Gynecology

Since gynecology ranges through such a vast spectrum, this segment is arranged in alphabetical order to locate the specific issue you wish to learn more about.

Bacterial Vaginosis (BV)

The vagina normally has a balance of mostly "good" bacteria and fewer "harmful" bacteria. Bacterial vaginosis, known as BV, develops when the balance changes. With BV, there is an increase in harmful bacteria and a decrease in good bacteria. BV is the most common vaginal infection in women of childbearing age.

What causes BV?

Not much is known about how women get BV. Any woman can get BV. But there are certain things that can upset the normal balance of bacteria in the vagina, raising your risk of BV.

What are the signs of BV?

Women with BV may have an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fish-like odor, especially after sex. The discharge can be white (milky) or gray. It may also be foamy or watery. Other symptoms may include burning when urinating, itching around the outside of the vagina, and irritation. These symptoms may also be caused by another type of infection, so it is important to see a doctor. Some women with BV have no symptoms at all.

How is BV treated?

BV is treated with antibiotic medicines prescribed by your doctor. Your doctor may give you either metronidazole (met-roh-NIH-duh-zohl) or clindamycin (klin-duh-MY-sin). Generally, male sex partners of women with BV don't need to be treated. However, BV can be spread to female partners.You can get BV again even after being treated.

Cystocele

Cystocele (SISS-toh-seel) is also called fallen bladder. It occurs when the wall between the bladder and the vagina weakens and allows the bladder to droop into the vagina. Common causes of cystocele are:

• childbirth - labor and delivery can weaken the muscles and ligaments that support and hold the vagina in place.
• strain from lifting heavy objects
• constipation and straining with bow-el movements
• lack of estrogen after menopause that weakens vaginal and bladder muscles
• being overweight or obese

Endometriosis

Endometriosis is a common health problem in women. It gets its name from the word endometrium, the tissue that lines the uterus (womb). In women with this problem, tissue that looks and acts like the lining of the uterus grows outside of the uterus in other areas. These areas can be called growths, tumors, implants, lesions, or nodules.

Most endometriosis is found:

• on or under the ovaries
• behind the uterus
• on the tissues that hold the uterus in place
• on the bowels or bladder

What are the symptoms of endometriosis?

• Very painful menstrual cramps
• Pain with periods that gets worse over time
• Chronic pain in the lower back and pelvis
• Pain during or after sex
• Intestinal pain
• Painful bowel movements or painful urination during menstrual periods
• Heavy and/or long menstrual periods
• Spotting or bleeding between periods
• Infertility (not being able to get pregnant)
• Fatigue

Women with endometriosis may also have gastrointestinal problems such as diarrhea, constipation, or bloating, especially during their periods.

Why is it important to find out if I have endometriosis?

The pain of endometriosis can interfere with your life. Studies show that women with endometriosis often skip school, work, and social events. This health problem can also get in the way of relationships with your partner, friends, children, and co-workers. Plus, endometriosis can make it hard for you to get pregnant.

Finding out that you have endometriosis is the first step in taking back your life. Many treatments can control the symptoms. Medicine can relieve your pain. And when endometriosis causes fertility problems, surgery can boost your chances of getting pregnant.

How is endometriosis treated?

There is no cure for endometriosis, but there are many treatments for the pain and infertility that it causes. Talk with your doctor about what option is best for you. The treatment you choose will depend on your symptoms, age, and plans for getting pregnant.

