Dangers of Laparoscopic Surgery vs. Hysterectomies

>> Thursday, September 11, 2014

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Many women have hysterectomies for various reasons like heavy bleeding, endometriosis, extreme pelvic pain, fibroids tumors, adenomyosis, and endometrial cancer. Uterine cancer, adenomyosis and uterine fibroids can cause the uterus to abnormally enlarge.

A hysterectomy is a major surgery and requires many weeks of recovery. Of course, many women work outside the home and some are the primary income providers, so taking too much time off to recover from surgery can be a big deal.

So there has been a push towards expansion of minimally invasive surgeries like laparoscopic and robotic techniques. This advance in technology has brought forth many devices quickly and the controversy behind some devices for gynecologic procedures has intensified. Some devices were designed to remove fibroids and large uteruses through a laparoscopic incision by grinding it into small pieces. Prior to these devices, there was no way to do this except through a traditional vertical or horizontal incision. The thinking was that, with smaller incisions and laparoscopic procedures, women could heal faster and spend less time in the hospital.

New technology is hard to resist - patients demand it from their doctors, and many doctors use it to promote their practices and increase business. Many times this enthusiasm from both sides creates short cuts in pre-operative evaluations, pushing aside the traditional protocols. These protocols were set in place to ensure patient safety during operative procedures. But even with a thorough pre-operative evaluation small or hidden cancers can be missed.

We even see huge billboards advertising procedures for fibroids or enlarged uterus removal. They may show a picture of a woman's tummy with a very long incision from the ribs down past the belly-button and stopping at the pubic bone. No one would want that if they can have same surgery done with only three or four 1-2 inch incisions. I sure wouldn't. But the truth is, we rarely use vertical incisions because most of these surgeries can be accomplished with the horizontal "Bikini Cut" incision called a pfanensteil incision.

The new devices are made to fit through the small laparoscopic incisions. With the help of an assistant to hold the fibroid or uterus through one laparoscopic incision, the device is placed through a second incision. It is then placed directly on the fibroid or uterus and can then be turned on to grind the tissue until all the fibroids or the entire uterus is removed.

Just as quickly as it rose in popularity, it's popularity fell away. This happened because it became the focus of many serious complications. During the procedure, many undetected cancers were reported to be found. Once opened and ground up, cancerous tissue can spill into the abdomen and pelvis, resulting in the spread and rapid advancement of the cancer. Manufacturers have recalled devices from hospitals and surgery centers.
We all love technology, as it can make our life so much easier, and hopefully we will see a return of a similar, but much safer, type of device.

Dr. Susan Boyd, MD

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What causes pelvic pain and how to relieve it.

>> Thursday, August 21, 2014

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Many women experience pain in their bodies. It comes and goes and can be cyclic, relating to menstrual periods and ovulation. Other pain can include migraines, breast pain, lower back pain and deep or superficial pelvic pain. It doesn't matter if it's cyclic or relatively constant - pain brings fear and disrupts our ability to enjoy life. Today we're going to focus on pelvic pain.

Pelvic pain can be dull and achy, sharp, steady, intermittent, crampy, and sometimes just feel like a deep pressure or heaviness. It can be triggered by menstrual cycles, sex, and even having a bowel movement or urinating, and it can worsen when sitting or standing for long periods of time. The pain may have obvious origins like painful periods, endometriosis or ovarian cysts. But for some women, it is not so obvious and can be so frustrating.

PCS (pelvic congestion syndrome) is one cause of pelvic pain that is common, but not well-known or talked about too much. In fact, you may never have heard of this before. There is no immediate treatment for PCS, and it can go on for years without being diagnosed. Pelvic congestion syndrome is also known as pelvic venous insufficiency. With PCS, the pelvis become swollen from the back flow of blood (similar to varicose veins in our legs). This prevents normal blood flow through the pelvis, creating congestion, and this causes pain and other symptoms. The condition is associated with ovarian and pelvic vein dilatation where the veins are stretched beyond normal dimensions. This over-stretching can cause permanent damage.

