct according to each case. The only slight discomfort that can be felt is the gentle pressure that the specialist applies when passing the transducer over the body area. The gel applied can also feel quite cold when applied.
The types of images that are considered abnormal are:
Urinary incontinence is an inability to control the bladder, meaning that urine is unintentionally passed. This is a common problem and can cause embarrassment. It is more common in older people because urinary incontinence is an inevitable part of ageing and it affects both men and women.
The symptoms can vary from a leak of light urine to the abundant and uncontrollable output of it. The type of urine loss will depend on the type of urinary incontinence experienced. The different types of urinary incontinence are:
If you experience frequent bladder incontinence, you should see a specialist as it could be indicative of an underlying health problem, and it can be managed to improve your quality of life and overall confidence.
Women are more likely to suffer from stress incontinence, but men are more likely to have urge and overflow incontinence.
Most control problems occur because the muscles that hold the bladder are too weak or too active. If they are weakened, small amounts of urine are lost when performing actions such as laughing or coughing. However, urinary incontinence is a symptom of either an underlying medical condition, everyday habits or physical problems. Some cases of urinary incontinence are temporary, caused by alcohol consumption, caffeine or medications. It may also result from urinary tract infections or constipation.
Persistent urinary incontinence, however, can be caused by:
Urinary incontinence is a problem that cannot always be prevented, but the following can reduce your risk of developing this problem:
Treatment will depend on the type and cause of your urinary incontinence. Some types can be managed with lifestyle changes (e.g. weight loss or cutting out caffeine), bladder training (learning to wait longer to urinate, guided by a specialist) or pelvic floor exercises (to strengthen the pelvic floor muscles).
The following can also help to manage urinary incontinence:
You may be offered surgery if other treatments have been unsuccessful or unsuitable. The type of surgery will depend on your type of urinary incontinence:
Urinary tract infection (UTI) refers to inflammation in the urinary tract caused by bacteria, the most common type of infection in the urinary tract. An infection occurs when bacteria reaches the bladder (cystitis) or kidneys, multiplying in the urine. If left untreated, the infection may cause permanent damage to the bladder or kidneys.
There are various symptoms of urinary tract infections, including:
There are many factors that increase the probability of a urinary tract infection. Some of these risk factors are:
There is no sure way to prevent UTIs, but there are recommendations for reducing the risk of developing an infection:
Antibiotics are used to treat urinary tract infections. Your doctor may prescribe a single dose of antibiotics or a course of therapy over several days. It is important to follow your doctor’s instructions, even if the symptoms have gone away, because the infection may return.
Womb cancer or uterine cancer is what happens when malignant tumour cells grow in the uterus. The most common type of womb cancer affects the endometrium, the uterus’ internal lining. A less frequent form of uterine cancer is sarcoma, which affects the soft tissues in the uterus.
Statistically, womb cancer mostly affects women between 50 and 70 years old. It is very rare for women under 50 to be diagnosed with the condition. Should the cancer be found in the early stages, when it is still limited to the uterine epithelium, survival rates range between 72% and 98%. The later the cancer is diagnosed, the more it will have spread and the harder it will be to treat it. That’s why it is crucial to get your screening exams done periodically.
The main symptom for womb cancer (in its early stages) is abnormal vaginal bleeding, i.e. any vaginal bleeding between periods. Other symptoms may include painful sexual intercourse, pain in the pelvic area, pain in the bladder area and problems when passing urine.
In order to diagnose you with womb cancer, the doctor will be looking at your medical history first. Then you will have a gynaecological exam, during which you’ll usually have a transvaginal ultrasound. The transvaginal ultrasound is a scan which shows the uterine cavity through a small transducer. If the diagnosis is still unclear, you might have further tests, including:
As of yet, it's not clear exactly what causes womb cancer. According to some studies, higher levels of oestrogen in your body, combined with lower levels of progesterone, could be one of the main reasons behind womb cancer. Statistically, it has been shown that women with this hormonal combination are more affected by womb cancer. #
Other risk factors include obesity, diabetes, suffering from polycystic ovarian syndrome (PCOS), having been or being through menopause, and suffering from Lynch syndrome.
