GYNECOLOGIC
CONDITIONS
Ovarian Cysts
Uterine Fibroids
Endometriosis
Cervical Dysplasia

ISSUES IN
GYNECOLOGY
Pelvic Pain
Abnormal Bleeding
Incontinence
Infertiliy
Pelvic Relaxation

GYNECOLOGIC
PROCEDURES
Hysteroscopy
Laparoscopy
Hysterectomy
Endometrial --
-- Ablation

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Ovarian Cysts

• The ovary of a woman of childbearing years has essentially two functions: One is to make hormones, like estrogen and progesterone, which are released into the bloodstream. The other is to develop, with each menstrual cycle, a cyst from which an egg is released. These so-called functional ovarian cysts will usually come and go without any symptoms. The release of the egg from one of these cysts (ovulation) is sometimes associated with a pelvic discomfort which will go away on its own. The formation of these cysts is usually halted by birth control pills and depo-provera. An ovarian cyst is a fluid-filled sac, like a small water balloon, which is usually not perceived by the woman who is growing it, no matter how big it gets. While most ovarian cysts are the "functional" type that come and go, on occasion an ovarian cyst will develop that is pathologic, meaning without any purpose. These cysts are almost always harmless, but may require surgery for diagnosis and removal. No one knows exactly why these pathologic cysts form. Usually they grow slowly, and they are rarely cancerous in women under 50. They can vary in size from as small as a pea to larger than a grapefruit. Ovarian cysts are most often discovered during a routine pelvic exam. An ovarian cyst that goes away on its own is not a pathologic one.
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• Fibroids are very common muscle tumors usually located in the wall of the uterus, occurring in one of every three women over the age of 40. They are benign tumors, which begin as one or more pea-sized lumps, but can grow steadily during the reproductive years. Most fibroids just need to be monitored. Others may require treatment if they become really large or cause severe symptoms. Although fibroids tend to run in families, no one really knows why some women grow them and others don't. Potential problems with symptomatic fibroids include heavy or prolonged periods, anemia, pelvic pain such as painful periods, pain with intercourse, pain with urination or bowel movements, and back pain. While fibroids can usually be monitored and require no treatment per se, uterine fibroids do account for the most common reason for hysterectomy in this country.
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• Endometriosis is a condition in which abnormal tissue is present on the internal lining of the pelvis, usually in very minimal quantities, but typically adjacent to the ligaments which carry the nerves to and from the uterus. Thus it takes only a minimal amount of endometriosis to cause quite a bit of pelvic pain. Less frequently, other areas of the pelvis, such as the surface of the bladder, bowel, fallopian tubes and ovaries, are involved. No one knows exactly how this abnormal tissue comes to be. Under the microscope, the tissue looks like the lining of the uterus (or endometrium), which is how it gets its name. Typical symptoms with endometriosis are: pain prior to, during, or after periods, painful intercourse, painful bowel movements or urination, and infertility. Endometriosis can only be diagnosed with surgery, usually using the minimally-invasive laparoscope. Fortunately, most endometriosis is minimal in amount and fairly easy to treat with the laparoscope. Treatment of severe endometriosis can be both surgical and medical.
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• Cervical dysplasia is a microscopic change in the surface of the cervix, which is pre-cancerous and which might, if left unchecked, progress over time to cervical cancer. Cervical dysplasia is not seen by merely looking at a cervix, but is suggested by a screening Pap Smear. If abnormal cells are seen under the microscope on a pap smear slide, then a colposcopy might be done, which involves looking through a special magnified lens at the cervix itself. Any abnormal-appearing areas seen with the colposcope would be biopsied to see if precancerous dysplasia is present. Cervical dysplasia can then be treated, to prevent the development into invasive cervical cancer. Because of our ability to diagnose and treat cervical dysplasia, cervical cancer can be prevented. It is important that a woman follow all recommendations for follow-up regarding abnormal pap smears, so that proper identification and treatment of possible cervical dysplasia can take place. One factor known to increase the risk of cervical dysplasia is tobacco smoking.
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• Pelvic pain is a condition which can arise from the normal functioning of the reproductive tract (normal ovulation, menstruation) or which can be a signal of possible pelvic pathology. Causes of pathologic pelvic pain include pelvic inflammatory disease, endometriosis, uterine fibroid formation, ovarian cysts or other tumors, appendicitis, irritable bowel syndrome, diverticulitis, or bladder infection. Less commonly, pelvic pain can be associated with a tubal pregnancy or twisted ovary. A woman should report any unusual pelvic pain to her health care provider.
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• Abnormal uterine bleeding includes heavy or prolonged periods, bleeding between periods, midcycle spotting, and bleeding after intercourse. A medical history and pelvic exam may be all that is needed to begin the work-up of abnormal bleeding. Common causes of abnormal uterine bleeding include hormonal problems and benign uterine growths, such as fibroids or polyps. Other possible causes include tubal (or ectopic) pregnancies or miscarriages, medications, bleeding disorders, infections or cancer of the reproductive organs, IUD problems, a thin, fragile vaginal lining, and thyroid or pituitary conditions.
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• Bladder control problems can occur at any age, but most frequently affect the aging woman. The loss of bladder control is called incontinence. Stress incontinence occurs with activities such as coughing or sneezing, and can be corrected with pelvic floor exercises, biofeedback, electrical stimulation and sometimes surgery. Urge incontinence involves the inability to hold urine when a sudden urge to urinate arises. It is sometimes related to stress incontinence, and has many varied causes, from urinary tract infections to instability of the bladder muscle to bladder tumors, to name a few. Medications can sometimes help to alleviate urge incontinence.

