Dr. Deepa Ganesh

When endometrial tissue goes out of the uterus in women, then endometriosis occurs. In most of the cases, lower tummy and pelvic areas of women show the prominent symptoms of this disease.  Symptoms of this disease can either be severe or mild, but immediate medical diagnosis is required so that unwanted symptoms can be effectively prevented.

Surgery, hormone treatment and painkillers are the most prominent treatments that can deal with the concerned trouble, but you can also follow a few natural therapies in this respect. Excessive intake of contraceptive pills can be one of the leading reasons for endometriosis, but you can also inherit this from your family or ancestors. 

List of the symptoms of Endometriosis:

1. Painful periods: If pain continues throughout the periods, then you get yourself checked as you may have developed endometriosis. These pains can even be quite severe making the situation troublesome to bear. If you find that you are facing unusual menstrual pain, then you should not delay and rather immediately consult your nearest gynaecologist. 
2. Bleeding periods: Sometimes, bleeding periods can be one of the clear symptoms that can help you to recognize the arrival of endometriosis. Therefore, if you notice excessive bleeding, then you should consult any specialized doctor immediately. 
3. Pregnancy difficulty: Reduced fertility might create a greater trouble for conceiving, and thus, you might get deprived bearing children. This is one of the most prominent or highlighting symptoms of endometriosis. Endometriosis clumps interrupt egg passage as a result, of which the eggs cannot reach the fallopian tube via ovary.  You can take the help of your gynaecologist so that the clumps can be reduced with the help of proper treatments. 
4. Pelvic area and abdomen pain: You will often experience a worse kind of pain, especially in the pelvic and abdomen areas during and before periods. Sometimes, the pain might even linger after the menstrual period is over. There are many women who take medications for reducing this kind of pain, but this is not the right procedure, rather proper treatment is needed for getting complete recovery on a permanent note. 
5. Painful sex: You will face a lot of troubles while making intercourse or sexual interaction with your partner, and this pain can be even severe at times. If you are facing painful sex for a long time, then you should immediately report the same to any experienced medical professional.

From a medical standpoint, intercourse during menstruation is completely fine. Most men have claimed that period sex seems messier when compared to intercourse on normal days but, other than that, there aren’t any risk regarding period sex. In fact, it is advisable to engage in vaginal intercourse during periods for a variety of reasons.

Here are a few things you should know about period sex:

1. Intercourse during periods isn’t harmful: Contrary to the popular myth, period blood doesn’t contain impurities which might affect the penis in any way. Instead, menstrual blood is normal blood mixed with disposed off tissues from the lining of the uterus and the penis isn’t affected by menstrual blood in any way. The menstrual blood serves as excellent lubricant to make the process of intercourse smoother.
2. Chances of pregnancy still persist: It is not okay to completely ward off protective measures during periods because even though it is safer than other days, there might be a small chance that the sperm of a man lives on in the female body till early ovulation. Besides, the chance of getting a sexually transmitted disease is the same during period sex.
3. Can relieve cramps: Some women claim that having sex during their period helps ease their cramps as having an orgasm releases ‘pain- reducing endorphins’ into the bloodstream. Also, some medical practitioners believe that sex provides relief by using up chemicals which are responsible for cramps. Thus, having period sex can prove to be relaxing and less painful than normal days.
4. Sexual arousal ups during menstruation: Most women feel hornier and more aroused during periods because of the increase in the hormonal levels. Some women feel heavier in the pelvic area which increases the sex drive; precisely the reason why having sex during this time is a good idea. So, for all you know, you might actually have a brilliant intercourse session when she’s on her period. If you wish to discuss about any specific problem, you can consult a gynaecologist.

The perineum is the area between the vagina and the anus. This fragile area plays a significant role in the female reproductive system. This is often intentionally or accidentally torn open to allow for the normal delivery of the baby. This needs to be repaired meticulously to ensure that the pelvic floor is safeguarded from further damage.

The pelvic floor contains multiple muscles and supporting tissues which help in keeping the vagina, rectum, uterus and supporting structures in their places. When these muscles become weak due to childbirth, ageing, perineal injury etc, the uterus, bladder and rectum loosen up and prolapse down.The most common problem that is encountered is urine and fecal incontinence, where the woman has difficulty holding urine and feces. Though not often discussed openly given the private nature of the topic, many women suffer from a weak pelvic floor. Read on to know some of the common causes, symptoms, and management measures.

