Q&A

If I have HPV, will I get cervical cancer?
How did I get HPV?
How common is HPV?
Are men affected?
What are the treatments for HPV?
How common is cervical cancer?
What is Gardasil?
WHAT IS A COLPOSCOPY?
HOW IS IT DONE?
Why do I get frequent yeast infections?
What are the symptoms of a yeast infection?
What is bacterial vaginitis?
How can I avoid bladder infections?
Why are my cycles getting heavier and more painful?
What causes bladder leakage?
What is urge incontinence?
What is prolapse?
What is vaginal rejuvenation?
What is the best way to have a hysterectomy?
Should I have my cervix removed during my hysterectomy?
Should I have my ovaries removed?
What about hormones?
Compounded hormones vs. pharmaceutical hormones?
What is saliva testing?
What is estrogen dominance?
What is food sensitivity?
How does food sensitivity differ from classic food allergies?
What are ovarian cysts?
What are my options for getting my tubes tied?
Why do I need to know about endometriosis?
What is endometriosis?
What are the symptoms of endometriosis?
How would I know if I have endometriosis?
What causes endometriosis?
What is the treatment for endometriosis?
What Is Ovarian Cancer?
What are uterine fibroids?
What is an endometrial ablation?
How effective is an endometrial ablation?
Does insurance cover endometrial ablations?
What else do I need to know about an endometrial ablation?

If I have HPV, will I get cervical cancer?

Very unlikely. Although certain types of HPV are responsible for causing cervical cancer the vast majority of people with HPV will eventually test negative. The younger you are, the more likely you are to have the infection. As you age your body will fight off the infection. Frequent testing is done to make sure precancerous changes are treated before they progress to more severe disease.

How did I get HPV?

HPV is a virus that is transmitted sexually. The more sexual partners one has the greater the chance of infection.

How common is HPV?

Very common. One study found 70% of sexually active college students tested positive. The majority of these students will eventually test negative as they get older.

Are men affected?

Generally men are not affected and do not show any symptoms. They are however, carriers. Men can be affected by other types of HPV, such as the types causing genital warts.

What are the treatments for HPV?

For HPV alone treatment may include more frequent pap smears and possibly a Colposcopy. Further treatments are indicated only if the cells become abnormal. HPV causing genital warts is treated with medication or surgery.

How common is cervical cancer?

There are about 13,500 new cases of cervical cancer every year in the United States. The majority of these occur in people who avoid regular pap smears.

What is Gardasil?

Gardasil is a vaccination that can be given to protect against some types of HPV infections. The theory is that if you prevent HPV infections you will reduce the risk of cervical cancers. The current vaccinations do not protect against all the types of HPV that can cause cervical cancer. I think there are numerous questions about the safety and effectiveness of these vaccines. We currently do not recommend or offer these vaccines.See the following links: http://www.cdc.gov/vaccinesafety/vaccines/hpv/gardasil.html and http://www.naturalnews.com/Gardasil.html

WHAT IS A COLPOSCOPY?

Colposcopy is a procedure used in conjunction with the Pap test (cancer detection) to diagnose abnormalities of the female reproductive organs, primarily the cervix and the vagina. It is used most frequently if the pap smear results suggest that further evaluation is indicated.

HOW IS IT DONE?

Colposcopy is conducted with an instrument called the colposcope. This is a low-powered microscope which does NOT touch or enter the body. This is a "looking" procedure which allows the doctor to see the cervix and walls of the vagina in much greater detail than would be possible with the naked eye. There is no pain. A speculum (the metal instrument used for most pelvic examinations) is inserted into the vagina. A pap smear may be taken and the cervix is cleansed with a vinegar solution. The colposcope is then used to visualize the cervix and or walls of the vagina. If abnormal areas are seen, biopsies (samples of tissue) are taken for laboratory study. The use of a colposcope in no way affects a woman or her childbearing capabilities. It takes approximately ten minutes to complete the examination.