• Pain Medication. For some women with mild symptoms, doctors may suggest taking over-the-counter medicines for pain. These include: ibuprofen (Advil and Motrin) or naproxen (Aleve). When these medicines don't help, doctors may advise using stronger pain relievers available by prescription.
• Hormone Treatment. When pain medicine is not enough, doctors often recommend hormone medicines to treat endometriosis. Only women who do not wish to become pregnant can use these drugs. Hormone treatment is best for women with small growths who don't have bad pain.
• Birth control pills block the effects of natural hormones on endometrial growths. So, they prevent the monthly build-up and breakdown of growths. This can make endometriosis less painful. Birth control pills also can make a woman's periods lighter and less uncomfortable. Most birth control pills contain two hormones, estrogen and progestin. This type of birth control pill is called a "combination pill." Once a woman stops taking them, the ability to get pregnant returns, but so may the symptoms of endometriosis.
• Progestins or progesterone medicines work much like birth control pills and can be taken by women who can't take estrogen. When a woman stops taking progestins, she can get pregnant again. But, the symptoms of endometriosis return too.
• Gonadotropin releasing hormone agonists or GnRH agonists slow the growth of endometriosis and relieve symptoms. They work by greatly reducing the amount of estrogen in a woman's body, which stops the monthly cycle. Leuprolide (Lupron®) is a GnRH agonist often used to treat endometriosis. GnRH agonists should not be used alone for more than six months. This is because they can lead to osteoporosis. But if a woman takes estrogen along with GnRH agonists, she can use them for a longer time. When a woman stops taking this medicine, monthly periods and the ability to get pregnant return. But, usually the problems of endometriosis also return.
• Surgery is usually the best choice for women with endometriosis who have a severe amount of growths, a great deal of pain, or fertility problems. There are both minor and more complex surgeries that can help.
• Laparoscopy can be used to diagnose and treat endometriosis. During this surgery, doctors remove growths and scar tissue or destroy them with intense heat. The goal is to treat the endometriosis without harming the healthy tissue around it. Women recover from laparoscopy much faster than from major abdominal surgery.
• Laparotomy or major abdominal surgery is a last resort treatment for severe endometriosis. In this surgery, the doctor makes a much bigger cut in the abdomen than with laparoscopy. This allows the doctor to reach and remove growths of endometriosis in the pelvis or abdomen. Recovery from this surgery can take up to two months.
• Hysterectomy should only be considered by women who do not want to become pregnant in the future. During this surgery, the doctor removes the uterus. She or he may also take out the ovaries and fallopian tubes at the same time. This is done when the endometriosis has severely damaged them.

Ovarian Cysts

The ovaries (OH-vuh-reez) are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus. The uterus (YOO-tur-uhss) is the hollow, pear-shaped organ where a baby grows. Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones. Hormones are chemicals that control the way certain cells or organs function.

Every month, during a woman's menstrual (MEN-stroo-uhl) cycle, an egg grows inside an ovary. It grows in a tiny sac called a follicle (FAH-lih-cull). When an egg matures, the sac breaks open to release the egg. The egg travels through the fallopian (fuh-LOH-pee-ihn) tube to the uterus for fertilization. Then the sac dissolves. The empty sac becomes corpus luteum (LOO-tee-uhm). Corpus luteum makes hormones that help prepare for the next egg.

Functional cysts often form during the menstrual cycle. The two types are:

• Follicle cysts. These cysts form when the sac doesn't break open to release the egg. Then the sac keeps growing. This type of cyst most often goes away in 1 to 3 months.
• Corpus luteum cysts. These cysts form if the sac doesn't dissolve. Instead, the sac seals off after the egg is released. Then fluid builds up inside. Most of these cysts go away after a few weeks. They can grow to almost 4 inches. They may bleed or twist the ovary and cause pain. They are rarely cancerous. Some drugs used to cause ovulation, such as Clomid® or Serophene®, can raise the risk of getting these cysts.
• Endometriomas (EN-doh-MEE-tree-OH-muhs). These cysts form in women who have endometriosis (EN-doh-MEE-tree-OH-suhss). This problem occurs when tissue that looks and acts like the lining of the uterus grows outside the uterus. The tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.
• Cystadenomas (siss-tahd-uh-NOH-muhs). These cysts form from cells on the outer surface of the ovary. They are often filled with a watery fluid or thick, sticky gel. They can become large and cause pain.
• Dermoid (DUR-moid) cysts. These cysts contain many types of cells. They may be filled with hair, teeth, and other tissues that become part of the cyst. They can become large and cause pain.
• Polycystic (pol-ee-SISS-tik) ovaries. These cysts are caused when eggs mature within the sacs but are not released. The cycle then repeats. The sacs continue to grow and many cysts form.

What are the symptoms of ovarian cysts?

