Question: Ten years ago I had a hysterectomy for fibroids, and my ovaries were removed. Do I need to have a Pap smear?
When a Pap smear is performed, the area examined is the cervix, and the test is primarily performed in order to find cancer of the cervix at an early stage. The cervix sits at the top of the vagina, and is the rubbery piece of tissue that forms the opening into the uterus (womb).
In a hysterectomy, the uterus and cervix are removed, but the vagina is left behind. After a hysterectomy, there is nothing left behind to perform a Pap smear on; you therefore do not require an annual trip to the doctor for this test. The one exception to this rule is those women who have had a hysterectomy because of cancer. There is a very slight risk that the cancer can spread to the top of the vagina, and so vaginal vault smears should be performed regularly in these women.
The Pap smear test is one that should be performed on all women who have ever been sexually active. A test every two years is ideal, but if there have been abnormal tests of some sort, this may be reduced to 6 or 12 months. Many other conditions other than cancer can be detected by a Pap smear. These include infections, abnormal discharges, erosions of the cervix and ulcers.

Question: I am due to have a hysterectomy because of fibroids. I want to keep my cervix, which is perfectly normal, but my gynecologist is reluctant to do this. If I have a regular Pap smear, why shouldn’t I have a sub-total hysterectomy and keep my cervix?
A sub-total hysterectomy in which the body of the uterus (the womb) is removed, but the neck of the uterus (the cervix) and the ovaries are retained is certainly an option, but it is not one that is commonly preferred.
The advantage is that you continue to have a cervix, which some experts claim is important for the full sexual satisfaction of the woman. The disadvantages are that the operation is technically more difficult, and more prone to complications, as the thick muscle of the neck of the womb must be cut through and secured, instead of the thin tissue at the top of the vagina. Your gynecologist will certainly be more experienced at doing a full hysterectomy than a partial one. As you mention, you also have the continued risk of cancer of the cervix, which can be detected early by a regular Pap smear.
My advice would be to have a full removal of your uterus and cervix (retaining one or both ovaries).

Question: What do sex hormones do? How do they affect men and women?
Sex hormones are produced by the ovaries in the woman and the testes in the man to give each sex its characteristic appearance. In men, they are responsible for the enlargement of the penis and scrotum at puberty, the development of facial hair and the ability to produce sperm and ejaculate. In women, the sex hormones that are produced for the first time at puberty cause breast enlargement, hair growth in the armpit and groin, ovulation, the start of menstrual periods, and later act to maintain a pregnancy.
If the sex hormones are reduced or lacking, these characteristics disappear. This happens naturally during the female menopause. During the transition from normal sex hormone production to no production in the menopause, there may be some irregular or inappropriate release of these hormones, causing the symptoms commonly associated with menopause such as irregular periods, irritability and hot flushes. After the menopause, the breasts sag, pubic and armpit hair becomes scanty, and the periods cease due to this lack of sex hormones. Men also go through a form of menopause, but more gradually, so the effects are far less obvious than in the female.
Sex hormones, and many synthesized drugs that act artificially as sex hormones, are used in medicine in two main areas—to correct natural deficiencies in sex hormone production; and to alter the balance between the two female hormones (oestrogen and progestogen) that cause ovulation, to prevent ovulation, and therefore act as a contraceptive. Female sex hormones can also be used to control some forms of recurrent miscarriage and prolong a pregnancy until a baby is mature enough to deliver, to control a disease called endometriosis, and to treat certain types of cancer.
Uncommonly, sex hormones can be used to alter the appearance of a person who wishes to change their sex. A small dose of male testosterone can increase the libido (sex drive) in women who are lacking this normal instinct.