After the examination, the doctor will discuss the findings with you. Laboratory results will be available in about 7 days. You will be contacted by phone for a follow-up visit to discuss those findings or for corrective treatment, medication, or surgical treatment. DO NOT PANIC. Most patients are easily treated in the office with minimal discomfort.

Why do I get frequent yeast infections?

If you are getting frequent “yeast infections” you need to be evaluated for other infections. If it is truly yeast infections your treatments may have been incomplete. In general avoid baths, douching, antibiotics, high sugar diet, and tight clothing.

What are the symptoms of a yeast infection?

Yeast infections usually cause a thick white discharge, vaginal redness and itching. Symptoms are persistent and usually without an odor. If self treating, use the seven day over the counter cream. Avoid the one day treatment.

What is bacterial vaginitis?

Bacterial vaginitis is caused by the overgrowth of abnormal bacteria. Symptoms are a thin watery discharge with odor. Symptoms are intermittent and worsen after intercourse. Current treatments require a prescription.

How can I avoid bladder infections?

Increase your fluids, especially water and make sure you empty your bladder after sex. If symptoms continue you may need evaluation for other causes.

Why are my cycles getting heavier and more painful?

A women’s cycle changes as she ages. These occur due to hormone changes and result in heavier and more painful cycles. Most changes can be managed with medication or progesterone cream. If these fail you may consider an endometrial ablation or other surgical options.

What causes bladder leakage?

Urine loss can occur at any age under challenging conditions. However, frequent urine loss with normal activities occurs due to a change in anatomy. Patients know this as a “fallen bladder” and can occur due to child birth or constant straining or lifting. Hormone changes may also weaken the bladder and urethra support. Keegle exercises can be done to gradually increase the strength of the support muscles. For most patients this has limited benefit. Surgical procedures to support the urethra are done as an outpatient surgery and have minimal discomfort and recovery. Modern procedures for bladder leakage are very different from the procedures even 10 years ago.

What is urge incontinence?

Urge incontinence occurs when the bladder fails to relax to allow more urine to fill and stimulates the need to urinate. Patients with this disorder may urinate every 15-20 minutes. Treatment requires medication and bladder training drills. It is important to rule out irritation from foods, medications, or bladder stones.

What is prolapse?

Prolapse is a general term used to describe the stretching of the vaginal support structures. This stretching can involve the bladder, rectum, upper vagina, or cervix. Symptoms of prolapse are described as a pelvic pressure, back pain, constipation, a protrusion from the vagina, difficulty with intercourse, or loss of urine. Careful examination can determine the cause and treatments can be offered to support the defects. Most treatments are surgical and have great long term success. Hysterectomy is not always necessary.

What is vaginal rejuvenation?

Vaginal rejuvenation is restoration of the tone and function of the vagina to a more youthful time. Many parts of vaginal rejuvenation are similar to the treatments needed for repair of pelvic prolapse (see above). Treatments for pelvic prolapse are covered by your insurance. Some patients request additional cosmetic procedures of the vagina such as labial reduction (reducing the size of the labia) or vaginoplasty (tightening of the vagina). These procedures are not covered by insurance. Dr. Syal performs these procedures for pelvic prolapse and vaginal rejuvenation.

What is the best way to have a hysterectomy?

Once it has been determined you need a hysterectomy, you should have the least invasive hysterectomy available to you. The simplest and quickest recovery is a vaginal hysterectomy. There are no abdominal incisions and the pain is minimal. Next easiest recovery is with the da Vinci robot or laparoscopic hysterectomy. Small incisions are placed on the abdomen to give access to the uterus. The longest recovery is with a abdominal hysterectomy (large abdominal incision). This route may be necessary for a very large uterus or cases complicated by scar tissue and endometriosis. Remember no incision or small incision equals less pain.

Should I have my cervix removed during my hysterectomy?

