The teenage years are a very special phase. Young girls are curious to understand their changing bodies. They have many questions and are seeking answers. These answers go a long way in building her confidence and a positive attitude towards the physical change that she will experience.
In our teenage counseling program, we conduct an informative counseling session in an open-friendly atmosphere. The young girl is informed about the normal body anatomy, physiology and the menstrual hygiene. Healthy habits regarding diet & exercise are promoted. Young girls have many misconceptions and myths regarding menstruation. Some of the common ones are questions like why one cannot go to the temple during periods and why should one not swim during periods? We address these whilst respecting the social/religious sentiments. Puberty & menarche are important milestones in a girl’s life. It is now the time to prepare her for womanhood. Sexual education is important subject and needs to be handled well. Professional expertise is valuable in addition to the role of parents, teachers & peer educators. In our counseling sessions we provide information on various issues such as how one gets pregnant, how to prevent pregnancy, what are sexually transmitted infections, and safe sex.
It is appropriately said that every child should be a wanted child. Sometimes a pregnancy may not be wanted. In this case one may seek an abortion. Abortion is legal provided it is carried out within the legal permits. An abortion can be done only up to 20 weeks of pregnancy.
Every pregnancy should be a wanted pregnancy and therefore it should be a planned pregnancy. It is imperative then to ensure use of a contraceptive that suits the need of the couple. In present times there is a wide range of options available in the basket of contraceptives. There are temporary methods i.e. reversible and permanent methods i.e. irreversible. Permanent methods are used when child bearing is no longer desired. Tubal sterilization and vasectomy are the choices available.
Amongst the temporary methods the choices vary on various factors. Barrier methods such as male and female condoms are popular. The male condom is widely promoted not only to prevent pregnancy but also to prevent STD and HIV. It is the single contraceptive that serves this dual purpose.
The combined oral contraceptive pills (COCP) have been around for decades and they have undergone numerous developments. From standard dose pills we have moved to the ultra low dose pills, which have minimal or negligible side effects. The COCP have many benefits over and above providing contraception.
Infection can affect the external genitalia, the lower tract i.e. vagina or the upper organs i.e. cervix,uterus, tubes and ovaries. Infections can be viral, fungal, bacterial, and parasitic. There can be mixed infections too.
Women will normally present with vaginal discharge, fever nausea, vomiting and pain in the lower abdomen, either singly or in various combinations. Infections can occur in all age groups and is particularly common in teenagers, young adults and the geriatric population. Sexual history, presence of important medical conditions such as diabetes and HIV, and pregnancy play an important role in the course of the infection and its management.
Diagnosis can be a challenge as many conditions in the lower abdomen will present with similar symptoms e.g. appendicitis. Various tests such as smear, culture, blood test, ultrasound of lower abdomen, and occasionally laparoscopy is done in the diagnosis and the management of these infections. Treatment will depend on the organism involved and the degree of spread. Prompt diagnosis and appropriate treatment is the key in preventing long term complications such as chronic pelvic pain, blocked tubes, inability to conceive and ectopic pregnancy.
The gynecological cancers are cancers in the cervix, womb, ovaries, vagina and vulva. Of these the cancers of cervix, womb and ovaries are relatively common. Each of these cancers is different in its risk factors, screening options, presentation, and response to treatment and survival rates.
The common symptoms are abnormal vaginal bleeding, pain in lower abdomen, back ache, bloating, loss of appetite and change in urinary and bowel habits. None of these are characteristic of any particular cancer and can happen even in benign conditions.
Screening tests can enable us to detect the disease even before it happens. Screening for cervical cancer by pap smear is extremely effective and enables us to detect changes in the cervix that are precancerous. Effective treatment can be given even before the cancer happens.
Unfortunately there is no reliable, practical and effective means of screening for all the other gynecological cancers. Uterine cancers present with vaginal bleeding early and therefore are diagnosed in early stages where treatment can be very effective. Ovarian cancers many times present quite late. Treatment then depends on the stage of the disease.
The treatment for all cancers depends on the type of cancer and how far it has spread. Common treatment modalities are surgery, chemotherapy, and/or radiation. Most patients may need various combinations of these modalities. Surgery involves removal of the cancerous mass, commonly the organs involved, the lymph nodes and sometimes adjacent organs that may be involved. Chemotherapy involves the use of drugs and radiation involves the use of high-energy rays (just like X-rays) that kill the cancer cells, or stop them from growing.
Therefore patients need multi-disciplinary approach, highly qualified, and experienced team of experts for the appropriate management to achieve the best results. Dr.Pallavi Daga is an expert gynecologist attached to a hospital where the whole team and infrastructure is available for the best treatment.
Breast health deserves special attention. Breast development occurs in various phases in a woman’s life. Some of the common problems that women report with are breast pain, breast lumps, infections and inflammations in the breast and nipple problems like discharge.
