Mr Angus McIndoe

Mr Angus McIndoe
Obstetrics & gynaecology
Central London


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Topdoctors Awards Top Doctor
2017

Mr Angus McIndoe

Obstetrician - gynaecologist in
London

PhD FRCS MRCOG

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Mr Angus McIndoe areas of expertise:

Professional statement

Mr Angus McIndoe is one of the UK's leading consultant gynaecologists based in London. After qualifying in New Zealand in 1980, he moved to England where he began working at the Whittington Hospital, gaining invaluable experience in surgical training. In 1986 he started training in colposcopy, and is now one of the field's most respected practitioners. He is a leading specialist in gynaecological oncology, treating cancers in the female reproductive organs, including endometrial, ovarian, vulval, cervical, and fallopian tube cancers.

Working in some of London's most prestigious hospitals and clinics, including the Wellington Hospital and the Hammersmith Hospital, has gained him a formidable reputation amongst his peers. He is particularly noted for his meticulously honed skill when performing complex pelvic surgery. His use of cutting-edge robotic surgical techniques in the treatment of benign and malignant tumours puts him at the forefront of obstetrics and gynaecology.

Always looking for new and innovative ways to improve treatments and surgical techniques, his research has included molecular immunology of HPV, and imaging in gynaecological oncology. Lately he has been investigating the healing of caesarian section scars. As well as giving lectures and training surgeons across Europe, he has also published extensively. He aims to give his patients the best service possible, keeping them informed and supporting them through each step of the way.

 Videos of doctor

How is a cervical smear test performed ...

View all videos by Mr Angus McIndoe

 Doctor's articles

menopause
Understanding postmenopausal bleeding

Read all articles by Mr Angus McIndoe

 Credentials

GMC: ‍2752701

 Professional experience

• More than 20 years of experience
• Consultant Gynaecologist, The McIndoe Centre. (present)
• Chief of Service for Gynaecology, Hammersmith Hospital (2008 - 2011)
• Lead Clinician for Gynaecological Oncology, Hammersmith Hospital (2006 - 2012)
• Colposcopy lead, Hammersmith Hospital (2006 - 2008)
• Consultant in Gynaecological Oncology, Hammersmith Hospital (1994 - 2012)
• Senior Registrar, Addenbrooke's Hospital, Cambridge (1993 - 1994)
• Subspecialty Trainee in Gynaecological Oncology, St Mary's Hospital, London (1991 - 1993)
• Clinical Research Fellow, Imperial Cancer Research Fund, (1988- 1990)
• Registrar in Obstetrics and Gynaecology, St Mary's Hospital, London (1987 - 1988)
• Registrar in Obstetrics and Gynaecology, National Women's Hospital, Auckland (1985 - 1986)
• Registrar in General Surgery, Northampton General Hospital (1984 - 1985)

 ...

 Sub-specialties

• Colposcopy
• Ovarian cyst
• Abnormal bleeding
• Gynaecological cancers
• Gynaecological laparoscopic surgery
• Pelvic pain
• Prolapse management & repair
• Endometriosis
• Robotic surgery
• Polyps
• Cervical cancer
• Endometrial cancer
• Gynaelogical examination
• High-risk pregnancy
• Human papillomavirus (HPV)
• Hysterectomy
• Ovarian cancer
• Uterine cancer
• Vulvar cancer
• Amennorrhea
• Breakthrough bleeding
• Cervicitis
• Cone biopsy
• Contraceptive methods
• Cystitis
• Cytology
• Dyspareunia
• Ectopic pregnancy
• Endocrine test
• Endometrial polyps
• Endometriosis surgery
• Endoscopic surgery
• Endoscopy
• Family planning
• Fertility test
• Hymenoplasty
• Hysteroscopy
• Infertility
• Intrauterine device (IUD)
• Intrauterine insemination (IUI)
• Labiaplasty
• Laparotomy
• Laporoscopy
• Miscarriage
• Osteoporosis
• Pelvic floor reconstructive surgery
• Pelvic inflammatory disease
• Pelvic pain
• Peritoneal carcinomatosis
• Polycystic ovaries
• Premenstrual syndrome
• Preparation for childbirth
• Rectocele
• Recurrent miscarriage
• Sarcoma
• Second medical opinion
• Sexually transmitted infections (STIs)
• Transvaginal ultrasound
• Tubal ligation
• Ultrasound
• Urinary incontinence
• Uterine fibroids
• Uterine malformations
• Vaginal dryness
• Vaginal ring
• Vaginismus
• Vaginitis
• Vaginoplasty
• Warts

 ...

 Teaching posts

• Robotic Mentor for Intuitive Surgical

 Education

• MRCOG, London (1987)
• PhD, Imperial College, London (1993)
• FRCS, England (1985)
• BSc, Auckland (1974)
• MB ChB, Auckland (1980)

 ...

 Publications and conferences

• Economic evaluation of robot-assisted hysterectomy: a cost-minimisation analysis. Ind T, McIndoe A, Butler-Manuel S, Tailor A, Prietzel-Meyer N, Smith JR, Nobbenhuis M, Gillespie A, Ellis P, Bali A, Elghobashy A, Moss E. BJOG. 2015 Apr;122(5):754.
• Radiological predictors of cytoreductive outcomes in patients with advanced ovarian cancer. Borley J, Wilhelm-Benartzi C, Yazbek J, Williamson R, Bharwani N, Stewart V, Carson I, Hird E, McIndoe A, Farthing A, Blagden S, Ghaem-Maghami S. BJOG. 2015 May;122(6):843-9.
• Predicting successful vaginal birth after cesarean section using a model based on cesarean scar features examined using transvaginal sonography. Naji O, Wynants L, Smith A, Abdallah Y, Stalder C, Sayasneh A, McIndoe A, Ghaem-Maghami S, Van Huffel S, Van Calster B, Timmerman D, Bourne T. Ultrasound Obstet Gynecol. 2013 Feb 1.
• Saso S, Haddad J, Ellis P, Lindsay I, Sebire NJ, McIndoe A, Seckl MJ, Smith JR. Placental site trophoblastic tumours and the concept of fertility preservation. BJOG. 2012; 119: 369-74.

 ...

 Prizes and awards

• Senior prize in Mathematics, University of Auckland, 1974
• University Junior Scholarship, New Zealand, 1972

 Professional membership

• British Society for Colposcopy and Cervical Pathology
• British Gynaecological Cancer Society
• Royal Society of Medicine
• British and Irish Association or Robotic Gynaecological Surgeons
• Society of European Robotic Gynaecological Surgery
• London Consultants Association
• British Medical Association

 ...

Languages spoken

  • English

Patient reviews for Dr. Angus McIndoe

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Patient reviews

Verified Patient
19/11/2017

Would you recommend this doctor?

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Verified Patient
17/07/2017

Would you recommend this doctor?

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Diseases, Medical Tests and Treatments

Colposcopy

What is colposcopy? Colposcopy is a procedure which allows the cervix (the neck of the womb) to be examined, using a device called a colposcope, wh ...

Fibroids

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 ma ...

Menopause

What is the menopause? The menopause refers to the process which naturally occurs in women as a result of ageing, meaning they no longer have p ...