Traditionally the cervix has been removed to avoid risk of cervical cancer in the future. This risk is minimal. Proponents of leaving the cervix argue it helps with sexual function and pelvic support. I am not convinced this is true. Most patients that do not have the cervix removed, have less post op pain and return to normal function sooner. I perform either and let the patient choose.

Should I have my ovaries removed?

This is not a simple decision. In the past we recommended removal of the ovaries at the time of hysterectomy for all patients over the age of 45 to reduce the risk of ovarian cancer. Current research suggests the ovaries continue to produce significant levels of testosterone in the menopause, and this may reduce the risk of heart disease. In this study, patients who had the ovaries removed died at a younger age than those with the ovaries in place. Currently, in patients without a significant family history of ovarian cancer or personal history of endometriosis or pelvic pain I recommend not removing the ovaries.

What about hormones?

This is the most controversial topic I deal with daily. The short answer is that I recommend hormones to most patients. For most the benefits and improvement in the quality of life far outweigh the potential increase in breast cancer. Since the WHI study in 1997, women have been unnecessarily apprehensive about taking hormones.

Compounded hormones vs. pharmaceutical hormones?

Either. I think it is more important that you take the hormones that you are most comfortable taking. Both are safe and cost about the same. I do think the use of compounded hormones requires more testing to prove effectiveness and achieve balance. We offer both, along with hormone testing as needed.

What is saliva testing?

Saliva testing is used to test levels of cortisol, DHEA, estrogen, testosterone, and progesterone. Saliva testing measures these hormones at the cell level, not what is circulating in the blood. Some feel that saliva levels more accurately represent the effectiveness of hormone therapy. We use saliva testing for achieving hormone balance and the workup of fatigue. See ZRT Labs for more information.

What is estrogen dominance?

As women age, their ovarian hormone production drops. The decrease in production is not balanced. When the decrease in progesterone is greater than the decrease in estrogen, a state of estrogen dominance occurs. Symptoms of this condition include cycles that are irregular and heavy, breast tenderness, bloating, low sex drive, fatigue, and PMS. Symptoms can usually be improved with low dose progesterone cream.

What is food sensitivity?

The inability to tolerate certain foods, also known as sensitivity or intolerance, induces chronic activation of the innate immune system and gives rise to inflammatory processes in the body. This inflammation has been linked to countless chronic conditions, including: digestive disorders, migraines, obesity, chronic fatigue, ADD, aching joints, skin disorders, arthritis and many more. A common food allergen is gluten. Gluten is a protein found in many grains. Other foods can cause a similar response of inflammation by the body. See gluten free and food allergy testing.

How does food sensitivity differ from classic food allergies?

True food allergies refer to foods that trigger the immune system to acutely produce massive amounts of the chemical histamine that leads to anaphylaxis. This potentially fatal condition causes the throat and esophagus to swell, cutting off air from the lungs, or may simply cause hives, skin rashes, and other non-life-threatening reactions.

What are ovarian cysts?

Each month the ovaries form multiple follicles of which one or two will enlarge and release an egg. These follicles can be as large as 3 inches and can cause pain and swelling. Many patients and physicians will refer to these follicles as “cysts.” Remember most “cysts” are a normal part of a women’s menstrual cycle and will resolve on their own. Abnormal cysts do form on the ovaries. If they do not resolve on their own, surgery may be needed to remove the abnormality. The best way to prevent cysts is to use the birth control pill or the Nuva Ring. Using an IUD will not prevent cysts from developing.

What are my options for getting my tubes tied?

When you are sure, a tubal ligation is a great form of birth control. There are two ways to have your tubes tied: laparoscopic and trans cervical. Laparoscopic tubal ligation is performed in an operating room with complete anesthesia. A camera is placed through the abdomen and small permanent clips are placed across the tubes. Most patients are sore for 1-2 weeks. This tubal ligation is effective immediately. A trans cervical tubal ligation is performed in the office with light sedation. There are no incisions and the recovery is minimal. The negative is that the procedure is not effective for 3 months. A dye test is required to verify the tubes are blocked. Both forms are very effective.