In normal veins, blood flows from the pelvis up toward the heart by way of the ovarian veins, and it is prevented from flowing backwards by valves within the vein. When the ovarian veins are damaged, the valves do not close properly, resulting in back flow of blood.

Weight gain and pregnancy can worsen this condition because increased pressure and stress on the pelvis affects the ovarian veins. This, along with the increase of estrogen in pregnancy and weight gain, causes the vessels to over-stretch and weaken.
The pain with PCS can worsen when sitting or standing, and it is relieved with lying down. It can sometimes be associated with varicose veins in the thighs, buttock regions, or vaginal area. Some women experience pain with urination and during or after sexual activity. This can worsen to the point where you may have constant pain or sharp, stabbing pain, even while laying down resting.

Problems with orgasms during sex can be a cause of PCS. This is because sexual excitement increases blood flow to the pelvis, and orgasm releases the buildup of blood, similar to what we can visibly see in a man who is excited. Increased blood flow to the pelvis will cause an erection in a man, which quickly goes away as pelvic circulation normalizes.

It is important to go see your doctor for a definite diagnosis of your pain and to rule out other causes. Abdominal and pelvic ultrasound is an important tool in the diagnosis of PCS because it can eliminate other common causes of pain and evaluate blood flow. CT Scans and MRI are helpful, but only if ultrasound is unable to see everything or to delineate an abnormality better. Pelvic venography is considered the most definitive imaging modality for diagnosing PCS because it can identify the abnormal veins and the reversal of blood flow within the affected veins.

This may seem strange, but physical therapy and relaxation techniques can be amazingly beneficial. Applications of heat and cold to your abdomen, stretching exercises and massage may help the pain because it can increase your circulation. Kegel exercises may also be helpful, but if the pain is caused from difficulty achieving an orgasm, sexual therapy and evaluation is crucial. Pain relievers that decrease inflammation like aspirin, ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol) may provide partial relief from your pelvic pain. Sometimes a prescription pain reliever may be necessary. Pain medication alone, however, rarely solves the problem of chronic pain and is not recommended long-term.

Laparoscopic surgery is an excellent way to evaluate pelvic congestion and to determine if there are other factors involved that can't be seen by any other means (i.e. extensive scarring, adhesions or endometriosis).

It is important to see your doctor and not continue to suffer with the pain. It could be easily corrected, or it may take some time and multiple treatments, but waiting may be making it worse and harder to treat as time goes on.

I hope you have a wonderful week and stay safe.

Dr. Susan Boyd, MD

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What Causes Dyspareunia (Painful Sex for Women)?

>> Thursday, July 17, 2014

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Dyspareunia is painful sex due to medical or psychological causes. This can affect up to one-fifth of women at some point in their lives, but, luckily, the causes are often reversible.

The diagnosis of dyspareunia is made when the patient complains of recurrent or persistent vulvar, vaginal or deep pelvic pain before, during, or after sexual intercourse. When pain occurs, it distracts from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease. When the vagina is dry and undilated, thrusting of the penis is painful.

Many times the original source of pain (a healing episiotomy, for example) is gone but, because we anticipate that we will still feel pain, we stress and tighten our pelvic muscles and cannot relax. This can cause continued pain and is the most common reason for emotional pain.

Complaints of sexual pain will typically fall into one of three categories:

1) When there is pain during initial penetration, it is usually associated with a range of factors like insufficient lubrication from too little foreplay or by a drop in estrogen levels from menopause or breastfeeding. When there is a lack of estrogen, it causes pain from inability to make the natural lubrication or "wetness" when sexually excited. And, the vagina also can't stretch normally or at all. This is called vaginal atrophy, which is the thinning, fragility, shrinkage and dryness of the vaginal tissues. Of course, this causes pain when trying to let the erect penis in.

Pain with penetration can also come from injury due to pelvic surgery, female circumcision, child birth, episiotomy or a congenital birth defect like a thickened hymen.

