Archive for May, 2010

Condoms: A little something for everybody

Condoms are one of the cheapest and most widely available methods of pregnancy prevention. They are a type of barrier protection. This means that they work by forming a physical barrier between sperm and egg. Most condoms are made of either latex or lamb skin and may be lubricated (or not) with spermicide (a chemical intended to kill sperm).

A condom is placed over the penis prior to intercourse. If the condom is put sometime in the middle of intercourse (ie prior to ejaculation), unintended pregnancy is still possible. This is because the penis does emit some pre-ejaculatory fluid which can (and often does) contain sperm.

Female condoms are also availabe. These are placed in the vagina and are held in place by a flexible plastic ring. They are a little more expensive than male condoms and a little trickier to put in place, but they work essentially the same way.

So if you choose to use condoms, the rules are

1. put one on before intercourse

2. leave it on until after intercourse is complete

3. use a new condom with each act of intercourse

4. never “double-wrap” with more than one condom at a time (this causes friction and can lead to breakage)

Condoms come in a variety of shapes and sizes. Some have features like flavor (a plus if you are using one to protect your partner during fellatio [oral sex]), texture (ie “ribbed for her pleasure”), color (to match your partner’s dress and/or eyes?), or glow in the dark (for… I don’t know what– A sudden loss of electrical power?!).  In short, there’s something for everybody.

Condoms are cheap and, when used correctly, over 90% effective in preventing pregnancy.  They are also one of the only methods of birth control that can also help prevent the transmission of a number of sexually transmitted diseases, including gonorrhea, chlamydia, HIV/AIDS, hepatitis, syphillis, HPV (human papilloma virus), herpes and other unpleasant nasties.

So what do you do if the condom breaks, falls off, or never made it out of your partner’s wallet? Plan B is a medication intended to prevent unintended pregnancy if used within 72 hours of unprotected intercourse. It’s more effective the sooner it is taken (ie 24 hourse is better than 48 hours is better than 72 hours). It contains progesterone, a hormone that is one of the 2 main components of conventional birth control pills.

Plan B is not the abortion pill and won’t bring an end to an already-established pregnancy. It is available over the counter at a number of major pharmacy chains nationwide. If you have questions about how to use it properly or how to make sure it was effective, or you need testing for sexually transmitted diseases, you should call your doctor.

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May 25, 2010 at 2:31 pm 4 comments

Abstinence: The world’s oldest form of contraception

There’s a lot more buzz about abstinence than there was when I was a teenager. My high school generated a lot of buzz back in the 1995 when it was the first on Long Island to distribute condoms.  (Then again, a lot of the fashion in those days had an unintended contraceptive effect.)  But I think the pendulum has begun to swing the other way in a lot of communities.  So I think it may be time to take another look at abstinence.

Abstinence is the oldest and cheapest form of contraception.  Not having sex with a male partner is a sure way for a woman to avoid pregnancy. 100%.  Pretty simple math.

Historically, abstinence has the method of choice for a lot of people because of expectations set by religious faith and family roles.  You remember: First comes love, then comes marriage, then comes baby in a baby carriage.  Premarital sex and unintended pregnancy don’t rhyme well.  (Neither does Baby Bjorn, so I guess baby carriages are also a more moral option for infant transport).

The downside of abstinence is that it can be an unrealistic expectation, especially for younger people.  Teens in particular may struggle with their natural inclination and interest toward sex.  This is compounded by things like peer pressure and widening social acceptance of premarital sex and sex outside of monogamous relationships.  We won’t even go into what constitutes maintaining one’s “virginity.”  But oral sex doesn’t get you pregnant.

If you choose to abstain from sex, it’s not a bad idea to have a back-up plan (ie condoms, the pill, etc…).  This doesn’t mean you’re not committed to abstinence, it means you’re realistic.  You wouldn’t drive a car without a spare tire, would you?  Does that mean you’re planning on getting a flat?  No.  It means you’re responsible.  What?  You don’t know how to change a flat?  Well, that’s what boyfriends are for.

May 19, 2010 at 1:40 pm 3 comments

Demystifying Hysterectomy Part III: Risks and Benefits

Having a hysterectomy means that you will no longer have the ability to bear children.  It also means you should no longer experience menstrual bleeding (although you may experience other cyclic changes depending upon whether you still have ovaries).  Hysterectomy alone (ie without removal of or damage to the ovaries) does not result in menopause.  However, hormonal changes after hysterectomy are possible. 

Many women are concerned that removal of the uterus will adversely affect their sexual functioning and satisfaction.  There are no studies demonstrating that hysterectomy (with or without removal of the cervix) has a negative effect on patients’ sex lives.  Neither the uterus nor cervix itself contributes to vaginal lubrication or orgasmic response. Most patients’ male partners can not detect the presence or absence of a uterus or cervix and among those who can, few feel that it impacts their experience during intercourse.  Therefore, the best predictor of sexual satisfaction and functioning after hysterectomy is your sexual satisfaction and functioning prior to surgery.

You should discuss these concerns with your gynecologist before considering any kind of surgery to remove all or part of your uterus.

Complications from hysterectomy are uncommon but can be serious.  Although it is impossible to predict or list every possible problem, these infrequent complications may include infection, bleeding, thromboembolic events (blood clots), injury to adjacent organs, bladder or bowel dysfunction, nerve injury, postoperative pain, and anesthesia complications.  You should talk to your doctor about the possible complications of any treatment you consider undergoing.

Hysterectomy is permanent.  Even when performed via minimally invasive techniques, it is still a major surgery. 

Other options for managing certain gynecologic conditions may be appropriate.  These options may include expectant management (watchful waiting), therapy with hormonal or other types of medication, the use of interventional radiology (uterine artery embolization), targeted ultrasound ablation, or other fertility-sparing surgical procedures (myomectomy, ablation of endometrium or endometriosis).

