GynoFiles

A physician performing a bimanual exam. in this case with one finger in the vagina, two is also normal. The vaginal finger is feeling the cervix, the abdominal finger is feeling the top of the uterus which is shown in cross section. The position of the uterus in an cross sectional diagram of a woman. The uterus is located in the back wall of the vagina, its axis is approximately a 90 degree angle to the vagina it self.  The uterus can be tipped forward on that axis: then it is called anteveerted, if it is tipped back it is called retroverted.  Some women have the uterus both tipped back and folded back. Here the physician is reaching for the top of the uterus with the hand on the abdomen but a tipped back uterus is so far back it cannot be felt well. The vaginal hand can feel the bulge of the back of the uterus. This uterus that is bent back on it self is called retroflexed. Aetroverted uterus is often also retroflexed. An anterverted uterus is usually antef...

If you have had an endometrial ablation and have developed symptoms of pelvic pain you might have post endometrial ablation syndrome. What is post-endometrial ablation syndrome? It is a constellation of symptoms due to entrapped blood or tissue within a uterus that has previously undergone an endometrial ablation. We are able to diagnose this at Women's Health Practic e but occasionally other conditions are causing similar symptoms. Other complications of endometrial ablation include pregnancy, risks from pre-existing conditions such as a polyp or fibroid, an infection of the uterus, or a pregnancy. If you have had a tubal ligation then it is possible that the condition could be post-ablation tubal sterilization syndrome. The ablation procedure is designed to destroy all lining tissue, but in fact there is no way to confirm the completeness of the ablation. It is thought that either residual or regrowth of the tissue is producing the symptoms of post-endometrial ablation syndrom...

We've stopped tracking small pox, but it's not time to stop tracking maternal deaths. The CDC reported that our USA maternal mortality rates were 13.3 deaths in moms per 100,000 babies born alive in 2006. But in 1996 we only had a rate of 7.6.  But now we have a rate of over 17 per 100,000. Rates of maternal deaths are going up. Those rates don't publish women with very serious 'close calls.". And there are some indications out of smaller studies like the California Maternal Quality Care Cooperative , that just reported the rates of maternal mortality in California, that the rates are going even higher. And many states, like Illinois, have enacted programs to specifically address risks to mom, such as conditions of acute bleeding or having a blood clot in your leg or lungs around the time of a birth. Other programs look at risks in sub populations, like African Americans who are at more risk than other ethnic groups. Physicians have to go through progr...

One in four pregnancies are lost to miscarriage, and your gyno is going to need to know what type of miscarriage you had in order to recommend any treatment or follow up. If you have bleeding in early pregnancy, your pregnancy is very likely to be fine. Only about half (or fewer) of the pregnancies with early bleeding will go on to a pregnancy loss by 20 weeks of pregnancy. If you have had pregnancy confirmed, and you are bleeding, please contact your gyno so you can be checked. When you first come in to be checked early in pregnancy thinking you are having a miscarriage the question will be: how far pregnant are you, how many babies (twins?), what is the source of the bleeding, and if the pregnancy is still healthy. Some of our patients have bleeding and what has occurred in prior pregnancies is important, did you have an early miscarriage, or an evolving miscarriage, a blighted ovum, a molar pregnancy or other types of history of miscarriage. Prior to trying to get pre...

 Over a third of women born today will live beyond 100. To live well is to have a healthy brain, and a brain fueled by estrogen is healthiest brain a woman can grow. Healthy brains are fueled by glucose sugars, and the metabolism of those sugars is responsive to many factors, but significantly to estrogen. Our brain is learning, unlearning and rewiring at all times.   What Dr. Sandra Chapman of the University of Texas at Dallas refers to as either our brain is moving forward or moving backward. If you want the most brain power, to be an independent planner, decision-maker, with vigorous memory and problem-solving skills then we have to control our frontal lobe of our brain as that is where those functions occur. Frontal lobe networks help us plan our day, and by thinking ahead as to how you will do that as you read: you are improving your brain. There are the negative forces we have to work against. The brain loses about 2% of total blood flow over each decade of our l...

Your belt can tell you if you have just too much belly fat. If you belt is greater than 35 inches you need to consider getting medical management. Don't be fooled by getting to your 'goal weight'  or even necessarily your 'BMI' target. We have a lot of nutritional factors that factor into the recommendations, and there is more than the total scale's number to say whether you are healthy. Body fat can be measured more accurately with DXA analysis, but body fat measurements while more accurate than your belt may have some errors to the caclulation. Total body fat, amount of energy and muscle you have at a particular weight, the amount you are hydrated, how constipated you are, all contribute to that number on the scale. So there is a new way to think about your weight: don't ignore the number, but track your belt size if you cannot get a measurement of the actual body fat percentage. Combining a measure of the amount of fat around your midsection or what i...

Many women have a "tipped" uterus, known to physicians as a retroverted uterus. It's likely normal, and not likely to produce symptoms. It is a different pelvic arrangement of ligaments and organs than having a uterus that isn't tipped and thus different positions during sex may be more or less comfortable, menstrual cramps may produce symptoms that are more likely to be rectal, and there has been a question as to whether women with a tipped uterus are in fact less fertile (probably not unless there is a new reason the uterus is tipped). In some cases the uterus is so tipped that pelvic exams or pap smears are more difficult for the gyno to perform and more uncomfortable for the patients. Rarely a pregnant uterus that is retroverted or tipped will not be able to grow out of the pelvis properly and become entrapped, but most gynos have never even seen one of these cases. To explain this medically, in more depth, uterus sits in a position at the top of the vagina ...

In gynecology (and all of medicine, but gals being our focus) the 'gold standard' of treatment is within the realm of "evidence based" data for diagnosis and therapies. And the way we define success is "cure." In some cases there is never cure, there is just control. Good gyno examples of conditions that we can control and not cure would be atrophic vaginitis and lichen sclerosus. For these conditions treatments render the patient free of disease, but stop the treatment and the disease returns. For other conditions cure is possible, for instance a urinary tract infection: if the appropriate antibiotic is used the urine can be shown to no long grow the bugs that were infecting it. But many conditions the treatments have to rely on the patient reports formally called " Patient-reported outcomes (PROs) . Headaches are a good example of this type of condition no test of headache resolution, only efficacy based on patient symptom questionnaires. Hysterect...

Mirena IUD Protruding into Abdominal Cavity Mirena IUD, After Being Freed From Scaring, Within the Pelvic Cavity, Left Ovar, Back of Uterus and Part of the Bowel Showing IUDs are an excellent form of contraception, and most of our posts have discussed significant health benefits. But there are risks to IUD use , and perforation of the IUD from the uterus into the abdominal cavity has been known to occur. When the Mirena protrudes this way, it's important to remove it, but oddly, since it can still leak it's hormone, it's still very likely there was good contraceptive protection from the device. This one was successfully removed, by a laparoscopic surgery, and the patient did well, and had her uterus and fertility preserved.

 Uterine fibroids may be affected by pregnancy, and women who are pregnant can have their pregnancy affected by uterine fibroids. If you have had children, you are less likely to ever get a uterine fibroid. Uterine fibroids can also cause infertility, and miscarriages, and preterm deliveries, and be of a size that will block the birth canal, and make your risk of having a c-section greater.  Only 10-15% of pregnant women will have a uterine fibroid. It is very ethnic dependent: African American Women are more likely to have uterine fibroids in pregnancy that Caucasian women. 18% of African American women will have uterine fibroids in pregnancy, and only about 5-8% of Caucasian women. You may or may not know that you have a fibroid, if it is large, such as over 2.5 inches (5 centimeters) then it's very likely your gyno will feel it on examination. If you have a smaller fibroid, it's most likely to only be detected on ultrasound, but no on examination. So you may not even kno...

