Dr. Vaishali Sharma M D ( A.I.I.M.S)

Vaginal Vault Prolapse is a condition where the upper portion of vagina may lose its normal shape and drop or sag down into the vaginal canal or maybe even outside the vagina. This may occur after a hysterectomy or even simultaneously with uterine prolapse. 

The treatment of vaginal vault prolapse varies with the severity and extremity of your symptoms. Your health care provider may suggest medications and physical therapy to treat your condition if you feel that the prolapse is not bothersome. However, you might have to undergo surgery later if your symptoms worsen and the prolapse affects your quality of life and hinders functional ability.  You must keep in mind that usually more than one area is affected by weakness in your pelvic floor. 

The symptoms of Vaginal Vault Prolapse include - backache, pelvic heaviness, bulging mass into or sometimes outside your vagina that hinders normal activities such as walking and sitting, vaginal bleeding and releasing urine involuntarily. 

Treatments:

1.  Medication
Most of the women with this condition usually go through menopause around the same time. Since the estrogen levels are severely lowered during menopause, it causes vaginal dryness. Discussing about estrogen therapy with your health care provider is a must if you wish to remedy your vaginal dryness. Not every woman should take estrogen so it is imperative to talk to a medical expert first. Usually women are treated with estrogens before they go into surgery.

2.  Physical Therapy

Most health care experts recommend pelvic floor exercises as physical therapy using biofeedback so as to strengthen the specific muscles of your pelvic floor. Biofeedback is the usage of monitoring devices that contain sensors and are placed either in your rectum, vagina or on your skin. Biofeedback is very important because it tells you the strength of each muscle you are squeezing i.e. contractions, and if you are squeezing the right muscles in order to perform the exercise correctly. Long term usage of biofeedback in physical therapy leads to strengthening of your muscles and a reduction in your symptoms. 

3. Surgery

Corrective surgery may be performed on you by the surgeon either through the abdomen or vagina. If the surgeon is performing the corrective surgery through the vagina, he will use the ligaments which support the uterus to solve the problem.          
 

To stay in shape, you are required to follow a fitness plan that’s different from men. And, to lose a lot of pounds one must go for running, cycling and any other cardio exercises. But there comes the point when the weight loss suddenly comes to a halt showing no results whatsoever and the woman who never missed her fitness classes is now losing interest in the ongoing fitness regime. In all such instances, you should visit a gynecologist, to get yourself checked for any hormonal imbalances. Medicines along with strength training will prove to be a miracle in otherwise nonresponding cases. Strength training is the best way to ensure that fitness remains at beck and call and a 4-week fitness program is what all women must try in order to have a solid foundation of strength and maintain fitness throughout. 

The 1st week
If a woman is not accustomed to the weight training exercises, it is natural to be overwhelmed by the idea. But weight training is not as difficult as it may appear to be. One shall have to complete each workout like the straight sets. For instance, it is recommended to do a set of leg presses, then proceed on to the next set of the workout. All the workouts must be completed in this manner with 12 repetitions for 3 sets and a rest of 30 seconds in between. The fitness experts suggest selecting a weight load where the final two repetitions of the set are harder to perform and don’t let the woman do a 13th repetition. One can also increase the load of weight for each set while sticking to 12 repetitions for all the three sets. 

The 2nd week 
One shall continue with the straight set format for all the workouts in the 2nd week as well. But the 12 repetitions must be increased to 15 with 15 seconds of rest in between. This means that the 2nd week of the fitness regime allows the woman to complete more movements in less time. The fitness training is a wonderful stimulus of taking the exercise regime to the next level. 

The 3rd week
The 3rd week is the juncture of the fitness regime and is extremely crucial for a thorough weight loss. In place of the straight sets, one would have to perform the circuit sets. One shall have to complete a set of each movement in 15 repetitions and then instantly move to the next movement without any rest in between. For instance, if someone is performing leg presses, then it has to be done for 15 reps and then move to the following movement such as goblet squat with no rest. After the completion of all the movements, the circuit has to be performed twice. 