Ovarian cyst

An ovarian cyst is a sac or pouch filled with liquid that develops on an ovary. The most common are the ovarian functional cysts, which develop as par ...

Robotic surgery

Robotic head and neck surgery is one of the latest technological advances in surgery. This novel technology helps overcome restrictions present with conventional surgical techniques. Surgery is not performed by a robot but by the surgeon using robotic technology. Robotic surgery permits access to small spaces and removes all natural hand tremor. It permits precision surgery in real time using a 3D visual field. ...

Vaginal prolapse

What is vaginal prolapse? 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: Bladder Uterus Urethra Rectum (end of the bowel)   Prognosis of vaginal prolapse While not life-threatening, vaginal prolapse can be very uncomfortable or painful.   Symptoms of vaginal prolapse Pelvic organ prolapse can cause the following symptoms: A heavy feeling in the pelvis A feeling of fullness in the vagina A lump protruding from the vagina Discomfort or numbness during intercourse Problems with urination – you may feel like you haven’t emptied your bladder or may need to go more often.   Medical tests to diagnose vaginal prolapse 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.   What are the causes of vaginal prolapse? 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: Pregnancy and childbirth – particularly if the baby was big, after a long and/or difficult birth or after a multiple birth Heavy lifting Pressure from being overweight or obese Chronic constipation Chronic lung disease or similar conditions that cause constant coughing Menopause   Treatments for vaginal prolapse 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.   Which type of specialist treats vaginal prolapse? Gynaecologists and urologists specialise in dealing with conditions affecting the vagina, including pelvic organ prolapse. ...

Amenorrhoea

What is amenorrhoea? 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: Primary amenorrhoea: it can occur in females under 16 who haven’t had their first period yet, but already have other traits of puberty (enlarged breasts and body hair). Secondary amenorrhoea: the absence of menstruation for three months in women whose menstrual period was never irregular, or for nine months in women who've had oligomenorrhoea (menstrual period being four or more days late) and are not pregnant, breastfeeding or going through menopause. Prognosis of amenorrhoea: 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. What are the symptoms of amenorrhoea? 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. How is amenorrhoea diagnosed? 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). What causes amenorrhoea? There are many potential causes for amenorrhoea, which can be associated with: Natural causes: pregnancy, breastfeeding and menopause; Being on (any kind of) birth control; Taking certain medications, such as antipsychotics, chemotherapeutic agents, antidepressants, blood pressure control medications and allergies control medications; Weight loss associated with anorexia nervosa or bulimia; Morbid obesity; Over training; Stress; Illegal drug abuse; Hormone imbalances caused by a tumour of the hypothalamus or of the pituitary gland, malnutrition, PCOS, thyroid conditions, or Cushing’s syndrome. Anatomical anomalies of the reproductive system: uterine scarring or intrauterine adhesions, partial or total removal of the uterus, malformations of the vagina; Radiotherapy; Depression and other psychiatric disorders; How can amenorrhoea be prevented? 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. How can amenorrhoea be treated? Possible treatments include: Eating a certain diet, either to reach a normal weight (if you are suffering from anorexia nervosa or bulimia) or to lose weight; If the underlying cause is overtraining, decreasing your exercise routine; Going off the medications which may be causing the amenorrhoea; Surgery, if it is caused by pituitary tumours, intrauterine adhesions and genital tract anomalies; Pharmacotherapy, if the amenorrhoea is caused by PCOS. Which doctor should I talk to? To accurately diagnose and treat amenorrhoea, you will have to see a specialised gynaecologist. ...

Breakthrough bleeding

What is breakthrough bleeding? Breakthrough bleeding is vaginal bleeding that occurs between a woman's monthly menstrual periods. What are the causes of breakthrough bleeding? The causes of breakthrough bleeding can include: uterine fibroids miscarriage ectopic pregnancy underactive thyroid cervical or uterine cancer 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. Can breakthrough bleeding be prevented? Depending on the cause, breakthrough bleeding sometimes cannot be prevented. However, in some cases it can be prevented by taking the following measures: maintaining a healthy lifestyle and a normal weight, as being overweight can cause irregular periods following the doctor's instructions to prevent hormonal imbalances (if you take oral contraceptives) What is the treatment for breakthrough bleeding? The treatment will depend on its cause, but usually, the following therapies are used: contraceptive pills, intrauterine device (IUD), progesterone pills and analgesics before the period to avoid discomfort hormonal medications to restore ovulation or control bleeding surgery to separate most of the endometrial tissue to reduce the amount of bleeding surgery to treat any structural abnormality of the uterus or endometrium iron supplements for women who have anaemia due to excessive bleeding ...

Cervical cancer

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. ...

Cervicitis

What is cervicitis? 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. What are the symptoms of cervicitis? Women with cervicitis may not notice any symptoms. However, some women may notice the following symptoms: Increased vaginal discharge Pain during intercourse Painful urination A burning feeling Frequent urges to urinate Bleeding or spotting between periods Bleeding after intercourse Pelvic pain If you are experiencing any of the above in combination, you should see a doctor. What causes of cervicitis? There are several causes of cervicitis, but infection is the most common. Cervicitis can result from: STIs – bacterial or viral infections transmitted through sexual intercourse (e.g. chlamydia, gonorrhoea the genital herpes virus or trichomoniasis). Bacterial imbalance – this can cause bacterial vaginosis, which can lead to cervicitis. Allergic reactions – reactions to allergens can cause cervicitis (e.g. feminine hygiene products, douches, scented sanitary wear, latex condoms or spermicides). Can cervicitis be prevented? 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. What is the treatment for cervicitis? 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. ...

Cone biopsy

What is a cone biopsy? A cone biopsy, also known as cervical conisation, is small diagnostic procedure, performed using general anaesthetic, that removes a cone-shaped section of abnormal tissue from the cervix. A cone biopsy is used to detect cervical cancer or pre-cancerous cells. It is also a treatment option to remove all abnormal (pre-cancerous cells). What does a cone biopsy involve? General anaesthesia is given. Surgery starts by the placement of a speculum into your vagina so that the cervix can be viewed. Next a small cone-shaped section of tissue is removed from the cervix, either by a scalpel, a heated wire loop or a laser. The procedure takes about 15 minutes. The removed tissue is then sent to the laboratory to ensure all abnormal cells have been removed or to check for cancer. To stop any bleeding gauze might be placed on the vagina. Whilst this is in place, a catheter might be inserted. Why is a cone biopsy done? A cone biopsy would be recommended if you are experiencing symptoms associated with cervical cancer. You might also have a cone biopsy to treat abnormal cervical cells, detected through cervical screening. Abnormal, pre-cancerous cells, if left untreated, can develop into cervical cancer. Preparation for a cone biopsy As this procedure is performed with general anaesthetic, food has to be avoided 6-8 hours beforehand, and drink stopped 2 hours before surgery. What does a cone biopsy feel like? Following a cone biopsy, you might have some cramping for a week. For 2-3 weeks following the procedure, your discharge might be bloody, heavy and yellow-coloured. It is important to refrain from using tampons and having sexual intercourse for 4-6 weeks following the surgery. What do abnormal results from a cone biopsy mean? A normal result would mean there are no cancerous or pre-cancerous cells in the cervix. An abnormal result would mean that there cancerous or pre-cancerous cells in the cervix. If cancer is detected, then further tests will be carried out and a treatment plan put in place, all to be discussed with your specialist. ...

