Pudendal and paracervical blocks are single-injection, or single-shot, nerve blocks that involve a one-time injection of local anesthetic adjacent to the nerve or plexus for pain relief. The duration and density of the block depends upon the dose, concentration, and pharmacology of the chosen local anesthetic.

Transvaginal Pudendal Nerve Block

A pudendal nerve block provides anesthesia to the lower vagina, vulva, and surrounding tissues, with some relaxation of the pelvic floor. Blocking the pudendal nerve with an injection of local anesthetic is used for vaginal deliveries and for minor surgeries of the vagina and perineum. The pudendal nerve provides the majority of sensations and functions of the external genitals, the urethra, the anus, and the perineum. It also controls the external anal sphincter and the sphincter muscles of the bladder. 

Pudendal nerve blocks are still used for certain obstetric and gynecologic indications, but they have been displaced by an increase in the use of neuraxial anesthesia (such as epidurals or spinals), especially in the context of treatment for pain in the second stage of labor. The procedure, however remains a useful tool for urgent or emergent deliveries when quick pain control and analgesia are indicated.

Your doctor may use this block when you undergo the following procedures:

• Operative vaginal deliver (forceps or vacuum)
• Episiotomy repair
• Office-based vaginal procedures

What does this procedure involve

The doctor will use two fingers to feel along the inner left wall of the vagina to locate a boney protuberance called the ischial spine. Using a special needle, pain medication can be injected into the nerve root located in this area. The process is repeated on the right side. This will numb the perineum and lower part of the vagina.

Paracervical Nerve Block

Paracervical blocks can provide excellent anesthesia for procedures that involve cervical dilation, uterine aspiration, or instrumentation of the uterus. The paracervical block is not recommended for loop electrosurgical excision procedure (LEEP) procedures because it may not be as dense on the surface of the cervix.

Your doctor may use this block when you undergo the following procedures:

• LEEP (loop electrosurgical excision procedure)
• IUD (intrauterine device) insertion
• Hysteroscopy (diagnostic, polypectomy, myomectomy, IUD removal)
• Colposcopy
• Cervical Biopsy
• Endometrial ablation

What does this procedure involve

There are a variety of techniques to perform a paracervical block. Each surgeon develops a preferred technique. In a basic paracervical block, anesthetic medication is injected into the upper and lower portions of the cervix. Typical medications are Lidocaine and Mepivacaine. This technique works quickly to numb the cervix.

More complex procedures require a deeper paracervical block to provide anesthesia to the cervix and upper uterus. There are many techniques. The doctor will inject medication in different areas of the cervix to allow the anesthetic to be absorbed into the surrounding nerve bundles. The procedure is done slowly to avoid injecting into any blood vessels. After the injections are complete, the surgeon will wait 10-15 minutes to allow it to take effect before proceeding with other procedures.

The post Pudendal and Paracervical Blocks appeared first on Medika Life.

The doctor’s office calls a few days after your annual pap smear. This can’t be good news. They say you have an “abnormal” pap smear. You get scheduled for a diagnostic procedure called a colposcopy to rule out cervical cancer.  

What is a Colposcopy

Before you hit the panic button, let’s break down exactly what you need to know about a colposcopy procedure. 

A colposcopy is a common office procedure that follows an abnormal pap smear. Using a microscope, doctors examine the magnified cervix to identify abnormal cervical tissue to prevent cervical cancer. 

Precancerous cells are caused by HPV, the human papillomavirus.

80% of Americans will contract HPV, making it the most common sexually transmitted infection. HPV causes genital warts, and persistent strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. 

Cervical screening through pap smear is how women’s health practitioners detect HPV effects. Paps smears are the first step in cervical cancer prevention. 

A pap (Papanicolaou) smear is a screening test for cervical cancer. The cervix is the opening of the uterus located at the back of the vagina. During a pap smear, doctors place a device called a speculum into the vagina. This allows the walls of the vagina to be spread apart allowing visualization of the cervix.

Cervical cells are then collected using a small brush. These cells are sent to a lab for analysis. The cells are processed under a microscope to evaluate for precancerous changes called cervical dysplasia. 

The goal of pap screening is to detect abnormal cervical changes so we can intervene long before cervical cancer develops.

When someone has an abnormal pap smear, the next step is a diagnostic procedure called a colposcopy.

A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye. 

Areas of the cervix concerning for pre-cancer or cancer can then be biopsied (sampled) during the exam.

If the biopsy shows a precancerous lesion then, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

Where is a colposcopy procedure performed?

A colposcopy procedure is performed in an office setting.

Can my family come with me?

Colposcopy procedures are performed in a medical office setting. A trusted family member should drive you to and from the appointment. 

Does my procedure require an anesthetic?

Anesthesia is not typically required for a colposcopy procedure. Some physicians spray a topical anesthetic directly onto the cervix. Occasionally local anesthesia can be provided via a paracervical anesthetic. 

A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery. 

Some gynecologists recommend oral medication to reduce anxiety.

What’s the procedure when I check-in?

Most procedures will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed.

The consent form is reviewed, signed, or updated with any changes.

Because a colposcopy is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions..

What happens in the procedure room?

Your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

The provider will position the colposcope (microscope) to allow visualization of the cervix. A chemical called acetic acid is applied to the cervix. Acetic acid, also known as vinegar, is applied to the cervix. (We call it acetic acid so we can sound smarter).  

Cells infected with HPV will absorb this chemical causing them to turn white. During the colposcopy, the doctor will see these characteristic changes, and any abnormal areas are may be sampled.

After the biopsy, a drying chemical called Monsel’s solution is painted onto the cervix to prevent bleeding later on. This chemical is messy and will cause a brown, coffee-ground vaginal discharge over the next few days.

How long will I be in the operating room?

Once the patient enters the procedure room a series of safety steps must occur. 

A colposcopy procedure takes approximately 2–5 minutes. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments.

When can I go home?