The final week 
The circuit set style would remain unchanged in this week, and the woman shall only have to perform 12 repetitions of each movement. But it gets harder in this week as in it is recommended to do 4 complete circuits without any rest in between. This week must be dedicated to keeping oneself moving, and once a movement is finished, one shall have to instantly return to the first movement to begin a new circuit.

The natural process of childbirth and/or aging can result in damage to the vaginal walls and muscles; all around the vaginal, urethral and rectal tubes-Similarly vaginal and pelvic tissue is also affected due to aging process and incontinence is a normal part of aging.

Women want a solution to rejuvenate and tighten the vagina and achieve improved sexual function-Even women with no children can experience these problems because of aging, hormonal issues, history of smoking, and weight gain or weight loss.

Femilift with its excellent patient satisfaction record and shows long lasting successful outcome-It is totally safe and recommended by hundreds of women-Femilift stimulates collagen regeneration through the heat of a pain free laser giving immediate effect.

Many women come to us tell us that their lives has been changed in a way that they never knew was possible- We are very proud to lead the way in this vaginal tightening revolution.

Advantages:

• Tighten and tone loose and sagging vaginal and labial area
• Proven technology for safe, accurate and effective results
• Pain free vaginal remodeling and stress urinary incontinence
• Lunch break procedure at the gynecologist clinic (15 - 30 min)
• Long lasting results
• No need for anesthetics
• Improves vaginal dryness
• Pain free treatment
• 3 to 4 treatment sittings for more than 90% treatment

Most women attain menopause between the ages of late 40s and early 60s, the average age being about 51. This is an important milestone in a women-s gynecological history. One major change is altered female hormone levels, and this leads to a lot of physiological changes. From hot flashes to mood swings, there is also increased predisposition to osteoporosis and uterine cancer.

If you have not had your menstrual cycles for close to 12 months, chances are you are into menopause. So, that means absolutely no vaginal bleeding anymore whatsoever. However, if you experience bleeding, even spotting, be on the alert. It is not normal and needs to be examined, and if required, diagnosed and treated.

Postmenopausal bleeding or PMB as it is popularly called can be due to a variety of reasons. While it could be something as trivial as inflammation of the uterine or vaginal lining, it could also be an indication of more severe issues like cancer.

-        Atrophic vaginitis - Decreasing hormonal levels lead to increased dryness and therefore inflammation of the vaginal and uterine tissue. This is one of the common causes of bleeding after menopause.
-        Endometrial atrophy - Also caused by lower hormone levels, the lining of the body of the uterus gradually thins down and can get inflamed.
-        Polyps - Noncancerous growths in the uterus, cervix, vulva, or vagina can also lead to bleeding
-        Infections - General infection of any area along the uterine tract could lead to occasional bleeding
-        Cancers - Though only 1 in 10 PMB cases turn out to be cancers, the prognosis improves with early diagnosis and intervention.

Diagnosis: As repeated above, reach out to your doctor if you notice postmenopausal bleeding.  Diagnostic methods could include the following:

-        Physical exam
-        Transvaginal ultrasound
-        Endometrial biopsy
-        Hysteroscopy
-        Dilatation and Curettage

Treatment: Needless to say, this would depend on the diagnosis.

For very minor cases with diagnosis like altered hormone levels, no treatment may be required other than modification of the hormone replacement therapy.

- For endometrial atrophy and atrophic vaginitis, use of estrogen creams and pessaries would be sufficient.
- Polyps would require removal followed by cauterization (application of slight heat) to stop the bleeding.
- Cancer - this would depend on the type and location and require a combination of chemotherapy and surgery.  Removal of the uterus also may be required in some cases.

So, if you have had bleeding of any sort after ayear of menopause, do not ignore it.  

Most women stay confused with the time of their ovulation or the duration of fertile period. A figure of 90% is often quoted as the proportion of couples, who are sexually healthy and are in their 20s and 30s and are not using any birth control measures, who will be expecting a child after staying together for a year. It is interesting to know that you have a high chance of getting pregnant at the time of ovulation. It is a small window period that comes each month. It is the time when your ovary produces ovum or egg and the egg is open for fertilisation. Even if you are having sex two or three days before ovulation, there is a high possibility of fertilisation. After ovulation is over, the window period gets shut for the next cycle. It is the safe period. Though doctors say that it cannot be considered 100% safe to have unprotected sex during this period, the chances of getting pregnant are considerably lower. 