Contraceptive methods

What are contraceptive methods? 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. Why are they used? 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. What types of contraception are there? Among the different contraceptive methods, the most common are: Barrier methods: Condoms - these must be placed very well to avoid pregnancy. You must be careful not to tear it with fingernails, rings or piercings. Female condoms Diaphragm - It is a latex or silicone plug that the woman inserts into her vagina and thus prevents the entry of sperm to the cervix. Its drawback is that you must wait between 6 and 8 hours to remove it. Hormonal methods: Pill (oral contraceptives) – consists of taking a pill every day. Its effectiveness, if it is well used, is 99.7%. Efficacy can decrease if the person forgets to take it, it is not done at the same time each day or she suffers vomiting or diarrhoea. Intrauterine system (IUS) – a plastic device that is inserted into the vagina which releases progesterone to prevent pregnancy. This is a long-lasting method. Vaginal ring – a plastic ring placed inside the vagina which gradually releases hormones. It must be changed with each new menstrual cycle. Transdermal patch – a "plaster" that contains hormones and placed on the skin. These are changed each week for three weeks out of each month. Injection – required every 8-12 weeks depending on the type. Implant – this lasts up to three years and works by slowly releasing hormones to prevent pregnancy. Intrauterine device (IUD) – a plastic and copper device inserted into the vagina which kills sperm and prevents eggs from becoming fertilised. Permanent methods: Tubal ligation – for women who wish to be permanently protected from pregnancy. Vasectomy – for men who no longer wish to have children. Side effects: 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

What is cystitis? 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.  What are the symptoms of cystitis? Symptoms include: A need to pee more frequently than ususal A burning/stinging sensation when peeing Cloudy urine Dark, or strong-smelling urine Pain in the lower abdomen Fatigue Feeling generally unwell In children: Vomiting Fever Feeling irritated A lack of interest in food/low appetite Feeling weak What causes cystitis? 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: Through sex Through insertion of a tampon By using a diaphragm Insertion of a urinary catheter Wiping back to front when going to the toilet Cystitis can also be caused by a damaged or irritated bladder. How can it be prevented? 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.   What is the treatment for 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.  ...

Cytology

What is a smear test? 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. What does it involve? 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. What is it for? 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. How can you prepare for a smear test? 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. What does it feel like during the procedure? 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. What would a “bad” result mean? 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

Dyspareunia or coitalgia is painful intercourse because of medical or psychological reasons. It entails discomfort just before, during, or after penetration. Although it is more common among women, men can also suffer during ejaculation.   ...

Ectopic pregnancy

What is ectopic pregnancy? 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: the fallopian tube the ovary the cervix the abdominal cavity Just over 1% of pregnancies are ectopic. Unfortunately, the fertilised egg cannot survive in an ectopic pregnancy. Prognosis 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. Symptoms of ectopic pregnancy An ectopic pregnancy can cause: vaginal bleeding pain when going to the toilet pain on one side of your abdomen pain in your shoulder 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. How is ectopic pregnancy diagnosed? 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. What causes ectopic pregnancy? The following can increase your chances of an ectopic pregnancy: sexually transmitted infections scarring from pelvic surgery infertility treatment such as IVF pelvic inflammatory disease smoking 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. Can ectopic pregnancy be prevented? You can reduce your risk of ectopic pregnancy by stopping smoking and reducing your chances of sexually transmitted infections. How is ectopic pregnancy treated? 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. ...

Endocrine test

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 cancer

Endometrial cancer is the most common within the different types of uterine cancer. Currently, the exact cause is not known but it may be related to increased levels of oestrogen. The symptoms present in endometrial cancer are abnormal vaginal bleeding after menopause, low abdominal pain or cramping in the pelvis, and white vaginal discharge. ...

Endometrial polyps

An endometrial polyp is a mass that grows in the uterus, in the endometrium, the inner lining of the uterus. The size and shape vary from patient to patient, and it has a slow growth, but sometimes it can occupy the entire endometrial cavity. Endometrial polyps are painless and usually do not cause problems. Women who have already gone through menopause are the ones more likely to develop these polyps. Some symptoms include: vaginal bleeding during or after menopause, heavy menstrual bleeding or longer than usual, cramps during or between periods, etc. A hysteroscopy is carried out to remove the endometrial polyps. ...

Endometriosis

What is endometriosis? 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. What causes endometriosis? 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). What are the symptoms of endometriosis? The symptoms of endometriosis can vary with some women are more affected than others. These can include: Period pain that is not relieved by painkillers Heavy periods Infertility Pelvic pain – this can occur just before the period or all of the time Pain during and after sexual intercourse Pain when going to the toilet Blood in the stool Fatigue Gastrointestinal upsets - diarrhoea, constipation and feeling nauseous. What is the treatment of endometriosis? 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: Anti-inflammatory painkillers Hormone medicines and contraceptives – the combined pill, the contraceptive patch and the IUD. Surgery In some cases a hysterectomy is used to remove the womb. Surgery and endometriosis Surgery for endometriosis can alleviate pain. There are two options of surgery: Conservative surgery – removes or destroys the deposits of endometriosis and is usually done using a laparoscopy. The endometriosis can be cut out by the surgeon or it can be destroyed using heat or laser. Surgery provides relief from symptoms but they can reoccur. Complex surgery – this depends on the severity of the patient’s endometriosis. The surgery may involve different organs of the body that are affected by endometriosis, such as the bowel or the bladder. 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 surgery

What is endometriosis surgery? 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. Why would you need endometriosis surgery? 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. What does endometriosis surgery involve? 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. How to prepare for endometriosis surgery 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. Post-operative care following endometriosis surgery 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. ...

Endoscopic surgery

What is endoscopic surgery? 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.   Why is endoscopic surgery done? 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).   What does it involve? 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.   How to prepare for it 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.   Care following 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.   Alternatives to endoscopic surgery 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

What is it? 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. What does it involve? 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. What is it for? 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. How can you prepare for it? 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. What does it feel like during 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. What would a “bad” result mean? 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

What is family planning? 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.   Why is it done? 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.   What does it involve? 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: Semen analysis (men) to check for low sperm count and abnormalities, such as poor movement. Blood tests can test that the correct hormones are being produced (women) Ultrasound scans and X-rays can be used to check the physical health of the reproductive organs and search for any blockages, e.g. in the fallopian tubes (women) Both sexes may be tested for STIs like chlamydia, which can affect fertility. 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.   Benefits of family planning Family planning carries several advantages: It allows a couple to plan and have more control over when they have their children, which can be good for health, economic, or personal reasons. It gives couples the ability to control the number of children they have, and the spacing between them. It reduces the need for abortions of unwanted preganancies Some contraceptive methods used, such as condoms, also help prevent the spread of STIs. It can help couples with below-average fertility to have a baby. ...

