Medical Questions & Answers » Female Problems

Vaginal Hysterectomy

medicalquestions — Fri, 18 Jul 2008 06:00:40 +0000

Question: My gynaecologist wants to try a microwave endometrial ablation before he does a hysterectomy in order to control my heavy painful periods. What do you think about this operation?
In the last few years, doctors have tried a range of new procedures to preserve the uterus and prevent the symptoms being suffered by the woman without resorting to a hysterectomy. One of the more recent, and most successful, is the ptocedure (it isn’t really an operation as nothing is cut) known as microwave endometrial ablation (MEA).
The reason for heavy painful periods is excessive production of the lining inside the uterus (the endometrium) which is shed with every period, and comes away with some bleeding and spasms (cramps) of the muscle that forms the uterus. The procedure involves a brief general anesthetic for ten to fifteen minutes. A thin probe is introduced through the vagina and cervix into the uterus. The probe contains a microwave generator that is carefully calibrated to produce just the right amount of energy to destroy the endometrium (lining of the uterus) without damaging the wall of the uterus or surrounding organs. The probe is turned on for a few minutes and gently moved around inside the uterus to destroy all the endometrium.
MEA is normally carried out as a day surgery procedure, and the woman can go home a few hours later. There are normally some bad period-like uterine cramps for a few days, and a bloody discharge for two or three weeks, but after that, 90% of women have no periods at all, and can therefore avoid a hysterectomy.
The worst outcome is that the procedure fails and a hysterectomy is eventually necessary, but if it works, a simple procedure has replaced significant surgery. You should probably give it a try.

Use of Tampons

medicalquestions — Sun, 08 Jun 2008 06:00:27 +0000

Question: I am concerned about using tampons after reading about the toxic shock syndrome. Is this a significant risk for women, or can I still use tampons safely?
The toxic shock syndrome, despite all the publicity, is actually a very rare condition, and most general practitioners have never seen a case. The people who do develop the condition are extremely ill, and about 5% of them die, despite the best efforts of doctors. Some bacteria, and particularly one called Staphylococcus aureus (the golden staph) which is a common cause of vaginal and other infections, may produce a toxin or poison. Most people have antibodies to protect them from this problem, but in a very small number of people, the toxin may cause severe effects.
The symptoms of toxic shock syndrome are a high fever, dizziness, severe diarrhea, vomiting, muscle aches, fainting and sometimes a rash. An examining doctor will find the blood pressure to be low. The syndrome can occur in anyone, but seems to be more common in women and particularly in women who are menstruating. Treatment involves antibiotics to treat the bacterial infection, and hospitalization to replace the fluids lost with the severe diarrhea and vomiting. There is no specific antidote to the toxin, and so the earlier the diagnosis is made, the better the chances of recovery.
There is no reason why women should not use tampons, as the risk of developing toxic shock syndrome with them is infinitesimally small. Only if the tampon becomes infected is there any chance of developing the syndrome. To reduce the risk to a minimum, ensure your hands are clean before unwrapping and inserting the tampon; use the lowest absorbency tampon necessary for your flow; never insert more than one tampon; do not leave the tampon in for any longer than necessary; and pads may be a better alternative overnight. Make sure you don’t forget to remove the last tampon of your period. There is no evidence that any one brand or type of tampon is more likely to cause the syndrome than any other.
Relax and use the menstrual hygiene product that best suits your needs.

