I recently  attended a conference in Wellington on Abnormal smears, colposcopy and the HPV VIRUS. As this was the most up to date information available I thought it would be prudent to share this with the readers of my website .

Firstly the HPV virus. It stands for HUMAN PAPILLOMA VIRUS (the wart virus).There are 100 known types with 20 infecting the ano genital region. Only 2 of these cause genital warts.  I have termed them the ‘Virus of intimacy’ It is the common cold of sexual activity. We give them to each other when we have sex with each other. The HPV virus is the only known virus that directly causes cancer of the cervix, anus, penis, vulva, oropharynx, some skin cancers and some cancers of the oral cavity. The virus is further divided  into high risk (Hr) and low risk (Lr) which one we get is a jackpot. We may get a single one or multiple both Hr and LR.The jackpot goes further. If it is Hr it can be 16 or 18 or others. The most dangerous is 16 followed by 18.The numbers represent the DNA classification.

Some interesting statistics. The risk of getting HPV with a first unprotected sexual event is 40%. With a second partner it’s about 60% and 3 or more partners it goes to almost 100%. Women at highest risk of severe abnormalities are in the 25-34 year age group. There can be a long latent phase between infection and the abnormal smear as the body can contain the virus. However that’s not always the case.

When we grade abnormal smears we use the term ‘Cervical Intra epithelial neoplasia’ (CIN). We use CIN1 as a mild change and CIN2 and CIN3 as a severe pre cancer change. The classification is based on the depth of the abnormal cells from the surface inwards. If left untreated 50% of CIN 1 will regress in 9 to 15 months, and 35% of the higher grades will regress. However and this is fundamental to the screening programme, 10% of CIN3 will progress to cervical cancer.

Another important thing to understand is that there are two types of cervical cancer.

1)      Squamous  cancer involving the ‘Skin of the cervix’

2)      Adeno cancer involving the glands.

Both of these are HPV related. Most of them are 16 and 18.

So, what does this all mean?

Firstly all women should take cervical screening very seriously and make sure they have regular screening. Most women who present with cervical cancer have not had a smear in at least 5 years.

If you have had a hysterectomy for an abnormal smear or have had abnormal smears in the past you need to continue screening. If you have had a hysterectomy and changed your partner then have a smear.

If the smear comes back as low grade you may be advised to repeat it in 6 to 12 months as at least 50% will revert to normal. Remember cervical cancer usually take a very long time to develop. If the smear comes back as high grade, persistant low grade or uncertain (ASCUS) then you will be asked to have a colposcopy.

Colposcopy is looking at the cervix with a microscope and taking tiny pieces called biopsies. I am a certified colposcopist and it is one of my main areas of interest.

One of the most important warning signs of a possible problem is bleeding after or during intercourse as well as intermensrual bleeding. If you have any of these please see your doctor as soon as possible.Please note that  most women with abnormal cells  have no symptoms at all.

Immunization for the virus is now available. It is offered to all school girls and hopefully boys soon. In Australia it is available free of charge to girls and boys. Older women and boys can still get the vaccine but they will need to pay for it. The product is called Gardisel and it protects against 16 and 18 as well as the two viruses that cause genital warts namely 6 and 11

I have endeavoured to briefly discuss HPV and its relationship to abnormal cells and cervical cancer. The cell undergoes a cellular reaction to the virus and this is what we try and pickup on smear testing.

PLEASE HAVE YOUR REGULAR SMEAR TESTING DONE, IT MAY SAVE YOUR LIFE.!!!!

Vulval itching is a very common and distressing symptom.

I often get women in my office telling me that they have chronic thrush that is not responsive to usual thrush medication.

The first thing I want to say is that thrush is only one of a multitude of reasons why the vulva becomes itchy.

The first thing with any successful doctor’s visit particularly the gynaecologist is for the doctor to take a detailed and full history.

In the patient’s own words a full disclosure of symptoms is helpful such as:

1. When the itch started
2. How long it’s been going on for
3. Is it worse at night?
4. How much scratching is there?
5. Response to any medication
6. Family history of:
   a) Psoriasis
   b) Allergic dermatitis
   c) Asthma, hay fever
7. Infections such as thrush, scabies, worms.

Full and detailed examination

Your doctor should then examine you in detail and take a number of swabs depending on what they find. You may need to have biopsies (tiny pieces of tissue taken for further analysis with a pathologist )

A diagnosis will then be made. This could be any one a number of causes.

Here are a few of the commoner ones and how they should be treated.