After an office-based colposcopy procedure, patients may go home after getting dressed as long as you are feeling normal.

Postoperative recovery time will vary from person to person.

Colposcopy procedures require a minimal amount of recovery. Patients may leave as soon as the procedure is complete.

What is the usual recovery time

You should be able to resume all work and household activities on the same day as your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

Some patients will require mild pain medication like NSAIDs.

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons.

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the same day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is to avoid vaginal intercourse for 1–2 weeks.

You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination to evaluate your cervix 1–2 weeks after the procedure. The cervical specimen pathology report will be reviewed during this visit.

If cervical dysplasia is proven on the biopsy, your doctor will discuss the next steps. If the biopsy is normal or mild cervical dysplasia is found, a follow-up pap smear will be scheduled. If moderate or severe cervical dysplasia is identified, the provider will discuss treatment options.

Danger Signs to look out for after the procedure

After a colposcopy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge

What should I pack at home to take with?

Nothing special is required after a colposcopy procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

This is a video presentation of the procedure, explaining how it works.

The post Preparing for: Colposcopy appeared first on Medika Life.

Cervical cancer is a disease in which malignant (cancer) cells form in the cervix. The cervix is the lower, narrow end of the uterus (the hollow, pear-shaped organ where a fetus grows). The cervix connects the uterus to the vagina (birth canal). Cervical cancer usually develops slowly over time. Before cancer appears in the cervix, the cells of the cervix go through a series of changes in which cells that are not normal begin to appear in the cervical tissue.

When cells change from being normal cells to abnormal cells, it is called dysplasia. The abnormal cervical cells may go away without treatment, stay the same, or turn into cancer cells over many years.

The Importance of Cervical Cancer Screening

What is cervical cancer screening?

Cervical cancer screening is an essential part of a woman’s routine health care. Nearly all cases of cervical cancer are caused by infection with sexually transmitted oncogenic, or high-risk, types of human papillomavirus, or HPV. The primary goal of screening is to identify precancerous lesions caused by HPV so they can be removed to prevent invasive cancers from developing.

A secondary goal is to find cervical cancers at an early stage when they can usually be treated successfully. Routine cervical screening has been shown to greatly reduce both the number of cervical cancer cases and deaths from the disease.

For many years, cytology-based screening, known as the Pap test or Pap smear, was the only method of screening. Its use reduced cervical cancer incidence and deaths in countries where screening is common.

However, with the advent of the ability to test for HPV, cervical cancer screening now includes three approaches: HPV testing, which looks for the presence of high-risk HPV types in cervical cells; Pap testing; and HPV/Pap cotesting, which checks the same cell sample for both high-risk HPV types and cervical cell changes.

How is cervical cancer screening done?

Cervical cancer screening can be done in a medical office, a clinic, or a community health center. It is often done during a pelvic examination.

While a woman lies on an exam table, a health care professional inserts an instrument called a speculum into her vagina to widen it so that the upper portion of the vagina and the cervix can be seen. This procedure also allows the health care professional to take a sample of cervical cells. The cells are taken with a wooden or plastic scraper and/or a cervical brush and placed in a vial of liquid preservative.

The slide or vial is then sent to a laboratory where the cells are tested for the presence of high-risk types of HPV and/or examined under a microscope with an automated liquid-based Pap cytology test. When both tests are done using the same sample, this is referred to as “cotesting.” 

Researchers have found that screening may be less effective for obese women, possibly because of challenges in visualizing the cervix and obtaining a cell sample. Approaches to improve cervical visualization in obese women, including the use of larger speculum, may be helpful.

When should a woman begin cervical cancer screening, and how often should she be screened?

Women should talk with their doctor about when to start screening and how often to be screened. In August 2018, updated screening guidelines were released by the United States Preventive Services Task Force. The updated guidelines are as follows:

• Women ages 21 through 29 should be screened with a Pap test every 3 years
• Women ages 30 through 65 should be screened with any of three tests:
  • every 5 years with high-risk HPV testing alone
  • every 5 years with Pap and high-risk HPV cotesting
  • every 3 years with a Pap test alone
• Women with certain risk factors may need to have more frequent screening or to continue screening beyond age 65. These risk factors include:
  • being infected with the human immunodeficiency virus (HIV)
  • being immunosuppressed
  • having been exposed to diethylstilbestrol before birth
  • having been treated for a precancerous cervical lesion or cervical cancer
• Screening for cervical cancer is not recommended for:
  • women younger than 21 years
  • women older than 65 years who have had adequate prior screening, with normal results, and who are not otherwise at high risk for cervical cancer
  • women who have had a total hysterectomy (surgery to remove the uterus and cervix) and have no history of high-grade cervical lesions or cervical cancer

A joint statement released by the American College of Obstetricians and Gynecologists, American Society for Colposcopy and Cervical Pathology, and the Society of Gynecologic Oncology noted that the updated guidelines are largely in line with their clinical guidance, with some differences in the details.

The screening intervals in the 2018 guidelines reflect scientists’ evolving understanding of the natural history of HPV infection and cervical cancer. Although HPV infection of the cervix is very common, most infections will be controlled by the immune system over the course of 1 to 2 years. Because most HPV infections are transient and produce only temporary changes in cervical cells, overly frequent screening could detect HPV infections or cell changes that would never cause cancer.

Treating abnormalities that would have gone away on their own can cause needless psychological stress. Follow-up tests and treatments can also be uncomfortable, and the removal of cervical tissue has the potential to weaken the cervix and may affect fertility or slightly increase the rate of premature delivery, depending on how much tissue is removed.

These screening intervals also limit false-negative results that would delay the diagnosis and treatment of a precancerous condition or cancer. With these intervals, if an HPV infection or cell changes are missed at one screening exam, chances are good that those changes will be detected at the next one, when they can still be treated successfully.

The success of cervical cancer screening is due, in part, to the repeat testing that women typically undergo over many years. A study of a large population of women receiving routine screening showed that women with a history of negative HPV/Pap cotest results have a very low risk of developing precancer or cancer even if a subsequent screening test reveals a new HPV infection or abnormal cervical cells.

