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Female Reproduction Clinical Views
Medical tests/procedures done on the female reproductive system:
There are many problems that can effect and occur within the female reproductive system. Some of these problems include: endometriosis, ovarian cysts, fibroids, severe menstrual pain, chronic pelvic pain, very heavy menstrual bleeding and uterine prolapse. Many women face and deal with these problems everyday, however, there are many women who do not know they have these problems. How can you find out if you are one of them? Going to your doctor is the first step. It is very important for women to receive a yearly exam by their doctor and complete a medical/physical history form every time they visit the doctor. The doctor will ask about your sex life, pregnancy history, surgeries, and illnesses that you may have. You may experience personal difficulty sharing your own sex life, however, it is vital for the doctor to know what your body has gone through for internal physical injuries. After further questions and concerns, your doctor may complete many different exams to determine diagnosis, which include:
1. A Vaginal Exam - The doctor will use instruments to look inside your cervix and uterus. He will use a special tool called the "spectulum" to keep the walls of the vagina lateral and away from the view of the doctor for examination. You may experience slight pain, or minor cramping due to the tightness of your muscles during the examination. If able, you should relax your muscles and body to feel a little more comfortable.
2. A Pap Test- In this examination, your doctor will take a sample of vaginal cells from the cervix with a wooden scraper, cotton swap, or small brush. This test has been proven to be quick and painless. This test can help diagnose cancer or dysplasia.
3. Laboratory Tests- The doctor will take blood and urine samples that are sent to the lab for examination. These tests will help result in good or bad general health. They will also test for pregnancy, if needed.
4. Imaging Tests-There are numerous ways to look inside the body without surgery. X-rays are the most well known, yet, your doctor may also suggest a CT scan, sonogram, or an MRI. These tests can help determine what is going on in your body without performing surgery.
Other procedures that can be preformed if there are complications.
Hysterectomy- a hysterectomy is a surgical removal of the women's uterus. This procedure can be vital if the woman has had serious complications before. This surgery is very common. This procedure is done and is usually performed by a gynecologist. There are different stages of a hysterectomy and sometimes only different internal organs are removed. A surgeon can remove the uterus, fundus, or the cervix, or all of it. The ovaries and uterine tubes may also be removed, one only removed or all left. Once this procedure is complete, the woman is no longer able to bear children. It is highly recommended for those that have cancer of the female reproductive organs. Severe cancers of the female reproductive organs can worsen post symptoms of children bearing.
Symptoms for needing a hysterectomy
A hysterectomy usually is performed as a result of complications with the uterus or with parts of the female reproductive system. These conditions can be treated be a hysterectomy: having uterine fibroids, adenomyosis, endometriosis, vaginal prolapse, and as stated earlier certain types of cancer of the female reproductive system.
Technique for performing hysterectomy's
1. In the United States and in most parts of the world hysterectomies are done via laparotomy, sometimes called the "open technique" or "open hysterectomy". A transverse incision is made through the abdominal wall, usually above the pubic bone, as close to the upper hair line of the individuals lower pelvis as possible. This incision is similar to the incision made for a cesarean section. Performing a hysterectomy in this way allows doctors to access the complete reproductive structures.
Recovery time for an open hysterectomy is usually 4-6 weeks and can be longer because of the need to cut through abdominal muscles. This technique carries with it an increased risk of infection because intestines are moved, hemorrhage because of the copious amount of blood in this region. However performing a hysterectomy by this method provides the most effective way to make sure all the reproductive complex is removed.