Lichen simplex.

This is a chronic itch . It represents the scratching the itch scratch cycle.

Try and find a cause . The treatment is to remove the cause and treat with steroid cream and night sedation

Lichen Sclerosis.

Can occur at any age but mainly peri- menopausal and post menopausal.

The skin is white, cracked and inflamed.

The diagnosis is made usually with a biopsy.

Can get loss of tissue around the labia and clitoris.

The treatment is topical steroid cream.

Lichen Planus.

This is an auto immune condition. It is less common than Lichen Sclerosis.

There is pain and itchiness.

The appearance is that of ulceration.

Can also occur in the mouth.

The diagnosis is made with biopsies.

The treatment is also topical steroid creams.

Bacterial Vaginosis.

This is extremely common . it is caused by a tiny organism that often lives normally in the vagina.

However it can cause an itcy, profuse white to green discharge and a fishy unpleasant odour.

Treatment is very simple and very effective and required a one off dose of oral tablets.

Thrush.

The is caused by a fungal infection and is extremely common. 30% of women show no symptoms.

The symtoms are itching, swelling, and a white milky to thick (cottage cheese) discharge.

The treatment is very effective and can be taken orally or as a vaginal cream or pessary.

An important rule is if the thrush does not respond to standard treatment then the diagnosis should be reconsidered.

Trichomonas Vaginitis.

This is caused by a tiny organism that lives in the vagina. Interestingly enough, it is one of the only infective organisms affecting the female genital tract that can live outside the body for up to 45 mins.

The symptoms are a frothy vaginal discharge that can be offensive.

It is sexually transmitted.

The treatment is simple and effective with oral tablets. Both partners need treatment.

Contact Dermatitis.

I have left the commonest cause for last. Most women with a vulval itch will have this as the cause.

The vulval skin is very sensitive and any irritant will cause itchiness, swelling and even ulceration.

The commonest causes of itchiness due to a contact are soaps, deodorants, sanitary products, condoms, lubricating gel (especially flavoured ones), toilet paper, washing detergents and waxing.

The important thing is to identify a cause and remove it.

Topical steroids will alleviate the acute itch.

I have tried to cover a large subject very briefly. Remember you don’t have to put up with embarrassing itches.

See your health professional and get the problem resolved.

A few months ago I was invited by a large group G.P. practice to participate in a lecture evening to the public on the menopause.

The topics were varied and included a talk by a physiotherapist on pelvic floor, a talk by a psychologist on moods, a G.P. talk on bones and my talk on the physiology of menopause and HRT.

It was a hugely successful meeting with about 50 women all keen to learn about “The change of life”.

My talk was medical and I discussed in detail the pros and cons of HRT.

HRT has almost come full circle. In the past everybody was on it and the HRT industry thrived.

Then all the negative facets of the medication started coming out and everybody stopped using it. We saw many women really suffering with incapacitating hot flushes, mood changes, sexual dysfunction and genital  prolapse. In fact we predicted an enormous increase in prolapse which has happened. Today the ‘Prolapse industry” is  huge  with research into different operations and different mesh usage receiving millions of dollars in funding.

People are now talking again about the positives of HRT. I get daily request from women about information regarding HRT. They are sick of feeling the way they do and are prepared to take the risks.

When we prescribe any medication we always ask ourselves the following questions.

1)      Is it indicated?

2)      Are there any contraindications to the use of the particular medication?

3)      What are the side effects of this medication?

4)      What is the cost and is there a cheaper alternative.

5)      Would there be compliance.

6)      How long would one need the medication?

7)      Does the person understand the risks of the medication?

I really believe there is a definite place for HRT.

Take for example Mrs. X.

She is 53, has a busy life with work (many meetings a day), has 3 demanding teenage kids, and a husband who “does not quite get it”.

She has about 10 hot flushes a day often quite embarising.At

At  night she is woken at least 3 times with flushing. She is sleep deprived and exhausted.

Her memory is not what it used to be and her employer is starting to be unhappy with her performance. She is moody and often feels down.

Her personal   life with her husband is almost nonexistent. When they do get together it is dry, uncomfortable and she is so tired that she can’t wait for it to be over so she can try and get some rest.

She has had a few thrush infections and recently had a bout of cystitis that she has not had since she was in her twenties.

Does this sound familiar. Yes it is an extreme case but still many of you reading this may have similar but less severe symptoms.

Mrs. X would benefit greatly and very dramatically with HRT. She has no contra indications .She would need to be on it for about 3 to 5 years and then see how she does off it.

