Mr Angus McIndoe

Mr Angus McIndoe
Obstetrics & gynaecology
Central London


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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

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 Doctor's articles

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 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)

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 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

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 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)

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 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.

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 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

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Languages spoken

  • English

Patient reviews for Dr. Angus McIndoe

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19/11/2017

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Verified Patient
17/07/2017

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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

Cervicitis is an inflammation of the cervix caused by an infection, usually a sexual transmitted infection. The most common infections are chlamydia, gonorrhoea, genital herpes and genital warts. Women may not notice any symptoms if they are affected, but usually the cervicitis increases vaginal discharge, causing pain during intercourse, burning, cystitis, abnormal vaginal bleeding (after intercourse, after menopause, between periods), pelvic pressure or heaviness and even skin lesions around the pubic hair. If not treated in time, the infection can reach the fallopian tubes and uterus. It is important to perform a pelvic examination at onset of symptoms. Cervicitis is usually treated with antibiotics in case of bacterial infections such as chlamydia and gonorrhoea, with antivirals for herpes infections or hormones in women who have reached menopause. ...

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 is thought to come through the urethra, which carries urine out from your body. Women have a shorter urethra, and it is closer to the anus in women, which means 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 cystitis from re-occurring or occurring frequently. For example, showering rather than bathing, and not using perfumed bubble bath/shower gel. Keep good sanitary habits, and wipe your bottom from front to back. 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

A fertility test is a medical protocol that aims to diagnose the causes of infertility in order to find the necessary help to get pregnant, including Assisted Reproductive Technology (ART). The couple undergo a series of tests if they have been trying for a child for at least a year without success. The tests generally last between one and two months, they are relatively simple, and their purpose is to find out if the man’s sperm count and characteristics are normal, if the sperm reaches the uterus after intercourse, if the woman has any ovulation problems or if the uterus and the fallopian tubes are normal. To do this, the fertility study may include tests such as transvaginal ultrasound, bacteriology tests, hormonal tests and hysterosalpingography, in the case of women; in the case of men, sperm count and sperm motility test. ...

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)

The human papillomavirus (HPV) is a virus that infects the skin and mucous membranes in humans. There are over 100 different types, most of them harmless, but some are associated with an increased risk of cervical cancer or dysplasia (abnormal cell changes in the surface of the cervix). These are acquired through sexual contact with an infected partner, and can be low risk or high risk. The low-risk types can cause genital warts. The high-risk can cause cervical, vulva, vagina and anus cancer in women; and cancer of the penis and anus in men. It is possible that the affected person has no symptoms; in the case of women, regular Pap smears can detect changes in the cervix that may end up leading to cancer. There is no cure for HPV. The treatment of cervical dysplasia that does not go away, may include surgery to remove the abnormal tissue. ...

Hymenoplasty

Hymenoplasty, also known as hymen restoration surgery is an intervention that is responsible for rebuilding the membrane of skin in the lower half of the vagina (known as hymen). This fibrous and elastic tissue tears with the first sexual penetration of women, but can also be broken by an accidental drop, shake, or even by using tampons. Generally, patients who require this type of operation want to reconstruct the hymen for cultural or religious reasons. The surgical procedure is quite simple and involves reconstruction of the hymen by fine sutures. If there are still remnants of the original hymen the restoration is carried out on that tissue. If this is not the case, then the surgeon takes a section of the lining of the vaginal wall in order to create a new hymen. The stitches will be reabsorbed and the patient can have sex after about one month. ...

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

Labiaplasty surgery is used to reshape the female external genitalia. This operation corrects the appearance of the labia without changing its functionality, by using different techniques according to each patient’s needs and the type of malformation. When the labia minora are too large or have an irregular and anomalous shape, reduction and correction of them is performed. Furthermore, the labioplasty also reshapes the labia with injections of hyaluronic acid or fatty tissue fillers. ...

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

Miscarriage is the loss of an embryo or foetus through natural causes, or through unintentional loss. If it happens after the 20th week of pregnancy it is called stillbirth. Miscarriage is divided into early stage (before 12 weeks) or late (between week 12 and 20). ...