2. Another technique for removing part of the reproductive complex is by performing a "supracervical laparoscopy". This method involves removal of the uterus through cervix, but leaving the ovaries. This can help reduce the recovery time as well. In this technique, the uterus is accessed either via the vaginal canal or through an incision inside the navel (or sometimes both, depending on the uterine problem being addressed by the surgery). The uterus itself is detached at the top of the cervical neck and pulled back through the vaginal canal (or out through the navel incision if fibroids or other indications prevent it from being able to pass through the cervix), after which the cervical neck is stitched shut. This provides the patient with a comparatively normal-length vagina which helps provide some support to the bladder, as well as a significantly decreased recovery time. The main drawback with supracervical hysterectomy is the increased risk of cervical prolapse due to the removal of the much stronger uterus (which would normally support the organs around it to prevent prolapse). This surgery also does not eliminate the possibility of cervical cancer, since the cervix itself is left in place; those who have undergone this procedure must still have regular PAP smears to check for cervical cancer.
3. The newest technique for hysterectomies is a "robotic-assisted laparoscopic hysterectomy." In this method small incisions are made through which thin instruments are passed through. This technique reduces pain, scarring, blood lass and healing time and duration of hospitalization.
Bloodless hysterectomy Technique
An advanced technique intrastromal abdominal hysterectomy has been developed. This technique is a blood less nerve-sparring method which does not disturb the pelvic support system. It is also a good alternative for the traditional hysterectomy.
The advantages include reduced hospitalization stay's, reduced blood loss and less frequent post surgery complications.
Endometriosis
This occurs when part of the endometrium is displaced onto the external surface of organs of the pelvis and abdominal cavity. Scientists think that during the regular uterine (menstrual) cycle of some women, a small amount of endometruim may be expelled from the fallopian tubes and become implanted on the surface of the ovaries, uterine tubes, urinary bladder, and intestines. If this displaced endometruim remains visible, it responds to hormone stimulation during each menstrual growth phase. Unfortunately, at the end of the monthly cycle, this displaced endometruim cannot slough and be expelled. The ensuring hemorrhage and breakdown of the displaced endometruim cause considerable pain and eventually scarring that often leads to deformities of the uterine tubes.
Treatments include:
1. The use of hormones that are designed to retard the growth and of the ectopic endometruim. These dense adhesion's are commonly associated with advanced endometriosis.
2. They can be treated with laparoscopy techniques, but are more likely to reform after surgery.
3. Dissection of the space between the rectum and vagina allows removal of deep endometriosis in patients with severe pain. (If preoperative testing reveals narrowing of the bowel, then a laparoscopic bowel resection can be performed at the same time.) It is important that a thorough cleansing of the bowel be carried out before any surgery for pelvic pain where endometriosis is suspected. Failing to prepare the bowel preoperatively may result in increased risk and limit the surgeons ability to perform a satisfactory resection.
Medical professionals say vaccines are expensive and unaffordable for public health services and for most women at risk from the disease in countries such as India. Some public-private model between the government and the manufacturer will have to emerge, rues Tongaonkar. Vaccines cannot replace screening, which, in the short term, is critical to reduce the high burden of the disease, says Tongaonkar.
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1. A Vaginal Exam - The doctor will use instruments to look inside your cervix and uterus. He will use a special tool called the "spectulum" to keep the walls of the vagina lateral and away from the view of the doctor for examination. You may experience slight pain, or minor cramping due to the tightness of your muscles during the examination. If able, you should relax your muscles and body to feel a little more comfortable.
2. A Pap Test- In this examination, your doctor will take a sample of vaginal cells from the cervix with a wooden scraper, cotton swap, or small brush. This test has been proven to be quick and painless. This test can help diagnose cancer or dysplasia.
3. Laboratory Tests- The doctor will take blood and urine samples that are sent to the lab for examination. These tests will help result in good or bad general health. They will also test for pregnancy, if needed.
4. Imaging Tests-There are numerous ways to look inside the body without surgery. X-rays are the most well known, yet, your doctor may also suggest a CT scan, sonogram, or an MRI. These tests can help determine what is going on in your body without performing surgery.
Other procedures that can be preformed if there are complications.