Fertility test

What are fertility tests? 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. What do fertility tests consist of? Fertility tests will usually begin by confirming the following: How long you have been trying to conceive for Whether or not you have had previous pregnancies, miscarriages or abortions How often you have been having unprotected sex How long since you stopped contraception Your medical history (for women, a history of their menstruation) What medications you take Your lifestyle 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: Chlamydia test – this STI can affect fertility and may not show symptoms. Blood tests – to assess hormone levels. Ultrasound scan – to assess the reproductive system and to check for any abnormalities. X-ray – to assess the uterus and fallopian tubes using a contrast fluid to check for any blockages. Men will have the following tests: Chlamydia test – can affect male fertility. Semen analysis – to assess sperm count and if they move properly. Why are fertility tests needed? Fertility tests are needed to determine why a couple who have tried for at least year to conceive have been unsuccessful. Preparation for fertility tests: Depending on the fertility test being carried out, the preparation varies. In each case, the specialist will indicate what care should be taken. Meaning of abnormal results: Abnormal results may indicate the following: Low sperm count Sperm that do not move properly Blockage of the fallopian tube Endometriosis Fibroids PCOS ( polycystic ovary syndrome) Epididymal blockage (blocked tube in the testicles) ...

Gynaecological cancer

What is gynaecological cancer? Gynaecological cancer refers to any cancer that occurs in any of the organs of the female reproductive system, which is located in the pelvic region below the stomach and between the hips. There are five types of gynaecological cancer, differentiated by location: Cervical cancer Ovarian cancer Uterine cancer Vaginal cancer Vulvar cancer Symptoms of gynaecological cancer Each type of gynaecological cancer has its own signs, symptoms and risk factors: Cervical cancer: Bleeding between periods. Abundant vaginal discharge with small amounts of blood. Bleeding after sexual intercourse. Abdominal pain and discomfort in the lower back. Ovarian cancer: Discomfort in the lower abdomen, similar to indigestion. Pelvic pain. Anaemia and weight loss. Fatigue, loss of appetite. Increased body hair due to hormonal disturbances. Uterine cancer: Bleeding between periods. Abundant vaginal discharge with blood. Bleeding after sexual intercourse. Vaginal cancer: Bleeding between periods. Back and/or pelvic pain. Pain while urinating. Small lumps in the vagina. Vulvar cancer: Burning sensation or bleeding in the vulva. Colour is more reddish or paler than usual. Appearance of warts or irritation similar to rash in the area. Non-healing ulcers or lumps. Pelvic pain during sexual intercourse or urination. What are the risk factors for gynaecological cancer? Cervical cancer: HPV (human papilloma virus). Being a smoker. Being HIV-positive. Having sexual intercourse with different people continually. Having given birth to more than three babies. Ovarian cancer: Being middle-aged or older. Family history. Certain genetic changes (mutations) can increase the risk of ovarian cancer. Mutations in the two breast cancer predisposition genes (BRCA1 and BRCA2) and those associated with Lynch syndrome increase the risk of ovarian cancer. History of breast, uterine or colorectal cancer. Having endometriosis. Having no children or having difficulty conceiving. Uterine cancer: Being older than 50. Obesity. Taking oestrogen-only (without progesterone) hormone replacement therapy during the menopause. Having had difficulty conceiving. Taking tamoxifen. Family history of uterine, colon or ovarian cancer. Vaginal cancer: Vulvar cancer Having HPV (human papilloma virus). History of cervical cancer. Weakened immune system. Being a smoker. Chronic burning sensation in the vulva. Can it be prevented? There is a different prevention strategy for each type of gynaecological cancer. The following aspects may help to lower the probability of developing one of the gynaecological cancers. Cervical cancer: The two tests that help to prevent cervical cancer are cytology and the HPV test. Ovarian cancer: Taking contraceptive pills for 5 years or longer. Removal of ovaries, tubal ligation, hysterectomy. Giving birth. Breastfeeding. Uterine cancer: Using contraceptive pills. Maintaining a healthy body weight and doing physical exercise. If you are taking oestrogen: taking it in combination with progesterone. Vaginal cancer and vulvar cancer: being vaccinated against HPV (which causes this type of cancer) and having cytology done. What is the treatment? If the cancer is detected at an early stage, it is very likely that it can be cured completely and that you can live a long life with a good quality of life. The different types of treatment are surgery, chemotherapy and radiotherapy, depending on the patient and the stage of the cancer. Surgery: the cancerous tissue is removed.   Chemotherapy: specific medications to reduce or eliminate the cancerous tissue. The medications may be given intravenously, in tablet form, or by both routes.   Radiotherapy: radiation administered to “kill” the cancer.   ...

Gynaecological examination

What is a gynaecological examination? 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. What does a gynaecological examination involve? 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. What is a gynaecological examination for? 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). How can I prepare for a gynaecological examination? 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. What does it feel like during the examination? A gynaecological examination is not painful at all. The feeling you will have during the internal examination is like that of using a tampon. What would a “bad” result mean? 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. ...

High-risk pregnancy

Risk pregnancy is a type of pregnancy in which there are many chances that the mother or the child develop problems during the pregnancy. Rest and medical supervision are required and, in some cases it is necessary to take medication or additional food supplements. To be considered a medium, high or very high risk pregnancy, the mother or the foetus would have an illness or be under circumstances that could endanger both. Medium risk: Pregnancies under the age of 17 and over 38, obese women with abnormalities in the pelvis, blood group Rh negative, those who smoke. High-risk: Mother with severe anaemia, pregnancy with twins, women who have had cervical surgery or who have a critical obstetrical history, infections, gestational diabetes, suspected foetal malformation, morbidly obese. Very high risk: Multiple gestations, uterine malformations, heart disease, diabetes, cervical incontinence, restricted foetal growth, foetal malformation confirmed, placenta praevia, severe pre-eclampsia, preterm labour, ruptured membrane. ...

Human papillomavirus (HPV)

What is the human papillomavirus (HPV)? 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. What are the symptoms of HPV? 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. What causes human papillomavirus infections? 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. Can HPV infections be prevented? 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. What is the treatment for an HPV infection? 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. ...

Hymenoplasty

What is hymenoplasty? 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. Why is hymenoplasty done? 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). What does hymenoplasty consist of? 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. Preparation for hymenoplasty: 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. Aftercare: 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. ...

Hysterectomy

What is a hysterectomy? 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. Why would you have a hysterectomy? There are a number of different reasons why a woman would have a hysterectomy which include: Endometriosis – a condition where uterine lining tissue develops outside of the uterus, causing pain, heavy periods and infertility. Cancer of the cervix, uterus or ovaries Non-cancerous tumours (fibroids) Chronic pelvic pain Heavy periods Uterine prolapse – when the uterus moves from its correct position into the vaginal canal. For non-cancerous illnesses a hysterectomy would only be offered if all other treatment options had been tried first. What does a hysterectomy involve? There are different types of hysterectomy, and the type you have depends on why the surgery is needed. The types of hysterectomy include: Subtotal hysterectomy – the upper section of the uterus is removed, but the cervix is left in place. Total hysterectomy – the most common of hysterectomy procedures where the womb and cervix are removed. Radical hysterectomy – the uterus, surrounding tissue, fallopian tubes, ovaries, lymph glands, fatty tissue and a section of the vagina are all removed. This type is nearly always only done if cancer is present. 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: Fatigue Hot flushes Sleep problems Vaginal dryness There are three ways for a hysterectomy to be carried out: Open surgery – the lower abdomen is cut open across the belly, and the uterus is removed via this incision. Vaginal hysterectomy – the uterus is removed via a cut made in the vagina. This cut is closed and rarely results in scarring. Laparoscopic (keyhole) hysterectomy – the uterus is removed via a number of very small incisions in the abdomen. 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. How to prepare for it 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. Post-operative care 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: Open surgery – up to 5 days in hospital with a 6 to 8 week recovery period. Vaginal hysterectomy – 1 to 4 days in hospital with a 2 week recovery period. Laparoscopic hysterectomy – 1 to 4 days in hospital with a 2 week recovery period. 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). ...

