gyns

Hysterectomy

A hysterectomy is surgery to remove a woman's uterus or womb. The uterus is the place where a baby grows when a woman is pregnant. After a hysterectomy, you no longer have menstrual periods and can't become pregnant. Sometimes the surgery also removes the ovaries and fallopian tubes. If you have both ovaries taken out, you will enter menopause.

Your health care provider might recommend a hysterectomy if you have:

Fibroids
Endometriosis that hasn't been cured by medicine or surgery
Uterine prolapse - when the uterus drops into the vagina
Cancer of the uterine, cervix, or ovaries
Vaginal bleeding that persists despite treatment
Chronic pelvic pain, as a last resort

Dept. of Health and Human Services Office on Women's Health

Teen Sexual Health

What is teen sexual health?

Teen sexual health is about how sex affects your physical and emotional health. It means knowing how to form healthy relationships and making decisions about sex that are right for you.

As your body changes during puberty, how you think, feel, and interact with others also changes. You may have new feelings and thoughts about sex. Understanding who you're becoming as a sexual young adult is also part of teen sexual health. For some teens, that includes understanding gender identity, gender expression, and sexual orientation.

For all teens, taking responsibility for sexual health is part of growing up. Whether you choose to have sex or wait, responsibility includes knowing about:

Sexually transmitted infections (STIs)
Birth control
What a healthy relationship is

What are sexually transmitted infections (STIs)?

Sexually transmitted infections (STIs), or sexually transmitted diseases (STDs), are caused by bacteria, viruses, and parasites that spread from person to person, usually during vaginal, oral, or anal sex. Some STIs are spread by skin-to-skin contact. Without treatment, some STIs can cause long-term health problems.

There are more than 20 types of STIs, including:

Chlamydia
Genital herpes
Gonorrhea
HIV
HPV (human papillomavirus)
Pubic lice
Syphilis
Trichomoniasis

STIs don't always cause symptoms. So it is possible to have an infection without knowing it and then pass it on to someone else. The only way to know for sure whether you have an STI is to get tested.

How can I reduce my chances of getting a sexually transmitted infection (STI)?

The most reliable way to avoid infection is to not have vaginal, oral, or anal sex. Saying "no" to sex is the right choice for many teens.

If you decide to have sex, "safer sex" practices will lower your chance of getting an STI. They include:

Talking with your partner about preventing STIs and getting tested before having sex. If you can't talk about STIs, you aren't ready to have sex.
Getting the HPV vaccine. You can be vaccinated between ages 9 and 26.
Using condoms correctly every time you have vaginal, oral, or anal sex:
- External (male) latex condoms provide the best protection against STIs. If you or your partner is allergic to latex, you can use polyurethane condoms.
- Internal (female) condoms, made of nitrile, are placed inside the body (vagina or anus). They may be less effective against STIs than latex external condoms.
- Don't use both type of condoms together because that increases the chance they'll rip
- Use a dental dam (a square piece of latex, polyurethane, or nitrile) to protect the mouth during oral sex
Having sex with only one person who has sex only with you (mutual monogamy). But first, both of you should get tested for STIs.
Not mixing alcohol or drugs with sex. You need to think clearly to make safer choices about sex.

How can I reduce the chance of pregnancy?

The only sure way to avoid pregnancy is not to have vaginal sex.

If you decide to have vaginal sex, birth control can help prevent pregnancy. There are many types of birth control that work in different ways. Your health care provider can help you choose birth control that's best for you.

Condoms are the only birth control method that protects against STIs. But condoms alone aren't the most effective form of birth control. It's safest to use condoms with another form of birth control to prevent both STIs and pregnancy.

What is a healthy relationship?

Healthy sex starts with a healthy relationship, so it's important to take an honest look at how you and your partner treat each other. Your relationship may be healthy if it includes:

Respect. You and your partner value each other's feelings. Neither of you pressure the other to do things they don't want to do.
Trust and honesty. You always tell the truth and trust your partner to do the same.
Good communication. You feel safe talking openly about your feelings, STIs, and other relationships. And you both listen.

Your relationship may be unhealthy if it includes:

Jealousy and control. One of you wants to make all the decisions and tries to keep the other from spending time with their friends and family.
Disrespect. One of you makes fun of the other person's ideas and feelings.
Pressure. One of you tries to bully the other into doing sexual things they don't want to do.
Violence. Hitting, shoving, grabbing, and sexual assault should never be part of a relationship. If you don't know how to end a violent relationship, get help.

Your decisions about sex can affect your future health. Make sure that you know the facts so you can decide what is right for you.

Vaginal Diseases

Vaginal problems are some of the most common reasons women go to the doctor. They may have symptoms such as:

Itching
Burning
Pain
Abnormal bleeding
Discharge

One common problem is vaginitis, an inflammation of the vagina. Other problems that affect the vagina include sexually transmitted infections (STIs), vaginal cancer, and vulvar cancer. Treatment of vaginal problems depends on the cause.