Causes:

1. Chronic cough: The next time you cough for prolonged periods, notice how much pressure it puts on the pelvic area. This goes unnoticed, but chronic cough can weaken the pelvic floor muscles. It is not common for women to lose some urine during these long-drawn coughing spells.
2. Chronic constipation: The pressure exerted during constipation weakens the pelvic floor, often leading to incontinence.
3. Pregnancy and delivery: Most common cause of perineal injury, where the perineum is torn (accidentally or intentionally) to allow for easy passage of the baby. If it is not repaired meticulously, the pelvic floor is weakened.

Symptoms:

Urinary incontinence is the most common symptom that women present to doctors with. However, there are minor symptoms which a woman would experience prior to reaching this stage. Most often, these are ignored, and only brought to doctor’s notice when symptoms become quite severe. If left unattended, there could be more severe repercussions too.

1. A heavy feeling in the pelvic area, commonly referring to as a bearing down sensation, a feeling that the internal organs are going to pop out through the vagina
2. A small lump that can be felt and/or seen at the vaginal opening
3. Feeling of incomplete emptying of the bladder and/or bowel
4. Constipation
5. Pain or bleeding from the vagina or the rectum
6. Recurrent pelvic and/or urinary tract infections

Management:

1. Kegel exercises are often used to strengthen the pelvic floor. This is very effective if the problem is identified quite early.
2. In more progressive cases, surgical repair is the most effective option. This not only corrects the prolapses but also helps boost confidence of the person, by correcting the incontinence problems and improving sexual experiences. If you wish to discuss about any specific problem, you can consult a gynaecologist.

Vaginal rejuvenation is a surgical procedure or technique where the inner and outer muscles and structures around the vagina are surgically tightened. Remember that the vagina and surrounding tissues are composed of muscles and elastic tissue. With age and the process of childbirth, these go through a lot of changes. This could lead to changes in the way a woman experiences sex and improve her urinary function. All of this can affect overall health, both physically and emotionally.

Vaginal rejuvenation as a surgery helps to restore muscle tone, improve control and strength. It not just increases sexual pleasure, but can also relieve urinary incontinence.
Ideal candidates: Now, there are specific women who would benefit from this. They are:

• Women who desire a more youthful appearance and improved functioning of the vulva and vaginal areas.
• Women with weakened muscle tone and strength. This could be result of aging, trauma, genetics, or childbirth. In these women, the vaginal tissues are stretched and therefore have less tone and strength and poor control. The sexual experience may be less than satisfactory because of the laxity of these tissues.

Options: Rejuvenation of the vagina can begin with a nonsurgical option and progress to gradually invasive modes.

• The first option would be the Kegel exercise. This involves conscious effort on the woman to hold her breath and consciously control the pelvic floor muscle contractions. This can be done anywhere and often yields wonderful results.
• The second option is the laser wherein a beam of fractional laser light is used to heat the vaginal tissues to about 60 to 70 degrees Celsius. This increased heat causes neocollagenesis, which is the production of new collagen that is firmer and more elastic. The result is growth of a thicker, more youthful vaginal lining.
• The next option would be surgical where the vaginal tissues are surgically manipulated to remove excess, redundant tissue, or shaped to improve cosmetic appearance. This is often required if the pelvic floor muscles have separated. These exercises need to be followed up with Kegel for long-lasting results.

Results:

1. Increases friction during sexual intercourse
2. Improves control over vaginal tissues and muscles
3. Improves sexual satisfaction
4. Improves cosmetic appearance of the vaginal area
5. Reduces internal and external vaginal diameters
6. Strengthens the pelvic floor, and can also help relieve urinary incontinence

What to expect?

1. This procedure may not be covered by insurance
2. Get yourself in safe hands and be clear on what to expect. Expectation mismatch can be a big disappointment post-surgery, and there is nothing much that can be done about that aspect. If you wish to discuss about any specific problem, you can consult a gynaecologist.

Adenomyosis is a condition which occurs when the muscle wall of the uterus is broken by the endometrium lining. You experience pressure in the lower abdomen, menstrual cramps and bloating, before the onset of menstrual periods, resulting in heavy bleeding during the periods. This disorder is not life threatening but is known to cause pain and heavy bleeding.

Symptoms-

The symptoms of adenomyosis are severe pain during periods, prolonged periods and pressure in the abdominal area. You may also experience heavy bleeding during the periods and may also experience intense pain. Sex may be very painful as well. The lower abdomen might feel tender and bigger; this occurs when the size of the uterus increases in this particular condition.