When does ovulation actually start? 
It should be remembered that ovulation takes place at the middle of your menstrual cycle. It usually occurs halfway through the cycle. Commonly, the average time period of a cycle is 28 days. In such cases, ovulation will occur approx on 14th day (first day of bleeding is counted as day 1 of cycle). But, in some cases, women may have cycles as long as 23 to 35 days. In these women, ovulation day varies from 9th day to 21st day of cycle. 

How will you know that you are ovulating? 

1. Check your calendar: It is a healthy habit to keep a menstrual calendar. Now a days, a number of apps are available for maintaining menstrual calender. You must maintain the dates for a few months. This will give you an idea as to when you actually ovulate.It is difficult to know the actual time of ovulation if you are having irregular periods. 
2. Carefully listen to your body: It is a common thing that your body spontaneously sends a memo to you before ovulation starts. You get cramps or feel pain in the lower abdomen before ovulation starts. This pain is called mittelschmerz. It is a reminder of the coming periods. 
3. Chart your body temperature: Well, you will need to keep a record of your basal body temperature. You can measure it early morning before getting up from bed. Your basal body temperature changes throughout the monthly ovulation cycle. Progesterone hormone is responsible for the increase in body temperature. In the first half of the month, the progesterone levels are low and hence the temperature remains low as compared to the second half of ovulation. You can also use an ovulation detector kit to know the dates. 
4. Fertile Period: Three days prior to ovulation and two days after ovulation are considered the fertile period because a sperm can remain alive for 3 days inside female genital tract and an ovum once released, is available for 2 days for fertilisation.

Though ovarian cysts can be well-treated with surgeries but not all surgeries are good for operating them. Thus, you have to choose the safest option that can help you to avoid adverse impacts after surgery.

Laparoscopic method is the approved surgical method that can operate ovarian cysts in the best possible manner. This treatment is completely painless, and thus you will not feel any pain at all while undergoing laparoscopic surgery.

What is the best surgical method for ovarian cysts? 

If you are looking for the best surgical method that can treat ovarian cysts, then nothing can be a better option other than laparoscopic surgery. There are many potential benefits of this surgical treatment for which it is more preferred in comparison to the traditional surgeries.  

- Improved treatment: This treatment is quite an advanced treatment which is not invasive and moreover, the count of side-effects is quite lower. Modernized surgical equipments are used in this regard so that ovarian cysts can be removed with great ease and convenience. Moreover, the chances of medical malpractices or errors can be completely eliminated, and thus the patients remain safe. 

- Needs short tenure: This treatment does not take a long time, and rather it can be completed within a short time. You do not have to stay at the hospital for long rather can get discharged on the same day treatment takes place. Thus, you can save a lot of medical expenses. 

- Reduction in sufferings caused due to surgery: Sufferings due to surgery can be reduced or completely eliminated to a great extent, and this is one of the leading reasons why this treatment is preferred for removing ovarian cysts. You will not face any painful sensation and on the other hand, the trouble of blood transfusion is also avoided in this case.

- No exposure to contaminants: Internal organs will be protected against different kinds of contaminants by implementing laparoscopic surgery. If the organs get contaminated, then the possibility of post-operative infections will rise. Infectious diseases are very much dreadful.

- Small incision-size: ncision size is quite small, and this is really quite beneficial in preventing different unwanted symptoms like pain, excessive bleeding and others. You do not have to take strong medications for getting rid of post-surgery symptoms. Scar tissues often get affected by infectious diseases, but in this case, it does not happen, and thus you will remain completely safe and secured.

- Preserved ovarian reserve: Removal of only cyst is possible laparoscopically without causing any damage to normal part of ovary, so future fertility aspects remain well preserved.