Birth Control

What is birth control?

Birth control, also known as contraception, is the use of medicines, devices, or surgery to prevent pregnancy. There are many different types. Some are reversible, while others are permanent. Some types can also help prevent sexually transmitted infections (STIs).

What are the different types of birth control?

There are several different types of birth control, and they work in different ways:

Barrier methodsMale condomA thin sheath that covers the penis to collect sperm and prevent it from entering the woman's body. Condoms that are made of latex and polyurethane can help prevent STIs.Female condomA thin, flexible plastic pouch. Part of the condom is inserted into the vagina before intercourse to prevent sperm from entering the uterus. The uterus, or womb, is the place where the baby grows during pregnancy. Female condoms can also help prevent STIs.Contraceptive spongeA small sponge that you put into the vagina to cover the cervix (the opening of the uterus). The sponge also contains a spermicide to kill sperm.SpermicideA substance that can kill sperm cells. It comes in a foam, jelly, cream, suppository, or film. You put it into the vagina near the uterus. Spermicide can be used alone or with a diaphragm or cervical cap.Diaphragm and cervical capCups that are placed inside the vagina to cover the cervix. They may be used with spermicide. They come in different sizes, so it's important to see your health care provider to figure out which size works best for you.Hormonal methodsOral contraceptives ("the pill")Pills that a woman takes every day. They may contain only progestin or both progestin and estrogen.Contraceptive patchA patch that a woman puts on her skin each week. The patch releases hormones into the bloodstream.Vaginal ringA thin, flexible ring. The woman inserts the ring into the vagina, where it continually releases hormones for three weeks. She takes it out for the fourth week. After that week, she puts in a new ring.Injectable birth controlAn injection of a hormone that a woman gets once every three months. This is done in your provider's office.ImplantA single, thin rod that a provider inserts under the skin of a women's upper arm. It is done in your provider's office. The implant can last for four years.Long-acting reversible contraceptives (LARCs)Intrauterine device (IUD)A small, T-shaped device that a provider inserts into the uterus. This is done in the provider's office. IUDs can last from 3 to 10 years. There are two types: hormonal IUDs and copper IUDs.SterilizationTubal ligationA surgery that prevents a woman from getting pregnant. It is permanent.VasectomyA surgery that prevents a man from getting someone pregnant. It is permanent.What are some other forms of pregnancy prevention?

There are some types of pregnancy prevention that do not involve medicines, devices, or surgery:

Other forms of pregnancy preventionFertility awareness-based methodsThey are also called natural rhythm methods. They involve tracking the woman's fertility cycle and avoiding sex or using barrier methods on the days when she is most likely to get pregnant. This method may have higher pregnancy rates than other types.Lactational amenorrhea method (LAM)A form of natural birth control for breastfeeding mothers. It relies on the new mother feeding her baby only breastmilk for up to six months and having no periods or spotting during that time.WithdrawalDuring intercourse, the penis is pulled out of the vagina before ejaculation. The goal is to keep sperm from entering the vagina . But the sperm can leak out before the penis is pulled out, so this method has higher pregnancy rates than other types.What is emergency contraception?

Emergency contraception is not a regular method of birth control. But it can be used to prevent pregnancy after unprotected intercourse or if a condom breaks. There are two types:

Copper IUD, which is a small, T-shaped device that a provider inserts into the within 120 hours of unprotected intercourse.
Emergency contraceptive pills (ECPs), which are hormonal pills which the woman takes as soon as possible after unprotected intercourse.

What else should I know about birth control?

When deciding which birth control type is right for you, there are many different factors to consider:

Do you want to have children someday? How soon?
Do you have any health conditions?
How often do you have sex?
How many sex partners do you have?
Do you also need protection from HIV and other STIs?
How well does the birth control method work?
Are there any side effects?
Will you be able to use it correctly every time?
How much does it cost?

Your provider can answer your questions about birth control to help you select the best type for you.

NIH: National Institute of Child Health and Human Development

Breast Cancer

What is breast cancer?

Breast cancer is a cancer that starts in breast tissue. It happens when cells in the breast change and grow out of control. The cells usually form a tumor.

Sometimes the cancer does not spread any further. This is called "in situ." If the cancer spreads outside the breast, the cancer is called "invasive." It may just spread to nearby tissues and lymph nodes. Or the cancer may metastasize (spread to other parts of the body) through the lymph system or the blood.

Breast cancer is the second most common type of cancer in women in the United States. Rarely, it can also affect men.

What are the types of breast cancer?