Many ovarian cysts don't cause symptoms. Others can cause:

• pressure, swelling, or pain in the abdomen
• pelvic pain
• dull ache in the lower back and thighs
• problems passing urine completely
• pain during sex
• weight gain
• pain during your period
• abnormal bleeding
• nausea or vomiting
• breast tenderness

How are ovarian cysts found?

Doctors most often find ovarian cysts during routine pelvic exams. The doctor may feel the swelling of a cyst on the ovary. Once a cyst is found, tests are done to help plan treatment. Tests include:

• An ultrasound. This test uses sound waves to create images of the body. With an ultrasound, the doctor can see the cyst's:
• shape
• size
• location
• mass - if it is fluid-filled, solid, or mixed
• A pregnancy test. This test may be given to rule out pregnancy.
• Hormone level tests. Hormone levels may be checked to see if there are hormone-related problems.
• A blood test. This test is done to find out if the cyst may be cancerous. The test measures a substance in the blood called cancer-antigen 125 (CA-125). The amount of CA-125 is higher with ovarian cancer. But some ovarian cancers don't make enough CA-125 to be detected by the test. Some noncancerous diseases also raise CA-125 levels. Those diseases include uterine fibroids (YOO-tur-ihn FEYE-broidz) and endometriosis. Noncancerous causes of higher CA-125 are more common in women younger than 35. Ovarian cancer is very rare in this age group. The CA-125 test is most often given to women who:
• are older than 35
• are at high risk for ovarian cancer
• have a cyst that is partly solid

How are cysts treated?

Watchful waiting. If you have a cyst, you may be told to wait and have a second exam in 1 to 3 months. Your doctor will check to see if the cyst has changed in size. This is a common treatment option for women who:

• are in their childbearing years
• have no symptoms
• have a fluid-filled cystYour doctor may want to remove the cyst if you are postmenopausal, or if it doesn't go away after several menstrual cycles, gets larger or looks odd on the ultrasound.
• Laparoscopy (lap-uh-ROSS-kuh-pee) - done if the cyst is small and looks benign (noncancerous) on the ultrasound. While you are under general anesthesia, a very small cut is made above or below your navel. A small instrument that acts like a telescope is put into your abdomen. Then your doctor can remove the cyst.
• Laparotomy (lap-uh-ROT-uh-mee) - done if the cyst is large and may be cancerous. While you are under general anesthesia, larger incisions are made in the stomach to remove the cyst. The cyst is then tested for cancer. If it is cancerous, the doctor may need to take out the ovary and other tissues, like the uterus. If only one ovary is taken out, your body is still fertile and can still produce estrogen.
• Birth control pills If you keep forming functional cysts, your doctor may prescribe birth control pills to stop you from ovulating. If you don't ovulate, you are less likely to form new cysts. You can also use Depo-Provera®. It is a hormone that is injected into muscle. It prevents ovulation for 3 months at a time.

Polycystic Ovarian Syndrome

The ovaries are two small organs, one on each side of a woman's uterus. A woman's ovaries have follicles, which are tiny sacs filled with liquid that hold the eggs. These sacs also are called cysts. Each month about 20 eggs start to mature, but usually only one matures fully. As this one egg grows, the follicle accumulates fluid in it. When that egg matures, the follicle breaks open to release it. The egg then travels through the fallopian tube for fertilization. When the single egg leaves the follicle, ovulation takes place.

In women with PCOS, the ovary doesn't make all of the hormones it needs for any of the eggs to fully mature. Follicles may start to grow and build up fluid. But no one follicle becomes large enough. Instead, some follicles may remain as cysts. Since no follicle becomes large enough and no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the cysts make male hormones, which also prevent ovulation.

What is polycystic ovary syndrome (PCOS)?

Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman's menstrual cycle, ability to have children, hormones, heart, blood vessels, and appearance. With PCOS, women typically have:

• high levels of androgens (AN-druh-junz). These are sometimes called male hormones, although females also make them.
• missed or irregular periods
• many small cysts (sists) in their ovaries. Cysts are fluid-filled sacs.

How many women have polycystic ovary syndrome (PCOS)?

About one in ten women of childbearing age has PCOS. It can occur in girls as young as 11 years old. PCOS is the most common cause of female infertility (not being able to get pregnant).

What causes polycystic ovary syndrome (PCOS)?