Chronic skin irritation from yeast, urinary tract or bacterial infection, and eczema that occurs around the vagina and urethra can also cause pain during sex.

Disorders like interstitial cystitis, Lichen Sclerosis, external yeast infections and (rarely) Sjögren's syndrome can also cause excruciating pain and vaginal dryness.

Medications that inhibit desire or arousal and cause a decrease in vaginal lubrication (and resulting increasing pain with sex) include: antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills. You can talk to your doctor about these and hopefully change them if needed.

2) Younger women with dyspareunia seem to have pain with pressure on the outside around the labia, pubic bone and vulvar area where most of the hair grows - causing a burning or a cutting type of pain.

3) Deep pain that comes with pushing deep inside and thrusting against the cervix may be more pronounced with certain sexual positions. This can be caused by infections (of the vagina, lower urinary tract, cervix or fallopian tubes), chlamydia, gonorrhea, coliform bacteria, PID (pelvic inflammatory disease), endometriosis, surgical scar tissue, uterine and vaginal prolapse, pelvic congestion, irritable bowel syndrome, retroverted uterus, uterine fibroids, cystitis, diverticulitis, appendicitis, hemorrhoids, ovarian cysts or other tumors.

Because there are numerous physical conditions that can contribute to pain during sex, a careful physical examination and medical history are always indicated.

It can help a lot if you know where you like to be touched so that it feels good. Try to add pleasant, sexually exciting experiences such as bathing together or mutual caressing without intercourse.

Lots of kissing on the lips and all over each other's body, including oral sex may relax and lubricate the vagina. Oral sex may also be an alternative, as it may be pleasurable without pain at all. Trying a change in your sexual positions may also help. Be sure to talk about what feels good and what doesn't. If you need your partner to go slow, say so. Don't rush. Longer foreplay can help stimulate your natural lubrication. And you may reduce pain by delaying penetration until you feel fully aroused. Lots of couples just don't talk out of embarrassment, shyness or awkwardness about telling your partner what you like and what you don't like (or what hurts).

Remember, if you are embarrassed about vaginal odor or discharge, you can talk to your gynecologist and check out WaterWorks if you do not have an infection that needs to be treated. WaterWorks is FDA cleared for clearing vaginal odor and for routine feminine hygiene. It is a safe way to cleanse your vagina so you can feel confident during sex.
I hope you are all well and happy. Take care and be safe out there.

Dr. Susan L. Boyd, MD

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Keeping Your "V" Healthy

>> Friday, July 11, 2014

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The vagina is an important part of a woman's body. Most of us don't think too much about it as we are growing up because, unlike little boys who have their parts on the outside, our vaginas are hidden. It's not until we begin puberty and start our periods that we begin to know and understand how important it is to our lives.

The vagina does not have a lot of sensitivity and is designed to stretch, so the main sensations of feeling have to do with these stretch fibers. So it is during sex with the erect penis or during childbirth that we feel these stretching and pressure feelings. Sexual pleasure and orgasm does not come from vaginal stimulation. Women are sexually excited to orgasm by stimulation of the clitoris, nipples, and pressure on the G-spot. The labial tissue is sensitive to touch and responds by swelling when sexually stimulated. Any touch or rubbing of the labia will also move and stimulate the clitoris.

The vagina will become "wet" with discharge during sexual stimulation, and most women will release even more fluids at the time of orgasm, just like men do. These fluids increase lubrication and help with transport of sperm through the cervix for fertilization.

The vagina is surrounded by our bladder on the upper side, and, in fact, the bladder is actually attached to the uterus. That's why we have to pee so often when we are pregnant. When we do c-sections or hysterectomies, we actually have to peel the bladder away from the uterus to protect it, just like peeling the skin off of an orange. Amazing, isn't it? On the backside of the vagina is our colon, just a few skin layers away. And at the top is our cervix and uterus, where the babies grow and where our period comes down.

