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Gynecology

Sexually Transmitted Diseases

Some common STDs are Hepatitis B, Chlamydia, Gonorrhea,  Trichomonas Vaginalis, and Syphilis.

Screening tests for Gonorrhea and Chlamydia are routinely performed at time of a pelvic exam for women sexually active and age 25 or under. At the time of the exam, a small special swab is used to used to collect a sample from the cervix. This could also be done through a triple test screen along with pap smear and chlamydia. This is collected using a special brush that is dropped in a liquid environment and sent to lab where all three tests are done. Trichomoniasis could be seen in a vaginal preparation (wet mount) and under direct visualization using a microscope. It could also be tested using a swab and special tube. A small amount of your blood may be drawn and sent to the laboratory for testing in order to screen for Syphilis, HIV, and Hepatitis B. Results from these tests are usually available within a week to ten days.

Gonorrhea

This is an infection that often occurs with no symptoms in women. A special Bacteria is the cause of this disease. It affects warm mucosas of the body. The most common place for this bacteria to grow in is cervix but oral cavity and throat infections are possible through oral sex. Gonorrhea can also infect the rectum and urinary tract. Gonorrhea is treated with antibiotics. This could be done orally or parenterally. As it is with almost all STDs Sexual partners must be treated to prevent the infection from recurring.

Chlamydia

Chlamydia is usually a symptomless and common STD in women. Chlamydia is a bacteria that commonly causes cervicitis. It may spread to the uterus and fallopian tubes. This may lead to permanent damage and sterilization. Urinary tract, rectum, throat, and even conjunctiva of the eye could also get infected. Chlamydia is treated by oral antibiotics. Sexual partners must be treated to prevent the infection from recurring.

Trichomonas

This is a condition caused by a microscopic parasite. Symptoms may include a mixed color vaginal discharge. It usually is yellow-gray or  The discharge may have a foul and fishy odor. There may be burning, irritation, itching,redness, and swelling of the vulva and sometimes there is pain during urination. Trichomoniasis is usually treated with a oral antibiotics. To prevent recurrence sexual partners must be treated .

What is Human Papillomavirus (HPV)?

HPV is a common virus. It is  estimated that close to 20 million people in the United States are infected with this virus. There are many different types of HPV. Some could lead to cancer . Others could cause genital disorders.

It is estimated that at least 50% of sexually active people catch HPV during their lifetime. Men and women of any age who practice any kind of sexual activity that involves genital contact are at risk but may remain asymptomatic for a long time. For the most part the virus goes away on its own. When the virus is resistant and does not go away it could develop into cervical cancer.

Gardasil

Two types of HPV that cause warts and another two types that cause about 70% of the cervical cancers could be prevented by using Gardasil. Gardasil is a protective vaccine that is given in 3 doses.The duration of protection of GARDASIL has not been established.

Who should get GARDASIL?
Vaccination is recommended for girls as young as 9 because GARDASIL works when given before there is any contact with HPV Types 6, 11, 16, and 18. Upper age that it could be given is subject to debate but usually the mid twenties is the upper limit of this vaccination. If a woman is sexually active she may not have been exposed to all types of HPV and as such may still benefit from Gardasil vaccination.

The most common GARDASIL side effects are: pain, swelling, itching, bruising, and redness at the injection site

  • headache
  • fever
  • nausea
  • dizziness
  • vomiting
  • fainting
  • Sometimes fainting is accompanied by falling with injury, as well as shaking or stiffening and other seizure-like activity.

Tell your health care professional if you have any of the following problems because these may be signs of an allergic reaction:

  • difficulty breathing
  • wheezing (bronchospasm)
  • hives
  • rash
  • Tell your health care professional if you have:
  • swollen glands (neck, armpit, or groin)
  • joint pain
  • unusual tiredness or weakness
  • generally feeling unwell
  • leg pain
  • shortness of breath
  • chest pain
  • aching muscles
  • muscle weakness
  • seizure
  • bad stomach ache

patients with allergic reaction, unknown fever, HIV infection, or if pregnant should avoid receiving the vaccination.