How do the three testing options compare?

For women age 30 or older, both HPV/Pap cotesting and HPV testing alone are more sensitive than Pap testing alone. Therefore, a woman with a negative HPV test and normal Pap test—or just a negative HPV test—has a very low risk of developing precancerous cervical lesions over the next several years.

It is for that reason that, when Pap and HPV cotesting or HPV testing alone are used, the  recommended screening interval is 5 years: this longer interval (compared with 3 years for women receiving Pap testing alone) still allows abnormalities to be detected in time to treat them while  reducing the detection of HPV infections that would be successfully controlled by the immune system.

Both Pap and HPV cotesting and HPV testing alone may also improve the detection of glandular cell abnormalities, including adenocarcinoma of the cervix (cancer of the glandular cells of the cervix). Glandular cells are mucus-producing cells found in the endocervical canal (the opening in the center of the cervix) or in the lining of the uterus. Glandular cell abnormalities and adenocarcinoma of the cervix are less common than squamous cell abnormalities and squamous cell carcinoma. Pap testing is not as good at detecting adenocarcinoma and glandular cell abnormalities as it is at detecting squamous cell abnormalities and cancers.

What do the results of cervical cancer screening tests mean?

A health care provider may simply describe Pap test results to a patient as “normal” or “abnormal.”

Likewise, HPV test results can either be “positive,” meaning that a patient’s cervical cells are infected with one or more of a group of high-risk HPV types (which is what most commercially available HPV tests detect), or “negative,” indicating that none of the high-risk HPV types were found. Several HPV tests are specific for HPV16 and HPV18—the types that cause most cervical cancers.

A woman may want to ask her provider for specific information about her Pap and HPV test results and what these results mean.

Most laboratories in the United States use a standard set of terms, called the Bethesda System, to report Pap test results. Under the Bethesda System, samples that have no cell abnormalities are reported as “negative for intraepithelial lesion or malignancy.” A negative Pap test report may also note certain benign findings, such as common infections or inflammation. Pap test results also indicate whether the specimen was satisfactory or unsatisfactory for examination. Guidelines committees are re-evaluating how results of cervical screening tests are reported, based on the most up-to-date research on the natural history of HPV infections.

The Bethesda System considers abnormalities of squamous cells and glandular cells separately. Squamous cell abnormalities are divided into the following categories, ranging from the mildest to the most severe.

• Atypical squamous cells (ASC) are the most common abnormal finding in Pap tests. The Bethesda System divides this category into two groups, ASC-US and ASC-H:
  • ASC-US: atypical squamous cells of undetermined significance. The cells do not appear completely normal, but the cause is unclear. The changes may be related to an HPV infection, but they can also be caused by other factors.
  • ASC-H: atypical squamous cells, cannot exclude a high-grade squamous intraepithelial lesion. ASC-H lesions may be at higher risk of being precancerous than ASC-US lesions.
• Low-grade squamous intraepithelial lesions (LSILs) are considered mild abnormalities caused by HPV infection. LSILs often return to normal as the immune system controls the infection, especially in younger women.
• High-grade squamous intraepithelial lesions (HSILs) are more severe abnormalities that have a higher likelihood of progressing to cancer if left untreated. 
• Carcinoma in situ (CIS) refers to severely abnormal cells that resemble cancer cells but remain on the surface of the cervix and have not invaded more deeply or spread beyond the cervix. 
• Squamous cell carcinoma is cervical cancer. The abnormal squamous cells have invaded more deeply into the cervix or into other tissues or organs. In a well-screened population, such as that in the United States, a finding of cancer during cervical screening is extremely rare.

Glandular cell abnormalities describe abnormal changes that occur in the glandular tissues of the cervix. The Bethesda system divides these abnormalities into the following categories:

• Atypical glandular cells (AGC), meaning the glandular cells do not appear normal, but doctors are uncertain about what the cell changes mean.
• Endocervical adenocarcinoma in situ (AIS), meaning that severely abnormal cells are found but have not spread beyond the glandular tissue of the cervix.
• Adenocarcinoma includes not only cancer of the endocervical canal itself but also, in some cases, endometrial, extrauterine, and other cancers.

What follow-up tests are done if cervical cancer screening results are abnormal?

Depending on the test results, a woman may be recommended to have repeat screening in a year because some abnormalities, especially more minor ones (ASC-US), will go away on their own as the immune system controls the HPV infection. If a woman has more severe cell changes (ASC-H or HSIL) and/or evidence of HPV16 or HPV18, she may be recommended to have a colposcopy, a procedure that involves the use of an instrument  (called a colposcope) to examine the cervix.

During a colposcopy, the provider inserts a speculum into the vagina to widen it and may apply a dilute vinegar solution to the cervix, which causes areas of HPV infection, inflammation, precancer, or other cell changes to turn white. The provider then uses the colposcope (which remains outside the body) to examine the cervix. When a provider performs colposcopy, he or she will usually remove cells or tissues from one or more concerning areas for examination under a microscope, a procedure called a biopsy.

Can an HPV infection come back after a negative test? 

Yes. Sometimes, after many years of negative HPV tests, an infection that the immune system had previously controlled can become active again, resulting in an HPV-positive test result. Such reactivation of an old, previously undetectable HPV infection can happen due to age-related changes in the immune system.

There is no way to tell whether a newly positive HPV result is a sign of a new infection or represents a reactivation of an old infection. It is also not yet known whether reactivated HPV infections can cause cell changes that lead to precancer and cancer.

Do women who have been vaccinated against HPV still need to be screened for cervical cancer?

Yes. Current HPV vaccines do not protect against all HPV types that cause cervical cancer, so it is important for vaccinated women to continue to undergo routine cervical cancer screening. 