Question: Could you explain the function of the adrenal glands and their connection to adrenalin?
The adrenal glands are part of the system that produces the body’s hormones (called the endocrine system). They sit on top of each kidney, a bit like a beanie. The glands are tiny—less than 5 cm long and weigh only a few grams—and yet produce more than three dozen hormones. The glands are divided into two quite distinct parts—an inner, reddish brown section called the medulla and an outer, yellow-colored section called the cortex. Each part has its own distinct function.
The hormones produced by the medulla in the adrenal gland include adrenalin, which causes the well-known ‘fight or flight’ response to danger. The medulla is part of the autonomic (unconscious) nervous system, and when the body becomes aware of danger through one of its senses, these hormones literally spurt out making the heart beat faster, increasing the blood sugar level, altering the blood flow and generally increasing the body’s capacity to deal with the emergency. Because many of the stresses of modern life do not require such a physical response, the release of adrenalin is sometimes inappropriate and the body has no way of using it up. If it happens too often it may eventually cause health problems.
The hormones produced by the cortex are steroids, of which there are three main groups. One group controls the balance of minerals in the body. Another group regulates the use the body makes of carbohydrates, and also plays a part in our ability to handle stress (cortisone is the most important hormone of this group). The third group affects the operation of our sex glands and influences our sexual development. Steroids are made from cholesterol, so a certain amount of cholesterol is necessary in our diet, provided it isn’t more than we need, which can cause heart problems. Like other glands in the endocrine system, the adrenal cortex is controlled by the pituitary gland, which sits under the brain.
If the adrenal glands are destroyed because of disease (eg. tuberculosis or cancer) or are overactive, the functioning of our entire body can be impaired. The most common disorders are called Addison’s disease and Cushing’s syndrome.

Question: Would you please explain what hormones are? I do not understand how they work.
Most people think of hormones in terms of the sex hormones (oestrogen and testosterone), but there are actually over 100 hormones that affect the functioning of every cell in the human body.
Hormones are chemicals of various types that are released by glands such as the pituitary gland (in the brain), thyroid and parathyroid glands (in the neck), pancreas (in the centre of the belly), adrenal glands (on each kidney), ovaries, testes and other less-well-known glands. These chemicals enter the bloodstream, and in this travel to every single cell in the body.
They give instructions to the cells on an enormously wide range of matters that affect the way in which all cells work. The system is orchestrated by a part of the brain called the hypothalamus, which in turn gives instructions to the pituitary gland which is attached to it. The pituitary releases hormones which travel to other glands through the blood, telling them what to do.
As an example, one of the hormones that the pituitary gland releases is thyroid-stimulating hormone (TSH). This stimulates the thyroid gland to produce more of the hormone thyroxine. Thyroxine controls the rate at which every cell in the body works. If there is more thyroxine, the cell works faster, if there is less thyroxine, it works slower. As the level of thyroxine rises in the blood, the pituitary gland senses this and reduces the amount of TSH produced.
This feedback mechanism regulates not only the thyroid gland and its production of thyroxine, but every other gland in the body, including the production of the sex hormones from the ovaries and testes.

Question: What is a hiatus hernia?
The chest cavity is separated from the abdominal cavity by a sheet of muscle (called the diaphragm) that runs across the body from front to back. Your stomach is immediately below the diaphragm, and is connected to the mouth by the gullet (oesophagus), which has to pass through a hole in the diaphragm.
Under certain circumstances, a small part of the stomach may slide through the hole in the diaphragm from the abdominal cavity into the chest cavity. This is a hiatus hernia. The stomach may slide backwards and forwards, or may be stuck in the diaphragmatic hole.
The hernia will allow the acid in the stomach to flow up into the oesophagus, where the cells are not protected from the stomach acid. This causes heartburn, an acid taste in the mouth, burping and in severe cases, ulcers. The factors that lead to the development of a hiatus hernia are obesity, stress, smoking, rapid eating, large meals, alcohol, heavy lifting and straining, repeated or constant bending and vomiting.
Treatment will involve avoiding these factors, antacids, medications to empty the stomach, drugs to reduce acid and spasm, and in very severe cases surgery may be tried.

Question: My baby has an umbilical hernia. It looks funny, but does not seem to worry him. I have heard conflicting advice on treatment for this problem. What do you think should be done for this?
Umbilical hernias occur when there is a weakness in the wall of the abdomen where the umbilical cord goes through the muscle layers into the baby’s body. Crying and straining force a piece of gut or fat through this weakened area leading to a lump under the belly button. This lump should go down when the child is lying at rest. The vast majorities of these require no treatment and close over spontaneously by the time the child is two or three years old. Only if it lasts beyond this time is corrective surgery necessary.
If the infant starts screaming, and the hernia is found to be hard, red and tender, an urgent operation will be required to reduce the trapped piece of gut. This problem is unusual.