Hysterectomy- a hysterectomy is a surgical removal of the women's uterus. This procedure can be vital if the woman has had serious complications before. This surgery is very common. This procedure is done and is usually performed by a gynecologist. There are different stages of a hysterectomy and sometimes only different internal organs are removed. A surgeon can remove the uterus, fundus, or the cervix, or all of it. The ovaries and uterine tubes may also be removed, one only removed or all left. Once this procedure is complete, the woman is no longer able to bear children. It is highly recommended for those that have cancer of the female reproductive organs. Severe cancers of the female reproductive organs can worsen post symptoms of children bearing.
Symptoms for needing a hysterectomy
A hysterectomy usually is performed as a result of complications with the uterus or with parts of the female reproductive system. These conditions can be treated be a hysterectomy: having uterine fibroids, adenomyosis, endometriosis, vaginal prolapse, and as stated earlier certain types of cancer of the female reproductive system.
Technique for performing hysterectomy's
1. In the United States and in most parts of the world hysterectomies are done via laparotomy, sometimes called the "open technique" or "open hysterectomy". A transverse incision is made through the abdominal wall, usually above the pubic bone, as close to the upper hair line of the individuals lower pelvis as possible. This incision is similar to the incision made for a cesarean section. Performing a hysterectomy in this way allows doctors to access the complete reproductive structures.
Recovery time for an open hysterectomy is usually 4-6 weeks and can be longer because of the need to cut through abdominal muscles. This technique carries with it an increased risk of infection because intestines are moved, hemorrhage because of the copious amount of blood in this region. However performing a hysterectomy by this method provides the most effective way to make sure all the reproductive complex is removed.
2. Another technique for removing part of the reproductive complex is by performing a "supracervical laparoscopy". This method involves removal of the uterus through cervix, but leaving the ovaries. This can help reduce the recovery time as well. In this technique, the uterus is accessed either via the vaginal canal or through an incision inside the navel (or sometimes both, depending on the uterine problem being addressed by the surgery). The uterus itself is detached at the top of the cervical neck and pulled back through the vaginal canal (or out through the navel incision if fibroids or other indications prevent it from being able to pass through the cervix), after which the cervical neck is stitched shut. This provides the patient with a comparatively normal-length vagina which helps provide some support to the bladder, as well as a significantly decreased recovery time. The main drawback with supracervical hysterectomy is the increased risk of cervical prolapse due to the removal of the much stronger uterus (which would normally support the organs around it to prevent prolapse). This surgery also does not eliminate the possibility of cervical cancer, since the cervix itself is left in place; those who have undergone this procedure must still have regular PAP smears to check for cervical cancer.
3. The newest technique for hysterectomies is a "robotic-assisted laparoscopic hysterectomy." In this method small incisions are made through which thin instruments are passed through. This technique reduces pain, scarring, blood lass and healing time and duration of hospitalization.
Bloodless hysterectomy Technique
An advanced technique intrastromal abdominal hysterectomy has been developed. This technique is a blood less nerve-sparring method which does not disturb the pelvic support system. It is also a good alternative for the traditional hysterectomy.
The advantages include reduced hospitalization stay's, reduced blood loss and less frequent post surgery complications.
Womens study
The Maine Women's Health Study of 1994 followed for 12 months time approximately 800 women with similar gynecological problems (pelvic pain, urinary incontinence due to uterine prolapse, severe endometriosis, excessive menstrual bleeding, large fibroids, painful intercourse), around half of whom had a hysterectomy and half of whom did not. The study found that a substantial number of those who had a hysterectomy had marked improvement in their symptoms following hysterectomy, as well as significant improvement in their overall physical and mental health one year out from their surgery.
The study concluded that for those who have intractable gynecological problems that had not responded to non-surgical intervention, hysterectomy may be beneficial to their overall health and wellness. One of the conditions most cited by women who have complex pelvic and reproductive issues is pain. This is particularly true for women who have other conditions that amplify pain, such as fibromyalgia and chronic fatigue syndrome. Removal of a condition that is causing pain has a dramatic effect on reducing the overall pain levels of a person with such disorders; for many women with such pain conditions, a hysterectomy is preferable to the continual pain which adds to the burden of their already painful lives, even though the loss of hormones post-surgery may initially contribute to an increase in the symptoms of their disorder.