There are different types of breast cancer. The types are based on which breast cells turn into cancer. The types include:

Ductal carcinoma, which begins in the cells of the ducts. This is the most common type.
Lobular carcinoma, which begins in the lobules. It is more often found in both breasts than other types of breast cancer.
Inflammatory breast cancer, in which cancer cells block lymph vessels in the skin of the breast. The breast becomes warm, red, and swollen. This is a rare type.
Paget's disease of the breast, which is a cancer involving the skin of the nipple. It usually also affects the darker skin around the nipple. It is also rare.

What causes breast cancer?

Breast cancer happens when there are changes in the genetic material (DNA). Often, the exact cause of these genetic changes is unknown.

But sometimes these genetic changes are inherited, meaning that you are born with them. Breast cancer that is caused by inherited genetic changes is called hereditary breast cancer.

There are also certain genetic changes that can raise your risk of breast cancer, including changes in the BRCA1 and BRCA2 genes. These two changes also raise your risk of ovarian and other cancers.

Besides genetics, your lifestyle and the environment can affect your risk of breast cancer.

Who is at risk for breast cancer?

The factors that raise your risk of breast cancer include:

Older age
History of breast cancer or benign (noncancer) breast disease
Inherited risk of breast cancer, including having BRCA1 and BRCA2 gene changes
Dense breast tissue
A reproductive history that leads to more exposure to the estrogen hormone, including
- Menstruating at an early age
- Being at an older age when you first gave birth or never having given birth
- Starting menopause at a later age
Taking hormone therapy for symptoms of menopause
Radiation therapy to the breast or chest
Obesity
Drinking alcohol

What are the signs and symptoms of breast cancer?

The signs and symptoms of breast cancer include:

A new lump or thickening in or near the breast or in the armpit.
A change in the size or shape of the breast.
A dimple or puckering in the skin of the breast. It may look like the skin of an orange.
A nipple turned inward into the breast.
Nipple discharge other than breast milk. The discharge might happen suddenly, be bloody, or happen in only one breast.
Scaly, red, or swollen skin in the nipple area or the breast
Pain in any area of the breast.

How is breast cancer diagnosed?

Your health care provider may use many tools to diagnose breast cancer and figure out which type you have:

A physical exam, including a clinical breast exam (CBE). This involves checking for any lumps or anything else that seems unusual with the breasts and armpits.
A medical history.
Imaging tests, such as a mammogram, an ultrasound, or an MRI.
Breast biopsy.
Blood chemistry tests, which measure different substances in the blood, including electrolytes, fats, proteins, glucose (sugar), and enzymes. Some of the specific blood chemistry tests include a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), and an electrolyte panel.

If these tests show that you have breast cancer, you will have tests that study the cancer cells. These tests help your provider decide which treatment would be best for you. The tests may include:

Genetic tests for genetic changes such as in the BRCA and TP53 genes.
HER2 test. HER2 is a protein involved with cell growth. It is on the outside of all breast cells. If your breast cancer cells have more HER2 than normal, they can grow more quickly and spread to other parts of the body.
An estrogen and progesterone receptor test. This test measures the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly.

Another step is staging the cancer. Staging involves doing tests to find out whether the cancer has spread within the breast or to other parts of the body. The tests may include other diagnostic imaging tests and a sentinel lymph node biopsy. This biopsy is done to see whether the cancer has spread to the lymph nodes.

What are the treatments for breast cancer?

Treatments for breast cancer include:

Surgery such as
- A mastectomy, which removes the whole breast
- A lumpectomy to remove the cancer and some normal tissue around it, but not the breast itself
Radiation therapy
Chemotherapy
Hormone therapy, which blocks cancer cells from getting the hormones they need to grow
Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells
Immunotherapy

Can breast cancer be prevented?

You may be able to help prevent breast cancer by making healthy lifestyle changes such as:

Staying at a healthy weight
Limiting alcohol use
Getting enough exercisee
Limiting your exposure to estrogen by
- Breastfeeding your babies if you can
- Limiting hormone therapy

If you are at high risk, your health care provider may suggest that you take certain medicines to lower the risk. Some women at very high risk may decide to get a mastectomy (of their healthy breasts) to prevent breast cancer.

It's also important to get regular mammograms. They may be able to identify breast cancer in the early stages, when it is easier to treat.

NIH: National Cancer Institute

Breast Diseases

Most women experience breast changes at some time. Your age, hormone levels, and medicines you take may cause lumps, bumps, and discharges (fluids that are not breast milk).

If you have a breast lump, pain, discharge or skin irritation, see your health care provider. Minor and serious breast problems have similar symptoms. Although many women fear cancer, most breast problems are not cancer.