• Age, lifestyle, or medical problems may cause infertility, which is often defined as the inability to conceive within one year of unprotected intercourse. Factors contributing to infertility might be found in one or both partners; sometimes a cause cannot be found. As your doctor helps you and your partner explore possible causes and treatment options, avoid feeling guilty or placing blame. Share the challenge and support each other.
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• Pelvic Relaxation is condition which develops after years of wear and tear on the muscle and tissue supports of the pelvic floor. It can become quite severe in women who do a lot of heavy lifting, have a history of chronic constipation or chronic coughing, and have had many vaginal deliveries. Incorporating pelvic floor exercies into daily activities helps to reduce the daily strain on the pelvic floor and can prevent progression of pelvic floor relaxation. Some women require a surgical repair to achieve a reasonable comfort level. It is important for all women to treat their pelvic floors with respect, and avoid straining with daily activities!
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• Hysteroscopy is a surgical procedure that allows the physician to view directly inside the uterus, with a small telescope- like instrument. Hysteroscopy is done without incisions, causes little discomfort, and it can help your gynecologist identify the cause of abnormal uterine bleeding. It can also be used to treat some of these problems identified.
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• A laparoscopy is a relatively quick surgery to help your doctor diagnose and possibly treat conditions that cannot be diagnosed with an office pelvic exam, with ultrasound, or with other, more simple tests, conditions such as endometriosis and pelvic inflammatory disease. Your gynecologist can learn inside information about the cause of symptoms such as unexplained pain or bleeding. To ensure that the procedure provides the whole story, your doctor must have an unobstructed view of your reproductive organs. While you are anesthetized, your abdomen is inflated by cardon dioxide gas to provide adequate visualization. Then, through a small incision, your doctor inserts the laparoscope and views your ovaries, fallopian tubes, and uterus. Sometimes a lot of work can take place with the laparoscopic instruments to correct whatever is found to be wrong. At the end of the procedure, the gas is released and your incisions closed. You can usually go home the same day.
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• A hysterectomy is the surgical removal of the uterus. This procedure can relieve severe pain and bleeding, and even save a woman's life if she has cancer. The incision for a hysterectomy can be made in the abdomen, or in the vagina, depending on the clinical circumstances. Depending on a woman's age, preference, and the clinical circumstances, the uterus may be removed with or without the cervix, and with or without the ovaries.
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