Hysteroscopy

What is a hysteroscopy? 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: Ambulatory, or in-clinic, to diagnose and treat uterine pathologies without surgical intervention. Diagnostic: a hysteroscope (a lighted tube) is inserted into the cervix to view the inside of the uterus. If samples are also taken, or if endometrial formations are resected or surgery is performed, it is known as a surgical hysteroscopy. Why is a hysteroscopy performed? A hysteroscopy is performed in the following cases: Irregular menstruation or metrorrhagia To perform sterility or infertility studies, recurrent miscarriages To diagnose changes in the shape of the inside of the uterus, such as polyps, fibroids or hyperplasia, as well as to detect foreign bodies or traces of placenta To study and control malformations of the uterus To block the fallopian tubes to prevent pregnancy To remove an IUD To perform a biopsy What does a hysteroscopy involve? 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. Preparing for a hysteroscopy: 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. Post-treatment care: 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. ...

Infertility

What is infertility? 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. Symptoms of infertility: 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. What causes infertility? Common causes of infertility among men and women are: Birth defects of the reproductive system Cancer, tumours, chemotherapy drugs, radiation therapy Excessive alcohol consumption Hormonal imbalances Obesity Scarring from sexually transmitted infections, abdominal surgery, or endometriosis Smoking Older age Pelvic infection In women, infertility may be caused by: Autoimmune treatments Clotting disorders Diabetes Excessive exercise Eating disorders Neoplastic lesions of the cervix and/or uterus, ovarian cysts, polycystic ovary syndrome Tubal ligation Thyroid problems In men, the causes of infertility may include: Impotence Infection Use of certain medications such as cimetidine, spironolactone, and nitrofurantoin Retrograde ejaculation Scarring from sexually transmitted diseases, injury, or surgery Environmental toxins Vasectomy or vasovasostomy failure Can infertility be prevented? 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: Take preventive measures against sexually transmitted infections (STIs) Do not use drugs Do not drink alcohol frequently or excessively Maintain good personal hygiene For women, have a gynaecological check-up once a year once you are sexually active For men, wear loose underwear and avoid hot baths, saunas and exposure to sources of radiation What is infertility treatment? 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. ...

Intrauterine device (IUD)

What is an intrauterine device (IUD)? 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. Why would you have an IUD? 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. How is an IUD inserted? 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. Preparation for the IUD: 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. Care after implantation: 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 and disadvantages of the IUD: Advantages: It works straight away It is more than 99% effective when inserted correctly It provides long-term protection (5-10 years) It is safe to use whilst breastfeeding No hormones are released, so there are no hormonal side effects (e.g. tender breasts, acne) It is not affected by other medicines or illness Disadvantages: Some women experience heavier or more painful periods following IUD insertion There is a small risk of pelvic infection if an infection forms after the IUD fitting If the IUD fails and you become pregnant, there is a risk of having an ectopic pregnancy ...

Intrauterine Insemination (IUI)

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

What is labiaplasty? 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. Why is labiaplasty done? 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. What does labiaplasty consist of? 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. Preparation for labiaplasty: 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. Aftercare: 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. ...

Laparotomy

What is laparotomy? 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.   What does it involve? 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.   Why is it performed? 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: Ovarian cancer Ectopic pregnancies Endometriosis Gallstones Acute appendicitis Pancreatitis (inflammation of the pancreas) Diverticulitis (an inflammatory condition of the bowel) Intestinal perforation Scar tissue or adhesions in the abdomen Abscess or infection   Preparing for laparotomy 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.   What do you feel during the procedure? 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.   Alternatives to laparotomy 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. ...

Laporoscopy

Laparoscopy is a surgical technique to inspect the abdominal cavity in cases there is no need to make large incisions. During the laparoscopic surgery, a laparoscope is inserted into the abdomen, which is a tube containing an optical system coupled to a light source. The camera allows the doctor to inspect the pelvic organs from a monitor and, if necessary, to introduce other instruments through the same laparoscope to correct a problem. The advantages of surgical laparoscopy are many, so it is applied in various specialties. When used in urology, patients require shorter hospitalisation and recovery times, there are fewer chances of infectious complications, and there is less postoperative pain and no visible scarring. In gynaecology, it is used for: cysts, fibroids, hysterectomies, pelvic inflammatory diseases, ectopic pregnancies, etc. In addition, laparoscopy is used in other medical specialties and conditions such as prostate cancer, variceal or some kidney diseases. ...

Miscarriage

What is miscarriage? 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. What causes miscarriage? 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. Symptoms 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: Cramp in your lower abdomen The regular symptoms of pregnancy, such as tender breasts, are no longer present Discharge of fluid or tissue from the vagina Can miscarriage be prevented? Most miscarriages cannot be prevented, however there are certain activities or states which can increase the risk of miscarriage. Risk factor is increased if: You smoke, drink, or take drugs while pregnant You are overweight Your caffeine intake is high You have diabetes which is not adequately controlled You have an overactive or underactive thyroid You have severe high blood pressure You have kidney disease You are a certain age: 1 in 10 pregnancies end in miscarriage in those under 30 Up to 2 in 10 pregnancies end in miscarriage in those between the ages of 35-39 Over 5 in 10 pregnancies end in miscarriage in those aged over 45 After a miscarriage 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. ...

Osteoporosis

What is osteoporosis? 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.   Symptoms of osteoporosis 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.   Medical tests to diagnose 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.   What are the causes of osteoporosis? 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: A family history of osteoporosis Certain other medical conditions, e.g. inflammatory conditions, malabsorption problems, some hormone-related conditions, etc. Certain medications  (corticosteroids in particular). Heavy drinking and/or smoking Low BMI (body mass index)   Can osteoporosis be prevented? 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: Regular exercise Diet - a healthy, calcium-rich diet, and vitamin D supplementation Give up smoking and reduce alcohol intake.   Treatments for osteoporosis 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: Biphosphonates to slow the rate of bone loss HRT  – in menopausal women Testosterone treatment – if osteoporosis is a result of hypogonadism in men. Selective oestrogen receptor modulators (SERMs) Denosumab (Prolia) – subcutaneous injections at six monthly intervals Parathyroid hormone analogues – delivered via subcutaneous injection, this hormone can actually increase bone density   Which type of specialist treats osteoporosis? Endocrinologists and rheumatologists treat osteoporosis. ...

