Answers to Your HPV Questions

>> Thursday, December 11, 2014

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How many of you have gone to your ObGyn for your annual exam feeling good that you did the right thing, by being responsible and getting your annual checkup and Pap smear? Then, you find out that your pap came back positive for HPV?

Now you may start searching the Internet for all available information on HPV and what it means. Since its a sexually transmitted virus, and my last pap was negative, does this mean my partner cheated on me? Does it mean I'm going to get cervical cancer? There different types, so does it matter which kind I have? I've never had warts - does this mean I'm going to get warts since its a warty virus? Will it affect my chance to get pregnant? Can I give it to my baby during birth? If my partner has it and I get treated can he give it back to me? Can men be treated too so I don't have to worry about him giving it back to me? Could I have had this and given it to my partner? Do we need to use condoms so we don't pass it back and forth? Is it living in my blood stream and infecting my whole body? I read that it can cause oral and throat cancers from oral sex and anal cancer from anal sex or just the semen or penis touching the anal area - is this true?

I know there are so many questions. I get it, it is confusing and so is the information out there.

First, the reason women are urged to get Pap smears every year is to screen for cervical cancer. Almost all cervical cancers are caused by human papilloma virus (HPV). HPV is a common virus that can be passed from one person to another during sex. This means that you can become infected with it the very first time you have sex if your partner has had sex with someone before you. Likewise, if your current partner was a virgin when you met and you were not, you can pass it to him. That's why we say, "When we have sex with someone, it's like we are having sex with everyone they have had sex with." We are exposed to any and all viruses and STDs that they have been exposed to. Not a happy thought.

This can be distressing to women because, today, there is no way to treat men or even screen them like we do with Paps for women. And, if you are married and trying to get pregnant, condoms are not an option.

The good thing is, if you are good about getting your pap exams and following up if you get HPV or an abnormal result, then you can be treated. So, this can ease your worry about getting cancer.

HPV and the treatment will not interfere with your ability to get pregnant, but active, untreated forms can be transferred to your baby at birth.
Just remember, sex is sex. So, you can get HPV or any other type of STD with anal sex (anal cancer, anal warts, herpes, gonorrhea, chlamydia, etc.), oral sex (oral HPV, warts on your vocal chords or gums and tongue) and even by rubbing genitals together without penetration.

HPV is the most common sexually transmitted infection in the United States. There are over 100 types of HPV and they all belong to the condyloma or wart family. Many of them can cause genital warts. There are the 40 types can cause cervical or other genital cancers. The other 60 or so HPV types can cause infections and warts elsewhere on the body, even on the hands and face. They can infect the genital areas like the vulva (area outside the vagina), labia, and anus, and the linings of the vagina, cervix, and rectum. These types can also infect the lining of the mouth and throat. Some HPV types can cause changes on a woman’s cervix that can lead to cervical cancer. They are invisible unless the cervix is washed by a strong vinegar solution called acetic acid while other types can cause visible warts on the labia, anus, throat, vocal chords or skin.

HPV is so common that most people get it at some time in their lives. HPV usually causes no symptoms so you can't tell that you have it. For most women, HPV will go away on its own because our immune system can eventually kick it, especially in monogamous relationships. High risk behavior, such as having sex with many different partners on a regular basis, smoking, or having HIV or AIDS, or any disease like diabetes or autoimmune syndromes can also increase your chances of HPV because they weaken the immune system.

HPV types are often referred to as "low-risk" (wart-causing) or "high-risk" (cancer-causing), based on whether they put a person at risk for cancer. The International Agency for Research on Cancer found that 13 HPV types can cause cancer of the cervix; one of these types can cause cancers of the vulva, vagina, penis, anus, and certain head and neck cancers (specifically, the oropharynx, which includes the back of the throat, base of the tongue and tonsils). The types of HPV that can cause genital warts are not the same as the types that can cause cancer.

When the body's immune system can't get rid of a high-risk HPV infection, it can linger over time and turn normal cells into abnormal cells and then cancer. About 10% of women with high-risk HPV on their cervix will develop long-lasting HPV infections that put them at risk for cervical cancer.

When high-risk HPV lingers and infects the cells of the cervix, vulva, vagina, penis anus, or the oropharynx, it can cause cell changes called dysplasia, which is not a precancerous change. If ignored and untreated, they may eventually develop into cancer.