At the moment there are no certain steps to take to avoid uterine cancer. However, you should lead a healthy lifestyle and maintain a healthy diet. Other risk factors which may lead to developing womb cancer are smoking, a weakened immune system due to other treatments or the presence of Human Papilloma Virus (HPV) in your body.
Womb cancer is mainly treated with surgery. The most common type of surgery consists in a minimal invasive laparoscopy during which the uterus and its surroundings (Fallopian tubes, ovaries and lymph nodes) are removed.
In case of an advanced tumour, or should the doctors fear the cancer might be recurrent, after the surgery you may also get started on chemotherapy or on a therapy based on platins, taxol or anthracyclines antineoplastics.
If you can’t get started on chemotherapy, hormone therapy is an effective alternative for treating womb. In the most severe cases of recurring cancer, your doctor may advise you to undergo radiotherapy, instead of undergoing surgery.
A gynaecologist is the best healthcare professional for diagnosing conditions affecting the uterus, including tumours. Treatment of uterine cancer is handled by interventional radiologists, clinical oncologists, and surgeons, depending on what type of treatment you opt for.
During foetal development, the uterus is formed from two small tubes, called Paramesonephric ducts or Müllerian ducts, which unite to form a single, larger organ: the uterus. However, sometimes these tubes do not unite in the center of the pelvis or do so irregularly, and that is what a uterine malformation is. The most common of these are:
Uterine malformations can significantly affect a woman's fertility, and can be the cause of repeated miscarriages. The consequences on fertility will depend on the type of malformation that the patient suffers from.
In some cases these malformations do not show symptoms, so women get the diagnosis in routine gynaecological examinations or some do not realise until after getting pregnant
In other cases, the most common symptoms of uterine malformations are:
At the moment, there are several imaging techniques to see the uterus to be able to detect abnormalities, such as ultrasounds, hysteroscopy, hysterosonography, MRI scans or even laparoscopy.
Uterine malformations develop during pregnancy, and the main factors have a genetic cause or prenatal environmental factors.
A uterine malformation that does not cause symptoms does not usually require treatment. However, if the malformation if causing problems, then surgery will be considered. Surgical intervention aims to fix the malformation and can often be performed laparoscopically with a hysteroscope.
On the other hand, many women with uterine malformations turn to assisted reproduction technology to improve their fertility and to be able to have children. The most common technique used in these cases is In Vitro Fertilisation (IVF).
The specialists that diagnose and treat uterine malformations are obstetricians and gynaecologists. If a mlaformation is detected, then regular gyanecological examinations are required to ensure problems do not occur, or if they do, they are treated accordingly.
Uterine myomas are non-cancerous growths that develop on the uterus, often showing no symptoms at all. They vary in size from as small as a pea to as large as a melon.
Vaginal dryness occurs due to a decrease on the levels of oestrogen hormones that keep lubricated the vagina and prevents any kind of pathology. When oestrogen levels are low, the vaginal lining shrinks and thickens impeding lubrication. The causes of this condition may be different: menopause, treatments for breast cancer, endometriosis, uterine fibroids or infertility, severe stress or depression, among others. There are different treatments for vaginal dryness and it is important to contact a specialist when there are symptoms like vaginal dryness or soreness, burning, itching or pain during sex, in order to avoid this disease getting worse.
There are a number of problems that can affect the vagina, including:
Infections can also lead to a number of vaginal problems. Common infections that affect that area include:
Sexually transmitted infections (STIs) that can cause vaginal problems include:
Symptoms vary depending on the condition, but signs that indicate a problem that should be checked out by a doctor include:
Some vaginal problems can be prevented or the risk of getting them can be reduced.
Obstetricians/gynaecologists and urologists treat vaginal problems in adult women, while paediatric urologists are responsible for treating girls.
Vaginal prolapse, also called pelvis organ prolapse (POP), is when the muscles that support the organs in the pelvis weaken and one or more of the organs begins to bulge into and even out of the vagina. Organs that can prolapse in this way include:
While not life-threatening, vaginal prolapse can be very uncomfortable or painful.
Pelvic organ prolapse can cause the following symptoms:
If vaginal prolapse has occurred, but hasn’t been serious enough to cause any symptoms, it may be picked up by chance during another internal examination, like a cervical screening.