Some common breast changes are:

Fibrocystic breast changes - lumpiness, thickening and swelling, often just before a woman's period
Cysts - fluid-filled lumps
Fibroadenomas - solid, round, rubbery lumps that move easily when pushed, occurring most in younger women
Intraductal papillomas - growths similar to warts near the nipple
Blocked milk ducts
Milk production when a woman is not breastfeeding

NIH: National Cancer Institute

Cervical Cancer

The cervix is the lower part of the uterus, the place where a baby grows during pregnancy. Cervical cancer is caused by a virus called HPV. The virus spreads through sexual contact. Most women's bodies are able to fight HPV infection. But sometimes the virus leads to cancer. You're at higher risk if you smoke, have had many children, use birth control pills for a long time, or have HIV infection.

Cervical cancer may not cause any symptoms at first. Later, you may have pelvic pain or bleeding from the vagina. It usually takes several years for normal cells in the cervix to turn into cancer cells. Your health care provider can find abnormal cells by doing a Pap test to examine cells from the cervix. You may also have an HPV test. If your results are abnormal, you may need a biopsy or other tests. By getting regular screenings, you can find and treat any problems before they turn into cancer.

Treatment may include surgery, radiation therapy, chemotherapy, or a combination. The choice of treatment depends on the size of the tumor, whether the cancer has spread and whether you would like to become pregnant someday.

Vaccines can protect against several types of HPV, including some that can cause cancer.

NIH: National Cancer Institute

Cervical Cancer Screening

The cervix is the lower part of the uterus, the place where a baby grows during pregnancy. Cancer screening is looking for cancer before you have any symptoms. Cancer found early may be easier to treat.

Cervical cancer screening is usually part of a woman's health checkup. There are two types of tests: the Pap test and the HPV test. For both, the doctor or nurse collects cells from the surface of the cervix. With the Pap test, the lab checks the sample for cancer cells or abnormal cells that could become cancer later. With the HPV test, the lab checks for HPV infection. HPV is a virus that spreads through sexual contact. It can sometimes lead to cancer. If your screening tests are abnormal, your doctor may do more tests, such as a biopsy.

Cervical cancer screening has risks. The results can sometimes be wrong, and you may have unnecessary follow-up tests. There are also benefits. Screening has been shown to decrease the number of deaths from cervical cancer. You and your doctor should discuss your risk for cervical cancer, the pros and cons of the screening tests, at what age to start being screened, and how often to be screened.

Cervix Disorders

The cervix is the lower part of the uterus, the place where a baby grows during pregnancy. The cervix has a small opening that expands during childbirth. It also allows menstrual blood to leave a woman's body.

Your health care provider may perform a Pap test during your health checkup to look for changes to the cells of the cervix, including cervical cancer. Other problems with the cervix include:

Cervicitis - inflammation of the cervix. This is usually from an infection.
Cervical incompetence - This can happen during pregnancy. The opening of the cervix widens long before the baby is due.
Cervical polyps and cysts - abnormal growths on the cervix

Cesarean Delivery

What is a cesarean delivery?

A cesarean delivery, also called a cesarean section or c-section, is surgery to deliver a baby. The baby is taken out through your abdomen (belly). In the United States, almost one in three babies are born this way. Some cesarean deliveries are planned. Others are emergency cesarean deliveries, which are done when unexpected problems happen during delivery.

When is a cesarean delivery needed?

You may need a cesarean delivery because:

You have health problems, including infection
You are carrying more than one baby
Your baby is too big
Your baby is in the wrong position
Your baby's health is in danger
Labor is not moving along as it should
There are problems with your placenta (the organ that brings oxygen and nutrients to your baby)

Not everyone who has had a cesarean delivery before will need another one next time. You may be able to have a vaginal birth after cesarean (VBAC). Talk to your health care provider about what is right for you.

How is a cesarean delivery done?

Before the surgery, you will be given pain medicine. Depending on your circumstances, you might get:

An epidural block, which numbs the lower part of the body through an injection in the spine.
A spinal block, which numbs the lower part of the body through an injection directly into the spinal fluid.
General anesthesia, which makes you unconscious during the surgery. This is often used during emergency cesarean deliveries.

During the surgery, the surgeon will:

Make a cut in your abdomen and uterus. The cut is usually horizontal, but in some cases it may be vertical.
Open the amniotic sac and take out your baby.
Cut the umbilical cord and the placenta.
Close the uterus and abdomen with stitches that will later dissolve.

What are the risks of a cesarean delivery?

A cesarean delivery is relatively safe for you and your baby. But it is still a major surgery, and it carries risks. They may include:

Infection
Blood loss
Blood clots in the legs, pelvic organs, or lungs
Injury to surrounding structures, such as the bowel or bladder
A reaction to the medicines or anesthesia used

Some of these risks do also apply to a vaginal birth. But it does take longer to recover from a cesarean delivery than from a vaginal birth. And having a cesarean delivery can raise the risk of having difficulties with future pregnancies. The more cesarean deliveries you have, the more the risk goes up.

NIH: National Institute of Child Health and Human Development