The lactation period is an important phase where breast care is very important. Breast engorgement, inflammation and abscess formation and cracked nipples are common unless proper breast feeding principles are followed. Dr.Pallavi Daga gives detailed counseling during and after pregnancy on correct principles of breast feeding.
The field of women’s health has always been a matter of concern. Women need care not only in pregnancy and childbirth but in all phases of life i.e. womb to tomb. It is important to have a holistic and comprehensive approach. Advances in technology, and innovations have made it possible to provide good prevention strategies, early diagnosis, appropriate and timely treatment.
In this section I have discussed some common gynecological health problems that affect women in various different stages of life. We aim to provide overall wellbeing of the women with the highest quality care in a compassionate manner using latest technology and leading edge evidence-based treatment.
PCOS is an endocrine and metabolic disorder. It is considered in any woman with acne, hirsutism, menstrual irregularity, or obesity.Patients with PCOS, have anovulation, i.e. they may not produce a follicle cyclically. They may therefore present with primary amenorrhea (i.e. no periods at all), too few periods (oligomenorrhea) or secondary amenorrhea i.e. absence of periods for six months or more. Some may also have excessive, frequent and irregular bleeding (dysfunctional uterine bleeding).
Resistance to insulin, and increase in insulin levels is an important factor in PCOS. Obesity is present in approximately one-half of patients with PCOS. The waist:hip ratio may be greater than 0.85.
The cause of PCOS is unknown, but there is a possibility that PCOS may be a complex genetic disorder in which the genetic factor interacts with various environmental factors and causes imbalance in the hormones.
Fibroids are one of the commonest benign i.e. non cancerous tumors of the uterus.They are whorls of smooth muscle tissue that can be very variable in size (few millimeters to more than 20 cms), in position (sub mucous, intramural, or sub serous), and in number (one or two to multiples of ten). Fibroids usually grow during the reproductive years and they tend to shrink after menopause.Fibroids are very variable in presentation. They may not cause any symptoms. They may cause symptoms on the basis of their location, size, and number.
Fibroids may cause very heavy bleeding during periods and sometimes even before and after the periods. They may be associated with very painful periods. Sometimes they may be implicated in infertility. If they are large enough to give pressure symptoms then one can have frequency of urine and / or constipation. If they are large enough then they may present as a mass felt by the women through her lower abdomen. Fibroids can be diagnosed on clinical examination of the pelvis. They can be further confirmed by ultrasonography. MRI can be done in special situations.
Endometriosis is a condition where cells of the lining of the uterus (the endometrium) are found in places outside the uterine cavity. The uterus is made of three layers and the innermost layer that lines the cavity is called the endometrium. In some women the cells of the endometrium may be found in the pelvis and around the uterus, ovaries and fallopian tubes. Endometriosis can happen to any women in the reproductive years i.e. 15 to 45 years of age.
Women who have endometriosis may complain of pain in the lower abdomen and pelvic region, pain during or after sex (dyspareunia), painful and/or heavy periods (dysmenorrhoea) and, sometimes difficulty in getting pregnant (infertility). These symptoms may affect the quality of her life significantly. The pain during sex/periods and the chronic pain may be very distressing. It is also possible that the woman has endometriosis but may have no symptoms at all.
Bleeding problems in women are common especially above 40 years. In a woman having abnormal and/or heavy vaginal bleeding, there are two possibilities.
Pregnancy is one of the most precious times in the life of a woman. Nine months and then a bundle of joy is true happiness. This pleasure needs to be nurtured very well. Signs and symptoms of pregnancy.
The commonest symptom is missing of a period. Occasionally one may have spotting at the time one would have expected the period. The other common symptoms are nausea, vomiting, shortness of breath, fatigue, and tiredness.On examination the doctor may notice a enlarged uterus which can be felt through the abdomen only when more than 12 weeks of pregnancy.
The pregnancy hormone is ß- HCG. This is easily detected by a simple two minute home pregnancy test. An ultrasound examination can confirm the pregnancy. It will also give very valuable information on the number of fetuses, location of pregnancy, size of the sac and overall health and viability of the pregnancy.
Nausea, vomiting and heartburn are common problems. One should avoid fried and spicy foods and maintain good hydration. It is safe to take doxylamine, and vitamin B -6 which are effective in preventing and controlling the symptoms. Ondansetron has also been used effectively. One may also have loss of appetite and very peculiarly have complete aversion to sight of some foods.
Constipation is also a common problem. It can lead to piles and unnecessary blood loss during pregnancy. Increasing fluid and fibre intake, and stool softeners can help tide over the situation.
During a pelvic exam, your doctor visually and manually inspects your reproductive organs for signs of masses, growths or other abnormalities. Blood tests. Your blood may be drawn to measure the levels of several hormones to exclude possible causes of menstrual abnormalities or androgen excess that mimic PCOS.
Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be. PCOS can cause missed or irregular menstrual periods. Irregular periods can lead to: