Dr. Shilpa Bansal Agrawal

A breast examination is a way of detecting early changes that may find lumps of other growth in the breast. This is a manual form of examination that may be carried out by the doctor or even by the patient. This kind of examination helps in detecting the onset of breast cancer and helps in successful treatment of the same. It is an essential screening strategy that all women must go through. Let us cast a glance on the various details regarding this examination, and also how frequently it must be conducted.

1. Age: Women who have reached the age of 18 are said to have matured physically and sexually. They should perform this examination once they have reached the said age in order to detect any anomalies in the way the physical changes occur in the breast tissue.
2. Procedure: One should begin by looking at one's reflection in the mirror to find any rashes or dimpling in the breasts. The shape, size and colour of the breasts and nipples must also be studied so as to check for any anomalies. Inverted nipples, redness and soreness must also be reported to the doctor. Once you are done checking the visuals, you can raise your arms and look for any changes. Then, you will need to lie down and feel your breasts by using a circular motion. The finger pads must be used in order to check for any lumps. One must start from the centre and move the breasts sideways. Any wet and slippery feeling must be reported to the doctor immediately.
3. Pressure: During the breast examination, you must use light pressure for the skin and tissue that lie beneath the breasts, while medium to moderate pressure should be used for the middle portion of the breasts. One must use a firm hand to check the tissue that lies at the back of the breasts, near the rib cage.
4. Frequency: One must get into the habit of conducting a breast examination at least once a fortnight or once a month, without fail. You can also go to the gynaecologist for an examination in case you are not confident of conducting it on your own with proper movements and accuracy. You may also journalise your breast examination findings.
5. Menstrual Cycles: When you are going through your menstrual cycle or period, it is important to remember that your breasts can become tender just before or after the start of the cycle. So, do not panic if you think you have found a lump or any other growth at this time. It is best to check again after a week and then visit the doctor about checking the same. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

During the natural course of events, a women's body starts its reproductive phase with menarche and at about 50 years of age, attains menopause. This is when the reproductive function ceases and the ovaries stop producing the hormone estrogen and progesterone. In some cases, for various reasons including medical, the ovaries stop functioning earlier, and this is medically termed early or premature menopause. Menopause that occurs before 40 years of age is termed premature menopause; it is due to primary ovarian insufficiency and occurs in 1% of the women.  If it occurs between 45 to 50 years, it is termed early menopause.

Causes: Normal ageing, family history, genetic disorders, autoimmune disorders, toxins, and surgery are some reasons that could lead to premature menopause.

Effects: Estrogen and progesterone have a lot of beneficial effects on a women's body. Reduction in their levels leads to some of the below changes:

• Emotional changes like mood swings, irritability, and in some cases depression, especially in premature menopause.
• Irregular cycles before complete cessation of the menstrual cycles.
• General mucosal dryness leading to vaginal dryness, dry skin, dry eyes.
• There also would be urinary incontinence and reduced sex drive due to reduced hormone levels.
• For women who still would want to have children, infertility would be a big cause for concern. This could lead to other emotional issues, worsening the depression.
• Osteoporosis - Bones lose their density and get weak and are more prone to fracture.
• Cardiovascular health - Post menopause, women are more prone to heart attacks and stroke. Though not fully proven, this is believed to be true as the good role that estrogen plays on blood vessels is negated with menopause.
• Accelerated ageing - Menopause leads to accelerated damage of genetic structures, thereby leading to faster ageing. This also leaves a feeling in the women of being less attractive and less desirable.

There is also a good news, that after menopause women are at lesser risk of cancer - especially breast and ovarian. 

It is not easy for women to handle premature menopause. The body undergoes some changes much earlier than expected, and it requires a lot of support and caring and comforting to come to terms with it - especially if associated with infertility or chemotherapy for cancer. Emotional issues of not being able to have children and feeling less attractive require frank talks to boost the person's confidence and increase self-worthiness.
It is easier said than done, but one of the key ways to handle premature menopause is an open discussion. If you wish to discuss any specific problem, you can consult a gynaecologist.

A rising number of teenage girls in the country are getting affected with Poly Cystic Ovarian Disease or PCOD. Though an advanced menarche has become very rampant these days, there are many young women who are suffering from a delay in menarche, which in turn is leading to PCOD as opined by gynaecologists. Obesity and sedentary lifestyle among young people have caused a rapid doubling of PCOD cases in the past five to eight years.

Occurrence and Symptoms:

Gynaecologists report that they get at least 15 fresh instances of PCOD cases and a considerable number of teenagers aged 16-17 are not getting their menarche. Such patients are recommended to take a strictly balanced diet, which will help them to lose weight. Initially, their mothers think that they would experience their menarche in proper time, but some girls are diagnosed with PCOD when taken to a family gynaecologist. Even worse, they could never imagine that their obesity can pave the way for such a grave health issue. PCOD can cause numerous other problems like delayed and irregular menses, rapid weight gain and tremendous difficulty in losing weight, developing acne and blocked skin pores. Furthermore, it leads to thinning of hair and excessive growth of hair on chest, back and face. Infertility, continual miscarriage, high blood pressure and high blood sugar are also common with PCOD.

