Gynecological and Surgical Q&A

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.

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

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.

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.

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.

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.

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. There are numerous questions about the safety and effectiveness of these vaccines. We currently do not recommend or offer these vaccines. The Centers for Disease Control and Natural News have further information.

Colposcopy is a procedure often used in conjunction with a Pap test for cancer detection. The procedure is done to help diagnose abnormalities of the female reproductive organs, primarily the cervix and the vagina. It is mostly used when a Pap smear result suggests that further evaluation is indicated.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

True food allergies refer to a reaction to foods that involve the immune system. The reaction can be so acute that massive amounts of the chemical histamine can be produced which leads to anaphylaxis. Sometimes it may simply cause hives, skin rashes, and other non-life-threatening reactions. However, this is a potentially fatal condition because it causes the throat and esophagus to swell, cutting off air from the lungs.

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.

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.

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. 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.

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.

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.

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

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.

Office Information

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Friday: 8 AM – 12 Noon
Location Map: 17183 I-45 The Woodlands, TX 77385

The Woodlands Office



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