Cervical Cancer Prevention

Key Points

• Avoiding risk factors and increasing protective factors may help prevent cancer.
• The following are risk factors for cervical cancer:
  • HPV infection
  • DES
• In women who are infected with HPV, other risk factors add to the increased risk of cervical cancer:
  • Giving birth to many children
  • Using oral contraceptives for a long time
  • Smoking cigarettes
• The following increase the risk of HPV infection:
  • Having a weakened immune system
  • Being sexually active at a young age or having many sexual partners
• The following protective factors decrease the risk of cervical cancer:
  • Avoiding sexual activity
  • Getting an HPV vaccine
  • Using barrier protection during sexual activity
• Cancer prevention clinical trials are used to study ways to prevent cancer.
• New ways to prevent cervical cancer are being studied in clinical trials.

Avoiding risk factors and increasing protective factors may help prevent cancer.

Avoiding cancer risk factors may help prevent certain cancers. Risk factors include smoking, being overweight, and not getting enough exercise. Increasing protective factors such as quitting smoking and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.

The following are risk factors for cervical cancer:

HPV infection

Cervical cancer is almost always caused by human papillomavirus (HPV) infection that is spread through sexual contact. There are more than 80 types of human papillomavirus and about 30 of these can infect the cervix. HPV types 16 and 18 are most often linked to cervical cancer.

Most of the time, the body’s immune system can fight the HPV infection before cancer forms. Only a very small number of women infected with HPV develop cervical cancer.

DES

Being exposed to a drug called diethylstilbestrol (DES) while in the mother’s womb increases the risk of cervical dysplasia and clear cell adenocarcinoma of the vagina and cervix. Between 1940 and 1971, DES was given to some pregnant women in the United States to prevent miscarriage (premature birth of a fetus that cannot survive) and premature labor.

In women who are infected with HPV, other risk factors add to the increased risk of cervical cancer:

Giving birth to many children

Among women who are infected with HPV, those who have had 7 or more full-term pregnancies have an increased risk of cervical cancer.

Using oral contraceptives for a long time

Among women who are infected with HPV, those who have used oral contraceptives (“the Pill”) for 5 to 9 years have a risk of cervical cancer that is 3 times greater than that of women who have never used oral contraceptives. The risk is 4 times greater after 10 or more years of use. In women who stop taking oral contraceptives, over a 10 year period, the risk of cervical cancer returns to that of women who never used oral contraceptives.

Smoking cigarettes

Among women who are infected with HPV, those who either smoke cigarettes or breathe in secondhand smoke have an increased risk of cervical cancer. The risk increases with the number of cigarettes smoked per day and how long the woman has smoked. Current and former smokers have 2 to 3 times the risk of cervical dysplasia and invasive cervical cancer.

The following increase the risk of HPV infection:

Having a weakened immune system

Having a weakened immune system caused by immunosuppression increases the risk of HPV infection and cervical cancer. Immunosuppression weakens the body’s ability to fight infection and other diseases.

Immunosuppression can be caused by these and other conditions:

• Human immunodeficiency virus (HIV). This virus causes AIDS and weakens the body’s immune system.
• Medicine given to prevent organ rejection after transplant. Women who have an organ transplant are given medicine to weaken the body’s immune system and help prevent organ rejection.

Women who are infected with the HIV virus or who take medicine to prevent organ rejection after transplant are less able to fight HPV infection and are at increased risk of cervical cancer.

Being sexually active at a young age or having many sexual partners

The risk of HPV infection is higher in women who become sexually active before age 18 and in women who have had 6 or more sexual partners.

The following protective factors decrease the risk of cervical cancer:

Note: Screening with the Pap test and the HPV DNA test reduces the number of new cases of cervical cancer.

Avoiding sexual activity

Nearly all cases of cervical cancer are caused by HPV infection, which is spread through sexual activity. Women who are not sexually active have almost no risk of cervical cancer.

Getting an HPV vaccine

Vaccines that protect against HPV infection greatly reduce the risk of cervical cancer. These vaccines do not protect women who are already infected with HPV.

Several HPV vaccines have been approved by the U.S. Food and Drug Administration (FDA). These vaccines have been shown to prevent infection with the types of HPV that cause most cervical cancers. Protection against HPV infection lasts for 6 to 8 years. It is not known if the protection lasts longer.

Harms of HPV vaccines include dizziness, feeling faint, headache, fever, and redness, tenderness, or warmth at the place of injection. Allergic reactions are rare. Getting the HPV vaccine while pregnant does not have a harmful effect on the pregnancy.

Using barrier protection during sexual activity

Some methods used to prevent sexually transmitted diseases (STDs) decrease the risk of HPV infection. The use of a barrier method of birth control, such as a condom or diaphragm, helps protect against HPV infection.

Drugs approved for Cervical Cancer

Drugs Approved to Prevent Cervical Cancer

• Cervarix (Recombinant HPV Bivalent Vaccine)
• Gardasil (Recombinant HPV Quadrivalent Vaccine)
• Gardasil 9 (Recombinant HPV Nonavalent Vaccine)
• Recombinant Human Papillomavirus (HPV) Bivalent Vaccine
• Recombinant Human Papillomavirus (HPV) Nonavalent Vaccine
• Recombinant Human Papillomavirus (HPV) Quadrivalent Vaccine

Drugs Approved to Treat Cervical Cancer

• Avastin (Bevacizumab)
• Bevacizumab
• Bleomycin Sulfate
• Hycamtin (Topotecan Hydrochloride)
• Keytruda (Pembrolizumab)
• Mvasi (Bevacizumab)
• Pembrolizumab
• Topotecan Hydrochloride

Drug Combinations Used in Cervical Cancer

• Gemcitabine-Cisplatin

The post Cervical Cancer appeared first on Medika Life.

What is a Loop Electrosurgical Excision Procedure?

LEEP stands for Loop Electrosurgical Excision Procedure. It’s a treatment to prevent cancer after precancerous cells are identified during cervical cancer screening. Precancerous cells are caused by HPV, the human papillomavirus.

80% of Americans will contract HPV, making it the most common sexually transmitted infection. HPV causes genital warts, and persistent strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives. 

80% of Americans will contract HPV, making it the most common sexually transmitted infection. Persistent HPV strains lead to cervical, vaginal, anal, throat, and neck cancer. Despite screening programs, 4,000 US women die from HPV related cervical cancer annually. A LEEP procedure saves lives.

A small wire loop is used to remove abnormal cells from your cervix. The thin wire loop is attached to an electrical current to cut away the top layer of cervical cells and remove the effects of HPV. 

HPV effects are detected during a routine paps smears, the first step in cervical cancer prevention. When someone has an abnormal pap smear, the next step is a diagnostic procedure called a colposcopy.

A colposcopy is an office procedure that allows your doctor to visualize the cervix more closely using a microscope. The colposcope identifies abnormal cervical tissue that cannot be seen with the naked eye. Areas of the cervix concerning for pre-cancer or cancer can then be biopsied (sampled) during the exam.

If the biopsy shows a precancerous lesion then, your healthcare provider may recommend a LEEP (loop electrosurgical excision procedure.)

Where is a LEEP Procedure performed?

A Loop electro excision procedure can be performed in a variety of settings. Most commonly, Obgyns perform this procedure in the office setting. 

The office, surgery center, or hospital are all reasonable and appropriate surgical settings.

Can my family visit me?

Most LEEP procedures are performed in a medical office setting. A trusted family member should drive you to and from the appointment. If the procedure is done in an hospital or Ambulatory Surgery Center, your family is welcome to stay with you before and after the procedure.

Does my procedure require an anesthetic?

Anesthesia is required for a LEEP procedure. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and the availability of office equipment. 

Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options. 

In the office setting, anesthesia is provided via a paracervical anesthetic. A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery. For a LEEP procedure, a medication called epinephrine is mixed with the anesthetic to reduce the risk of intraoperative bleeding.

Some gynecologists also recommend oral medication to reduce anxiety.

What’s the procedure when I check in?

Most surgeries will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

When a LEEP procedure is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

If a LEEP is scheduled in a hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. If an IV is required, it will be placed at this time. You will meet the nursing team who will provide care during your stay. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room??

For an office-based procedure, your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina. The cervix is cleaned to make the area sterile. 

A paracervical block anesthetic is then gently injected into the cervical tissue. The medication absorbs into the surrounding area to numb the nerves and make the procedure more comfortable. 

The surgeon selects the appropriate sized LEEP wire to match the size and appearance of your cervix. Because a low dose electrical current is used to do the cutting, a grounding pad is placed on the outside of your leg. The doctor will take extra precautions to ensure an adequate and safe view of the cervix. A grounding pad is placed on the outside of your leg.

Once all preoperative safety checks are confirmed, the surgeon will activate the electrical current to pass the wire across the top layer of the cervix. This action removes a small, pancake layer of cervical cells. This specimen is sent to a pathologist for analysis. 

The electrical current is then used to stop any bleeding through a process called cauterization. Often, a drying chemical called Monsel’s solution is painted onto the cervix to prevent bleeding later on. This chemical is messy and will cause a brown, coffee-ground vaginal discharge over the next few days. 

In the hospital setting, things function a little differently. 

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV if the procedure is being done outside of the office setting. 

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure as described above.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. Once complete, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room a series of safety steps must occur. This process takes about 20 minutes. 

A LEEP procedure takes approximately 10–15 minutes of surgical time. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments.

When can I go home?

After an office-based LEEP procedure, patients may go home after getting dressed as long as you are feeling normal. 

Hospital-based procedures under general anesthesia will follow a different process. 

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

LEEP procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

You should be able to resume all work and household activities the day after your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common. 

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time. 

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge. 

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons. 

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the next day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is no intercourse for 1–2 weeks. 

You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised. 

Your doctor will schedule a postoperative examination to evaluate your cervix 1–2 weeks after the procedure. The cervical specimen pathology report will be reviewed during this visit. 

A follow-up pap smear will be scheduled to confirm all of the abnormal cells have been successfully removed and do not come back. 

Danger Signals to look out for after the procedure

After a LEEP procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

What should I pack at home to take with?

Nothing special is required after a LEEP procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

The post Preparing for: Loop Electrosurgical Excision Procedure (LEEP) appeared first on Medika Life.

What is Laparoscopic Tubal Sterilization?

Are you done having kids and tired of taking birth control? When the family is complete, many couples look for permanent options so they never have to worry about a “surprise” pregnancy again. Permanent birth control allows couples to take control of family planning.

For men, vasectomy is a simple and quick office procedure to prevent sperm from mixing with semen. The procedure is typically done in an office setting or ambulatory surgical center.

Women may choose the option of laparoscopic tubal surgery. During this out-patient procedure, the fallopian tubes are tied, cut, or removed to prevent pregnancy. Tubal surgery blocks the pathway between the uterus and ovaries preventing sperm from reaching the egg.

Having your tubes tied does not affect your hormones or periods. Hormones come from the ovaries which are not affected by tubal surgeries. The fallopian tubes are located outside of the uterus so removing them does not change the timing, length, or heaviness of the menstrual cycle.

What are the risks of tubal surgery?

The most common problem with sterilization procedures is regret. Tubal surgery is considered to be permanent so it is important that you are 100% sure that you do not want to get pregnant again. Tubal reversal surgeries and in-vitro-fertilization are options for those who desire children after having a previous tubal sterilization procedure. For more information and to assist you in making an informed decision, we recommend watching this video.

All surgeries have risks. Any procedure requiring anesthesia may result in a bad reaction. During any surgery, organs in the surrounding area are at risk. Tubal surgery is an operation where a laparoscope is inserted in the abdominal cavity. Risks associated with tubal ligation include:

• Damage to the surrounding organs such as bowel, bladder or major blood vessels
• Bleeding
• Wound infection
• Failure of the procedure to prevent pregnancy
• Abdominal pain
• Deep venous thrombosis
• Pelvic adhesions

Can family visit me?

Laparoscopic tubal surgery is performed in a hospital or ambulatory surgery center. A trusted family member should drive you to and from the appointment. Your family is welcome to stay with you before and after this outpatient procedure.

Does my procedure require an anesthetic?

General anesthesia is required for any laparoscopic surgery. The surgeon may also inject an anesthetic into the incisions to decrease post-operative pain.

What’s the procedure when I check in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

Because laparoscopic tubal surgery is considered a permanent form of birth control, your doctor will ask questions to make sure you are certain you will not want children in the future.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

After arrival at the hospital or Ambulatory Surgery Center. The staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. An IV will be placed at this time.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and prep the abdomen for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The laparoscopic camera is positioned to show the pelvic anatomy. Small instruments are passed through one or two additional ports. This allows the surgeon to operate with both hands. The fallopian tubes are located and grasped with one instrument. Then, with the other hand the surgeon cuts, clamps, ties, or removes the tube from the adjacent anatomy.

Type of tubal surgery

• Occlusion techniques: Hulka spring, Filshie Clip, or Fallope ring
• Mid-segmental salpingectomy (Parkland tubal)
• Pomeroy or Modified Pomeroy technique
• Bipolar Cauterization
• Monopolar Cauterization
• Bilateral salpingectomy

Many surgeons recommend complete removal of the fallopian tubes (bilateral salpingectomy) as this technique reduces the risk of ovarian cancer.

Once the procedure is complete, a post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake you up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for laparoscopic tubal surgery varies. The surgeon’s experience, surgical technique, patient body type, and patient previous surgeries are all factors.

In general, 15–30 minutes of total operative time should be expected.

When can I go home?

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

Laparoscopic tubal procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

Most women should be able to return to normal daily activities within a few days. Most patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time. Many experience discomfort in the right shoulder due to air irritating the nerves of the diaphragm.

Mild uterine cramping is also common. Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins and tampons are safe to use.

What aftercare is required?

You should speak with your physician regarding the resumption of exercise and sexual activity. Most can return to normal activities in less than one week. Typically, the recommendation is no intercourse for 1–2 weeks.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure to evaluate the incision.

Danger Signals to look out for after the procedure

You should call your doctor if you experience heavy vaginal bleeding, fevers, severe nausea or vomiting, worsening abdominal pain, or the inability to pass gas.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home?

Laparoscopic procedures require very little postoperative care. Keep the incisions clean and dry. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet the day of surgery and begin light exercise the day after the procedure or when you feel ready.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

The post Preparing for: Laparoscopic Tubal Sterilization appeared first on Medika Life.

What is a hysteroscopic polypectomy?

Hysteroscopy is a simple procedure where a doctor uses a small camera called a hysteroscope to evaluate the inside of the uterine cavity. During a hysteroscopy, a surgeon can remove uterine fibroids (myomectomy) and polyps (polypectomy) without having to cut or remove any part of the uterus.

Endometrial polyps are small overgrowths of tissue hanging inside the cavity of the uterus. The vast majority are benign, but in rare, cases polyps can be cancerous.

Many women have endometrial polyps without having symptoms (asymptomatic). Others, have irregular menstrual bleeding and spotting.

A hysteroscopic polypectomy combines the visualization of hysteroscopy with a cutting device to remove the polyps. The polyps are removed without having to make any incisions on your body.

Your cervix will be slightly dilated to allow the introduction of the camera into the uterus. The gynecologist confirms proper placement and evaluates the polyp to identify its attachment to the uterus. A resection instrument is chosen and placed down the operative channel to allow surgical removal.

How long will I be in hospital?

Hysteroscopic polypectomies are outpatient procedures. You may go home after the surgery is complete.

Can family visit me?

Some hysteroscopic procedures can be performed in a medical office setting. A trusted family member should drive you to and from the appointment. 

Most hysteroscopic procedures are performed in a hospital or Ambulatory Surgery Center. A trusted family member should drive you to and from the appointment. Your family is welcome to stay with you before and after this outpatient procedure

Does my procedure require an anesthetic?

Anesthesia is required for a hysteroscopic polypectomy procedure. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and office equipment availability.

Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options.

What’s the procedure when I check in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

If the procedure is being performed in an office setting, the process may feel like a normal office visit.

Most hysteroscopic myomectomies are performed in a hospital or Ambulatory Surgery Center.

The staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. An IV will be placed at this time. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute question.

What happens in the operating theater?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV if the procedure is being done outside of the office setting.

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in theater?

Multiple medical device technologies can be used to perform hysteroscopic polypectomy. Gynecologic surgeons typically have a personal preference or comfort level with one or more of the various options. Each medical device works by combining the visualization of hysteroscopy with a cutting device to remove the fibroids. 

The most common technologies include hysteroscopic scissors, lasso, graspers or a resecting device such as Myosure, Symphion, and True Clear. While each system functions differently, each subscribes to the same basic concept: polyp resection under visual surveillance. 

Your cervix will be slightly dilated to allow the introduction of the camera into the uterus. The gynecologist confirms proper placement and evaluates the polyp to identify its attachment to the uterus. A resection instrument is chosen and placed down the operative channel. A small cutting instrument slides down the operative channel to allow surgical removal.

The polyp is cut into small pieces and removed. The procedure is complete once we have restored a normal-appearing uterine cavity. 

When the treatment is complete, the devices are safely removed.

How long will I be in theater?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for a hysteroscopic polypectomy varies. Small, soft polyps may take only a few minutes. Large, dense, or hard to reach polyps may take longer. 

In general, 30 minutes of operative time should be expected.

When can I go home?

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

Hysteroscopic polypectomy procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

Most women should be able to return to normal daily activities the next day. You should speak with your physician about the resumption of sexual activity. You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

The short term effects on menstrual bleeding vary. Some may see immediate improvement. Others will continue to see menstrual cycle lightening for a few weeks as fibroid fragments and endometrial tissue are expelled. 