If you are in any way unhappy about your menopausal symptoms, discuss it with you doctor and explore with the doctor the possibility of HRT.

Of course it is not for everybody but it may be for you.

What was interesting about our talk was the question time. I heard a number of really unhappy and suffering women. A number of them have started HRT and they and function so much better.

One of the most common problems we face as gynaecologists on a daily basis is the very personal and often embarrassing issue of painful intercourse. By the time a woman comes to see us things are pretty bad. Often they are faced with resultant relationship issues and are quite desperate to get this problem sorted. Yes, in most cases it can be sorted and nobody should have to suffer from this.

The medical term for painful intercourse is Dyspareunia. It can be divided into two;

1. Superficial which is mainly outer and inner vagina but not to the deepest part
2. Deep dyspareunia which is pain deep in the pelvis and lower abdomen.

Let’s talk about each one in a bit more detail.

Superficial Dyspareunia

This is an extremely common complaint. The most common cause is thrush or other vaginal infections. Anything that impedes penetration such as scar tissue (from birth tears), an entry that is too narrow, painful hymenal tags, imperforate hymen, vaginal prolapse, or cysts or growths in the vagina can cause pain.

In older women and sometimes in younger ones vaginal dryness can cause pain and discomfort.

The treatment will obviously depend on the cause. Almost always these can be remedied with either medication or relatively simple surgery.

The most important thing is not to leave it. Get it sorted as soon as possible.

Deep Dyspareunia

The pain is deep in the pelvis or lower abdomen. The commonest reason is a retro-verted uterus. This is when the uterus is facing downwards and is being “ hit “ directly. About 20% of uteruses face downwards and this normal. A change in positions is all that is needed to overcome this problem.

Other more serious problems such as endometriosis, adenomyosis (endometriosis of the uterus), ovarian cysts or pelvic infection (both acute and chronic) can all cause painful intercourse.

The most important message is don’t leave it.

If sex has always been painful from the beginning you should address it. Relationships can be adversely affected and there is almost always a solution.

If sex has been fine and then becomes painful especially deep, then attention is more urgently needed.

Seek help. The issue is extremely personal and private, so choose somebody who you can talk and relate to. That person could be your G.P. or specialist. Be honest and frank however embarrassing you may find it. THERE IS ALMOST ALWAYS A REMEDIAL ANSWER.

From time to time I give the local General Practioners a question and answer session where we spend a few hours discussing problems that they may come across in their day to day work.

It is always fascinating to see that we all have similar problems with certain conditions. The standard of general practice in New Zealand is extremely high so when they have a problem you can be sure it is challenging for me to provide an adequate answer.

One of the most taxing day to day problems is that of a “Chemical Pregnancy”.

Now what does that mean?

In essence it is a very early pregnancy.

When fertilization takes place the fertilized egg then makes it way down the fallopian tube into the uterus. Once there it implants and stars producing a hormone Human Chorionic Hormone or HCG. This can then be measured. Technology is so good now that even the most minute amounts are measurable. This is where we run into trouble. The test becomes positive and is quantitated early on when the levels are very low. Sometimes just too early. This is what is understood as being a chemical pregnancy.

As we know a large number of pregnancies fail and these very early ones fail the most. Often the HCG is measured even before a period is missed.

So one can understand the disappointment and frustration that  emerges when in fact the pregnancy was doomed to fail anyway and if one waited just a wee while longer then a period would ensue and we would all be none the wiser.

I don’t quite know what the answer is other than when an HCG is measured that early on one should be prepared for the possibility of a pregnancy failure.

As pregnancy is a dynamic event, if one wants to know the pattern of progress HCG testing should be done about twice a week. Normally the level should double every 2 and a bit days until a level of somewhere around 30,000 is reached and then it plateaus or may even fall. By this time however a fetal heart beat should be detected on ultra sound. If the pattern is not going up appropriately then the pregnancy may fail.

The HCG measurements do not obviously improve outcome but definitely give us guidance as to how it is progressing until such time that the fetal heart beat is seen ( somewhere around 6 to 6  and a half weeks.)

Last week I saw a patient who had a very severe uterine and vaginal prolapse. She needed to have a vaginal hysterectomy and a pelvic floor repair.

Of course this came as a huge shock to her. As I always do I explained everything to here is detail including drawings, alternative options and gave her printed information. She went home, looked up on “the web”, spoke with friends and her husband and came back for her second visit together with her husband.