Using condoms can help prevent getting it. Using WaterWorks for famine hygiene immediately after sex can help clear the vagina of semen that could be infected with it. It is always easier to get any STD when having sex during our period so this is an especially important time to use WaterWorks. WaterWorks is not the same as douching because it uses only plain water with no chemicals and can be used every day if you want. It is FDA cleared for clearing vaginal odors and feminine hygiene.

I hope this helps you understand better.

Be safe and have some fun,
Dr. Susan Boyd, MD


Pelvic Pain

>> Thursday, December 4, 2014

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Good morning. I am hope you are all looking forward to this beautiful holiday season with friends and family. Unfortunately, I know many of you may be smiling and laughing in between your episodes of pelvic pain. You have become so accustomed to it and even expect it by planning your holidays around it.

Pelvic pain is located in the lowest part of your abdomen, way down about half way between your pubic bone/pubic hairline and your belly button. Any pain that is at your belly button or higher is considered abdominal pain. It can be difficult to know for sure, because pain can radiate up from the pelvis to your belly button or ribs and back pain from your spine or tailbone can wrap around to the front. And, of course, abdominal pain can radiate down from your stomach, gallbladder or kidneys into the pelvis. It can be frustrating and scary!

Depending on its source, pelvic pain may be dull or sharp; it may be constant or intermittent; and it may be mild, moderate or severe. Pelvic pain can move around to your lower back, buttocks and shoot down your vagina and thighs. Pelvic pain can occur suddenly and sharply and last for just a few minutes 3-4 times a month. You my notice that it only hurts when you have sex, go to the restroom, have your period, or ovulate (about a week to 1 ½ weeks after your period).

Pelvic pain can be so complicated that it may have nothing to do with your uterus or ovaries. It may come from the muscles and connective tissue (ligaments) in the structures of the pelvic floor. This pain may be caused by irritation of nerves in the pelvis and can hurt when you exercise or walk your dog. There is no surgery for this -- not even a Total Hysterectomy with both ovaries removed will take away this type of pain.
There are many things that can cause pelvic pain. Some are chronic (which means it is a part of how your body was made and functions and can never be cured). The occasional or acute pain will come and go and is usually caused by something curable and temporary. Most women don't have chronic pain and all women have episodes of pelvic pain during their lifetimes.

Female reproductive system related: It may be caused by female conditions like Adenomyosis, Endometriosis, Menstrual cramps (dysmenorrhea), Ectopic pregnancy (or other pregnancy-related conditions), Miscarriage (before the 20th week), intrauterine fetal death, Mittelschmerz (ovulation pain), Ovarian cysts, Pelvic inflammatory disease (PID) or Uterine fibroids.

Pain from non female related organs: Include Appendicitis, Colon cancer, Chronic constipation, Crohn's disease, Diverticulitis, Fibromyalgia, Inguinal hernia Interstitial cystitis (also called painful bladder syndrome), Irritable bowel syndrome, Kidney stones, Past physical or sexual abuse, Pelvic floor muscle spasms, Ulcerative colitis or Urinary tract infections.

If you suddenly develop severe pelvic pain, it may be a medical emergency like a ruptured ectopic (tubal) pregnancy or a ruptured cyst that is causing internal bleeding. You should seek medical attention promptly as these are life threatening.

I hope you all have a wonderful week and stay safe during the holidays.

Dr. Susan Boyd, MD


Could Changes in My Cycle be a Sign of Cancer?

>> Thursday, November 20, 2014

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Good morning to all of you. I hope you are looking forward to the upcoming holidays, even if it's just a time of rest.

In my last blog, I discussed the frustration and worry of abnormal vaginal bleeding. Nothing is more frustrating than unpredictable vaginal bleeding that keeps happening over and over. I have discussed extensively in prior blogs the different reasons for abnormal bleeding, both serious and not serious. I have also discussed that the major concern for most of us is that the abnormal bleeding could relate to cancer or some other life-threatening illness.

Women use monthly cycles to monitor our overall health. This means that when our periods are regular, we assume our bodies are healthy. When we start having irregular, heavy or prolonged bleeding or no bleeding at all, it can be alarming. The most common thing I hear is, "My cycles are so regular, I can calculate not just the day, but almost the hour my period will start."

This puts it into perspective why it can be so scary when there is a change. Many of you logon to the Internet for an immediate explanation or an answer. Of course, this only increases anxiety because the first thing you may read about is uterine, cervical or other female cancer.

While that can be one cause, cancer is a rare reason for abnormal periods. There are so many more common reasons for abnormal bleeding than cancer. I'm not saying I would ignore it and not check for cancer, but I would be checking for everything from ovarian cysts to hormone imbalance. I mentioned many of these disorders in the last blog but did not go into detail as I've done that in past blogs and will do it again.