If your doctor suspects a vaginal prolapse, he will need to perform an internal pelvic examination, which is done in a similar way to a smear test.
A group of muscles and tissues known as the pelvic floor sits above the vagina and supports the organs in the abdomen such as the bladder and the colon. Pelvic organ prolapse occurs when the pelvic floor weakens and can no longer hold up these organs. This weakening may be caused by:
The first line of treatment is pelvic floor exercises designed to strengthen the muscles in the pelvic floor so that they can support the bladder, uterus, and other organs properly. This, combined with lifestyle changes, such as losing weight and giving up smoking can be enough for some patients.
Other patients may require a pessary – a device that is inserted into the vagina to hold the prolapse in position.
If the prolapse is severe, surgical options may be considered.
The ideal treatment depends on the case and should be discussed thoroughly and decided on by you and your doctor.
Gynaecologists and urologists specialise in dealing with conditions affecting the vagina, including pelvic organ prolapse.
The vaginal ring, also known as the contraceptive ring, is a contraceptive method to avoid pregnancy. The ring sits inside the vagina and releases continuous doses of oestrogen and progestogen into the bloodstream to prevent pregnancy by preventing the ovaries from releasing an egg each month. The progestogen helps prevent sperm from entering the uterus by causing the mucus that exists in the cervix to thicken.
When used correctly, the vaginal ring is more than 99% effective in preventing pregnancy. An advantage of the ring, compared to other methods such as the contraception pill is that it will work if you have nausea or diarrhoea and does not require daily doses as the ring stays in place for a month at a time.
It is a flexible ring about five centimetres in diameter that is placed inside the vagina. It is a monthly contraceptive that must remain in the vagina for three weeks (21 days). You then have a 7-day ring-free break during which you will menstruate. During this week you are not protected against pregnancy. After the 7-day break you insert a new ring for the next 21 days. You can start to use the ring at any point in your menstrual cycle, and you will even be protected against pregnancy if you insert a ring on the first day of your period.
For some women, the vaginal ring will not be a suitable contraceptive method. The following exclude your suitability for using the vaginal ring:
Advantages:
Disadvantages:
Vaginismus is a condition where the muscles in the vagina spasm and tighten involuntarily in response to sexual penetration, gynaecological examination or insertion of a tampon. The tightening or even closing of the vagina is completely unconscious, like the reflex of the eye shutting when something comes close to it. For many women and their partners this can cause a great degree of stress and anxiety because sexual intercourse and gynaecological examinations become painful or impossible, which in turn can worsen the condition.
The symptoms of vaginismus are the inability to have intercourse or vaginal penetration without pain. The condition is usually identified during adolescence and early adulthood with the onset of menstruation and sexual activity.
The causes of vaginismus is not a small vagina, women with this condition have the same size vagina, but the internal muscles are prone to involuntarily contracting. The underlying causes can include one or more of the following factors:
Treatment of vaginismus depends on the underlying cause. It can include:
Vaginitis is the inflammation of the vagina and vulva, causing itching, pain or discomfort and discharge. It is one of the most frequent gynaecological problems and it is estimated that 90% of women will suffer from some form of vaginitis throughout their lives.
There are different types of vaginitis:
The main symptoms of vaginitis are:
It is helpful to know that the type of discharge you have can indicate what type of vaginitis you have:
The causes of vaginitis can be several:
To prevent vaginitis is advisable to:
Both bacterial vaginosis and trichomoniasis can be treated with antibiotics. Yeast infections must be treated with over-the-counter antifungal cream or prescription oral antifungal medication (e.g. fluconazole). If vaginitis has resulted from an irritant, identifying the irritant and eliminating it should cause symptoms to go away. Vaginal atrophy can be treated with special creams or oral medications prescribed by a doctor.
Vaginoplasty is a vaginal rejuvenation surgery that aims to correct the distension and loosening of the vaginal canal tissues and to recover the tightening and contraction capacity of the vaginal muscles. Both childbirth and ageing can cause the vaginal canal muscles to loosen. Vaginoplasty is sometimes referred to as vaginal rejuvenation surgery and is performed with either local or general anaesthesia.
