FAQ About Gynae

Fibroid uterus
• Polyps
• Dysfunctional uterine bleeding
• Foreign body in uterine cavity
• Genital cancers of as uterus & cervix

Pelvic examination
• Ultrasonography
• Hysteroscopy
• D&C Biopsy
• Colposcopy & Cervical biopsy
• MRI
• Laboratory Investigations

Medical –Only for benign conditions ( Non cancerous)
• Surgical:
     I) D&C
    II) TABC – Thermal Balloon Ablation of Endometrium.
   III) TCRE – Trans cervical Resection of Endometrium.
  IV) HYSTERECTOMY
   V) Radical Hysterectomy malignant (Malignant or Causes)

Removal of uterus (womb)

1. Laparoscopic removal of uterus (Laparoscopic Hysterectomy)
   a) Total Laparoscopic Hysterectomy (TLH)
   b) Laparoscopic Assisted Vaginal Hysterectomy (LAVH)
2. Total Abdominal Hysterectomy
3. NDVH-Non descent Vaginal Hysterectomy
4. Vaginal Hysterectomy

1. Fibroids.
2. Prolapse
3. Heavy uterus bleeding.
4. Cancers of uterus and cervix.

The separation of uterus through multiple ports (key holes) in the abdominal wall & removal of uterus through the birth canal (normal passage)

i) Quick recovery time.
ii) Less painful – Post surgery.
iii) Cosmetically better.
iv) Less blood loss during surgery.

i) Ovarian cysts.
ii) Ectopic pregnancy – Pregnancy in tubes or outside uterus.
iii) Infertility
a) Ovarian drilling
b) Tubal cannulation
iv) Myomectomy

No, as a comfortable anaesthesia is given to do the Operation. Preferably, it is done under general anaesthesia.

Varying on the type of surgery & condition of the patient. Doctor will advice you on how soon you can return to work.

It depends on the type of surgery. Some surgeries may be require an overnight stay.

It depends on a patient’s tolerance level. In pain medications are prescribed for the post-surgery patients.

This again depends on the type of surgery performed. All patients are suggested to start a slow walking routine on the second day of post-surgery day. She keeps on increasing the exercises depending on her convalescence.

No, all patients diagnosed to be having fibroid uterus need not be treated. A symptom less patient whose fibroid is a coincidental finding while investigating for something else should be left untouched. Only fibroids causing symptoms like:

a) excessive bleeding
b) Infertility
c) Pressure symptoms
d) Sudden enlargement
e) Appearance of degenerative changes
f) It becomes painful
g) Cancerous changes which are mostly sarcomatous.
h) Very big fibroids causing abdominal distension need to be treated surgically.

There is no permanent medical treatment of fibroids.
Surgical treatment is HYSTERECTOMY i.e. removal of uterus and MYOMECTOMY i.e. removal of fibroids only.

1) When should I contact a doctor for not able to conceive after marriage?
When after one year of cohabitation i.e. living together after marriage if a couple doesn’t conceive should report to a doctor for investigation or report earlier if the female partner has irregular menstrual cycle.

Infertility is not able to conceive which may be because of many factors.
• Male Factors
• Female Factors
• Factors from both partners

Male Factors:

  Azoospermia
 Oligospermia
 Asthenospermia
 pyospermia
 Blockage in the ducts that carry sperm
 Physical problems with the testicles
 Hormonal problems
 Genetic disorder
 Lifestyle or environmental factor
  a) Addiction of smoking
  b) Excessive drinking
  c) More stress
  d) Working in hot places
  e) Wearing tight clothes
 

Female Factors:

 Uterine
   a) Congenital Abnormality
        I. Small Uterus ( Hypo-plastic Uterus )
       II. Septum of Uterus
      III. Double Uterus
  b) Synechiae Uterus
  c) Polyp of Endometrial Cavity
  d) Fibroid Uterus
  e) Tuberculous Endometritis
   f) Foreign body

 Tubal
   a) Hydrosalpinx
   b) Pyosalpinx
   c) Blocked Tubes

 Ovarian
a) Hyoovalation
b) Anovulation
c) PCOD
d) Ovarian Cysts

 Harmonal Factors
   a) Thyroid Diseases
       I. Hypothyroidism
      II. Hyperthyroidism
b) Ovarian Hormonal imbalance
c) Hypothalamic Factors
d) Hyperprolactinaemia

 Others
a) Endometriosis
b) Adhesions in ‘Pouch of Douglas' (POD)
c) Previous abdominal surgery

A) Investigations for the male partner
    a) Semen examinations
    b) Testicular biopsy if azoospermic (FNAC OR INCISION BIOPSY)
    c) Male hormonal study
    d) Routine blood investigations.

B) Investigation for the female partner
    a) Routine blood investigations
    b) Female hormonal study
    c) Follicular study
    d) HSG/ SSG
    e) PCR for tuberculous endometritis.

No as already mentioned infertility can be from both partners. So investigation for both the partners is mandatory.

HSG stands for HYSTEROSALPINGOGRAPHY. It is a test to know the patency of the fallopian tubes. It is done by injecting a dye in the uterus through cervix by inserting a cannula under screening and taking X-RAYS. In normal patent tubes the dye should freely move from uterus to fallopian tubes and should be seen in the peritoneal cavity i.e. abdomen. If we don’t see the dye in the tubes then it shows that tubes are blocked.

SSG stands for SONOSALPINGOGRAPHY, which is done by putting a dye/saline through the cervix and the movement of the dye through the tube is visualised under ultrasound.

Hysteroscopy is visualising the endometrial cavity with an endoscope which helps to find out the factors of the uterus effecting the implantation of the embryo. The various common factors are foreign body, polyp, myoma in the cavity, septum of the uterus or tubercular endometritis.

Laparoscopy is visualization of the abdominal cavity i.e. peritoneal cavity with an endoscope. It helps to find out:

A) Shape, size and position of uterus.
B) Size position and texture of the ovary.
C) Any pathology associated with the fallopian tubes.
D) Any adhesions surrounding female genitalia.
E) Any nodes or masses.

Pregnancy which is outside uterus is ectopic pregnancy. The various common sites are:

A) Fallopian tubes
B) Ovaries
C) Broad ligament
D) In the abdomen