What is important is that non-cancerous causes are just that, non cancerous. They won't just magically change into a malignant cancerous situation.

Please, if you are experiencing changes in your periods, go to your doctor first, not the Internet. I know it's hard, but negative information can cause stress and anxiety and can actually worsen the bleeding and irregularity.

Don't forget to write in if you have questions. Have a wonderful week and please check out our WaterWorks for help with feminine hygiene and to stop recurrent vaginal odor.

Dr. Susan Boyd, MD


What Can I Do About Abnormal Vaginal Bleeding?

>> Thursday, November 13, 2014

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There is absolutely nothing more frustrating than abnormal vaginal bleeding and not knowing when your period is coming.  For many of you, this is a common occurrence.  Just when you think, 'Yay!!  I'm so happy that period is gone!', and you can stop wearing a panty liner…..then, here comes more bleeding and spotting.  And forget planning a romantic evening when there is bleeding, spotting or pinkish and gooey brown discharge.  And, as if the bleeding isn't bad enough, there is the battle with horrible odor from blood that causes a rise in vaginal pH.

Unfortunately, you have probably been told different things from different doctors and still don't know why you don't have regular bleeding once a month like everyone else.  You may have heard of Dysfunctional uterine bleeding (DUB), Abnormal uterine bleeding (AUB), thyroid or metabolic disorders, Polycystic ovarian syndrome (PCOs), Hypermenorrhea or Polymenorrhea, Anovulation, Chronic cervicitis or endometritis, polyps, fibroids, and even hormone imbalance. 

So what does it all mean?  I know you just want it to stop, and you worry about it being harmful to your body or becoming cancer.  You wonder if you can get pregnant or if you are infertile.  You want to know how to determine when you are ovulating, if you need surgery, if it's something you're doing wrong, like eating the wrong diet or exercising too much or too little.   You wonder if it is a hormone issue, and, if so, can they be fixed?  Will you always struggle with this?  There are just so many questions!

The medical definition is AUB or Abnormal uterine bleeding, which is irregular bleeding from the uterus for unknown reason.  For example, you may get your period more often than every 21 days or farther apart than 35 days.  Some women will skip for 3 months and then bleed for several days or weeks.  Your period may last longer than 7 days.   Abnormal uterine bleeding has also been called dysfunctional uterine bleeding (DUB).  It is usually not serious, but it can be annoying and can definitely disrupt your life.

Normally one of your ovaries releases an egg during your menstrual cycle - called ovulation.  Abnormal uterine bleeding is often triggered when women don't ovulate.  This causes abnormal changes in hormone levels and in some cases can lead to unexpected vaginal bleeding.  When we don't ovulate, it puts our entire cycle into dysfunction and causes us to go into unsynchronized phases.

Of course it's just not that simple because we can ovulate and have normal hormone balance and still have AUB.  Women always judge their overall health by the regularity of their monthly cycles, so any changes in how long they last, how many we get in a month, or how much we bleed triggers concern.  Some of you have never experienced a normal, monthly cycle that lasts 4-5 days with one or two days of moderate to heavy bleeding.

In order to rule out all other causes of AUB, there are certain tests that can be done that will check your blood for thyroid disease, hormone imbalance, bleeding and clotting disorders, anemia and kidney or liver disease.  Ultrasound or CT scans can help check for physical and anatomic abnormalities.  It sounds scary, for sure, but even brain tumors, usually benign and located in the pituitary gland, can be a reason and would require a brain MRI.  It is also important to have your doctor look over all your current medicines, vitamins and herbs, as they can cause a profound effect on periods and bleeding patterns.

Once you are evaluated, a plan can be initiated between you and your doctor as to the best way to regulate the bleeding.  The increased yeast and bacterial infection (which can cause vaginal odor and irritation) can also be worked on.  There are combination medicines that include pills, vaginal creams and gels that can be used.  But, it is common for it to take several treatments to get things back in balance.

Douching is tempting, as it is normal to want to rinse out the smelly, brownish or bloody discharge.  But, douching is a temporary fix, because all the chemicals, vinegar etc., will just contribute to the imbalance and will rinse out the healthy bacteria with the abnormal bacteria and yeast.  So this process just goes on and on.
Hopefully you have checked out "WaterWorks", as it is a reusable FDA-cleared feminine cleansing system.  It is great for daily use to clean out blood, discharge and semen.  It uses plain water (no chemicals), and can be used over and over.  All parts are replaceable, so it has no negative effect on the environment.  The best part is that, after the first use, you will have no more vaginal odor.  So, when the bleeding slows or calms way down, you can enjoy sex with confidence that the odor is gone.  Yay!! 

So go get your tests done, and if you have questions write to me.  

I hope you learned a little more about your body and that it helps you feel better and less scared about getting things checked out. 

Have a happy week and have fun.

Dr. Susan Boyd, MD


Treatment Options for Heavy or Prolonged Menstrual Periods

>> Thursday, October 30, 2014

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Heavy or prolonged menstrual periods, or menorrhagia, is the most common type of abnormal bleeding that women experience.  Periods are considered heavy if there is enough blood to soak a pad or tampon every hour for several consecutive hours.  Sometimes, it's nighttime bleeding that requires getting up to change pads or tampons or passing large blood clots.  And, when our periods last longer than 7 days with heavy bleeding, not spotting.  All of this can interfere with sleep and daily activities and lead to anemia, causing symptoms such as fatigue and shortness of breath.

As we have discussed, a balance between estrogen and progesterone regulates the buildup of the endometrial lining of the uterus, which is shed during menstruation.  If a hormone imbalance occurs, this lining can thicken too much, causing many menstrual irregularities.

Certain drugs, including anti-inflammatory medications like aspirin, and anticoagulants or blood thinners can contribute to heavy or prolonged menstrual bleeding.  Also, if someone has a blood coagulation disorder from birth, such as Von Willebrand's disease, the blood doesn't clot well.  There are other inherited disorders as well that can cause abnormal menstrual bleeding. The good thing is these are usually identified at the same time as the first period, because it will be very heavy.

There are a number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, that may be associated with menorrhagia.  Also, fibroids, polyps or other noncancerous tumors of the uterus, and things like Adenomyosis, which is a condition that causes the glands from the lining of the uterus to become imbedded in the muscular wall of the uterus.  Of course, the worst case scenario would be some kind of female cancer like uterine, ovarian, or cervical cancer.  These are rare, but possible, causes of heavy menstrual bleeding.  Other medical conditions can prevent normal blood clotting, including liver, kidney, or thyroid disease, and bleeding or platelet disorders.

Treatment for menorrhagia once you have identified the reason, may include one or more of the following things:

  • The nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen can reduce the amount of blood loss and help with pain.
  • Lysteda (tranexamic acid), a non-hormonal medication that can also be prescribed to you because it promotes blood clotting and will significantly decrease blood loss.
  • Birth control pills or hormone therapy is a common method used to stabilize the endometrial lining of the uterus, regulate menstrual cycles, or correct hormonal imbalances.
  • The IUD Mirena is used for heavy bleeding and also prevents pregnancy.  It works by local progesterone absorption, not systemic absorption.  That means no hormone goes into the blood stream, so it doesn't affect or change our own hormone balance.  In fact women continue to ovulate and have their own natural hormone fluctuations.  Because this local absorption thins the lining of the uterus (endometrium), it makes periods very light, or absent.  This makes it a wonderful method for helping with heavy or irregular menstrual bleeding.  It is also effective in preventing pregnancy because it thickens the cervical mucus, or discharge, so much that the sperm cannot pass through the cervix to fertilize the egg.  This is a good choice for women who do not want surgery or who cannot or don't want to take hormones.

Many women have chosen more permanent procedures when they are done having children.  Endometrial ablation can be done in several ways like freezing, hot thermal balloon ablation, electro-cautery, and hot water.  This effectively cauterizes the endometrial lining so it won't build up monthly any more.  It can last 3-5 years and occasionally can be permanent.  It is considered a semi-permanent way to stop heavy menstrual or frequent/continuous vaginal bleeding.
Hysterectomy, which is complete removal of the uterus, as it is the uterus that bleeds.  Ovaries produce all the female hormones and can be removed, but if there is no pain problems, it is best to leave them for hormone support. 

Many women who have continuous or irregular bleeding can also have odor problems.  This happens because the vagina maintains health by being slightly acidic.  Blood is a higher, physiological pH and this will cause a rise in vaginal pH.  When this happens, yeast and abnormal vaginal bacteria overgrows and this brings abnormal odors and could lead to yeast or bacterial infections.

UsingWaterWorks during this time to rinse out the excess blood would help keep away unwanted orders.  It is safe to use daily, uses no chemicals and is FDA cleared to help with vaginal odor. :)

I hope you have a wonderful week and stay safe!