This surgery is performed for women who wish to correct vaginal laxity after childbirth or those who suffer a widening of the vagina due to age, menopause or multiple births. Vaginal tightening can improve the appearance of the vagina, which for some women is a cause of lower self-esteem, and it can resolve sexual dysfunction problems. Hence, vaginoplasty can be performed for both reconstructive and cosmetic purposes.
The surgical procedure of vaginoplasty consists in closing the muscles located around the vagina, which are distended or deformed, and which are responsible for giving strength to the vaginal walls, while improving the elasticity and control of the vulva.
The results of this operation are usually highly satisfactory since you get a narrower vagina and a stronger pelvic floor without leaving visible scars in the area. In addition, in many cases the satisfaction of sexual relations affected by this type of malformations is improved.
Before your surgery, it is important to follow your surgeon’s instructions about fasting and stopping any medications.
During the first 48 hours after surgery it is normal for the patient to notice some discomfort. It is necessary to rest during this period. You should avoid using tampons and sexual intercourse for up to eight weeks after surgery. You will need one to two weeks of time off following vaginoplasty surgery.
Vulval (or vulvar) cancer happens when tumour cells start developing in the vulva. The vulva is a woman's external genitals. It includes the lips surrounding the vagina (labia minora and labia majora), the clitoris, the vaginal orifice and the urinary meatus. Vulval cancer can spread to the vagina, the ovaries, the uterus and the Fallopian tubes.
Vulval cancer is relatively rare, with around 1,300 cases diagnosed in the UK each year. It is more common in older women over the age of 65.
There are several kinds of vulval cancer:
The most common symptoms are:
If you have started a targeted therapy to treat these symptoms and they haven’t gone away, you will need to see a gynaecologist.
To diagnose vulval cancer, the gynaecologist will examine your vulva. In case there’s any anomalies, the doctor will have you do some specific tests. These may include:
The exact cause of vulval cancer is unknown, but certain things can increase your chances of developing the condition:
You can prevent HPV infection (which can lead to vulval cancer) by getting a vaccine.
You should also avoid secondary risk factors such as smoking and obesity, and remember to go for a gynaecological check-up at least once a year.
Treatment varies according to which stage the tumour has reached and to your general state of health. This is essential, as a lot of the women who get this type of cancer are over the age of 65.
The most common treatments include:
The first examination will be done by a gynaecologist, who could refer you to an oncologist specialised in the gynaecological field. Should it be necessary, the oncologist will have you see an oncological surgeon or a radiotherapist, based on which treatment you need.
Warts are hard growths that can occur in various areas of the body, caused by a viral infection. They are more frequent in children and teenagers and are usually benignant formations (not cancerous ones). Warts aren’t normally painful. Healing takes from a few weeks to six months with adequate treatment.
There are several types of warts. The most common ones are:
Warts are usually innocuous and heal after a couple of weeks. However, in some cases they should be removed to avoid potential complications (such as skin melanoma).
Warts can appear weeks or months after contagion. They are usually rough and fairly small growths of variable shape. In some cases, small and dark dots can be seen within a wart.
Although is not common, warts can cause pain, itching and bleeding.
A dermatological examination with a specialist is usually enough to confirm the presence of warts. Your doctor may also request a skin biopsy: in that case, the wart is removed and sent to a laboratory for analysis.
Warts are caused by the human papilloma virus (HPV). There’s a higher chance of contagion if your skin is damp or wet, or if you have a small lesion (such as a cut) on your skin. Warts can be transmitted in the following ways:
You should:
If you have a wart, you should cover it with a plaster when going to higher-risk places (such as the pool or the gym) to avoid spreading it to other areas of your body or to other people. You should also avoid touching the wart and sharing your personal hygiene objects.
Warts usually disappear on themselves in 6 to 24 months, especially in children. However, this is not always the case for adults, so if you have a wart you may need to have it removed, because autonomous healing could take much longer.
The following treatments are not always conclusive, as the wart could be recurrent or occur in other areas of your body. Should new warts appear, even if you’ve been treating them, this could mean that the viral cells of the old warts have spread to other parts of your body. In this case, you should see your dermatologist again.
The most common treatments are:
Dermatologists are generally the specialists who treat and remove warts.
e-Consultation is a private messaging and video conference service that allows contact with leading specialists at the time you choose, from any place.
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