Urinary Incontinence Problem

medicalquestions — Fri, 06 Jun 2008 06:00:40 +0000

Question: I am only 55, but I am having terrible problems with urinary incontinence. Can you help me with this problem?
Embarrassing, unpleasant, uncomfortable, distasteful, offensive, distressing, intolerable and very annoying. Urinary incontinence is all these things, and more, but it is a topic that is never discussed with friends or family, and mentioned to doctors often only after many visits for other more socially acceptable diseases. Incontinence is usually associated with the old man lying semiconscious in a nursing home bed. But it is far more common in women, and many relatively young women in their thirties or earlier can be victims.
Incontinence is the loss of urine from the bladder at times when such loss is not desirable. It can vary from constant bed-wetting, to the occasional dribble when a woman jumps, coughs or laughs. The most common cause of incontinence is the damage done to the genitals during childbirth, and this is the reason for women being the victims far more frequently than men. Other causes include urinary infections, strokes, confusion in the elderly, bladder injury, epilepsy and damage to the spinal cord in paraplegics and quadriplegics.
The urethra is the tube that carries urine from the bladder to the outside of the body. In women it is only 1 to 2 cm long. It leaves the bladder at an acute angle, and this angle causes the pressure of the urine inside the bladder to keep the urethra closed. It requires a voluntary muscular effort to open the urethra and allow the urine to escape. The stretching that occurs during childbirth can cause this critical angle to be lost and the urethra to become a straight tube leading from the bladder to the outside. Any pressure put on the bladder, or any significant volume of urine, can then cause incontinence. Unfortunately this straightened tube can also allow bacteria and infection to enter the bladder more easily and cause the pain and discomfort of cystitis (bladder infection).
Because the bladder is controlled by nerves, damage to the nervous system by a stroke or the cutting of the spinal cord in paraplegics may also lead to incontinence. As with most diseases, the earlier incontinence is treated, the better the results. Prevention is even better than cure. Exercises to strengthen the muscles of the pelvic floor should be undertaken by all women immediately after childbirth. These can also be done in the early stages of incontinence to help control the bladder function as normally as possible. A patient can start by practising stopping and starting the urinary stream several times whenever they go to the toilet. Physiotherapists can teach the finer details of these exercises.
If the problem has progressed beyond control by exercises alone, the options are rather limited. In younger women, an operation to correct the abnormal bladder/urethra angle is usually successful. In older women, a specially shaped rubber ring may be worn inside the vagina to put pressure on the urethra and prevent urine from escaping. These rings must be fitted and regularly checked by a doctor.
In intractable cases it may be necessary to insert a semi-permanent catheter (tube) into a woman’s bladder that drains urine into a collecting bag. A woman’s concern about incontinence can become a significant mental problem and a social barrier, and should therefore be treated sooner rather than later.

Lump in Vagina

medicalquestions — Fri, 06 Jun 2008 06:00:06 +0000

Question: I have a terribly personal and embarrassing problem. Whenever I try to pass faeces, a lump comes out of my vagina. I can pass a little bit, but no more. As soon as I stand up, the lump goes and I need to go again. Is it cancer?
You probably have a rectocoele, and not cancer.
During childbirth the vaginal canal becomes very stretched. As you age, the tissues supporting the walls of the vagina becomes slack. The combination of these two factors leads to a weakness on the back wall of the vagina and the lower part of the gut (the rectum) can sag (prolapse) into the vagina. When you attempt to pass faeces, the increased pressure in the abdomen pushes the rectum further into the vagina, even to the point where part of the back wall of the vagina is pushed outside as a lump. When this happens, the rectum takes on a very sharp S shape, and this makes it difficult for the faeces to pass down further. You can expel the small amount of faeces just inside the anus, but no further faeces can pass the S to reach the anus.
When you stand up and relax, the lump goes down, the S straightens out, faeces moves down the rectum a bit further, and you want to go to the toilet again. The solution is to have an operation to strengthen the back wall of the vagina and suspend the rectum so that it cannot sag. In the short term, a rubber ring inserted by a doctor into the vagina may prevent the problem.

Question: What is the best treatment for the itch of thrush? I get this terrible infection every few months, and it drives me crazy!
The almost irresistible, but socially unacceptable itch is what drives most patients to the doctor. The treatment of vaginal thrush revolves around vaginal pessaries (tablets), vaginal creams and an oral tablet. These can give rapid relief, and are given in a course that can vary from one to ten days depending on the severity of the infection and the method of treatment used.
You can prevent infections by wearing loose cotton panties, drying the genital area carefully after swimming or showering, avoiding tight clothing, wiping from front to back after going to the toilet and not using tampons when an infection is likely. Even using all these measures, it is a fortunate woman who avoids catching thrush at some time in her life.

Prolapse of the womb

medicalquestions — Fri, 06 Jun 2008 06:00:03 +0000

Question: My doctor commented when doing a Pap smear that my womb was prolapsed. He said I shouldn’t worry about it until it caused problems. What causes a prolapse of the womb?
The womb (uterus) is where the baby grows during pregnancy. It therefore has the ability to expand dramatically in size, and is only loosely attached to the rest of the body. The ligaments that support it are stretched during pregnancy and may not return to their original size, allowing the uterus to move around more freely.
The more pregnancies you have, the slacker the ligaments become. With the assistance of gravity, pressure on the abdomen from lifting (eg. the result of pregnancy—children), constipation and lack of fitness it is possible for the womb to slowly slip lower and lower into the pelvis. This causes pressure on the bladder and bowel, leading to problems with these organs. Eventually, the womb may move all the way down the vagina to expose the cervix (opening of the womb). The main symptoms are discomfort and bladder incontinence. Correction is by best performed by surgery, but elderly women may use specially shaped rings that are inserted into the vagina to keep the womb in place.