Moderate Cystocele, Atrophic Vaginal Tissue  The base of the bladder is located in the upper vaginal wall. When that wall protrudes into the vagina or through the vaginal opening, the medical term is cystocele. Some will just call it vaginal wall prolapse. Factors that cause the wall to weaken: age, straining, birthing, or even overly full bladders on a chronic basis. In the case when the cystocele is more than just a fullness when your bladder has filled the condition becomes a bulge and the condition is called a cystocele. For most women, it's something you are first told about at a gyno exam. Some women hear an actual pop and then notice the bulging. Others just notice that there is tissue plopping into their vagina. Other women just report discomfort with intercourse. Kegals exercises for your pubococcygeous muscles or strengthening balls (yes, you've been reading about these in your 50 Shades book!) help to make the muscles strong, but will nev...

For women who have used tampons for years they insert their favorite one, it pops right in, and you are off to deal with your day without a care or a thought. But if you didn't have a mom or a girlfriend or a sister to show you the ropes, that first time, well, many of us have a story! And for some, no matter how expert the advice, there is still a catch and it won't go in! So what could be the problem? Tense muscles, a temporary irritation, or improper knowledge of the basics of anatomy can be reasons for difficult tampon insertions.And technique aside, some of us were born with anatomic conditions that prevent successful tampon use! A vaginal septum, or simple wall, is one of the more common causes. This configuration doesn't prevent sex or having a baby for most, the wall can push to one side and for some the one side is so small they don't even realize they have two sides until a gyno check discovers it. For most women, once this is discovered a gyno who performs ...

Women who have the muscle tumors of the uterus called uterine leiomyomata, and nicknamed fibroids often get pregnant and go to term. It's been thought that when women have more babies they are less likely to have problems with fibroids over time. It's not really been known if in fact that some women with fibroids actually never conceive and that this fact actually has confused our thinking about pregnancy's affect on the fibroids themselves. The fibroid lumps do grow in early pregnancy, and eventually they shrink, and about 3-6 months after a pregnancy they are about half the size that they were. A small group of women who were recently pregnant were studied in a NIH study published in the June 2011 issue of the American Journal of Obstetrics and Gynecology. A new finding was that users of the progesterone only pills seemed to have their fibroids shrink less even if they were breastfeeding. The fibroids that are in the lining of the uterus seem to shrink the most, and bl...

  People say tummy tuck, and really they are asking about a variety of operations designed to reduce fat, remove extra skin, improve old scars, or generally rearrange the lay of the skin and fat of the lower abdomen. The most bothersome aspect of some weight gain in early adulthood is often just a simple excess of the lower skin. In the most significant cases the excess develops into an overhanging area of tissue. I often get asked if that tissue can get removed at the time of a C-section. The correct term for an operation that removes an area of over-hanging skin is panniculectomy. And it's usually done with a wedge-shaped incision. In the days before prophylactic antibiotics (everyone gets at least a dose or two of antibiotics during their surgeries) infections of the incision at the time of C-section was much more common, and we didn’t want to risk any increased risk with extra surgery. It is also true that much of the abdominal fat is going to resolve naturally and that many...

Fortunately IUD pregnancy failures are rare. But if you have an IUD for contraception, and you get a positive pregnancy test, you probably ask yourself, what next? Well, make your gyno appointment promptly, this is a condition that is not typically an emergency, but it can be and it’s not handled over the phone or on a blog, or through self diagnosis! That being said, some researchers from University of Texas Southwestern Medical Center in Dallas decided to look back at over 4100 women who had IUDs and of those 42 cases who became pregnant in their institution, over about a year period of time, to help understand what these women could expect when they got to their gyno and what actually happened to their pregnancies. Accurate pregnancy diagnosis, pelvic examination, and pelvic ultrasound were the cornerstones of the evaluations. They had very specific ways they looked at their ultrasound to prove there was no pregnancy in the fallopian tube, or partially in the fallopian tube...

Examination of a Retroverted Uterus The tipped uterus is called a retroverted uteus, and often they are retroflexed as well (bent back). The Hodge Pessary was designed to push the uterus more forward in the pelvis, and thus correct the positioning. In texts fro the turn of the 20th century (1900s!) they thought they could actually sew the uterus to the abdominal wall to correct this. And eventually some even tried to suspend by shortening the round ligaments, which really doesn't work as they are pretty stretchy and can shorten back up. And the uterus that is tipped from birth rarely causes symptoms that need treatment.  The Hodge Pessary Hodge Pessary in place Correcting Retroversion In the 1900s women were treated with ventro-suspension of the uterus which sewed the uterus to the anterior abdominal wall

Sperm With Bacteria on Surface Pelvic Inflammatory Disease (PID) comes from an infection inside the female organs. The question is how does bacteria gets past what is an effective mucus cervical barrier, and yet wind up in the uterus and fallopian tubes? Did you know how to avoid infection with these bacteria? How to avoid infection women: One very effective way, Avoid contact with these bacteria hitchhiking sperm! Take a look at this picture that shows the bacteria on the surface of sperm. Yes that's how infections get past the cervical mucus, into the cavity of the uterus, into the corners of the fallopian tubes, out into the the tubal fimbria (the fingers on the ends of tubes) and finally bacteria then tumbling past the ovaries into the the peritoneal cavity. PID can be a serious disease, with about 12% of women infertile after a single episode and over 50% of women infertile after three or more episodes of PID. And how to avoid contact: still condoms are the best defense! ...

Uterine fibroids are non-cancerous muscle tumors of the womb. They are not symptomatic in most people, and they are extremely common occurring in about 20-40% of all women who can have children. Treatments depend on the size, the location, the goals of the patient, the amount of menstrual bleeding. And if you surf around to the other fibroid posts you'll probably get a few of these type questions answered. One issue is really determining the size of the fibroid, and a second issue is determining the fibroid growth, and a third issue all together is treating any heavy periods due to the uterine fibroids. In order to know if iyour fibroid has grown or changed, it is important to get accurate ultrasound measurements measurements. At Women's Health Practice we use several ultrasound techniques to get these measurements done. We know that from a publication in the Ultrasound Obstetrics and Gynecology journal in 2010, in a study by researchers from University College Hospital i...

You hear the word progesterone used a lot. This general class of hormone, and it's synthetic varieties is about ubiquitous as any medication in current use. If a compound acts like a progesterone its classified as a "progestin" and this class of medicines is very broad and some form or other is in the birth control pill, its made by the ovary, it's made by the placenta, it's used to prevent miscarriages, its been a treatment for PMS, it's been used to bring on missing periods, to prevent preterm birth, and it's used to protect the uterus from estrogen use in menopausal hormone therapy. So when we say there is a tug of war out there of information on which is better to be taking, natural or synthetic, we want you to understand there is a lot of scientific evidence and some of it conflicting. In general you can think of two big classes of medicines if we are just talking about menopausal hormones: we are talking about Natural Progesterone vs Synthetic...

A writer asked what is the chance of getting endometriosis after a tubal ligation if you have not had this before? Not that the post tubal ligation syndrome has ever been really validated, exactly, but there are issues to review. Some studies have reported that between 16-63% of the stumps of the tubes after traditional tying or burning tubal sterilization procedures will have spots of endometriosis. So as sterilizations evolve into the newer procedures, with the metal inserts, it may be seen that some women will have a risk of post tubal ligation syndrome if they have an Essure placed. It is very unlikely that either, tubal ligation or tubal blockage with the Essure of would increase the chance of endometriosis or endometrial implants that were not in the pelvis before the surgery. But before you get sterilized find out from you gyno, have you been assessed for risk of this syndrome? 1951 was first report of the post tubal ligation syndrome, and in the years since there are man...