You should be able to resume all work and household activities the day after your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time.

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.

You will be instructed to abide by pelvic rest for approximately one week. This includes no douching, no sex, and no tampons.

You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the next day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is no intercourse for 1–2 weeks.

You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure. The fibroid specimen pathology report will be reviewed during this visit.

Danger Signals to look out for after the procedure

After a hysteroscopic polypectomy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

DANGER SIGNALS TO BE AWARE OF POST PROCEDURE

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home??

Hysteroscopic procedures require very little postoperative care. Vaginal discharge and spotting are expected. One should have a supply of sanitary pads available. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet and exercise the day after the procedure.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

The post Preparing for: Hysteroscopic Polypectomy appeared first on Medika Life.

Endometrial Ablation explained

A heavy period (Menorrhagia) is a common gynecological problem affecting one in twenty women. Menorrhagia is frequently treated by hysterectomy, but many women can benefit from uterine-sparing minimally invasive approaches.

Endometrial ablation is a minimally invasive treatment designed to minimize, or in some cases, eliminate menstrual bleeding. Endometrial Ablation is an alternative treatment option for premenopausal women suffering from menorrhagia, for whom childbearing is complete.

Endometrial ablation is a short, outpatient surgical procedure to treat abnormal uterine bleeding without the need for incisions. The procedure destroys the endometrial lining, the tissue responsible for menstrual bleeding. This low-risk option has a 95% patient satisfaction rate and requires minimal patient downtime.

After the procedure, patients may never bleed again. If they do, their bleeding is generally reduced. In approximately half of the women that have the ablation they no longer experience menstrual cycles. Of the 50% that do continue to have a cycle, most have little bleeding and are satisfied with their results. The overall satisfaction rate is approximately 95%.

As not all patients experience a satisfactory reduction in bleeding, all treatment options should be discussed with your doctor.

Candidates for endometrial ablation include those who:

1. Have periods lasting longer than seven days
2. Use more than 3 pads or tampons per day
3. Pass clots during menstrual cycles
4. Period bleeding affects your work, social, athletic, or sexual activities
5. Medical management has failed to control heavy bleeding
6. Anemia due to heavy periods
7. Wish to reduce menstrual bleeding without major surgery

Where is the procedure performed?

Endometrial ablation can be performed in a variety of settings. Many Obgyns perform this procedure in the office setting using oral sedation medication and a paracervical anesthetic. A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery.

Other gynecologic surgeons perform this outpatient procedure in an ambulatory surgery center or a hospital setting.

The office, surgery center, or hospital are all reasonable and appropriate surgical settings.

How does the procedure work?

Multiple technologies can be used to perform an endometrial ablation. Gynecologic surgeons typically have a personal preference or comfort level with one or more of the various options. Each medical device works by destroying the endometrial lining.

The most common technologies include Novasure, Genesys HTA, and Minerva. While each system functions differently, each subscribes to the same basic concept. Heat is employed to destroy the endometrial lining of the uterus to eliminate or reduce bleeding to normal levels.

Her Option is the exception to the rule. This device uses freezing technology called cryoablation. Cryoablation utilizes cold temperature to affect the uterine lining.

First, your cervix will be slightly dilated to allow the introduction of the device through the cervix and into the uterus. Once the gynecologist confirms proper placement the ablation is performed. Novasure and Minera typically last 60-90 seconds. Genesys HTA is a ten-minute procedure. Her Option takes up to 20 minutes.

When the treatment is complete, the devices are safely removed. The uterine lining has been treated and will slough off similar to a menstrual period over the next few weeks.

Does my procedure require an anesthetic?

Anesthesia is required for endometrial ablation. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and the endometrial ablation technology. Oral sedation, paracervical block, IV sedation, and general anesthesia are all potential anesthetic options.

If general anesthesia is required, instructions will be given to avoid any food or liquid intake starting the night before surgery.

What’s the procedure when I check in?

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

Most surgeries will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed. The surgical consent form is reviewed, signed, or updated with any changes.

After arrival for the procedure, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. If an IV is required, it will be placed at this time. You will meet the nursing team who will provide care during your stay. The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV.

The OR nursing team will cover your body with sterile drapes after cleaning the surgical site for sterility. The team then performs a “surgical time-out.” A surgical safety check list is read out loud requiring all surgical team members to be present and attentive. The surgeon then performs the surgical procedure.

Once the procedure is complete. A post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. Once complete, the anesthesiologist will begin to assist the patient in waking up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room a series of safety steps must occur. This process takes about 20 minutes. Endometrial ablation procedures can take between 2-20 minutes of operative time depending on which ablation technology is used.

When can I go home?

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding. The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

Endometrial ablation procedures require a minimal amount of post operative recovery. Patients are often discharged as early as 30-60 minutes after the procedure.

What is the usual recovery time

After the procedure, you may experience some cramping that should be controlled with minimal pain medication. Most patients will probably have a pink or yellow watery discharge for a few weeks after your treatment. Many patients may return to work the following day.

What aftercare is required?

Most women should be able to return to normal daily activities the next day. You should speak with your physician about the resumption of sexual activity. You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection.

The short term effects on menstrual bleeding vary. Some may see immediate improvement. Others will continue to see menstrual cycle lightening for a few months. Optimal improvement typically occurs in the first six months.

Danger Signals to look out for after the procedure

After Endometrial ablation, if you experience two days of heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

What preparations should I make for aftercare at home?

Endometrial ablation requires very little postoperative care. Vaginal discharge and spotting is expected. One should have a supply of sanitary pads available. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet and exercise the day after the procedure.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

The post Preparing for: Endometrial Ablation appeared first on Medika Life.

“Don’t make me laugh, cough, or sneeze.” For the one in four women over forty who suffer from stress urinary incontinence (SUI), one funny joke can lead to an embarrassing moment.