Why do I need to know about endometriosis?

Endometriosis is a common disease that can affect any menstruating woman from the time of her first period to menopause. Sometimes, the disease can last after menopause. There is no cure for endometriosis and it can be hard for a health care provider to figure out if a woman has it. It can also be hard to figure out the best way to treat it if a woman has the disease. Endometriosis can affect a woman in many ways, such as her ability to work and have children, and her relationships with her partner, children, friends, and co-workers. Researchers are working to find out both causes and ways to manage this disease, so that women who have it can lead full lives.

What is endometriosis?

When a woman has endometriosis, the tissue that lines her uterus, called the endometrium, grows outside of the uterus. No one is sure why this happens. When this tissue grows outside of the uterus, it is mostly found in the pelvic cavity, usually in one or more of these places: on or under the ovaries, behind the uterus, on the tissues that hold the uterus in place, or on the bowels or bladder. In very rare cases, endometriosis areas can grow in the lungs or other parts of the body.

As the tissue grows, it can develop into growths. Growths can cause mild to severe pain, infertility, and heavy periods. The endometriosis growths are affected by the monthly menstrual cycle. Each month, the lining of the uterus thickens to get ready for pregnancy. If a woman does not become pregnant, the lining of the uterus sheds and the woman bleeds. When a woman has endometriosis, the growths outside of the uterus also bleed during her period. But there is no way for the blood to leave her body, and inflammation and scar tissue can develop. Blockage or bleeding in the intestines and problems with bladder function may also occur.

What are the symptoms of endometriosis?

A common symptom of endometriosis is pain, mostly in the abdomen, lower back, and pelvic areas. The amount of pain a woman feels is not linked to how much endometriosis she has. Some women have no pain even though their disease affects large areas, or there is scarring. Some women, on the other hand, have severe pain even though they have only a few small areas of endometriosis.

General symptoms of endometriosis can include (but are not limited to):

Extremely painful (or disabling) menstrual cramps; pain may get worse over time
Chronic pelvic pain (includes lower back pain and pelvic pain)
Pain during or after sex
Intestinal pain
Painful bowel movements or painful urination during menstrual periods
Heavy menstrual periods
Premenstrual spotting or bleeding between periods
Infertility (not being able to get pregnant)

Also, women who have endometriosis may have gastrointestinal symptoms that are like those of a bowel disorder, as well as fatigue.

How would I know if I have endometriosis?

If you think you might have this disease, talk with your OB/GYN, since they are the only type of doctor trained to look for this condition. There are a number of tests a doctor can perform to try to find out if you have endometriosis. Sometimes, imaging tests are used to make a "picture" of the inside of the body, which allows a doctor to locate larger endometriosis areas. The two most common imaging tests are ultrasound, a machine that uses sound waves to make the picture, and magnetic resonance imaging (MRI), a machine that uses magnets and radio waves to make the picture.

The only way to know for sure if you have endometriosis is to have a laparoscopy. This is a surgery with general anesthesia in which a tube with a light is placed inside your abdomen. The surgeon can then check your organs and see any growths or tissue from endometriosis. This procedure will show the location, extent, and size of the growths and help you and your doctor make better treatment decisions.

What causes endometriosis?

No one knows for sure what causes this disease. One theory is that during menstruation some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. Another theory suggests that endometriosis may be genetic, or runs in families.

What is the treatment for endometriosis?

There is no cure for endometriosis. But there are many treatments, each of which has pros and cons. It is important to build a good relationship with your doctor, so you can decide what option is best for you.

Pain Medication
For some women with mild symptoms, no further treatment other than medication for pain may be needed. For women with minimal endometriosis who want to become pregnant, doctors are saying that, depending on the age of the woman and her amount of pain from the disease, the best thing to do is to have a trial period of unprotected sex for six months to one year. If she does not get pregnant in that time, then further treatment may be needed.

Hormone Treatment
For patients who do not wish to become pregnant, but need treatment for their disease, their doctors may suggest hormone treatment. Hormone treatment is most effective when growths are small.

