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Gynecology  is the branch of medicine which deals with the function and diseases of reproductive system of   girls and women. Most of the issues relating to the the women starts from the commencement of period s which is called Menache. But there are certain condition which can affect young girls too. It can be broadly divided depending on the age, menstrual function and certain procedures which impact the women life. Our hospital has expert gynaecologists who have vast experience and we are blessed with modern testing facilities like Ultrasound scan, well equipped laboratory etc.

 

 Paediatic gynaecology

 Premature menache

 Adolescence gynaecology

 Reproductive age

 Postmenopausal period

 Cosmetic gynecology

 Laparoscopy in gynecology

Paediatic gynaecology :

certain gynac condition  seen in gilrs from the birth till the age iof 12 years

 Abnormal vaginal discharge - usually due to infection and bad hygiene. Can also be due to some tumors.

 Bleeding per vagina - certain spotting or bleeding can be noticed after few days of delivery which is due to hormone withdrawal. Can again be due to infection and tumors.
These conditions can also be due to sexual abuse and foreign body in vagina

 Premature menarche  - menarche before the age of 8 years .

Management –

1. Detailed history regarding the health, habits, medications, behavior and family history of the child generally point to the cause.
2. General examination of the child to rule any general condition which can lead to bleeding or infection
3. Gentle examination of the pelvic area to look for any sign of infection, trauma and abnormality.
4. Internal examination to look for any foreign body, infection, growth and any signs of trauma.
5. Blood tests- hormone analysis and to rule out any bleeding disorders
6. Ultra-sound abdomen and pelvis


 

Adolescence gynaecology :

most sensitive period of life of women. Onset of menstruation is called menarche. With years presiding menarche and menarche brings lots of changes both physically and physiologically.

Some very important issues associated in this period are –

   Abnormal uterine bleeding - first 2 years following menarche could be irregular and sometime heavy bleeding.
  Not attaining puberty and menarche
  Vaginal discharge.

 


 

Reproductive Age :

  General check - regular checks for the general and reproductive health is recommended. women who are sexually active regular PAP smear is recommended to detect precancerous stage of cervical cancer.

  Menstrual disorder - normal cycle is defined as when the periods happen regularly, between 21 – 45 days, when the bleeding lasts for less than 8 days, not associated with heavy bleeding and unusual pain .  Any deviation from above is abnormal bleeding and needs to be checked.

  Infections - vaginal, pelvic and urinary infection are very common in sexually active women. Vaginal infection need to be treated early as it could ascend up to cause pelvic infection with devastating sequelae . vaginal infection is recognized by abnormal and foul smelling vaginal discharge and  itching.
  Tumors - in this age group the tumors are mostly non- malignant.

Management –

1. Regular check ups- most of the issues can be diagnosed and treated conservatively if detected early . a general physical examination and pelvic examination is enough most of the times .
2. Pap smear helps to detect precancerous change so the cervical cancer. Cervical cancer is the most common cancer of the genital tract in women . it has 100% cure if diagnosed at precancerous stage .


 

Postmenopausal Period :

Any symptom even like abnormal white discharge could suggest major problem.

  General checks - yearly check up is recommended. This group of women are more prone for cancers of genital tract and breast. They are also more prone for osteoporosis and bone fractures .

  Menopausal symptoms -  most distressing and very difficult to explain. Can range from no symptoms to that of depression.

  Postmenopausal bleeding - any bleeding occurring one year stoppage of the period / menopause is called postmenopausal bleeding . More often than not they are non malignant causes but have to be investigated as they may point towards early genital tract cancers.

  Tumors - malignant growth more common during this age group.

Management -

1. general check up- yearly check up is recommended . as they are more chance of cancers in this age group cancer screening should be the part of the check up .
2. Checking for bone health - checking for bone mineral density, Serum Vit- D3 levels and B12 levels
3. Abdominal pelvic scan – to rule out any abnormal growth . I sugest pelvic scan done vaginal which could pick up early signs of ovarian cancer.


 

Cosmetic gynecology :

following childbirth there is increased vaginal laxicity or there could be formation of abnormal scar which could lead to unhappy sexual life. Or women may not be happy with appearance of the external genitalia which could lead to psychological problems .some of the  procedures and there indications are –

  Hymenoplasty -  hymen is a thin membraine at eht inlet of the vagina which suggests tvirginity of the women. This membrane can be broken during the 1st intercourse but also can be broken in certain non sexual conditions.  Hymen could be re-created in a simple day care procedure called hymenoplasty .

  Vagional tightening – after a vaginal delivery the vagina becomes vary lax and this could cause unsatisfactory sexual life. Vagina could be restructured to its original tightness and shape.

  Vaginaoplasty – vagina could be absent congenitally or due to some surgically procedures stenosed or absent. vanigal anomaly can be corrected and create a functional vagina.

 Labioplasty – labia is the skin covering the external vaginal orifice. this can sometime be abnormally large and obstructing proper and satisfactory sexual


Laparoscopy in gynecology :

most of the gynecology related surgeries can be performed laparoscopically. Laparoscopic surgery is technically more challenging but has lots of benefits to patients. Some of the advantages are -

 Faster recovery time- as the surgery is minimally invasive tissue healing is faster.

  Less blood loss

 Fewer incidences of infections.

 Less pain

 Less hospital stay

Some of the surgeries which we regularly perform laparoscopically –

1. Diagnostic laparoscopy and Hysteroscopy – as a part of investigation for Fertility treatment, chronic pelvic pain and in case of unsure diagnosis of Ectopic pregnancy.
2. Ovarian cyst – there are different types of ovarian cyst like Simple Cyst, Endometriotic cyst ( Endometrioma ), dermoid cyst and Mucinous cyst . These generally non – malignant. Most of the non- malignant ovarian cyst can be removed laparoscopically.
3. Uterus removal ( Hysterectomy )- uterus removal is indicated in many different conditions mainly due tp increaded bleeding which is not controlled by all the available medical methods and fibroids in uterus . Uterus removal can be done even if the size of the uterus is upto 28 – 30 weeks pregnant uterus size.
4. Myomectomy - removal of fibroids from the uterus
5. Adhesiolysis – adhesion can form following pelvic infection, pelvic surgery, endometriosis and bowel surgeries . adhsions can cause chronic pelvic pain . adhesiolysis can bring pain relief to the patient
6. Ectopic pregancy – depending on the size of the ectopic gestation different type of laparoscopic surgery can be decided . if the size ios small tube sparing surgery – Salpingostomy can be performed . if the size of the ectopic gestation is large or there is sings of rupture then –Salpingectomy can be performed .
7. Radical Hysterectomy - is performed in cases of early stages of Cancer cervix and Cancer Endometrium . here along with the removal of the uterus pelvic Lymph nodes and adnexa is also removed . technically difficult surgery but gives lots of benefit to the patient in terms of recovery abnd quality of life .
8. Salpingectomy - fallopian tubes can get blocked and collect fluid in it which is one of the reason for difficulty to conceive . in this situation its ideal disconnect the tubes from the uterus or even remove the tube if its very grossly infected and enlarged.
9. Removal of misplaced IUCD