The study concluded that for those who have intractable gynecological problems that had not responded to non-surgical intervention, hysterectomy may be beneficial to their overall health and wellness. One of the conditions most cited by women who have complex pelvic and reproductive issues is pain. This is particularly true for women who have other conditions that amplify pain, such as fibromyalgia and chronic fatigue syndrome. Removal of a condition that is causing pain has a dramatic effect on reducing the overall pain levels of a person with such disorders; for many women with such pain conditions, a hysterectomy is preferable to the continual pain which adds to the burden of their already painful lives, even though the loss of hormones post-surgery may initially contribute to an increase in the symptoms of their disorder.
Risks and side effects
The average onset age of menopause in those who underwent hysterectomy is 3.7 years earlier than average. This has been suggested to be due to the disruption of blood supply to the ovaries after a hysterectomy. When the ovaries are also removed, blood estrogen levels fall, removing the protective effects of estrogen on the skeletal and cardiovacular systems.
Sometimes hysterectomy is referred to as surgical menopause. This is incorrect because it implies that surgical menopause has the same effects as natural menopause. Those who are naturally menopausal have the benefit of the functions of their uterus and ovaries (which continue to produce small amounts of hormones even after natural menopause), while those who undergo hysterectomy and/or removal of the ovaries have a permanent loss of their functions.
When only the uterus is removed there is a three times greater risk of cardiovascular disease. If the ovaries are removed the risk is seven times greater. Several studies have found that osteoporosis (decrease in bone density) and increased risk of bone fractures are associated with hysterectomies. This has been attributed to the modulatory effect of estrogen on calcium metabolism and the drop in serum estrogen levels after menopause can cause excessive loss of calcium leading to bone wasting.
Those who have undergone a hysterectomy with both ovaries removed typically have reduced testosterone levels as compared to those left intact. Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density, while conversely, increased testosterone levels in women are associated with a greater sense of sexual desire. Hysterectomy has also been found to be associated with increased bladder function problems, such as incontinence. Removal of the uterus without removing the ovaries can produce a situation that on rare occasions can result in ectopic pregnancy due to an undetected fertilization that had yet to descend into the uterus before surgery. Two cases have been identified and profiled in an issue of the Blackwell Journal of Obstetrics and Gynecology; over 20 other cases have been discussed in additional medical literature.
Sometimes hysterectomy is referred to as surgical menopause. This is incorrect because it implies that surgical menopause has the same effects as natural menopause. Those who are naturally menopausal have the benefit of the functions of their uterus and ovaries (which continue to produce small amounts of hormones even after natural menopause), while those who undergo hysterectomy and/or removal of the ovaries have a permanent loss of their functions.
When only the uterus is removed there is a three times greater risk of cardiovascular disease. If the ovaries are removed the risk is seven times greater. Several studies have found that osteoporosis (decrease in bone density) and increased risk of bone fractures are associated with hysterectomies. This has been attributed to the modulatory effect of estrogen on calcium metabolism and the drop in serum estrogen levels after menopause can cause excessive loss of calcium leading to bone wasting.
Those who have undergone a hysterectomy with both ovaries removed typically have reduced testosterone levels as compared to those left intact. Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density, while conversely, increased testosterone levels in women are associated with a greater sense of sexual desire. Hysterectomy has also been found to be associated with increased bladder function problems, such as incontinence. Removal of the uterus without removing the ovaries can produce a situation that on rare occasions can result in ectopic pregnancy due to an undetected fertilization that had yet to descend into the uterus before surgery. Two cases have been identified and profiled in an issue of the Blackwell Journal of Obstetrics and Gynecology; over 20 other cases have been discussed in additional medical literature.
Alternatives
Many alternatives to hysterectomy exist. Those with dysfunctional uterine bleeding may be treated with endometrial ablation, which is an outpatient procedure in which the lining of the uterus is destroyed with heat. Endometrial ablation will greatly reduce or entirely eliminate monthly bleeding in ninety percent of patients with DUB.