She was armed with a long list of questions and comments. I welcome this and we spent well over half an hour going through her issues and concerns. I thought afterwards how wonderful that interview was for her as now she is fully informed and if she decides to go ahead the consent she signs will be an informed consent.

I often ask people “Do you have any questions ?” They reply “I don’t know what to ask!” So here are a few pertinent questions you may want to know from your surgeon.

1. Do I really need to have the surgery? What are the indications?
2. Are there  any alternative treatments available especially non surgical ones
3. How urgent is this surgery and can it wait.
4. What are the risks associated with the procedure
5. What risks do I face if I don’t have the surgery
6. What risks do I face if I delay the surgery?
7. How many of these procedures has the surgeon done
8. What is his/her complication rate
9. How long will the procedure be
10. How long will I be in hospital?
11. Do you have access to other surgeons such as general bowel surgeons, urologists or other gynaecologists in case they are needed during my operation? If so who are they?
12. Who is your anaesthetist and can I talk with him/her prior to the surgery
13. What is my recovery time and when can I go back to work.
14. When can I resume household activities?
15. When can I resume sexual activity?
16. How can I get hold of you if I have a problem post operatively?
17. Do you see me in hospital after the surgery and will you see me every day
18. Can you talk to my husband/partner/children or nominated person post op
19. When will you see me for a follow up?
20. How much is the surgery and can I expect surprises in costing. I am affiliated to Southern Cross healthcare so all affiliated procedures have a capped cost so there will be no surprises.
21. How does he/she feel about a second opinion and if so who would they recommend.

What I have listed is a general help. By asking these questions (and of course any others you may think of) you should have a very good idea of what you are in for. Naturally your surgeon should explain what they intend to do in absolute detail in a language that you fully understand. Always remember you have a choice as to whether you want the procedure and who will do it. Armed with all the information your choice becomes informed and that is your empowerment.

One of the most distressing aspects of our work as gynaecologists is the management of early pregnancy loss.

Often the awareness is made at a routine scan when the fetal heart is not seen to be beating.

Sometimes this is preceded by a brownish discharge or some abdominal cramping.

One of the most important signs is that the woman no longer feels pregnant.

A very important fact is that usually the woman has done or could have done absolutely nothing to cause the death of her foetus. The pregnancy is a bad one very often a severe chromosomal abnormality and by natural selection has died.

The big debate is what to do next. Should one undergo a surgical evacuation or wait for nature to take its course. We as gynaecologist’s more often than not opt for the surgical emptying of the uterus. The operation is relatively safe (although complication may occur) and it finalizes the event so one can move on. The other advantage is that there is much less risk of infection.

The operation is usually done under general anaesthesia and takes about 15 minutes to do. After the procedure there may be some bleeding and cramping bet that settles fairly quickly.

Afterwards your doctor would probably want to see you. I call it a “debriefing” where we discuss the operation, the outcome, possible causes and most importantly what about the next time.

My plan that I propose and very often do is as follows:

1. One can try again whenever. There is very little evidence to show that waiting is of any benefit at all. In fact recent evidence shows the sooner the better.
2. Once the pregnancy is suspected an early HCG (pregnancy hormone) blood test should be done.
3. If this is positive then I like to do these twice weekly on a Monday and a Thursday. They should approximately double every 2 and half days until the level plateaus.
4. I then do a six week scan to try and see a fetal heart.
5. As many scans as indicated until we are sure that all is well

Remember that this plan does not improve outcome but does give us peace of mind and will alert us early on if things are going wrong.

More often than not the cause of the miscarriage is never found.

If one has had 3 or more consecutive miscarriages we call this a habitual abortion and we would then instate a number of tests to try and identify the cause.

Recently I went to a conference run by The incontinence society of New Zealand. It was attended by a wide range of health professionals  including gynaecologists, urogynaecologistes, physios, nurses and people dealing with incontinence.

As always with such a diverse group of people there were so many options and such a variety of options that people can follow.

Let me spend a few minutes going over what we mean by the different term we use to define incontinence. I will stick to urinary incontinence and not faecal incontinence.

Urinary Incontinence is the involuntary passage of urine.

1) Urinary Stress incontinence or USI: This is the involuntary passage of urine when there is an increase in intra abdominal pressure such as coughing sneezing or laughing. This is extremely common; in fact almost all women may at some point in their lives may experience this. The causes are often related to child birth and vaginal prolapsed. During childbirth the pelvic floor muscles are often damaged resulting often in a prolapse. As one get older and the hormones change this will further aggravate the situation. Last but by no means is least what you inherit from your mum, aunts and grandmother.