Birth control pills control the growth of the tissue that lines the uterus and often decrease the amount of menstrual flow. They usually contain two hormones, estrogen and progestin. Once a woman stops taking them, the ability to become pregnant returns, but the symptoms of endometriosis also may return. Some women take birth control pills continuously, without using the sugar pills that signal the body to go through menstruation. When birth control pills are taken in this way, the menstrual period may stop altogether, which can reduce pain or get rid of it entirely. Some birth control pills contain only progestin, a progesterone-like hormone. Women who can't take estrogen use these pills to reduce menstrual flow. With these pills, some women may not have pain for several years after stopping treatment. All birth control pills might cause some mild side effects like weight gain, bleeding between periods, and bloating.

Surgery
Surgery is usually the best choice for women with extensive endometriosis, or those with severe pain. There are both minor and major surgeries that can help. Your doctor will have to discuss with you the different surgical options.

What Is Ovarian Cancer?

Ovarian cancer is cancer that begins in the cells that constitute the ovaries. Cancer cells that metastasize from other organ sites to the ovary (most commonly breast or colon cancers) are not then considered ovarian cancer.

According to the American Cancer Society, ovarian cancer accounts for 4 percent of all cancers among women and is ranked fifth as a cause of their deaths from cancer. The American Cancer Society statistics for ovarian cancer estimate that there will be 25,580 new cases and 16,090 deaths in 2004. The death rate for this disease has not changed much in the last 50 years.

Unfortunately, almost 70 percent of women with the common epithelial ovarian cancer are not diagnosed until the disease is advanced in stage—i.e., has spread to the upper abdomen (stage III) or beyond (stage IV). The 5-year survival rate for these women is only 15 to 20 percent, whereas the 5-year survival rate for stage I disease patients approaches 90 percent and for stage II disease patients approaches 70 percent.

There are many types of tumors that can start in the ovaries. Some are benign, or noncancerous, and the patient can be cured by surgically removing one ovary or the part of the ovary containing the tumor. Some are malignant or cancerous. The treatment options and the outcome for the patient depend on the type of ovarian cancer and how far it has spread before it is diagnosed.

BRACA testing can be done for patients with a family history of ovarian cancer. Additional testing with pelvic ultrasound and blood tests for tumor markers can be done for early detection. Removal of the ovaries after child bearing will reduce the risk of ovarian cancer.

What are uterine fibroids?

Uterine fibroids are usually non cancerous growths that occur on or in the uterus. They can be a cause of excessive bleeding, painful periods, or painful sex. Fibroids can also be a cause of infertility. Fibroids will continue to grow until menopause, at which time they may shrink. In general if the fibroids are not causing a problem, they can be watched. Excessive or rapid growth may warrant removal. Surgical options for removal include myomectomy (removal of the fibroids) or hysterectomy. Either procedure can be performed using the da Vinci robot to minimize your discomfort and recovery. http://www.davincisurgery.com/gynecology Other treatments include uterine artery embolization. This is a procedure where the vessels feeding the fibroids are blocked. The procedure is long, has significant x-ray exposure and has a low success rate. Complications can be significant.

What is an endometrial ablation?

Endometrial ablation is a procedure performed for excessive bleeding. The purpose of the procedure is to destroy the endometrial lining of the uterus. This is the layer that grows and sheds each month. Reducing this layer will decrease the amount bleeding. We use several different methods to perform the endometrial ablation.

How effective is an endometrial ablation?

Fifty percent of the patients that have an ablation will experience no further bleeding. Another 45% will have reduced periods. Five percent will continue to have heavy bleeding.

Does insurance cover endometrial ablations?

Yes. Insurance coverage is excellent, especially if the procedure can be performed in the office.

What else do I need to know about an endometrial ablation?

An ablation is not birth control. Some form of permanent birth control is needed (tubal ligation or vasectomy). An ablation can only be done when pregnancy is no longer desired.