In addition, uterine fibroids may be removed without removing the uterus. This procedure is called a myomectomy. A myomectomy may be performed through an open incision or, in appropriate cases, laparoscopically. Various other techniques (such as Fibroid Artery Embolization, Myolysis, HALT, and Focused Ultrasound Surgery) kill the fibroid, and then leave it in place to be (usually only partially) reabsorbed by the body.
Prolapse may also be corrected surgically without removal of the uterus.
Menorrhagia(heavy or abnormal menstrual bleeding) may also be treated with the less invasive endometrial ablation. Uterine artery embolization blocks the arteries that supply blood to uterus. It is a minimally-invasive procedure, which means it requires only a tiny nick in the skin, and is performed while the patient is conscious but sedated — drowsy and feeling no pain. It can be used to control bleeding in conditions like postpartum hemorrhage and for treatment of uterine fibroid. Embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally-invasive procedures under radiology guidance who makes a small nick in the skin (less than one-quarter of an inch) in the groin to access the femoral artery, and inserts a tiny tube (catheter--like a piece of spaghetti) into the artery. Local anesthesia is used so the needle puncture is not painful. The catheter is guided through artery to the uterus while the interventional radiologist guides the process of the procedure using a moving X-ray (flouroscopy).
Complications of the female reproductive system In addition, uterine fibroids may be removed without removing the uterus. This procedure is called a myomectomy. A myomectomy may be performed through an open incision or, in appropriate cases, laparoscopically. Various other techniques (such as Fibroid Artery Embolization, Myolysis, HALT, and Focused Ultrasound Surgery) kill the fibroid, and then leave it in place to be (usually only partially) reabsorbed by the body.
Prolapse may also be corrected surgically without removal of the uterus.
Menorrhagia(heavy or abnormal menstrual bleeding) may also be treated with the less invasive endometrial ablation. Uterine artery embolization blocks the arteries that supply blood to uterus. It is a minimally-invasive procedure, which means it requires only a tiny nick in the skin, and is performed while the patient is conscious but sedated — drowsy and feeling no pain. It can be used to control bleeding in conditions like postpartum hemorrhage and for treatment of uterine fibroid. Embolization is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally-invasive procedures under radiology guidance who makes a small nick in the skin (less than one-quarter of an inch) in the groin to access the femoral artery, and inserts a tiny tube (catheter--like a piece of spaghetti) into the artery. Local anesthesia is used so the needle puncture is not painful. The catheter is guided through artery to the uterus while the interventional radiologist guides the process of the procedure using a moving X-ray (flouroscopy).
Endometriosis
This occurs when part of the endometrium is displaced onto the external surface of organs of the pelvis and abdominal cavity. Scientists think that during the regular uterine (menstrual) cycle of some women, a small amount of endometruim may be expelled from the fallopian tubes and become implanted on the surface of the ovaries, uterine tubes, urinary bladder, and intestines. If this displaced endometruim remains visible, it responds to hormone stimulation during each menstrual growth phase. Unfortunately, at the end of the monthly cycle, this displaced endometruim cannot slough and be expelled. The ensuring hemorrhage and breakdown of the displaced endometruim cause considerable pain and eventually scarring that often leads to deformities of the uterine tubes.
Treatments include:
1. The use of hormones that are designed to retard the growth and of the ectopic endometruim. These dense adhesion's are commonly associated with advanced endometriosis.
2. They can be treated with laparoscopy techniques, but are more likely to reform after surgery.
3. Dissection of the space between the rectum and vagina allows removal of deep endometriosis in patients with severe pain. (If preoperative testing reveals narrowing of the bowel, then a laparoscopic bowel resection can be performed at the same time.) It is important that a thorough cleansing of the bowel be carried out before any surgery for pelvic pain where endometriosis is suspected. Failing to prepare the bowel preoperatively may result in increased risk and limit the surgeons ability to perform a satisfactory resection.
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