Infertility is a condition where a couple trying to conceive in a natural way is not able to do so even after one year of trying. It is also a matter of worry for patients who are over the age of 35 years and those who are not able to conceive naturally even after 12 months of trying constantly.

So here are the causes, risks and treatment for this condition.

* Causes

There are many causes of infertility. It may be down to a condition present in one or both partners. As per a medical study, 20% of the cases of infertility are due to males, while 40% to 50% cases are due to problems in the female partner. 30% of the cases suffer from infertility due to problems in both males and females. Ovulation and fertilisation are the main elements of the conception process, and any condition in the female or male can upset either function which can make it difficult to conceive. While abnormal sperm production and transport may be a common condition that leads to infertility in males, other factors like side effects of cancer treatments and too much exposure to toxins and chemicals can also play an important role in this regard.

For females, the causes of infertility may range from ovulation disorders, uterine and fibroid tumours, uterine and cervical anomalies, damage to or blockage of the fallopian tubes, endometriosis, primary ovarian insufficiency and pelvic adhesions. Also, factors like thyroid, cancer and medication leading to temporary infertility may be at play. 

* Risk

There are a number of factors that put a male or a female at risk of infertility. Being in your mid 30s usually has an adverse effect on the ovulation and production of well functioning sperm. Further, smoking and tobacco are among the main causes of infertility in either partner. Excessive alcohol consumption may also lead to this problem. Being overweight or underweight can also make a person infertile. Further, not getting enough exercise and routine activities out of your day, can lead to this condition as well. 

* Treatment

Male patients can go through treatment for any existing infections, hormonal injections and medication, surgical options like vasectomy reversal, and ART or assistive reproductive technology. Female patients can turn to medication that will stimulate ovulation, Intrauterine Insemination, and surgical processes to correct a uterine septum and remove endometrial polyps, or even a hysteroscopy surgery. 

If these methods fail, the patient or the couple can always turn to methods like In Vitro Fertilisation. For other mild reasons, lifestyle changes along with a stress free environment can help in increasing the chances of conception.
 

Hi,

I am Dr Vaishali Sharma I am practicing as consultant gynaecologist and laparoscopic surgeon and infertility specialist in South Delhi. Fibroids are non cancerous growth these are actually in a overgrowth of the normal tissue of the uterus commonly known as rasoli in normal layman term and we should not worry about the fibroids, most of the time we can find the fibroids incidently on Ultrasound, if we will do the ultrasound in hundred women than 50% of them will be having small one or two fibroids. So there is nothing to worry about until unless there are symptoms which are caused by the fibroids.

Like if a female is having increase bleeding during periods or pain during periods or she is unable to conceive or there is history of multiple abortions then we may need to treat the fibroids and investigate further. We need to look at the size of the fibroid what is the sight of the fibroid and the surgery also depends on these factors. So, in cases where the fibroids are small and these are away from the cavity in such cases the patient can go ahead with the pregnancy, there is no problem.

But in case is the fibroids which is a bit bigger like 3-4cm or more than, or just close to the uterine cavity then we need to treat that fibroid by surgery. There are many methods which are available for treatment medicines are there, injections are there, and the surgeries are also available which are needed only in a small subset of the patients. The Laparoscopic surgery can be used to treat the fibroids, they can be many fibroid, they can be large fibroids. Nowadays we can remove them with the laparoscopy and there are hardly 2-3 small scars on the abdomen. The patient has to get admitted for one or two days in the hospital and if the fibroid is inside the uterine cavity than those can we remove hysteroscopically, it is absolutely scar less surgery there is no suture or any scar in the abdomen and patient can go home either the same day or the next day. So in case if you have any further query or you need to know something more about the Fibroid, you can contact me via Lybrate.

In a normal pregnancy, the baby develops with its head pointed down, and the head is usually the part which comes out first during normal delivery. However, in many cases, the baby could have its legs, feet, or buttocks pointing to the cervix. In a majority of cases, the baby may have this position, but rotates to have its head pointing down before the third trimester. However, this may not happen, and this is referred to as breech.