Ovarian cancer

What is ovarian cancer? 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: benign tumours: for example, ovarian cysts epithelial ovarian tumours: these represent more than 90% of ovarian malignancies and are arise from the epithelial cells surrounding the ovaries; germinal tumours: this type of cancer comes from germ cells. These tumours make up for 5% of malignant ovarian cancers and almost exclusively affect children and young people; stromal tumours: these are generally less dangerous and account for 4% of malignant ovarian tumours. This kind of cancer is derived from the gonadal stroma and it causes an uncontrolled hormone production (both male and female). What are the symptoms 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: bloating loss of appetite feeling the need to urinate frequently. How is it diagnosed? The most common tests to make a diagnosis are: transvaginal ultrasound (TVU) abdominal computed tomography (CT) scan barium enema X-rays magnetic resonance imaging (MRI) What causes ovarian cancer? It is not clear yet what exactly causes ovarian cancer, but the following factors may increase your risk of getting ovarian cancer: increasing age (especially after menopause) never having carried a pregnancy to full term; early menarche (first menstrual cycle) late menopause genetic predisposition: this affects 7-10% of women diagnosed with ovarian cancer and may cause the tumour to grow in younger women. If there have been several cases of breast cancer or ovarian cancer in your family, it may be helpful to see a genetic counsellor in order to know whether you’ve inherited a faulty gene. How can it be prevented? 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. How can it be treated? The most common treatments for ovarian cancer are: surgery chemotherapy radiotherapy: this is a palliative treatment aimed at relieving the pain from the cancer symptoms Which doctor should I talk to? 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. ...

Pelvic floor reconstructive surgery

What is pelvic floor reconstruction? Pelvic floor reconstruction is a surgical procedure involving the repositioning of the internal organs of the female pelvis.   Why is it done? 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. What does it involve? 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. How to prepare for it 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. Post-operative care 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 inflammatory disease

What is pelvic inflammatory disease? Pelvic inflammatory disease is an infection of the female reproductive organs, including the womb, fallopian tubes and ovaries. What are the symptoms? Most women with pelvic inflammatory disease experience mild symptoms, such as: heavy or painful periods pain or difficulty urinating abdominal pain pain during sex bleeding between periods yellow or green vaginal discharge In severe cases, pelvic inflammatory disease can cause: fever severe abdominal pain nausea If you are experiencing severe abdominal pain or a high fever, you should seek emergency medical treatment. How is it diagnosed? 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. What causes pelvic inflammatory disease? 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. Can pelvic inflammatory disease be prevented? 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. Treatments for pelvic inflammatory disease 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

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. ...

Peritoneal carcinomatosis

Peritoneal carcinomatosis is a form of intra-abdominal dissemination, through the peritoneum of malignant gastrointestinal and gynecological tumors and also of abdominal-pelvic sarcomas, with or without evidence of metastasis.  ...

Polycystic ovaries

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

Polyps are abnormal tissue growths. They can form in different parts of the body: Colon polyps Uterine polyps Nasal polyps, etc. Polyps are a common problem and most of them are benign, although some types have been linked to cancer.  ...

Premenstrual syndrome

Premenstrual syndrome is characterised by a set of symptoms that affect the body and the mood of women. They usually start one to two weeks before menstruation and disappear when it starts. The vast majority of women experience at least one of these symptoms: joint pain, tender and swollen breasts, migraine, acne, fatigue, constipation, irritability, hot flushes, depression, changes in mood, low sex drive, etc. Sometimes they are severe enough to interfere with their normal life. There is no definitive treatment for premenstrual syndrome, but general recommendations include to exercise regularly, take pain killers or evening primrose and follow a healthy diet (avoiding sugars, replacing processed food with whole food, reducing fat). ...

Preparation for childbirth

What is childbirth preparation? 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. Why is it done? 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. What does preparation for childbirth involve? 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: Theoretical sessions : the pregnant women receive information about the changes they will undergo during pregnancy, types of childbirth, and in general what they will experience in each of the phases of childbirth. Practical sessions : postural exercises, breathing and relaxation techniques for childbirth. What you need to know before childbirth preparation 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: The Bradley method: places emphasis on avoiding as much as possible the administration of medications, taking care of one’s diet, physical activity and relaxation, and also involving the partner in the process. The Lamaze method : places emphasis on supporting the pregnant woman with words of encouragement, massages, tactile and visual stimulation, that help her feel confident about the pregnancy and delivery. The partner plays a fundamental role in supporting the woman. Alternatives to childbirth preparation 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. ...

Rectocele

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: Genetics – some women are born with weaker connective tissues in the pelvic area. Childbirth – delivering more than one child creates a higher risk of having rectocele. Ageing – growing older means naturally losing muscle mass and elasticity. Being overweight – carrying extra body weight causes stress on the pelvic floor tissues. How can you prevent rectocele? To reduce the risk of worsening rectocele, a woman can: Follow Kegel exercises on a regular basis – these movements can help to strengthen pelvic floor muscles. Treat constipation – by eating high-fibre foods and drinking plenty of water. Avoid heavy lifting. Treat chronic coughing. Maintain a healthy weight. 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 miscarriage

What are recurrent miscarriages? 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.   Causes of recurrent miscarriage There are several factors that can lead to repeated miscarriages: Genetic factors – in a small number of cases, one partner may be repeatedly passing on an abnormal chromosome that is causing the miscarriages. Hormonal – conditions like polycystic ovarian syndrome or imbalances in pregnancy hormones can be risk factors for miscarriage. Uterine problems – an abnormally-shaped womb, such as in a patient with bicornuate uterus increases the risk of miscarriage. Cervical weakness – if this is detected early, stitches or cervical cerclage may be recommended to reinforce the cervix. Blood clotting disorders – rare disorders like systemic lupus erythematosus and antiphospholipid syndrome affect the blood flow to the placenta. Clots may form, which can affect the function of the placenta and potentially starve the foetus of oxygen and essential nutrients, leading to miscarriage. Age – the older the parents, the lower the chance of carrying a baby to term.   Can miscarriages be prevented? 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: Karyotyping – testing for chromosome abnormalities. This may involve testing the DNA of the foetus and both parents. If genetics are found to be responsible, a clinical geneticist will be able to go over options with the patients and explain if there are any fertility treatments, such as IVF, that could help. Ultrasound scans – these scans can detect abnormalities in the structure of the womb or weakness in the muscles of the cervix. Blood tests 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. ...

Sarcoma

Sarcoma is a malignant tumor in the bone or soft parts of the body. Among the different types of cancer, sarcomas are rare, about 1% of such cancers are diagnosed each year and only affect 4 or 5 people in a hundred thousand.   Sarcomas are malignant tumors that can occur in bones or in so-called "soft tissue" of the body. A variety of sarcomas, according to the cell type which are formed. Currently, it is a rare type of cancer, representing only 1% of all cancers. ...

Second medical opinion

What is a second medical opinion? 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. Why would you get a second medical opinion? 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: Potential treatment is risky and could be life-changing or the diagnosis is possibly life-threatening The diagnosis is not clear-cut If you are considering a new treatment approach that is experimental The aims of obtaining a second medical opinion are: To confirm whether a diagnosis is correct and/or appropriate. To confirm whether a suggested treatment is correct and/or appropriate. To compare information received from each doctor so that you can make an informed decision – sometimes a second medical opinion can rule out the need for a potentially unnecessary invasive procedure. Possible disadvantages of seeking a second medical opinion include: The process can delay the start of treatment. Logistically, seeing another specialist might be difficult and possibly time-consuming. It might be stressful to hear the same diagnosis again. How would you seek a second medical opinion? 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.  ...