It is normal to have vaginal "wetness" and discharge. Some women have more than others do, and it is normal for it to change throughout the month. Depending on the time of the month, it can be thin and watery, thick and pasty, or gooey and stretchy, like mucous. But, the vaginal discharge should never smell. Sometimes we will notice an odor right after sex or after our period because both blood and semen have a higher pH than is normally healthy for our vagina.

We have discussed this before -- to stay healthy, the vagina should be a little bit acidic. The acidic environment keeps bacteria and yeast from over growing. It is the abnormal bacteria that causes the smelly smells we don't like. Of course, if you have been exercising, or running around and sweating all day, you may notice an odor that comes from the outside around our labia. For this, all that is needed is a shower or bath. It is okay to clean the outside with soap and water, but never let the soap get inside of your vagina, because soap is very alkaline. This will affect your vagina negatively by changing the pH inside from acidic to alkaline and set you up for bacterial and yeast infections. These cause odor that won't wash away.

We should never clean inside our vagina with anything except plain water. That's why women love WaterWorks -- because it is a natural "green" method of maintaining our feminine hygiene and cleansing the vagina. Douching will always make the odors worse, and even though WaterWorks looks similar to a type of douche, it was designed with the help of OB/GYNs to be completely different.

WaterWorks is reusable and all parts are replaceable if needed. It works by filling the reservoir with plain water and letting it sprinkle into the vagina through the medical grade stainless steel nozzle. The water and stainless steel react to eliminate unwanted discharge and odor. Check it out on our website, www.waterworkshealth.com. I know you will love it.

I hope you all will stay safe and enjoy this week.

Dr. Susan L. Boyd, MD

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Fishy Odor That Won't Wash Away

>> Wednesday, June 18, 2014

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Good morning!! I hope you and your families are safe and healthy, and having a happy start to summer.

Most women have odorless vaginal discharge that serves to keep the vagina moist and healthy. This is completely normal. But right after sex, there can be a strong, fishy odor that won't wash away, no matter how many showers and baths we take. Why is that? It can be embarrassing and it even last up to 24 hrs. This happens to all of us, even those who are rarely bothered with odor.

Normally, we notice that our discharge changes throughout our menstrual cycle. After our period, it changes from thin and watery to thick and pasty, and during ovulation it becomes like mucous and very gooey, but not smelly or itchy.

Vaginal discharge that is odorous, itchy or burning is usually caused from an imbalance of vaginal pH. This imbalance causes an overgrowth of a variety of microorganisms such as yeast, bacteria and fungi and can cause yeast and bacterial infections (BV). This change suppresses the healthy bacteria, Lactobacillus, and causes it to be unable to do its job of keeping the vagina clean and healthy.

Of course, there are other reasons why we might have vaginal odor, and rarely is it from lack of bathing. In fact, most of the time excessive washing and douching is the cause of reoccurring infections and odors. Wearing tight or non-absorbent panties and nylons and not changing tampons or pads frequently enough can also cause vaginal odor.

Vaginal odor may also worsen after sex due to the mixing of semen, sweat, vaginal fluids and chemicals our body makes called amines. Semen has a neutral pH of 7, the same as period blood. But, a healthy vagina should be acidic, with a pH of 4.
When semen is ejaculated into the vagina, the vaginal flora will be become disrupted as the pH rises. It is this rise of pH that allows the yeast and abnormal bacteria to grow and overpower the Lactobacillus. The abnormal bacteria and yeast produces the odor. The same is true of period blood and hormone imbalances.

So, make it a habit to jump out of bed and rinse the semen out of the vagina with plain water only. Do not let soap get into your vagina, as it is very alkaline and will bring on recurrent infections and odor. Use soap to wash your outer vaginal area, labia, and anus.

This is why WaterWorks makes feminine hygiene so easy. It is FDA cleared to help reduce vaginal odor. It is reusable and uses just ordinary tap water. The unique design was developed with OB/GYNs to helps us easily rinse our vaginas clean every day. Many of my patients use it daily and have overcome their recurrent odor and discharge problems.