Dr. Susan L. Boyd, MD


Cysts and Ovarian Cancer

>> Friday, October 24, 2014

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Good morning to all of you. I hope you are all feeling well and looking forward to the day. Over the past couple weeks, we've been discovering how our ovaries work and what it means when we are told we have cysts. We've learned that cysts do not necessarily mean cancer or that you are more likely to get cancer.

We have learned that, before menopause, we make cysts called follicular cysts (or follicles) every single month. Our eggs mature in these. Then, once we ovulate or release the egg, all the rest of the follicles shrink up and go away. In a normal menstrual cycle, the balance between the hormones estrogen and progesterone regulate the buildup of the uterine lining (the endometrium), so that it doesn't get overly thick or come out at the wrong time. Without this precise synchronization, it can cause prolonged, irregular or excess bleeding or miscarriages.

So many of us worry about getting cancer or have friends and family members who have died because of it. It is just so scary! Some cancers are genetically linked, but the majority are not and have no hereditary or genetic link.

It is important to note that most ovarian cysts, whether cancerous or benign, cause very slight or no symptoms. So what changes should we look for in our body? Is it pain, extreme weight loss or weight gain, or weakness and fatigue? Or perhaps sharp stabbing and shooting pains down our legs or in our lower back and vagina? Well, when women reflect after being diagnosed with cancer, they often agree on some of these symptoms:

  • Persistent abdominal bloating, indigestion or nausea
  • Changes in appetite or feeling full sooner
  • Feelings of pressure in the pelvis or lower back that can make you feel like you have to pee or poop more often
  • Sometimes there are changes in bowel movements like diarrhea or constipation
  • Feeling like your pants are too tight, but you are not gaining weight
  • Feeling tired or low energy for no reason

What's scary is that all these same symptoms can also occur with many things like benign cysts, uterine fibroids, Irritable Bowel Syndrome and diverticulitis. Women may also feel pelvic pain when they have chronic problems like endometriosis, interstitial cystitis (chronic bladder inflammation), painful periods or painful sex. And any severe or persistent pelvic pain can cause nausea and vomiting.

Whether benign or cancerous, ovarian pain becomes worse when the ovaries become enlarged, or are bumped/pinched during sex or when having a bowel movement. The left ovary sits right next to the colon and, when it is enlarged from a benign or follicular cyst, it can be bumped as the colon moves when we are passing gas or getting ready to go poop. Both benign or malignant cysts can pop and bleed or they can flip over and block their own blood flow, which is called torsion.

Getting back to 'square one'… can we know if we have ovarian cancer? Uterine cancer and cervical cancer cause abnormal bleeding, and breast cancer causes lumps or breast retractions, but ovarian cancer is so silent.

It may be helpful to know that ovarian cancer is very rare, with less than 1% of women getting it. We are more likely to die of heart disease, lung cancer, breast or skin cancer.

Certain risk factors may make some women more likely to get cancers (ask your doctor for specific tests along with the annual exam and Pap smear):

  • Menopause, although due to the increase of hormone use and growth hormone in our food we are seeing cancer at younger ages; we are seeing an increase in breast and ovarian cancer as early as 22 years old when it was unheard of 20 years ago
  • Smoking
  • Obesity
  • Never having had children
  • Not breastfeeding
  • Taking fertility drugs for many years
  • Family history of ovarian, breast, thyroid or colorectal cancer or any cancer yourself
  • Note: Birth control pills and hormone replacement therapy, because they rest your ovaries, can actually reduce the risk of ovarian cancer

If you ask for an ultrasound along with specific blood tests called tumor markers, it can help diagnose early cancer. The ovary should not show any cyst and a blood test called a CA-125 should read in the normal range. If either one are abnormal, then further testing should be done. Tests like CT scans, Doppler flow studies, or MRI can see the ovaries better and define any growth. They can also see the lymph nodes to evaluate them for cancer as well. Other blood tests include CBC, Chemistry panel and Tumor markers such as LH, CEA, FSH, and HCG, plus estradiol and testosterone. Tumor markers test for the different types of cancer - whether ovarian or not. The blood tests for cancer are becoming more sophisticated and specific every year.