Causes-

The exact cause of this disorder is not yet ascertained. However, certain possible causes could be:

1. Congenital Defect: In this case, the condition is known to occur from birth wherein the endometrial tissue grows on the uterine muscle wall during the fetus formation.
2. Invasive Growth of Tissues: This is said to occur when endometrial cells invade the uterus lining, leading to adenomyosis. This can also be triggered by a C-section operation.
3. Inflammation During Childbirth: During the childbirth process, inflammation may occur in the lining of the uterus leading to this disorder.

In addition to the possible cause, there are certain risk factors which increase the risks of the disorder, such as:

1. Aging

2. Giving birth to a child

3. Surgery related to the uterus such as a C-section

Treatment-

Once you reach menopause, this disorder tends to subside. So depending on how close you are to menopause, the treatment is designed accordingly. The various treatments for adenomyosis are –

1. Anti-inflammatory Medications: If you are nearing menopause, then anti-inflammatory medications will be administered. This helps in reducing pain and the heavy blood flow.

2. Hormone Medications: Hormone medications such as hormone patches can also help with the bleeding and pain.

3. Hysterectomy: If the pain turns intense, then the doctor may recommend hysterectomy, a surgery to remove the uterus. If you wish to discuss about any specific problem, you can consult a gynaecologist.

Genital warts refer to small (sometimes invisible), cauliflower shaped bumps, which form around the genital region and severely affect the moist tissues around the concerned region. Genital warts are more common in sexually active people and are one of the most commonly transmitted sexual diseases. The virus responsible for the disease, Human Papillomavirus can also cause other serious disorders such as genital cancers.

Genital warts can occur in both the genders. The virus generally spreads through sexual intercourse. In men, warts appear around the scrotum, the tip of the penis or the anus. In women, warts might form around the vaginal walls, the cervix or around the anal canal. If you had any form of oral contact with the genitals of an already infected person, genital warts can form around your throat or mouth.

The symptoms of genital warts are as follows:
1. Severe itchy sensation and discomfort around the genital areas.
2. Bleeding during sexual intercourse
3. Formation of numerous small, grey bumps around the genital region
Genital warts are caused by genital HPV’s, which are transmitted, primarily through sexual contact. In most of the cases, the immune system is able to combat the virus and makes you less susceptible to this disorder.

However, you might be at an increased risk of developing genital warts because of the following reasons:

The treatment for genital warts depends on the severity of the condition. If the warts are causing significant pain and discomfort for you, your doctor might opt for one of the following procedures to get rid of the same:
1. Application of Imiquimod creams around the affected area might help treat the condition.
2. A regulated application of ‘Trichloroacetic’ acid on the affected areas might help to burn off the genital warts.
3. Application of a solution of ‘Podophyllin’ on the affected areas might help destroying the soft tissues around the genital areas.
4. If your warts are significantly large in size or do not respond well to medications, you can also opt for surgical excision or laser therapies to get rid of them. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

The fallopian tubes are not mere passages for the egg to travel from the ovaries to the uterus. It is here that conception occurs and hence healthy fallopian tubes are essential for the fertilization of an egg. 

Damaged fallopian tubes are the most common cause of infertility. This damage can fall under three categories. 

1. Blocked fallopian tubes
2. One blocked and one open fallopian tube
3. Tubal scarring

The third is usually an effect of pelvic infections or natural healing after a pelvic surgery. Sadly, in most cases, this condition is discovered only after infertility has been diagnosed. Other causes of fallopian tubal scarring include:

1. STDs such as chlamydia trachomatis and neisseria gonorrhea
2. Adhesions caused by ruptured ovarian cysts
3. Appendicitis
4. Peritonitis
5. A history of ectopic pregnancies

Fallopian tubal scarring has no recognizable symptoms. Chronic pelvic pain is the only known symptom of this damage and that too can be seen only in severe cases of tubal scarring. On diagnosing infertility, your doctor will perform one of these tests to determine the condition of your fallopian tubes.

1. Hysterosalpingogram: This is a type of X-ray. Your doctor will open the vagina with a speculum and inject a liquid into the uterus with the help of a catheter. If the liquid does not pass through the fallopian tubes, it is said to be blocked. This however, does not say much about tubal scarring.
2. Laparoscopy: A small incision is made below the belly button and a slim, flexible tube with a camera is passed through the incision. This gives your doctor a clear view of the condition of your fallopian tubes. A laparoscopy can also be used to rule out other causes of infertility such as endometriosis or blocked fallopian tubes. 