Remember, it is also important to wear loose cotton underwear or no underwear at bedtime. This will help ventilate the vaginal area.

I hope this helps you all have a better understanding of how our bodies work and what keeps us healthy.

Have a safe and wonderful week,

Dr. Susan L. Boyd, MD

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Dr., What Feminine Hygiene Products are Recommended?

>> Thursday, May 22, 2014

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The skin of a woman’s genital area is sensitive but tough at the same time. This area is designed to protect from germs and produces protective natural oils and discharge that keep the area healthy.

That's why we discourage chemical or perfumed feminine hygiene products, especially douching, as these products readily break down this natural protective barrier and actually promote infections. Gentle daily cleaning on the outside skin and in all the creases with mild soap and water is all that is needed for many women.

Many also find that using WaterWorks helps them with daily vaginal cleansing to help them feel fresh and clean. It is FDA - cleared for the treatment of vaginal odor. It is a reusable device, with a slim medical grade stainless steel nozzle that sprinkles warm water gently downward within the vagina to rinse out old period blood or semen (or just for daily hygiene). The tip is connected to a reusable bag and hose to deliver the warm water through the nozzle. It is becoming a "must have" for many of us as part of our daily cleaning regimen in the shower.

The body produces vaginal discharge that naturally cleanses and protects the vagina. When women use traditional drugstore douches or use tampons or pads, they are removing the natural protection of the body. It is a well known fact among gynecologists that regular use of minipads and tampons to "soak up" or "wick away" excess discharge can actually make the body form more discharge. This is because the body has to replace the discharge that was taken away to continue protecting itself. Deodorants and perfumes added to pads and tampons can also cause allergy problems.

Everyone’s private area has a normal odor that cannot be removed or covered, no matter how much we try. The odors come from the chemicals in sweat, including pheromones, which are made by the body and can attract (or repel) others in general or sexually. If the odor is strong or the discharge yellow, this may indicate that you have an infection.

The vagina is able to clean itself with no special care. During menstruation, you can wash your body, including your genital area, in the same way as you always do. Be sure to change your tampons and sanitary pads regularly, at least four to five times a day.

Vaginitis is the medical name for swelling, burning, and itching from the vagina. When the vulva (outer area around vagina) is also affected, it is called vulvovaginitis. This is usually caused from imbalances of pH and organisms such as bacteria, viruses, protozoa, yeast or the more severe types of vaginitis from sexually transmitted diseases (STDs) like trichomoniasis, chlamydia, gonorrhea, syphilis, genital herpes or human papillomavirus. The main symptom of vaginitis is a lot of whitish, gray, or yellowish discharge from the vagina. Milky-white vaginal discharge is normal for females of all ages, but with infections there is an abnormal amount of odorous even blood-tinged discharge. Many women experience a swollen, red vulva, which may be painful or itchy and cause painful sex.

Proper hygiene contributes to overall good health. Daily genital cleansing is so important. Mature women have natural hormones that cause oil and sweat glands to be more active. Vaginal discharge may vary due to the menstrual cycle, amount of sexual activity, exercise and the types of birth control used.

Accumulation of this normal bodily discharge can promote rashes, irritations and odors. Daily showers or baths can help with this, as can wearing clean clothing. And it is essential to wipe from front to back to prevent the spread of bacteria and also use a blow dryer or air dry before dressing, especially when you are fighting off infections.

Wearing all-cotton underwear or underwear with cotton crotches can prevent vaginitis. Then changing your underwear and pantyhose every day and removing them as soon as possible at the end of the day, especially in hot, humid weather.
Use deodorant-free white toilet paper or baby wipes to avoid perfume and dye. Avoid using feminine hygiene products like sprays, powders, lubricants, or bath additives. Do not douche as douching is not necessary. Use deodorant-free sanitary pads or tampons and stay away from spermicidal foams, gels, and creams.

I hope this helps as we approach summer. Please stay safe and have fun.