The different types and classifications of tumors are:

  • Epithelial cell tumors that start from the cells on the surface of the ovaries; these are the most common type of ovarian tumors
  • Germ cell tumors that start in the cells that produce the eggs and can either be benign or cancerous
  • Stromal tumors originate in the cells that produce female hormones

Treatment really depends on the type of cancer and how early or late it is discovered. It is up to the Cancer Specialist to make the decision as to whether chemotherapy, radiation, surgery, or a combination of these would be most helpful.

So, to summarize, it is comforting to know that Ovarian Cancer is rare, but the difficulty in screening and lack of symptoms can make it hard to detect early. Most are found at an advanced stage, and that is why most women do not survive, not because it can't be cured.

Some women will notice an increase in vaginal discharge with a hormone active cyst or when a large cyst ruptures. Since the vagina likes to maintain a slightly acidic or low pH, any increase or change in vaginal discharge can change the normal flora and raise the pH to a more alkaline environment.

This can cause unwanted odors, and most abnormal vaginal odors won't go away with bathing. The worst thing to do is douche, as this can further disrupt the vaginal environment and make it harder/longer to heal. Never wash inside your vagina with soap either. If you feel you need to clean inside the vagina, only use plain water, as it will not disrupt the natural self-cleaning ability.

WaterWorks is a natural, easy way to accomplish feminine hygiene every day, inside and out. It can be used after your period, after sex, or everyday to rinse out discharge and erase unwanted odors. Since it is FDA cleared to help remove vaginal odor, it is the best way to stay feeling confident and fresh without the use of medicine or chemicals. If you think you have an infection, you need to see your doctor for cultures and for that you may need medicine. It is still safe to use WaterWorks while you are being treated for infection.

Hope you all have a safe, happy weekend :)

Dr. Susan L. Boyd, MD


More About Ovarian Cysts

>> Wednesday, October 15, 2014

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I hope you all had a good week. Last week I was explaining how the ovaries function in hopes it will help you understand that having an ovarian cyst can just mean that they are functioning normally.

The eggs (or ova) form and then mature in clear, fluid-filled cysts. When they reach the size of a large cherry, they "pop" to release the egg into the fallopian tube - a process called ovulation. If the ova is fertilized, then it will implant and pregnancy occurs. If it doesn't, it will pass from the body or dissolve. Once ovulation has occurred, all the remaining developing ova shrivel up, and within 14 days our period comes and the entire process will repeat itself.

But sometimes the developing ova do not shrivel up and will continue to grow and fill with clear or straw-colored fluid until they are the size of a tennis ball or even as large as a soccer ball!!

Mucinous cyst adenomas are similar to the enlarged follicular cysts and behave the same, but do not originate from ovulation. Both of these types of cysts are rarely painful unless they "pop", causing many women to pass out and end up at the emergency room. This is usually not life threatening unless a blood vessel is torn during the rupture, causing internal bleeding.

Torsion is another complication of these benign cysts, which is most likely to happen when they are no larger than the size of a golf ball. Torsion is when the ovary literally flips over on itself, twisting off the blood flow. This is an emergency because not only is it extremely painful, but will cause the ovary to die from lack of blood flow if not surgically corrected as quickly as possible.

'Benign' cysts means they are not cancerous. Benign cysts do not change to 'malignant' (meaning cancerous) cysts, and women with benign cysts are not at a higher risk for making malignant cysts.

There are other forms of benign cysts like Dermoid cysts, also known as mature teratomas. These cysts are known for the hair, fat, muscle, bone and teeth that can be found in them. Hemorrhagic cysts are cysts that have clear fluid and blood clots in them. Women with endometriosis are at risk for making cysts called Endometriomas or "Chocolate cysts". These are cysts filled with old, brownish appearing blood and endometrium that has come from the back flow of period blood into the Fallopian tubes and onto the ovaries. When they rupture it looks like chocolate syrup pouring out and that is why they were nicknamed Chocolate cysts.

Most cysts are identified by ultrasound. Ultrasound is very good at characterizing cysts as benign or malignant, and can identify simple fluid filled cysts from the other types. If simple, fluid filled cysts are 5 cm or less in size they can resolve on their own and you may never need surgery.

Sometimes women notice an increase in discharge when small cysts rupture or leak. This is usually a thin, watery, odorless fluid.
It is always best to see your doctor if you notice changes in your menstruation, pain with sex or when using the restroom, walking or exercising, increase in need to urinate, or a feeling of fullness in your abdomen or pressure on your bladder.
I hope this helps answer your worries and questions about ovarian cysts. There is so much more on this subject but I wanted to simplify it for you a little bit.

Take care and have a safe and happy week.

Dr. Susan L. Boyd, MD


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