Treatment for infertility caused by tubal scarring is of two types:

1. Surgery: This is suggested in cases where tubal scarring is minimal. Depending on the intensity and placement of scar tissue, your doctor may decide to perform one of many types of surgeries. He may choose to remove the scarred section of the fallopian tube, create a new opening (in case of blockages) or rebuild the damaged edges of the fallopian tubes.
2. In Vitro Fertilization(IVF): Women with badly scarred fallopian tubes usually have poor chances of conceiving naturally. Hence, IVF is the preferred treatment route. However, your doctor may still advise you to undergo surgery and remove the damaged tubes prior to IVF to prevent the tubes from filling with fluid.

A woman is an extraordinary and beautiful creation of nature, and it is natural that she would want to see herself as perfect and complete. And, staying sexually attractive is one of the major factors that motivate a woman to seek the benefits of Cosmetic Gynaecology. Cosmetic Gynaecology or Intimate Aesthetic Surgery covers procedures which alter the appearance of female external genitalia and make it seem more natural and youthful. These methods, aid in correcting congenital defects, enhances the self Confidence of a woman, and positively affects the intimacy she shares with her partner.

With age and life events like childbirth, the vagina and labia often change in appearance and structure, which not only hampers the feeling of self-worth in a woman, but also prevents her from enjoying sexual activities completely and Cosmetic Gynaecology emerges as the savior in such situations.

Here are some procedures, which are here to help the fairer sex rediscover the beauty of their body:

1. Vaginal Rejuvenation: With the help of laser technique, this process helps in tightening the internal diameter of the vagina, when it gets stretched during birth or owing to genetic factors.
2. Labiaplasty: Through this method, the contours of the labia majora or labia minora are changed. It may cover reconstruction, augmentation or reduction.
3. Hymenoplasty: It is done to create a pseudo hymenal membrane from hymenal tissue, which already exists or non*hymenal soft tissue. The intention is to cause bleeding when the membrane tears during intercourse.
4. Clitoroplasty: This procedure deals with the surgical transformation of the clitoris, which caters to conditions involving increased tissue volume. It can also aid in creating clitoris in transgender women.
5. Clitoral Hood Reduction: The method is focused on the loose skin around the clitoris, and can be conducted during labiaplasty or as a separate procedure.
6. Monsplasty: The contours of the Mons pubis can be changed through this process. It involves liposuction for the reduction of excess fat, subcutaneous fat, as well as skin. Often, techniques like laser and ultrasound are used during monsplasty.
7. Perineoplasty: Repairing and restoration of the loose, ageing or injured perineum is taken care of through this method. Perineum is the area between the vagina opening and the rectum. And this procedure is usually helpful for women who don't heal efficiently after a vaginal delivery or experience scars.

So if you are worried about the structure or appearance of your intimate area, don't fret.

It is very common for women to experience vaginal problems due to the menstrual cycle, birth control methods, sex or aging. Vaginal odor may change according to your sexual health. Sometimes, it is wrongly interpreted as infection or any other problem but it is a naturally existing odor which can also be caused by normal sweating. Nevertheless, an unpleasant vaginal odor can also be indicative of infection, irritation or an overgrowth of vaginal bacteria. Four common reasons of vaginal odor are:

1. Bacterial vaginosis
Bacterial vaginosis (BV) is an overgrowth of naturally existing bacteria in the vagina which can occur due to unprotected sex, douching or low production of lactobacilli bacteria. This can cause irritation, itching and makes women more vulnerable to sexually transmitted infection and other complications like preterm birth. Bacterial vaginosis is a very common occurrence for women in their reproductive years and is the primary reason for the vaginal odor in most cases.

2. Poor hygiene
Poor hygiene can be one of the major causes of vaginal odor. In terms of hygiene two common reasons which can cause unpleasant odor are the lack of proper washing and not wearing clean undergarments. Due to the presence of sweat around the genitalia and poor maintenance of hygiene, women often experience bad odor.

3. Forgotten tampon
A forgotten tampon can cause bacterial infection and lead to vaginal odor. The growth of bacteria along with menstrual blood can cause itching and lead to unpleasant smelling vaginal discharge. Sometimes, the infection can spread and cause serious problems like pain in the lower abdomen.

4. Trichomoniasis
Trichomoniasis is a sexually transmitted disease which is caused by a protozoan parasite. It can cause a foul smelling odor, soreness, pain while urination and intercourse and also vaginal itching. Pregnant women suffering from this disease are more at risk to deliver premature babies. It can be treated with antibiotics and can be prevented with proper use of condoms.