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Looking After "V"

>> Wednesday, April 30, 2014

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The vagina is an amazingly sensitive and resilient organ. The muscles of the vagina and pelvic floor are incredibly strong and powerful. Kegel exercises can help to maintain this strength and vaginal tone that may weaken after childbirth or with age. This strength and tone makes sex more enjoyable and helps to prevent urinary incontinence. During sexual excitement, or even masturbation, we can feel that our clitoris enlarges along with the labia minora and vagina. This is because, just like a man's penis, they also contain erectile tissue that becomes engorged with foreplay.

Interestingly, the male and female fetus start out in the womb the same. In fact, there is no way to know if it is a boy or girl prior to 9 weeks. All of us begin life the same - with a set of little gonads that are located inside near the bladder. Then, between 8-9 weeks in the womb, the genetic differences produce different hormones that cause the gonads to change. The male hormones will change the gonads to testicles and the female hormones will change the gonads into ovaries. So it makes sense that, just like when the penis becomes engorged with blood and enlarges, our vagina, labia and clitoris swell and engorge too. When a man enters, it may feel tighter as our vagina wraps around the penis.

Many women worry that after childbirth they are damaged and stretched out. This is rarely true. Women that feel a big change after childbirth usually have some nerve damage from the over stretching of the vagina when the head delivers. Once healed, this over-stretching can leave some of us shocked, because nerve damage, numbness and inability to squeeze the penis with your vaginal muscles will decrease sexual pleasure and ability to orgasm.

It is normal to sweat more in the groin and vaginal area, and this perspiration has a clear function. The multiple glands in the vaginal area supply necessary lubricants that help prevent micro tears and over-heating during normal sexual activity. Because women are at risk for micro tears during normal, pleasurable sex (in both the vaginal and anal areas) it is much easier for women than men to get STDs and other infections. Note: don't share razors and consider holding off sexual contact until a day or two after shaving or waxing the pubic area - longer if you have visible bumps or wounds.

If you have multiple partners or you are concerned your partner is cheating on you, then it is important to use condoms to prevent against STDs. They should be used every time you have sex. But there are many infections that even condoms won't protect you from. They include warts, condylomata, Herpes, molluscum contagiosum (looks like little pimples, some with a head on them) and HPV (Human Papilloma Virus) which is the #1 cause of cervical, labial, anal and mouth cancers. This is because they can be transferred from skin-to-skin contact. Foreplay fun can put you at risk way before you start having sex.

Daily discharge is normal for women. The vagina can produce an average of a teaspoon of discharge per day. It is typically white or transparent and odorless, so any changes like odor or itching needs to be checked out. Most odors are from imbalance of the healthy bacteria or from a forgotten tampon. Just before the ovulation phase of the menstrual cycle, the discharge is stretchy and more of a mucousy texture and it may have a tinge of blood in it. Ovulation is usually about 2 weeks before your next period, so this can cause concern if you don't know it is normal.

You know we describe the vagina as 'self-cleaning', so resist the urge to douche because it can not only worsen infections but actually cause them. Our bodies naturally possess a delicate balance of yeast and bacteria aimed at keeping the vagina infection free. In fact, being too clean and using over-the-counter feminine hygiene products can actually cause itching and irritation by disrupting our natural balance. They can also put you at risk for more serious infections.

In most cases, the vagina will provide early clues to vaginal infection. A small amount of clear or cloudy fluid passing each day is likely normal, but the vagina signals infection with symptoms such as copious discharge, foul odor, itching, burning, and abnormal bleeding. Routine yearly screenings for vaginal infections, especially when having sex with multiple partners, is extremely important.

WaterWorks is an FDA-cleared device that is meant to remove unwanted vaginal odor. Nothing is more frustrating and embarrassing than vaginal odor that won't go away no matter what we do. None of us want our partner to come near us when we have noticeably smelly vaginal discharge and odor. WaterWorks is a "green" product that is reusable, with replaceable parts, and it uses no pharmaceuticals or chemicals. Please check out the website and www.waterworkshealth.com.

Take care and have a safe week,

Dr. Susan L. Boyd, MD

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