Stress urinary incontinence is the temporary loss of bladder control. SUI is triggered when bladder pressure overcomes the surrounding muscles designed to keep urine contained. Exercising, laughing, sneezing, or lifting heavy objects increases bladder pressure and can lead to accidents.

Stress urinary incontinence may be common, but it is never normal. No one has to live with bladder leaking.

Lifestyle changes improve symptoms. Overweight women often notice an improvement after weight loss. Reducing the intake of inflammatory chemicals like caffeine also helps. Eliminating smoking can decrease the number of times you leak.

Nonsurgical options such as pelvic muscle exercises and physical therapy can play a roll in the treatment of stress incontinence. Some women benefit from local injections of Botox or bulking agents like Collagen.

A minimally invasive surgical repair called a mid-urethral sling is an effective treatment to stop the leak,

Getting prepared for surgery can be scary. Learning about an upcoming procedure alleviates fear and anxiety. Let’s talk about a mid-urethral sling procedure and answer questions about how long it will last, what’s involved, what to expect, and even advice on packing your bag. While your surgeon preps, we’ll make sure you’re ready.

What is a Mid-urethral Sling?

A mid-urethral sling is the most common type of surgery used to correct SUI. A small, supportive material of synthetic mesh is placed under the bladder neck and then anchored to the other pelvic tissues creating a “hammock-like support” to prevent leakage.

The goal is to restore the natural support system for the bladder. These procedures are performed from a vaginal approach to minimizes incisions, pain, and recovery time. Mid-urethral slings are performed as outpatient surgery.

Where is a mid-urethral sling performed?

A mid-urethral sling can be performed in various settings, but most commonly, Obgyns performs this procedure in an Ambulatory Surgery center or hospital. Some Obgyns will do these surgeries in the office.

Choosing the appropriate surgical setting depends on a few different factors, including the physician’s experience, the availability of equipment impact the decision, and the extent of pelvic organ prolapse.

How long will I be in the hospital?

A mid-urethral sling is an outpatient procedure. Patients may go home after the surgery is complete. An overnight stay is not needed unless we are combining it with other gynecological surgeries.

Can my family visit me?

Most incontinence procedures are performed in a hospital or Ambulatory Surgery Center. A trusted family member should drive you to and from the appointment. Your family is welcome to stay with you before and after this outpatient procedure.

Does my procedure require an anesthetic?

Anesthesia is required for a mid-urethral sling procedure. The type of anesthesia will vary depending on the surgical setting, the surgeon’s experience, and office equipment availability.

Oral sedation, IV sedation, and general anesthesia are all potential anesthetic options. General anesthesia is the most common anesthetic choice for this type of surgery.

What’s the procedure when I check-in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

The staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. An IV will be placed at this time.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV.

The OR nursing team will cover your body with sterile drapes and prep the vagina for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read out loud requiring all surgical team members to be present and attentive.

The surgeon then performs the surgical procedure.

Once the procedure is complete, a post-procedure review is done together as a surgical team. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake you up for transfer to the recovery room.

How does the procedure work?

Multiple medical device technologies can be used to perform mid-urethral sling surgeries. Urologists, urogynecologist, and gynecologic surgeons typically have a personal preference or comfort level with one or more of the various options.

Each medical device works similarly by providing support to the urethral to reduce the risk of stress incontinence. The entry point and attachment sites vary between different technologies.

The surgeon identifies the urethra and makes a small incision. The bladder is pushed away from the vaginal tissue to create a space. The synthetic mesh is placed under the bladder neck. The mesh is attached to the surrounding pelvic tissues to create support and prevent leakage.

The incisions are closed with sutures. Many surgeons examine the inside of the bladder with a camera to confirm no injuries occurred. This is called a cystoscopy.

Once the surgeon confirms, the bleeding is under control and the bladder is intact, then the procedure is complete.

What are the risks of a mid-urethral sling procedure?

The following risks are associated with any type of surgery for SUI:

• Injury to the bladder, bowel, blood vessels, or nerves
• Bleeding
• Infection of the urinary tract or wound infections
• Urinary retention (difficulty urinating or urgency symptoms)
• Problems related to the anesthesia

Synthetic mesh has a small risk of vaginal erosions when the mesh will erode through the vaginal tissue. Vaginal erosions are more common in patients with diabetes, obesity, and smokers. Additional surgery may be required to repair mesh erosion.

How long will I be in surgery?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for incontinence surgery varies if other gynecologic or urologic procedures are required.

In general, 30–60 minutes of total operative time should be expected.

When can I go home?

Postoperative recovery time will vary from person to person. Each patient must meet certain discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

Mid-urethral sling procedures require a minimal amount of postoperative recovery. Patients are often discharged as early as 30–60 minutes after the procedure.

What is the usual recovery time

Most women should be able to return to normal daily activities within a few days. Patients will need to avoid heavy lifting or sexual activity until cleared by the doctor. Typically, the recommendation is no intercourse for 4–6 weeks

Some patients may notice difficulty starting the urine stream when trying to void. The tissue surrounding the urethra swells after surgery. This issue typically resolves quickly as the swelling subsides.

In rare cases, if a woman is not able to void, the stitches or the sling may need to be adjusted or removed.

Vaginal soreness and a small amount of bleeding are expected.

Some patients will require mild pain medication like NSAIDs or even low dose narcotics for a brief period of time.

It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.

What aftercare is required?

Most women should be able to return to normal daily activities and work within a few days.

After surgery, discomfort may last for a few days or weeks. During this time, avoid anything that puts stress on the surgical area, such as the following activities:

• Excessive straining
• Strenuous exercise
• Heavy lifting
• Sexual activity

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure.

Danger Signals to look out for after the procedure

After a mid-urethral sling procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Inability to void (urinate)
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home?

Incontinence procedures require very little postoperative care. Vaginal discharge and spotting are expected. One should have a supply of sanitary pads available. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet and exercise the day after the procedure.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

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