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

Pelvic inflammatory disease is an infection that affects the upper part of the internal female reproductive system: uterus, ovaries and fallopian tubes. It is caused by the ascent of bacteria from the vagina to the cervix, which is transmitted sexually during childbirth or an abortion. The main symptom is abdominal pain, and can also manifest through long and painful periods, fever, pelvic pain, nausea or vomiting. ...

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

Repeated miscarriages are the loss of three or more consecutive pregnancies before the 20th week of gestation. Each case should be individualized, with the age of the woman, the circumstances surrounding the losses or the anxiety of the couple all being aspects to be taken into account. ...

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)

Sexually transmitted infections (STIs) are a set of infectious diseases caused by different microorganisms. They all have in common that they are spread, most of the time, through sexual intercourse. More than 20 STIs are known, including chlamydia and lymphogranuloma, gonorrhoea, genital herpes, human immunodeficiency virus (HIV), genital warts caused by human papillomavirus, syphilis and trichomoniasis. Although most STDs affect both men and women, women have the most serious health problems. Not all STDs can be cured: those caused by bacteria, such as chlamydia, are treated with antibiotics, but in those that are caused by viruses, such as genital herpes, treatment is limited to alleviating the symptoms. ...

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

Urinary incontinence is the inability to control the bladder, which means that you can not always hold urine. It can affect anyone, but is most common in people over 50 years. Most control problems occur because the muscles that keep the bladder are too weak or too active. If they are weak, small amounts of urine to perform actions such as laughing or coughing are lost, which is known as stress incontinence. On the contrary, if they are too active, you can have an urgent need to go to the bathroom while having little urine in the bladder (urge incontinence or overactive bladder). Other causes include prostate problems and neurological damage. The treatment of urinary incontinence depends on the cause and type, but in general usually includes simple exercises, medicines and special devices. Surgery may be helpful at times. ...

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 fibroids

Fibroids are benign growths of variable sizes that develop in the muscular wall of the uterus. Generally, women with these growths do not suffer any symptoms. However, there are some women who may experience the following: heavy and very long menstrual bleeding, bleeding between periods, pelvic cramps, heaviness in the lower pelvic area and legs. The treatment for fibroids may include oral contraceptives to help control heavy periods or nonsteroidal anti-inflammatory drugs, such as ibuprofen for cramps or pain. In severe cases, it may be necessary surgery to remove the fibroids. ...

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

Vaginitis is a vaginal inflammation, usually due to an infection. The causes may be chemical or traumatic. Chemical causes include the use of some creams or aggressive soaps near the vagina or urethra. Traumatic or external causes that cause inflammation of the vagina can range from sexual intercourse without sufficient lubrication, or practice sports without the necessary clothing. Sometimes, symptoms may go unnoticed, but usually, women who suffer from vaginitis present an excessive discharge, burning, painful urination, intercourse discomfort and irritation in the vulva and vagina. Treatment of vaginitis may be a cream or gel which is introduced into the vagina. Sometimes, even if symptoms disappear, the infection may still be dormant. ...

Vaginoplasty

Vaginoplasty is a vaginal rejuvenation surgery aimed to correct the loosening of the tissues of the vaginal canal and restore tone and contractility of the vaginal muscles. The surgical procedure involves tightening the muscles around the vagina that are distended or deformed, and are responsible for giving strength to the vaginal walls, while improving elasticity and control of the vulva. The results of this operation are usually highly satisfactory: a tighter and stronger vagina without visible scars. Additionally, in many cases sexual intercourse improves after 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

Warts are small skin lesions or growths that are usually painless and harmless. There are many types of warts: Common warts usually appear on the hands and are common in children. Genital warts grow on the genitals an surrounding areas. They are caused by the human papilloma virus and it is advisable to see a doctor if symptoms occur Plantar warts appear on the soles of the feet and can be very painful. There are also subungual and periungual warts that are underneath or around the fingernails or toenails. ...

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