In a lot of cases, the doctor would try to move the baby’s head downwards usually around the 37th week, and this is referred to as external cephalic version (ECV) or even as version. The process is done externally by manipulation and hence the name external. It is done before labor and may allow for a vaginal birth. In very rare cases, it may be done during labor, but before the amniotic sac has ruptured. As a backup, there should be a provision for the patient to undergo C-section, if ECV is not successful.

Indications:

1. Single pregnancy, into 36 weeks of pregnancy, with no complications, and preferably not the first pregnancy
2. No engagement of the fetus (any part) in the uterus
3. Adequate amniotic fluid, which will provide a good environment to move the baby with minimal injury

Contraindications:

1. Suspected/known birth defects
2. Multiple pregnancies (twins/triplets)
3. Ruptured amniotic sac
4. Fetus with a hyperextended neck
5. Mother’s health is not optimal and is on cardiac medications
6. Condition that mandates a cesarean section (placental separation from the uterus, placenta covering the cervix, etc.)

Procedure

The fetal position is first estimated using an ultrasound. The position of the placenta and the amount of amniotic fluid are also closely monitored. Under constant monitoring, the uterus is relaxed through medications. With one hand on the fetal head and another on the buttocks, the doctor tries to rotate the fetus. Depending on how much pressure the mother is able to tolerate and how flexible the uterus is, version may be successful (success rate is about 60%).

A second attempt under epidural anesthesia may be done, if the first one did not succeed. However, the chances of success with subsequent attempts is very doubtful. The fetus is constantly monitored through ultrasound and fetal heart rate monitoring. A fetus is considered healthy if the heart rate moves up during this procedure. However, if the heart rate seems abnormally high, the procedure would be abandoned.

After the procedure, the mother and the fetus would be monitored for a while before being sent home. As the fetus is constantly monitored throughout pregnancy, the doctor would be able to tell if this procedure is required.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Pregnancy is that wonderful and beautiful phase that most women rejoice about. However, many may find it hard to believe that pregnancy can bring with it a condition known as ‘antenatal depression’. This is a common condition in expecting mothers and should not be ignored.

Depression during pregnancy like regular depression is a clinical condition and requires further investigation and management. Pregnancy is related to the female hormones and therefore, mood swings are common (as during PMS and menopause). However, depressed pregnant women would typically have the following associated symptoms too.

1. Altered eating habits

2. Altered sleeping patterns (too much or too less)

3. Loss of attention/ability to focus

4. Losing interest in activities which usually interest the person

5. Feeling very anxious

6. Constant feeling of sadness

7. Uncertainty about the future

8. Feeling of worthlessness

9. Suicidal tendencies

It has been noted about 25% of women can get depressed during pregnancy for varying periods of time. Some potential reasons for this are as below.

1. Strained relationships: One of the most important factors for a healthy pregnancy is a happy relationship, not just with the partner, but with immediate and close family members with whom there is a high level of regular interaction.

2. Work stress: For working women, a stressful office environment could take a toll on their moods.

3. Previous miscarriages: This can cause anxiety and depression about possible repeat incident.

4. Potential complications: If the periodic examinations showed up possibility for complications in pregnancy, the chance of depression in the mother increase.

How it affects pregnancy?

A depressed mother would not be able to care for herself and  therefore, the baby may not get adequate nutrition for its development. Additionally, the potential for nicotine and alcohol abuse increases, which also negatively impacts the baby’s growth. There could be low birth weight, premature birth and developmental delays after birth.

How it can be managed?

While the hormonal changes during pregnancy causes mood swings, diagnosing if it is depression is important. A consultation with a psychiatrist may be required for some women.

Some of the options available for treatment include support groups, individual counseling, and medications.

1. It is important to understand that this is a common condition and you are not the only one going through this. Talking to other women who feel depressed can help in mood uplifting of all involved.

2. If you are too shy about it, individual counseling could be the next best thing.

3. Stress management including light exercise, music, meditation, rest, diet, and support from close friends and family are highly recommended.

4. Since most antidepressants would reach the baby, it is advisable to avoid these less you need them as a last resort.

In case you have a concern or query you can always consult an expert & get answers to your questions!