Sexually transmitted infections (STIs)

What are sexually transmitted infections (STIs)? 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: Chlamydia Gonorrhoea Genital herpes HIV Genital warts HPV (human papillomavirus) Syphilis Trichomoniasis Pubic lice (‘crabs’) What symptoms do STIs present? Sexually transmitted infections can cause symptoms, although not always. Some patients may experience the following symptoms: Pain when peeing Unusual discharge from the vagina, penis or anus A rash Itchy genitals Vaginal bleeding Blisters or sores around the genitals Flu-like symptoms Skin growths around the genitals What causes sexually transmitted infections? The cause of sexually transmitted infections is either bacteria, parasites, fungi or viruses. Can STIs be prevented? 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. What is the treatment for STIs? 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. ...

Transvaginal ultrasound

What is a transvaginal ultrasound? 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. What does it consist of/involve? 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. Why is it done? In pregnancy, a transvaginal ultrasound can be used to: detect development in the uterus at an earlier stage than a traditional (transabdominal) ultrasound identify or rule out issues such as miscarriage or an ectopic pregnancy, where the baby is developing outside the uterus look for signs of early labour A transvaginal ultrasound might also be ordered if you have: pelvic pain or an abnormal pelvic exam unexplained vaginal bleeding difficulty getting pregnant How to prepare You don’t need to do any special preparations for a transvaginal ultrasound, other than emptying your bladder before the exam. What does it feel like during the test? 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. What do abnormal results mean? 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. ...

Tubal ligation

What is tubal ligation? 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. Why is tubal ligation done? 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. What does tubal ligation consist of? 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. Preparation for tubal ligation: 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: Infection A failed procedure, resulting in pregnancy in the future (which has a greater risk of being ectopic) Reaction to the anaesthesia Damage to surrounding tissue Aftercare following tubal ligation: 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

What is ultrasound? 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. What does an ultrasound scan consist of? 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. Why are ultrasounds carried out? 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. Preparation for Ultrasound 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. How does it feel during the ultrasound? 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. Meaning of abnormal results The types of images that are considered abnormal are: Congenital anomalies An alteration to tissue due to trauma or injury Cysts ...

Urinary incontinence

What is urinary incontinence? 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. What are the symptoms of urinary incontinence? 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: Urge incontinence – a sudden urge to urinate with a sudden loss of bladder control and urination. Stress incontinence – urine leaks when pressure is placed on the bladder (e.g. sneezing, coughing, laughing or lifting). Overflow incontinence – a constant dribbling or urine because you are unable to fully empty the bladder. Total incontinence – your bladder is unable to store urine at all, causing constant leakage. Mixed incontinence – you can experience more than one type of urinary incontinence. 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. What causes urinary 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: Pregnancy – increased size of the baby can put pressure on the bladder. Vaginal childbirth – this can weaken the muscles needed for bladder control and damage bladder nerves and tissues. Ageing – as we age, our bladder is less able to store urine. Hysterectomy – pelvic floor muscles may be damaged during such a procedure. Enlarged prostate in men – this obstructs the bladder, meaning it cannot empty properly. Prostate cancer – either as a side effect of prostate cancer treatment, or a symptom. Neurological disorders – some disorders can interfere with nerve signals that are needed for bladder control (e.g. Parkinson’s disease, multiple sclerosis). Obesity – puts pressure on your bladder. Can urinary incontinence be prevented? Urinary incontinence is a problem that cannot always be prevented, but the following can reduce your risk of developing this problem: Maintaining a healthy weight Avoid consuming things that irritate the bladder (e.g. alcohol, acidic foods and caffeine) Stop smoking Doing pelvic floor exercises High-fibre diet to avoid constipation What is the treatment for urinary incontinence? 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: Incontinence products (e.g. absorbent pads) Medications (e.g. duloxetine for stress incontinence, antimuscarinics and mirabegron for urge incontinence) Electrical stimulation (electrodes inserted into the vagina or rectum stimulate and strengthen the pelvic floor muscles) 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: Sling procedures – a sling is placed around the neck of the bladder to give support and to prevent leaks. Colposuspension – the neck of the bladder is lifted in position to prevent leaks in women with stress incontinence. Urethral bulking agents – a substance is injected into the walls of the urethra in women so that they increase in size, stopping leakages as the urethra is better able to stay closed. Artificial urinary sphincter – an artificial urinary sphincter is fitted to stop incontinence. ...

Uterine cancer

What is it? 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. Prognosis 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. What are the symptoms? 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. How is it diagnosed? 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: A hysteroscopy - an endoscopic exam of the uterus’ internal lining. During this exam, a sample of the lining will be taken so that it can be analysed. A magnetic resonance imaging (MRI) scan of the pelvic area, in order to see how far the tumour has spread. A computed tomography (CT) scan of the abdominal area to verify whether the tumour has spread to the lungs or not. A Positron Emission Tomography (PET) scan, which can show where the tumour is located and how is it evolving. What causes womb cancer? 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. How can it be prevented? 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. How can it be treated? 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. Which doctor should I talk to? 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. ...

Uterine malformations

What are uterine malformations? 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: Unicornuate uterus: Only one side of the Mullerian ducts is formed. Double uterus: The ducts develop but do not merge, so the patient has a double uterus. Bicornuate uterus: The upper part of the uterus is separate, often appearing as ‘heart-shaped’. Uterine septum: the most common uterine malformation, in which the uterus is partially or totally divided by a muscle wall. Mullerian hypoplasia: also known as vaginal agenesis, it is the absence of the uterus as the Müllerian ducts have not developed. Prognosis: 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. Symptoms of uterine malformations 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: Pain before or during menstruation Irregular blood loss outside of menstruation Pain during sexual intercouse Repeated miscarriages Premature births Medical tests for uterine malformations 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. What are the causes of uterine malformations? Uterine malformations develop during pregnancy, and the main factors have a genetic cause or prenatal environmental factors. Treatments for uterine malformations 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). What specialist treats uterine malformations? 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. ...

Vaginal dryness

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....

Vaginal ring

What is the vaginal ring? 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. How successful a contraceptive method is the vaginal ring? 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. How does the vaginal ring work? 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. Who can use the vaginal ring? For some women, the vaginal ring will not be a suitable contraceptive method. The following exclude your suitability for using the vaginal ring: You smoke or recently stopped smoking You are obese You have had a blood clot before You have high blood pressure You have diabetes with complications You have had breast cancer You suffer from migraines What are the advantages and disadvantages of using the vaginal ring? Advantages: No long-term effects on your fertility It will still work when you have nausea or diarrhoea It does not interrupt sex You do not have to think about it every day Periods may become lighter and less painful It is easy to insert and remove Disadvantages: You may have spotting in the first few months of use It does not protect against STIs Temporary side-effects can include breast tenderness, headaches, and mood changes You may struggle to insert and remove it You must remember to remove it after 21 days, and then insert a new one after your 7-day break ...