Pap Smears

The Pap smear is a screening test for detecting cancerous or precancerous changes of the cervix. It was introduced about half a century ago and has caused about 80 percent decrease in cervical cancer rate. This makes the Pap smear one of the most effective cancer screening tests ever invented.

The cervix is the opening of the uterus (or womb). It has a canal that is covered with a thin layer of mucosa and tissue. Portion of this canal that has two different cell types is called transformation zone.  Cells from this region or any where along the cervical canal and also the surface of the cervix are shed off and studied under a microscope in pap smear evaluation. Abnormalities are detected before cervical cancer ever comes to be. this is known as dysplasia or cervical intraepithelial lesion. It has different gradings. Multiple factors are considered in further evaluation and treatment of abnormal pap smears.

Bottom line is that one should not panic with an abnormal pap smear result.

It is ancer is not usually the cause of most abnormal smears. Before cervical cancer develops, there are usually several stages of abnormal cells called “dysplasia” (also known as “cervical intraepithelial neoplasia” or CIN). CIN changes take several years to develop and progress, which is why the Pap smear is so effective. When these abnormal cells are found, they can often be treated with procedures in your doctor’s office which avoids hospitalization. Keep in mind that like any screening test, 10-20% of the time, a normal Pap result could be a “false-negative”. This means that a normal result is reported even though abnormal cells are present. This reinforces the need for yearly Pap smears, which in the long run will cut down on the false-negative results.

If you have an abnormal Pap smear result, don’t panic. Usually this means that you would need  either a repeat of the Pap smear in several months or a colposcopy.

Colposcopy

Colposcopy is an office procedure that  a special equipment is used by a physician to magnify and closely inspect the cervix.

A diluted vinegar solution is placed on the cervix and a special light is used  to allow a clear view of the cervix. Abnormal areas are then biopsied and sent to pathologist for further evaluation.

If there are any suspicious findings, mismatches, or abnormal pathology reports from the colposcopy, a cervical conization biopsy may be required. Most commonly done type of conization biopsy is LEEP.

LEEP

A loop electrosurgical excision procedure, commonly referred to as a LEEP. This is both a diagnostic and a therapeutic treatment for abnormalities of the cervix.

During the LEEP procedure, a speculum is inserted in to the vagina. Cervix is observed and then numbed with local anesthetic. Special solution is placed on the cervix to highlight areas of abnormal cells. The physician will view the cervix through a colposcope.

A fine wire loop with a special electrical current is used to resect a small cone shaped segment of the cervix. Different sizes and shapes of the loop is used depending on the size of the biopsy in mind. After completion of the tissue removal, a special device may be used to seal blood vessels and/or a medicated solution may be applied to the cervix to reduce bleeding.

The tissue samples taken are sent to a pathology laboratory and examined by a pathologist.

Endometrial Biopsy

Endometria biopsy is a procedure in which a tissue sample is taken from the lining of the uterus (endometrium) and is checked under a microscope for any abnormal cells or signs of cancer.

Endometrial Ablation

Any woman with heavy periods that has completed her childbearing plans is a candidate for this procedure. Heavy periods, or menorrhagia, affects 15- 20% of all women.

There are several different choices available. Some are done in the office and some as an outpatient procedure in the hospital. The treatment essentially eliminates the lining of the uterus that is shed off monthly. improvement has been reported in majority of cases. complete loss of periods have also been reported but they gradually and over the years may return.

Office procedures for contraception

IUD

An IUD is an intrauterine device that could be used for contraception as well as reducing heavy periods. Special types of IUD are implanted inside the uterine cavity. They produce special hormone to reduce the thickening of the uterus and therefor decrease or eliminate periods. This is a reversible method of contraception. It could be removed at any time.is a reversible form of contraception. This method provides either 5 or 10 years of contraception depending on the device used.

Essure

Essure is a permanent birth control procedure. Two tiny coils are placed into each fallopian tube through a hysteroscopy. These coils work with your body to create a natural barrier against pregnancy. This well tolerated procedure can be performed in a doctor’s office in minutes.

 

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