If it is a minor irritant and occasional it best to follow the conservative approach which involves pelvic floor exercise alone or under the guidance of a physiotherapist. If it is of such a problem that you need to constantly wear pads and it adversely affect your life then surgery may be the answer.

2) Urgency and urge incontinence UI :

The woman who always knows where the nearest toilet is is probably suffering from urgency. This is the need to go feeling and if you can’t make you will wet. It is the urgent desire to pass urine often small amount.

The commonest cause is a cystitis or bladder infection. However, it also occurs in older women who lack oestrogen or hormone support of their vaginas. Other causes are neurological disease, tumours, small capacity bladders and a condition called interstitial cystitis.

This is an extremely debilitating condition and should always be medically addressed.

3) Overflow incontinence: the bladder overfills, the desire to empty is not felt or their is an obstruction to the outflow and the bladder gets overfull. Causes are neurological or obstructive.

Often the incontinence is mixed and has components of one two or three.

With each of these types there are specific treatments most of which are extremely successful.

Often a test called urodynamics is performed. These are pressure testing where we would be able to determine which incontinence you have and then the correct treatment can be offered.

Talk to your health care professional about this. It is often embarrassing but there is help at hand which as I say is usually excellent

As a busy gynaecologist one of the most common complaints I see on a day to day basis are problems related to the menopause.

What is the menopause?

The menopause signals a time of change in a woman’s life hence the common term “change of life”. It is when ovulation ceases and periods stop. The ovaries in effect stop producing eggs and most of their hormones mainly oestogen but also progesterone and testosterone.  Fertility ceases and therefore she no longer needs to consider contraception.

For a large number of women this change happens with very little ill effects and they happily enter a more carefree and exciting phase in their lives. However for a group of women this phase becomes extremely uncomfortable and very distressing. It is this group that we as gynaecologists see and help.

The average age of menopause is approximately 52 but the normal range is between 45 and 60. If it is before 40 it is called ‘premature menopause’ and that has a number of problems on its own.

Briefly,  premature menopause or premature ovarian failure often has no known cause. It may be a genetic problem, as part of an overall gland failure or surgically induced when the ovaries are removed either by surgery or destroyed by radio therapy or chemotherapy.

The symptoms of menopause

1. Change in the menstrual cycle: Periods may suddenly disappear or become irregular lighter or heavier. Everybody is different
2. Hot flushes:  This is one of the most common symptoms of menopause and the most distressing. These are characterized by a feeling of intense heat that usually begins around the face and neck causing a flush. The face is red and may be sweaty. The heat then moves to the rest of the body. It can last from a few seconds to many minutes. They are common at night and there can be several during this time resulting in sleep deprivation and exhaustion. They may also be accompanied by general sweating, nausea, tiredness and heart palpitations.
3. Vaginal Dryness: I find this to be the most complained about long term symptom. As with the mouth the vagina needs to be comfortably moist at all times. The vaginal mucosa (skin) is extremely sensitive to hormones so when they disappear the skin becomes thin, less elastic, dry, irritating, and sore and becomes susceptible to infections such as thrush. Intercourse becomes dry and uncomfortable with pain, bleeding and difficulty with penetration.
4. Urinary symptoms:  Many women complain of frequency, waking up at night to pass urine, urgency and leaking when coughing, sneezing or laughing. These symptoms are because of a lack of hormone acting on the urinary tract.
5. Mood swings and other emotional problems:  Hormone lack can exacerbate other life problems such as domestic issues, aging, children and relationship issues.
6. Sexual issues: In some women there is a marked change in their sexuality around the menopause. Feelings and desires may change. Intercourse can be dry and uncomfortable. Tiredness due to sleep disturbances can further decrease her desire. The aging process and related body image issues can all lead to a loss of desire.  Low or absent Oestrogen, progesterone and testosterone levels can all reduce one’s libido.
7. Other less obvious changes: Dry skin, itchy crawly skin, coarse hair growth, weight gain, aching joints and muscles can all occur.

Management of the menopause

The first thing I do when I see a woman with menopausal symptoms is listen. I take a full and detailed history going into detail of all her symptoms. I also go into detail about general health issues.

I then do a full and detailed physical examination including a smear test and a vaginal swab. I then do an internal vaginal examination paying particular attention to the vaginal skin, the wall of the vagina (looking for prolapsed), and the internal vaginal organs such as the uterus and ovaries.