The cause of PCOS is unknown. Most researchers think that more than one factor could play a role in developing PCOS. Genes are thought to be one factor. Women with PCOS tend to have a mother or sister with PCOS. Researchers also think insulin could be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. For many women with PCOS, their bodies have problems using insulin so that too much insulin is in the body. Excess insulin appears to increase production of androgen. This hormone is made in fat cells, the ovaries, and the adrenal gland. Levels of androgen that are higher than normal can lead to acne, excessive hair growth, weight gain, and problems with ovulation.

How is polycystic ovary syndrome (PCOS) treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:

• Birth control pills. For women who don't want to become pregnant, birth control pills can control menstrual cycles, reduce male hormone levels, and help to clear acne. However, the menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone, like Provera®, to control the menstrual cycle and reduce the risk of endometrial cancer. However, progesterone alone does not help reduce acne and hair growth.
• Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, there is an increased risk for multiple births (twins, triplets) with fertility medications. For most patients, clomiphene citrate (Clomid®, Serophene®) is the first choice therapy to stimulate ovulation. If this fails, metformin taken with clomiphene is usually tried. When metformin is taken along with fertility medications, it may help women with PCOS ovulate on lower doses of medication. Gonadotropins (goe-NAD-oh-troe-pins) also can be used to stimulate ovulation. These are given as shots. But gonadotropins are more expensive and there are greater chances of multiple births compared to clomiphene. Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any one cycle and gives doctors better control over the chance of multiple births. But, IVF is very costly.

UTI (Urinary Tract Infection)

A UTI is an infection anywhere in the urinary tract. The urinary tract makes and stores urine and removes it from the body. Parts of the urinary tract include:

• Kidneys - collect waste from blood to make urine
• Ureters (YOOR-uh-turz) - carry the urine from the kidneys to the bladder
• Bladder - stores urine until it is full
• Urethra (yoo-REE-thruh) - a short tube that carries urine from the bladder out of your body when you pass urine

What are the signs of a Urinary Tract Infection (UTI)?

If you have an infection, you may have some or all of these signs:

• Pain or stinging when you pass urine.
• An urge to pass urine a lot, but not much comes out when you go.
• Pressure in your lower belly.
• Urine that smells bad or looks milky, cloudy, or reddish in color. If you see blood in your urine, tell a doctor right away.
• Feeling tired or shaky or having a fever.

How is a Urinary Tract Infection (UTI) treated?

UTIs are treated with antibiotics (an-tuh-beye-OT-iks), medicines that kill the bacteria that cause the infection. Your doctor will tell you how long you need to take the medicine. Make sure you take all of your medicine, even if you feel better! Many women feel better in one or two days.

If you don't take medicine for a UTI, the UTI can hurt other parts of your body. Also, if you're pregnant and have signs of a UTI, see your doctor right away. A UTI could cause problems in your pregnancy, such as having your baby too early or getting high blood pressure. Also, UTIs in pregnant women are more likely to travel to the kidneys.

How can I keep from getting Urinary Tract Infections (UTI)?

The following are steps you can take to try to prevent a UTI. Despite doing these things, you may still get a UTI. If you have any symptoms of a UTI, call your doctor.

• Urinate when you need to. Don't hold it. Pass urine before and after sex. After you pass urine or have a bowel movement (BM), wipe from front to back.
• Drink water every day and after sex. Try for 6 to 8 glasses a day.
• Clean the outer lips of your vagina and anus each day. The anus is the place where a bowel movement leaves your body, located between the buttocks.
• Don't use douches or feminine hygiene sprays.
• If you get a lot of UTIs and use spermicides, or creams that kill sperm, talk to your doctor about using other forms of birth control.
• Wear underpants with a cotton crotch. Don't wear tight-fitting pants, which can trap in moisture.
• Take showers instead of tub baths.

Uterine Fibroid

Fibroids are muscular tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is "leiomyoma" (leye-oh-meye-OH-muh) or just "myoma". Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.

Why should women know about fibroids?

About 20 percent to 80 percent of women develop fibroids by the time they reach age 50. Fibroids are most common in women in their 40s and early 50s. Not all women with fibroids have symptoms. Women who do have symptoms often find fibroids hard to live with. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or the rectum, causing rectal pressure. Should the fibroids get very large, they can cause the abdomen (stomach area) to enlarge, making a woman look pregnant.

