Posts tagged ‘pain’
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).
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
- functional (or simple) ovarian cysts, which are related to the menstrual cycle and often resolve on their own
- endometrioid cysts, which are due to endometriosis, are often called “chocolate” cysts or endometriomas
- 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.
Tackling your first gynecologic visit – No fear!
At your first gynecologic visit, your doctor should introduce him or herself and discuss the reason for your visit. You should be open and honest about your reasons for needing gynecologic care.
THE HISTORY: Your doctor will take a complete gynecologic and menstrual history. Never be embarrassed to bring up concerns regarding bleeding or pain, sexual activities and concerns, current or past sexual or physical abuse, or questions about changes in your body.
**Believe me, you are NOT the first or only person who has these concerns. Your doctor should be familiar with them and make sure you are comfortable discussing them. If not, you should consider finding a doctor who DOES make you comfortable.**
Your doctor will also discuss your medical and surgical history, any medications you may be taking, any allergies you may have to medicines or foods, and will ask whether you drink alcohol, smoke cigarettes, or use drugs. Your doctor will be able to provide the best of care if he or she receives complete and honest information from you.
THE PHYSICAL EXAM: The majority of your physical examination will be very familiar to you from visits with other types of doctors. The examination of your head, neck, heart, lungs, abdomen (belly), and extremities will not differ much from that performed by your primary care physician.
The parts of your exam which may be new and unfamilar include the breast and pelvic exam.
The breast exam includes a visual inspection of your breasts. Then your doctor will examine your breasts by palpation (touch). He or she is looking for abnormal lumps or masses. Many breast lumps are benign (non-cancerous). Some are malignant (cancer). Your doctor may order tests such as a mammogram or breast ultrasound if he or she detects abnormalities of the breast during your exam.
Your doctor should also ask you whether you are performing breast self-examination. He or she can teach you how to do a good breast exam on yourself at home. If you have questions about how and when to do this type of exam at home, you should ask them during the breast exam.
The pelvic exam consists of two parts. The first part is usually the speculum examination. This part of the exam is often accompanied by a great deal of anxiety and trepidation. This is understandable, as the speculum examination can be uncomfortable. It should not, however, be painful. It helps if you try to maintain a relaxed, calm attitude as this REALLY can make the exam more physically comfortable.
A speculum is a metal or plastic instrument that is inserted into the vagina. It is usually warmed (if metal) and lubricated (with gel) to make the exam more comfortable. The speculum is not used to ‘clamp’ anything. This is a common misconception. The speculum is actually designed to gently open the vaginal canal to allow visualization and sampling of the cervix (which is the lowest part of the uterus, protruding into the vagina). Once this is done, the speculum is gently removed.
The speculum exam
The second part of the pelvic examination is called the bi-manual examination. The examiner will insert one or two fingers into the vagina, placing the other hand on your abdomen (belly). This is done so that the examiner can feel the size and shape of your uterus and ovaries. Ovarian cysts, fibroids, and some types of endometriosis can be detected this way.
A rectal examination may also be necessary to evaluate certain types of conditions and is a necessary part of the examination of any woman over 50 years of age. The examiner inserts a lubricated finger into the anus (the lowest part of the rectum). This may occur in conjunction with a vaginal exam (a recto-vaginal examination) or may include sampling of fecal material for blood (a stool sample).
THE WRAP-UP: After that, you’re all done! Your doctor may include certain types of testing such as a PAP smear or a cervical culture for STD’s as part of the gynecologic evaluation. Always ask your provider what tests you require and how you will be informed of the results.
When to schedule your first exam with a gynecologist.
Your first gynecololgic visit can be a daunting prospect at any age. But with a better idea of what to expect, there’s no reason for your visit to be intimidating, uncomfortable, or painful.
It is appropriate to make an appointment to see a gynecologist for the first time, whatever your age, for any of the following reasons:
- If you are considering becoming sexually active and need to discuss contraceptives and STD prevention
- If you are already sexually active
- If you have not been sexually active, but are experiencing symptoms which may be related to your menstrual cycle (such as pain, irregular cycles or excessive bleeding)
- If you think you may be pregnant
- If you think for any other reason you might need gynecologic care. (Even if you might be wrong.)
Some organizations recommend seeing a gynecologist by age 21 even if none of the above applies to you.
It is not unusual to bring a parent, a good friend, or your partner to your first visit. It can help to have someone there to share your concerns, be an additional listening ear, or to calm your nerves. They don’t have to go into the examining room with you. Most of the time, they don’t want to anyway.
There should always be a time during your visit when your doctor gives you the opportunity to discuss things with him or her alone, so that you can discuss private issues in PRIVATE, without alienating the person who accompanied you. This is especially important to remember if you are under 18 and you are considering bringing a parent.
A note on timing: The best time to schedule your visit is about a week after your period. However, it may not be necessary to cancel your visit if you are still bleeding the day of your exam. If you are unsure, call ahead and ask if your provider recommends that you still keep your appointment. Most providers don’t charge a cancellation fee if you need to reschedule.
The Gynecologist 