I then order some blood tests which include lipids (cholesterol), full blood count, liver and kidney function tests and hormone tests.

If indicated I order a pelvic ultrasound and a bone density examination (to rule out osteoporosis).

I then see her again, collate all these results and then work out a management plan with her.

Treatment of the menopause

For a large number of women simple advice, reassurance of normality and support is all that is required.

There are however those women who will need HRT or hormone replacement therapy. This is where the controversy exists. The popular media and certain interest groups have condemned the usage of HRT.I believe very strongly that where the indication exists and as long as the risks and benefits are fully discussed and understood  there is definitely a place for HRT in the treatment of menopause.

HRT can alleviate hot flushes, vaginal dryness, low sex drive, urinary symptoms, sleep disturbances and a multitude of symptoms that make the menopause a miserable time for the woman, her partner and her family.

HRT can be given as pills, patches, implants and/or vaginal cream or pessaries.

The best thing to do is discuss these issues with your doctor and together work out whether HRT is appropriate for you and if so what the best way of delivering the hormone is.

I have often found when a woman is faced with the prospect of having a hysterectomy there is a mixture of shock, disbelief and anger. However equally often there is absolute relief that their problem/problems will be taken away.

A hysterectomy is the surgical removal of the uterus (womb).  Most hysterectomies are performed for non cancerous problems such as heavy bleeding, pain and discomfort.

The most common reasons we would do a hysterectomy are:

1. Uterine fibroids. These are benign growths of the muscle of the uterus. These can cause pain, bleeding, pressure on the bladder or bowel, and an abdominal mass.
2. Prolapse of the uterus. Weakness of the pelvic floor muscles can cause the uterus and the walls of the vagina to prolapsed or come out through the vagina.
3. Heavy or irregular bleeding. Often this is unexplained and fits into the group of conditions called Dysfunctional Uterine Bleeding or D.U.B.
4. Adenomyosis or endometriosis of the uterus. This is when the lining of the uterus migrates into the uterine muscle and may cause:
   - Abdominal pain
   - Heavy bleeding
   - Painful intercourse
   -Very painful periods
   - Uterine tenderness.

What kinds of hysterectomies are there?

1. Total Hysterectomy: This is when the uterus and the cervix (lower part of the uterus) are removed.
2. Total Hysterectomy plus unilateral (one) or bilateral salpingo-oophorectomy (both). What this means is the total hysterectomy plus one or both ovaries and fallopian tubes.
3. Subtotal hysterectomy with or without ovaries and tubes. This is when the uterus is removed but not the cervix.
4. Radical Hysterectomy. This is usually done for cancer and is when the uterus, top of the vagina and the tissue around the cervix is removed. The ovaries and fallopian tubes may or may not be removed.

There are different ways to perform this operation which your surgeon will discuss with you.  Your choice will depend on the reason for the surgery and what your surgeon is most comfortable doing.

There are three groups of procedures:

1. Abdominal Hysterectomy; an incision is made into the tummy and the operation is done through an abdominal wound.
2. Vaginal Hysterectomy: The operation is done through the vagina.
3. Laparoscopic Hysterectomy; This is when the operation is done through a telescope and is referred to as minimal invasive surgery.  Always remember that although the skin incisions are small the internal surgery is the same major surgery.

All the operations have pros and cons and it is really up to you and your surgeon as to which type of hysterectomy is most appropriate for you.

The Subtotal Hysterectomy.

This is when the tummy is opened or it can be done laparoscopically but not vaginally. The uterus is removed but the cervix is left untouched meaning that the vagina does not need to be opened.

This is the most common type of surgery I perform and one which many women are requesting. This type of surgery is particular for benign conditions such as fibroids which is my special interest.

Many women feel that their cervix is an integral part of their sexual fulfillment and would prefer the vagina not to be opened from above and have it disturbed. I have also found less postoperative bleeding and less post operative complications related to this surgery. The recovery time seems to be quicker, the problem is resolved and as much of the anatomy is left intact. Hospital stay is also usually reduced.

Of course the smears should be normal and it is very important to remember that you should continue to have ongoing smear tests as you normally would.

The hospital stay for hysterectomy is about 3 to 5 days depending on the person, type of operation and whether there have been any complications. The off work period is usually 4 to 6 weeks.

Please always remember that a hysterectomy is major surgery and as with any surgery there can always be complications. This needs to be discussed with your doctor and explained to you in detail.