The choice of whether hysterectomy is the right option for you depends on a number of factors.  Talk to your doctor about your condition and all of your options when considering hysterectomy as part of a treatment plan.

May 17, 2010 at 6:32 pm 3 comments

Demystifying Hysterectomy Part II: “How and why is hysterectomy performed?”

A hysterectomy can be performed in several ways. Minimally invasive surgical techniques include the removal of the uterus (and/or ovaries) through laparoscopy, a surgical technique which involves the insertion of long thin instruments through very small holes in the patient’s abdomen.  Hysterectomy can also be done via the vagina in a procedure called vaginal hysterectomy.  Despite the proven benefits of minimally invasive surgical techniques, the most common method of removing the uterus is still through an open abdominal incision called a laparotomy.  

Hysterectomy is used to treat a number of gynecologic conditions including uterine fibroids, adenomyosis, endometriosis, intractable pelvic pain, pelvic organ prolapse, and certain types of cancer.  It may also be required in certain types of emergencies (such as hemorrhage during childbirth) or electively (in persons undergoing gender reassignment).

May 14, 2010 at 3:42 pm 3 comments

Demystifying Hysterectomy Part I: What is a hysterectomy?

Hysterectomy is the most commonly performed gynecological surgical procedure. Over 600,000 hysterectomies are performed in the United States every year, most often for benign (non-cancerous) conditions. 

But what is hysterectomy?  Literally, the term means “removal of the uterus.”  But there are many types of hysterectomy and several ways in which it can be performed.

First, the types:

A total hysterectomy (often called a complete hysterectomy) means surgical removal of the uterine body or corpus, the dome of the uterus or fundus, and the neck of the uterus or cervix.

The term partial hysterectomy is often used to describe what doctors call a supracervical hysterectomy.  This surgery involves removal of the uterine body and fundus.  It leaves all or a portion of the cervix intact. 

Patients with certain types of cervical cancer may require a procedure called radical hysterectomy, which involves the removal of all parts of the uterus as well as other tissues adjacent to it the pelvis, including the upper vagina. 

The removal of the ovaries and fallopian tubes, called salpingoophorectomy, is not included in any of the terms describing hysterectomy, even if both procedures are done at the same time.

May 11, 2010 at 6:55 pm Leave a comment

Minimally Invasive Gynecologic Surgery: Pursuing a gentler path

Minimally invasive surgery includes a diverse and varied set of techniques which differ from traditional “open” surgery.  When open surgery occurs in the abdomen, it is performed through an incision called a  laparotomy.  Put simply, the goal of minimally invasive gynecologic surgery is to avoid unnecessary laparotomy.

Avoiding large incisions allows a surgeon to offer patients a faster recovery, decreased pain from surgical incisions, a more rapid return of bowel function, and decreased risk of certain types of complications.  Patients usually go home the same day or stay in the hospital only one night.

There are several common techniques used in minimally invasive surgery.  These include the use of laparoscopy (aka bandaid surgery, keyhole surgery, or pinhole surgery) and mini-laparotomy.

Laparoscopy is a type of sugery in which a camera is attached to a thin instrument (the laparoscope) which can be inserted into the abdomen through a very small incision.  This allows the surgeon to see the entire abdominal cavity without creating a large incision.  Additional small incisions may be made so that thin surgical instruments can be inserted into the abdominal cavity. 

Many types of surgery can be performed in this manner, including certain types of hysterectomy (removal of the uterus), removal of fibroids and ovarian cysts, treatment of endometriosis, and treatment of other kinds of gynecologic disorders.

Mini-Laparotomy is sometimes combined with laparoscopy to allow a much smaller abdominal incision in certain types of surgery which would otherwise have to be done by laparotomy.

When you need surgery, it is important to have a discussion with your doctor about how your recovery can be optimized.  Minimally-invasive surgery could be the best option for you.

May 9, 2010 at 8:02 pm 5 comments

Understanding Ovarian Cysts

Ovarian cysts are very common and can affect women of all ages.  Most women will have an ovarian cyst at some time in their reproductive lives.  Although they are less common after a woman stops menstruating, they are present in up to 14.8% of postmenopausal women.

But what is an ovarian cyst?  An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary (one of a pair of organs in the pelvis responsible for producing female hormones and eggs).  Eggs normally mature within the ovaries in small, fluid filled spaces called follicles.  Any ovarian follicle larger than two centimeters can be called an ovarian cyst.  They vary greatly in size (as big as a cantaloupe or larger!) and in etiology.  Most ovarian cysts are benign (non-cancerous) in nature.  Several common types are

  1. functional (or simple) ovarian cysts, which are related to the menstrual cycle and often resolve on their own
  2. endometrioid cysts, which are due to endometriosis, are often called “chocolate” cysts or endometriomas
  3. dermoid cysts (or teratomas) which can have solid components like hair or teeth

 

Many ovarian cysts are asymptomatic and are discovered only incidentally at the time of an exam or ultrasound.  However, some ovarian cysts cause problems.  Rupture of an ovarian cyst can cause bleeding or pain.  An enlarged ovarian cyst can cause an ovary to twist on the stalk containing its blood supply, a condition called torsion.  Ovarian cysts may also interfere with fertility treatments and goals. 

Surgery may be required to remove large cysts or to make sure a cancer is not present.

If you think you have symptoms consistent with an ovarian cyst, it is important to be evaluated by a physician.  Ultrasound or other imaging as well as simple blood tests may be done to help determine whether treatment is necessary. 

 

May 8, 2010 at 2:57 pm 38 comments

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Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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