Where can fibroids grow?

Most fibroids grow in the wall of the uterus. Doctors put them into three groups based on where they grow:

• Submucosal (sub-myoo-KOH-zuhl) fibroids grow into the uterine cavity.
• Intramural (ihn-truh-MYOOR-uhl) fibroids grow within the wall of the uterus.
• Subserosal (sub-suh-ROH-zuhl) fibroids grow on the outside of the uterus.
• Pedunculated (pih-DUHN-kyoo-lay-ted) fibroids grow on stalks that grow out from the surface of the uterus or into the cavity of the uterus.

What are the symptoms of fibroids?

Most fibroids do not cause any symptoms, but some women with fibroids can have:

• heavy bleeding (which can be heavy enough to cause anemia) or painful periods
• feeling of fullness in the pelvic area (lower stomach area)
• enlargement of the lower abdomen
• frequent urination
• pain during sex
• lower back pain
• complications during pregnancy and labor, including a six-time greater risk of cesarean section
• reproductive problems, such as infertility, which is very rare

Can fibroids turn into cancer?

Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma (leye-oh-meye-oh-sar-KOH-muh). Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus.

How do I know for sure that I have fibroids?

Your doctor may find that you have fibroids when you see her or him for a regular pelvic exam to check your uterus, ovaries, and vagina. The doctor can feel the fibroid with her or his fingers during an ordinary pelvic exam, as a (usually painless) lump or mass on the uterus. Often, a doctor will describe how small or how large the fibroids are by comparing their size to the size your uterus would be if you were pregnant. For example, you may be told that your fibroids have made your uterus the size it would be if you were 16 weeks pregnant. Or the fibroid might be compared to fruits, nuts, or a ball, such as a grape or an orange, an acorn or a walnut, or a golf ball or a volleyball.

Your doctor can do imaging tests to confirm that you have fibroids. These are tests that create a "picture" of the inside of your body without surgery. These tests might include:

• Ultrasound - uses sound waves to produce the picture. The ultrasound probe can be placed on the abdomen or it can be placed inside the vagina to make the picture.
• Hysterosalpingogram (hiss-tur-oh-sal-PIN-juh-gram) (HSG) or sonohysterogram (soh-noh-HISS-tur-oh-gram) - An HSG involves injecting x-ray dye into the uterus and taking x-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures. You might also need surgery to know for sure if you have fibroids. There are two types of surgery to do this:
• Laparoscopy (lap-ar-OSS-koh-pee) - The doctor inserts a long, thin scope into a tiny incision made in or near the navel. The scope has a bright light and a camera. This allows the doctor to view the uterus and other organs on a monitor during the procedure. Pictures also can be made.
• Hysteroscopy (hiss-tur-OSS-koh-pee) - The doctor passes a long, thin scope with a light through the vagina and cervix into the uterus. No incision is needed. The doctor can look inside the uterus for fibroids and other problems, such as polyps. A camera also can be used with the scope.

How are fibroids treated?

Most women with fibroids do not have any symptoms. For women who do have symptoms, there are treatments that can help. Talk with your doctor about the best way to treat your fibroids. She or he will consider many things before helping you choose a treatment. Some of these things include:

• whether or not you are having symptoms from the fibroids
• if you might want to become pregnant in the future
• the size of the fibroids
• the location of the fibroids
• your age and how close to menopause you might be

Medications

If you have fibroids and have mild symptoms, your doctor may suggest taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.

Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Low-dose birth control pills do not make fibroids grow and can help control heavy bleeding. The same is true of progesterone-like injections (e.g., Depo-Provera®). An IUD (intrauterine device) called Mirena® contains a small amount of progesterone-like medication, which can be used to control heavy bleeding as well as for birth control.