Question: I have had vaginal infections before that have been treated by Flagyl, and I think I have the same infection again. Can I use the drug Flagyl if I am pregnant?
Flagyl is an excellent antibiotic for treating certain types of bacterial infections that occur deep inside the body. Infections of the woman’s Fallopian tubes and pelvic organs are one example.
No medication should be used between the 6th and 14th week of pregnancy unless it is absolutely essential, as this is the time when the organs and limbs of the baby are developing. Flagyl should NOT be used at this time, and it should only be used during the rest of the pregnancy and during breast feeding if there is no alternative. There is no evidence that Flagyl causes damage to the foetus, but it is known to enter the foetal circulation, so there is a potential for problems. It is better to be safe than sorry!

Woman’s Period Problems

medicalquestions — Thu, 05 Jun 2008 06:00:31 +0000

Question: What is the purpose of a woman’s period?
Once a month, just after a woman releases the egg (at ovulation) from her ovary, the lining of the womb (uterus) is at its peak to allow the embedding of a fertilized egg.
If pregnancy does not occur, the lining of the womb starts to deteriorate as the hormones that sustain it in peak condition alter. After a few days, the lining breaks down completely, sloughs off the wall of the uterus, and is washed away by the blood released from the arteries that supplied it. Contractions of the uterus also help remove the debris.
After 3 to 5 days, the bleeding stops, and a new lining starts to develop ready for the next month’s ovulation.

Question: I have a very embarrassing problem that I am reluctant to discuss with my doctor. It is a discharge from the vagina. What could it be?
Vaginal discharges fall into three major categories—excess normal secretions, infections, aqd bloody discharges.
The most common cause is excess production of the normal lubricating fluid that is present in the vagina. This can be due to hormonal changes at puberty, menopause and with pregnancy; the use of hormones including those in the oral contraceptive pill; sexual excitement or even stress and anxiety. Vaginal douches can sometimes irritate the vagina to cause a discharge. Infections can include thrush (a fungus being the cause), trichomoniasis (a small organism that is transmitted sexually), various venereal diseases and a bacterial vaginitis. Doctors can usually distinguish between these by the appearance of the discharge, the smell produced or by using laboratory tests. Bloody discharges are cause for concern. It may be just an abnormal period, but can also be a sign of significant vaginal or uterine disease.
Please do not be embarrassed, see your doctor to obtain the correct diagnosis and treatment.

Wetting of Vagina

medicalquestions — Thu, 05 Jun 2008 06:00:19 +0000

Question: I am a 52 year old woman. I have a dragging feeling in my groin that has been getting worse for six months. I also keep wetting myself whenever I cough or laugh. My doctor says it is a prolapse. What is a female prolapse and how can it be cured?
A prolapse is a protrusion of an organ into an abnormal place.
The vagina leads from the outside up to the uterus. During childbirth, it becomes very stretched and it does not always return to its original size. The muscles around the vagina may become weakened and the ligaments supporting the uterus may also become stretched and sag. After some years, this may lead to the uterus slowly moving down the vagina to a point where it completely fills it. Occasionally it may even protrude through to the outside. This is a uterine prolapse. In some women, part of the bladder which is in front of the vagina may push back into the vagina, causing a bladder prolapse and difficulty with passing urine. The large gut, which is behind the vagina, may also push forward into the vagina as a rectal prolapse, this time causing bowel problems. Often there is a combination of these three types of prolapse.
Treatment is usually successful by means of an operation. In some older women, a ring inserted into the vagina may be used to hold everything in the correct place. Younger women can help prevent the problem by undertaking special pelvic floor exercises under the guidance of a physiotherapist both before and after the delivery of their baby.

Woman’s Period Problems

medicalquestions — Mon, 05 May 2008 06:00:38 +0000

Question: I have a very embarrassing problem that I am reluctant to discuss with my doctor. It is a discharge from the vagina. What could it be?
Vaginal discharges fall into three major categories—excess normal secretions, infections, and bloody discharges.
The most common cause is excess production of the normal lubricating fluid that is present in the vagina. This can be due to hormonal changes at puberty, menopause and with pregnancy; the use of hormones including those in the oral contraceptive pill; sexual excitement or even stress and anxiety. Vaginal douches can sometimes irritate the vagina to cause a discharge. Infections can include thrush (a fungus being the cause), trichomoniasis (a small organism that is transmitted sexually), various venereal diseases and a bacterial vaginitis. Doctors can usually distinguish between these by the appearance of the discharge, the smell produced or by using laboratory tests. Bloody discharges are cause for concern. It may be just an abnormal period, but can also be a sign of significant vaginal or uterine disease.
Please do not be embarrassed, see your doctor to obtain the correct diagnosis and treatment.