Vaginismus

What is vaginismus? 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. What are the symptoms? 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. What causes vaginismus? 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: Worrying that the vagina is too small Worrying that sex will be painful or cause damage History of sexual abuse Previous damage to the vagina, e.g. an episiotomy Painful conditions of the vagina or surrounding areas Painful/uncomfortable first experience of intercourse Relationship problems Fear of getting pregnant What is the treatment? Treatment of vaginismus depends on the underlying cause. It can include: Vaginal trainers: a series of cylindrical cones in differing sizes that are used in the comfort of one’s own home to progressively get used to inserting something into the vagina. It can take days or months, and the patient must go at her own pace. Pelvic floor exercise: these are recommended with the above treatment, so the patient gets used to the feeling of contracting and relaxing the muscles, with the aim to be able to voluntarily choose to relax while having intercourse for example. Sometimes a biofeedback machine can be used with a gynaecologist. This device allows the patient to be told when she is contracting (in the case that she cannot tell) and get used to the feeling so as to be able to master controlling it. Sex therapy: psychological therapy is a recommended option especially if the underlying cause has been sexual trauma. Dynamic analysis, counselling or CBT may be employed. Surgery: in some cases, where there may have been previous surgical trauma, or an obstruction which narrows the vagina, surgery may be necessary. The patient will undergo an anaesthetic and a small amount of tissue is removed. ...

Vaginitis

What is vaginitis? 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: Bacterial vaginosis Yeast infection (thrush) Trichomoniasis What are the symptoms of vaginitis? The main symptoms of vaginitis are: Itching Swelling and redness of the vagina A strange vaginal discharge that is different in smell, colour and amount Pain when urinating or during intercourse Abdominal pain Light bleeding or spotting It is helpful to know that the type of discharge you have can indicate what type of vaginitis you have: Bacterial vaginosis – greyish-white, smelly discharge. Yeast infection – white, thick discharge that is said to resemble cottage cheese. Trichomoniasis – green or yellow discharge. What causes vaginitis? The causes of vaginitis can be several: Bacterial vaginosis: caused by a change in the normal balance of bacteria found in the vagina. This can be linked to sexual activity, but sometimes is not. Yeast infections: caused by an imbalance of candida fungi in the vagina. This may result from antibiotic use or pregnancy. Trichomoniasis: a common STI caused by a parasite. This is transmitted sexually and in men this may cause a urinary tract infection. Allergic reactions: to medicines, condoms, lubricants, to the material of underwear, to products for intimate hygiene or even to laundry detergent. Hormonal: atrophic vaginitis is common in postmenopausal women due to decreased oestrogen levels and thinning of the inner lining of the vagina. Can vaginitis be prevented? To prevent vaginitis is advisable to: Wear cotton underwear Avoid irritants, such as perfumed soaps for washing the vagina or scented sanitary products, Avoid douching the vagina (your vagina does not need to be washed anymore than other parts of your body) Practise safe sex with a condom Ensure you wipe from back to front when going the toilet What is the treatment for vaginitis? 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

What is vaginoplasty? 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. Why is vaginoplasty done? 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. How is a vaginoplasty performed? 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. Preparation for vaginoplasty: Before your surgery, it is important to follow your surgeon’s instructions about fasting and stopping any medications. Aftercare: 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. ...

Vulvar cancer

What is vulval cancer? 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: Squamous cell carcinoma: this type of cancer represents 90% of the cases of vulval cancer Verrucous carcinoma: it is more common in younger women Adenocarcinoma Melanoma Sarcoma Basal cell carcinoma   What are the symptoms of vulval cancer? The most common symptoms are: A persistent itch in the vulva, which may be followed by a burning sensation A lump, nodule or wart-like growth on the vulva which you can feel by touching it In the most advanced stages, foul-smelling vaginal discharge; blood-stained vaginal discharge between periods and abdominal pain If you have started a targeted therapy to treat these symptoms and they haven’t gone away, you will need to see a gynaecologist.   How is it diagnosed? 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: Colposcopy and vulvoscopy: while a colposcopy analyses the epidermis of the vulva and the cervix, a vulvoscopy analyses the external genitalia. Fine-needle aspiration or biopsy: a tissue sample is taken and analysed under a microscope to determine whether or not there are tumour cells. Computed tomography (CT) scan Magnetic resonance imaging (MRI) scan PET scan Cystoscopy or bladder endoscopy Proctoscopy or endoscopy of the rectum and anal canal   What causes it? The exact cause of vulval cancer is unknown, but certain things can increase your chances of developing the condition: Human papilloma virus (HPV) infection Being infected with HIV Vulval intraepithelial neoplasia (VIN) Syphilis Lichen sclerosus Diabetes High blood pressure Obesity Increasing age Smoking A previous history of cervical or vaginal cancer   How can it be prevented? 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.   How is it treated? 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: Surgery: depending on the extent of the cancer, the surgeon may need to remove only a small section of the vulva or the whole vulva, including the inner and outer labia and possibly even the clitoris. In other cases, the doctor may decide to remove the lymph nodes of the inguinal and pelvic area, where some tumour cells may be. Radiotherapy: it is usually done before or after surgery. If you can’t have surgery, radiotherapy can be done to relieve the symptoms of the tumour. Chemotherapy: the drug is administered via injection or orally. Its purpose is to destroy the tumour cells in your body. Chemotherapy is often done together with radiotherapy in order to fight a cancer which has reached an advanced stage.   Which doctor should I talk to? 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

What are warts? 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: Common warts: these usually occur on the fingers, hands, elbows, and knees; Flat warts: most common on the face, arms, and knees; Plantar warts: they are usually found on the soles of the feet. Plantar warts can be painful, as they are continuously rubbed and under pressure; Mosaic warts: these commonly occur under the toes; Filiform warts: thread- or finger-like warts often occurring on the face; Condylomas or genital warts: sexually transmitted warts, most common in the genital area. Prognosis 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). What are the symptoms? 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. How are they diagnosed? 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. What causes them? 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: Contact with the skin of somebody who has HPV; Contact with contaminated surfaces (the floor of a pool, common showers, at the gym); Sharing personal hygiene objects, such as towels or razors; If you already have a wart, you may spread it to other areas of your body by touching it. How can they be prevented? You should: Use rubber flip flops in the changing room and common showers at the gym; Thoroughly disinfect lesions of the skin; Wash your hands multiple times a day. 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. How are they treated? 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: Cryotherapy: liquid nitrogen is used to freeze the warts. This procedure can be carried out at home, with products that can be bought at your local pharmacy; Cantharidin: by applying this compound directly on the wart, it will die out and the doctor will remove it after a couple of days; Electrodesiccation: electricity is used to heat up the affected area until the wart dies. This procedure is often associated with curettage, which consists in removing the wart by cutting it with a scalpel or by scraping it off with a spoon-like instrument; Laser treatment: this procedure ensures a highly precise intervention on the affected area, without compromising neighbouring tissues; Keratolysis: this exfoliation method destroys the wart, by using specific medications which can also be applied at home. Which doctor should I talk to? Dermatologists are generally the specialists who treat and remove warts.  ...

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