Surgery

If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:

• Myomectomy (meye-oh-MEK-tuh-mee) - surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver. Myomectomy can be performed in many ways. It can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy. The type of surgery that can be done depends on the type, size, and location of the fibroids. After myomectomy new fibroids can grow and cause trouble later. All of the possible risks of surgery are true for myomectomy. The risks depend on how extensive the surgery is.
• Hysterectomy (hiss-tur-EK-tuh-mee) - surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. Fibroids are the most common reason that hysterectomy is performed. This surgery is used when a woman's fibroids are large, if she has heavy bleeding, is either near or past menopause, or does not want children. If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the doctor may be able to reach the uterus through the vagina, instead of making a cut in the abdomen. In some cases hysterectomy can be performed through the laparoscope. Removal of the ovaries and the cervix at the time of hysterectomy is usually optional. Women whose ovaries are not removed do not go into menopause at the time of hysterectomy. Hysterectomy is a major surgery. Although hysterectomy is usually quite safe, it does carry a significant risk of complications. Recovery from hysterectomy usually takes several weeks.
• Endometrial Ablation (en-doh-MEE-tree-uhl uh-BLAY-shuhn) - the lining of the uterus is removed or destroyed to control very heavy bleeding. This can be done with laser, wire loops, boiling water, electric current, microwaves, freezing, and other methods. This procedure usually is considered minor surgery. It can be done on an outpatient basis or even in a doctor's office. Complications can occur, but are uncommon with most of the methods. Most people recover quickly. About half of women who have this procedure have no more menstrual bleeding. About three in 10 women have much lighter bleeding. But, a woman cannot have children after this surgery.

Uterine Prolapse

The uterus is held in position by connective tissue, muscle, and special ligaments in the pelvis. The uterus drops into the vaginal canal (prolapses) when these muscles and connective tissues weaken.

Uterine prolapse usually happens in women who have had one or more vaginal births. Normal aging and lack of estrogen hormone after menopause may also cause uterine prolapse, as can chronic cough (such as a smoker's cough) and obesity. Uterine prolapse can also be caused by a pelvic tumor, although this is rare.

Chronic constipation and the pushing associated with it can worsen uterine prolapse.

Symptoms

• A feeling as if "sitting on a small ball"
• Difficult or painful sexual intercourse
• Low backache
• Protrusion from the vaginal opening
• Sensation of heaviness or pulling in the pelvis
• Vaginal bleeding

Exams or Tests

A pelvic examination with the woman bearing down will show how far the uterus comes down. Uterine prolapse is mild when the cervix drops into the lower part of the vagina. Uterine prolapse is moderate when the cervix drops out of the vaginal opening.

The pelvic exam may show protrusion of the bladder and front wall of the vagina (cystocele) or rectum and back wall of the vagina (rectocele) into the vaginal space. The ovaries and bladder may also be positioned lower in the pelvis than usual.

Treatment

Uterine prolapse can be treated with a vaginal pessary or surgery.

A vaginal pessary is an object inserted into the vagina to hold the uterus in place. It may be a temporary or permanent form of treatment. Vaginal pessaries are fitted for each individual woman. Some pessaries are similar to a diaphragm device used for birth control. Many women can be taught how to insert, clean, and remove the pessary herself.

If the woman is obese, attaining and maintaining optimal weight is recommended. Heavy lifting or straining should be avoided.

Measures to treat and prevent chronic cough, such as smoking cessation, are also recommended.

There are some surgical procedures that can be done without removing the uterus, such as a sacral colpopexy. This procedure involves the use of surgical mesh material to support the uterus.

Often, a vaginal hysterectomy is used to correct uterine prolapse. Any sagging of the vaginal walls, urethra, bladder, or rectum can be surgically corrected at the same time.

Vaginal Prolapse

If you have difficulty emptying your bladder or bowel, you may be experiencing pelvic organ prolapse. Prolapse occurs when pelvic structures, like the bladder or rectum, bulge or protrude into the vaginal wall. Bladder prolapse is sometimes referred to as cystocele. Rectal prolapse is referred to as rectocele. Sometimes, pelvic organ prolapse is described as a hernia into the vaginal wall.

While the signs and symptoms of pelvic organ prolapse can be disturbing, it is important to know that you are not alone. As many as 14 million women in the USA suffer from prolapse. Vaginal prolapse is more common in women who have had a hysterectomy. Prolapse occurs when the uppermost part of the vagina - called the apex - descends because it does not have the same support that was there when the uterus was present. As a result, the vaginal apex pulls the rest of the vagina down into the vaginal canal or even outside the vagina.

