A uterine fibroid is the commonest non-malignant tumour in the human body. It is made up of smooth muscle fibres and, like the ovarian cyst, can grow up to horrendous sizes. Unlike the ovarian cyst, the uterine fibroid is rarely malignant.
A hormonal imbalance with a higher level of oestrogen influence is said to be a factor in the formation of fibroids but the actual cause is not clearly known. Fibroids tend to occur in women in the higher socio-economic classes, like the busy executive who puts off child bearing until a late age. In fact, women who have given birth to many children tend to have a lower incidence of fibroids. Some gynaecologists sum up the situation dramatically: “The womb, after waiting for years and years to produce a baby, gets so frustrated that it decided to produce fibroids instead.”
Whether or not you need surgery depends on whether the fibroid is troubling you, for example, causing heavy menstruation to the point of anaemia or preventing conception by causing blockage of the Fallopian tubes.
By virtue of their size, fibroids which cause the womb to be larger than as if it was at the 12th week of pregnancy should be removed. This is because at this size, the fibroid would eventually cause problems. If done at a later stage, it would pose a higher operative risk as the patient would be older and morel likely to suffer from medical complications like high blood pressure or heart disease.
Endometriosis is a disease in which the inner lining of the womb is found in places outside the womb. This usually occurs in the ovary or in the lower part of the abdomen just outside the womb.
The vast majority of women with endometriosis do not know they have this condition as it is very mild. Others may complain of painful menstruation, pain during intercourse and even bleeding when passing motion during menstruation if the endometriosis is found in the rectum.
Any woman in the reproductive age can suffer from endometriosis – even those who are unmarried and those without children. However, this condition is more common in busy working executives who delay having children.
For mild cases or when there are small blood cysts, treatment with medication is usually effective. For more serious cases of endometriosis, an operation is required.
Endometriosis is a disease of the fertile years. Hence it tends to improve after menopause. Having children is a good way to minimize the extent of the disease.
An ovarian cyst is a fluid filled structure, similar to a small water filled balloon, arising from one or both ovaries. A cyst is different from a fibroid in that it stems from the ovary whereas a fibroid arises from the uterus. Also, a fibroid is solid as it is made of muscle fibres unlike a cyst which contains fluid.
Although there are many different types of ovarian cyst, they usually give rise to similar problems. The woman usually complains of pain or discomfort on one side of the lower abdomen. Pain becomes intense and unremitting if the whole ovary together with the cyst becomes twisted (torsion). As the cyst enlarges and presses on adjacent organs, the patient may complain of constipation or the frequent desire to pass urine. Pain on intercourse especially on deep penetration is another symptom.
As the ovary is an internal organ, it is quite common for the cyst to be symptomless until it has grown to a larger size. In this instance, the patient complains of progressive enlargement of the lower abdomen. I had a patient come to see me after the New Year when she found that she could not get into her cheong-sam. On examination, she was found to have a left ovarian cyst the size of a water-melon, which was totally painless.
Whether to remove an ovarian cyst is a vexing question. The decision mainly hinges on the possibility of cancer. Early diagnosis is therefore crucial for the patients long-term survival.
Vaginoplasty or Vagina Shaping is a procedure whereby the lower genital tract is reconstructed or modified for cosmetic purposes or to treat diseases. The carbon dioxide laser is almost invariably used as it results in a very clean surgical outcome with the minimmum of pain , infection or bleeding. The procedure can be divided into three broad groups:
1. Labioplasty whereby the lips of the external genitalia or vulva is modified surgically with the CO2 laser. This is done when the two sides of the labia are of different sizes or if the labia are too large. Following the procedure, they would then be of equal size or of the correct size.
2. Hymenoplasty. This is usually done to reconstruct the hymen which would resemble that of a virgin at the end of the procedure. The procedure is totally painless.
3.Vaginoplasty. This is done to correct extra looseness of the walls of the vagina due to and following childbirth and/or ageing. The extra tissue is excised and the vagina narrowed and lengthened. This would enhance sexual pleasure in both the woman and her partner. The procedure is relatively painless.
4. Laser vaporization of diseases of the cervix, vagina and vulva. Infections of the cervix, vagina or vulva such as that caused by the human papillloma virus are readily and very effectively treated by the CO 2 laser to prevent the progression of the disease to cervical cancer. The procedure is painless.
I have in my own personal experience performed a few hundred gynaecological laser operations for my patients.
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