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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.

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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.

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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.

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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.

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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?

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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.

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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.

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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.

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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.

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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.

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