Vaginal prolapse may occur alone or along with a:

• Cystocele (bladder prolapse) - Occurs when the wall between the bladder and the vagina weakens, causing the bladder to drop or sag into the vagina.
• Urethrocele (urethra prolapse) - Occurs when there is loss of support for the tube (urethra) that carries urine from the bladder to outside the body. It results in the tube sagging or bulging into the vagina.
• Rectocele (rectal prolapse) - Occurs when there is a bulge in the lower back vaginal wall caused by the front wall of the rectum sagging and pushing against it.
• Enterocele (intestinal prolapse) - Occurs when the small intestine bulges into the upper back vaginal wall.

Sometimes, these different types of pelvic organ prolapse occur simultaneously.

Weakened or damaged pelvic muscles and ligaments can cause pelvic organ prolapse. These structures can be weakened by:

• Pregnancy
• Childbirth
• Menopause
• Previous surgery
• Obesity
• Chronic heavy lifting
• Coughing

Sometimes, prolapse can simply be caused by aging or genetics. Pelvic organ prolapse is experienced almost entirely by adult women.

While many women do not have symptoms that accompany pelvic organ prolapse, some may notice a bulge or lump in the vagina or even notice the vagina protruding outside the body. Other symptoms may include:

• A pulling or stretching feeling in the groin area
• Painful sexual intercourse
• Vaginal pain, pressure, irritation, bleeding or spotting
• Urinary and fecal incontinence
• Difficulty with bowel movements
• Delayed or slow urinary stream

Yeast Infection

A vaginal yeast infection is irritation of the vagina and the area around it called the vulva.Yeast is a type of fungus. Yeast infections are caused by overgrowth of the fungus Candida albicans. Small amounts of yeast are always in the vagina. But when too much yeast grows, you can get an infection. Yeast infections are very common. About 75 percent of women have one during their lives. And almost half of women have two or more vaginal yeast infections.

What are the signs of a vaginal yeast infection?

The most common symptom of a yeast infection is extreme itchiness in and around the vagina.

Other symptoms include:

• burning, redness, and swelling of the vagina and the vulva
• pain when passing urine
• pain during sex
• soreness
• a thick, white vaginal discharge that looks like cottage cheese and does not have a bad smell
• a rash on the vagina

You may only have a few of these symptoms. They may be mild or severe.

Should I call my doctor if I think I have a yeast infection?

Yes, you need to see your doctor to find out for sure if you have a yeast infection. The signs of a yeast infection are much like those of sexually transmitted infections (STIs) like Chlamydia (KLUH-mid-ee-uh) and gonorrhea (gahn-uh-REE-uh). So, it's hard to be sure you have a yeast infection and not something more serious.

If you've had vaginal yeast infections before, talk to your doctor about using over-the-counter medicines.

How is a vaginal yeast infection diagnosed?

Your doctor will do a pelvic exam to look for swelling and discharge. Your doctor may also use a swab to take a fluid sample from your vagina. A quick look with a microscope or a lab test will show if yeast is causing the problem.

Why did I get a yeast infection?

Many things can raise your risk of a vaginal yeast infection, such as:

• stress
• lack of sleep
• illness
• poor eating habits, including eating extreme amounts of sugary foods
• pregnancy
• having your period
• taking certain medicines, including birth control pills, antibiotics, and steroids
• diseases such as poorly controlled diabetes and HIV/AIDS
• hormonal changes during your periods

Is it safe to use over-the-counter medicines for yeast infections?

Yes, but always talk with your doctor before treating yourself for a vaginal yeast infection if you:

• are pregnant
• have never been diagnosed with a yeast infection
• keep getting yeast infections

Studies show that two-thirds of women who buy these products don't really have a yeast infection. Using these medicines the wrong way may lead to a hard-to-treat infection. Plus, treating yourself for a yeast infection when you really have something else may worsen the problem. Certain STIs that go untreated can cause cancer, infertility, pregnancy problems, and other health problems.

If you decide to use these over-the-counter medicines, read and follow the directions carefully. Some creams and inserts may weaken condoms and diaphragms.