Help yourself with the right diet:

There is no proven evidence regarding the cause of PCOD though gynaecologists are of the opinion that some females possess a predisposition to this disease and it may run hereditarily in the family. You can alleviate your PCOD symptoms to a considerable extent by regulating your diet properly. Have loads of fruits and green leafy vegetables and try to abstain from dairy products as many experts believe that dairy products are a direct cause of an increase in insulin levels, which can aggravate skin troubles along with other PCOD symptoms. Avoiding red meat and eating lean meat instead will help the condition and reduce the chances of infertility. It is always recommended to avoid hydrogenated and saturated fats, which are normally found in animal and dairy-based food. Try to put a stop to cheese, cottage cheese, clarified butter, pork, lamb, beef, etc. and certain baked products like cookies, cakes and fudges as they will trigger a rise in your blood sugar and cholesterol levels.

PCOD is such a condition, which you can never afford to overlook. If you had been facing any of the common symptoms, then it is probably time to pay a consult to a responsive gynaecologist.

Postpartum hemorrhage is a condition where a woman may lose a lot of blood (approximately 500ml to 1000ml) from her vulva shortly after childbirth. This usually occurs within the first 24 hrs of childbirth and can even result in severe blood loss threatening the mother’s life in case the blood loss is over 2000 ml. Secondary postpartum hemorrhage can also occur until 12 weeks after childbirth and this extra care should be taken, if there is any such possibility.

Symptoms of postpartum hemorrhage:
1. Rapid increase in heart rate.
2. Feeling dizzy while standing up.
3. Increase breathing rate.
4. Feeling cold and chilly even if the room temperature is normal.
5. Sudden fall in blood pressure levels.
6. Fainting or becoming unconscious.

Causes of postpartum hemorrhage:

1. Uterine atony: This is a condition in which the uterus contracts and may lead to excessive bleeding. Infection in the placental tissue can also lead to postpartum hemorrhage.

2. Trauma: This is a very common cause for postpartum hemorrhage. Sometimes, the uterus (womb), vagina, cervix (passage forming the lower end of the womb) and the perineum (area between the vulva and the anus) can get injured. These areas become vascular during the course of pregnancy and may rupture in the process of childbirth causing excessive bleeding.

3. Tissue: At times, the whole placenta or fetus tissue does not come out of the body after childbirth. This can lead to profound blood loss resulting in postpartum hemorrhage.

4. Thrombin: This is a disorder which occurs when there is excessive bleeding when the blood fails to clot inside the body.

How can you prevent postpartum haemorrage?

1. Oxytocin is a substance which is used after the delivery of the baby. This prevents postpartum hemorrhage. It can be administered in the following ways :

   • As an injection which is directly injected into the blood stream.

   • After delivery, breastfeeding your baby can also trigger natural oxytocin. This occurs as encouraging the baby to suckle also stimulates the nipples which release oxytocin, thus preventing postpartum hemorrhage.

   • In the form of intravenous drips mixed in with important medications. IV drips can administer oxytocin along with other important fluids along with it.

2. Uterine massage is also recommended to prevent postpartum hemorrhage. After delivery, massaging the uterus makes the muscles relax and contract. This reduces the risks of excessive bleeding.

A lot of women can also die due to excessive bleeding after childbirth, especially in developing countries including India. This is a cause for concern and proper care should be taken if you start experiencing these symptoms. If you wish to discuss about any specific problem, you can consult a gynaecologist.

Hymenoplasty is also known as hymen surgery. It is a surgical procedure where the hymen within the vagina is restored. The Hymen is a membrane covering the vaginal opening, which can be torn when a woman engages in coitus for the first time or it could be damaged due to other factors such as heavy lifting, exercise, cycling, swimming among many other activities. Hymenoplasty involves putting back the hymen’s torn edges to make it look like the hymen is intact.

Why do women want hymen reconstruction?
A woman would want a hymen reconstruction surgery for a number of reasons. They are:

1. Religious reasons: In certain cultures, a woman’s hymen is inspected to make sure she has not engaged in coitus in the past. Virginity is valued highly is such places and if the woman is not a virgin, she may have to face social or even legal ramifications.
2. In case of rape or sexual assault victims: In some cases, a rape victim may undergo this surgery to empower herself and feel mentally peaceful.
3. Hymen related injuries: Certain factors like heavy exercise or sexual intercourse can cause rupture of the hymen which may cause bleeding, infections or other complications. A woman may want to rectify this with the help of this surgery.

The procedure
The entire surgical process lasts for about 45-60 minutes. The surgery is carried out in an outpatient setting under general anesthesia. The torn skin membranes are rejoined using dissolvable stitches so that scaring is minimal.

This procedure can be carried out in three ways
1. Joining the torn edges with stitches.
2. An artificial membrane is placed in the area whose function is to behave as an artificial hymen. This hymen however, does not have any blood supply, so a capsule that contains blood can be placed with it.
3. A flap is taken from the vaginal lining, which is used to create a functional hymen with proper blood supply.
4. You can return to your work in about 2-3 days after the surgery. However, the entire healing process takes around two months.

Risks
The procedure caries some risks that you should be aware of, they are -
1. Bleeding: Some bleeding is normal after the procedure, but any prolonged case of bleeding may indicate a complication.
2. Infection: Like all surgeries, you may have infections in the concerned area. The doctor may prescribe antibiotics to deal with these infections.
3. Narrowing of the vaginal opening: In some cases, the vaginal opening can become narrow after the procedure. This however, can be resolved without the need for any treatment as it may become wider on its own over time. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

An infection in a woman’s reproductive organ is characterized by pain, discomfort, itching, burning sensations and a foul smell. Even normally, a women’s reproductive organ creates a discharge which is a clear liquid but slightly cloudy. However, when this discharge becomes abnormal and has a foul smell, it could be a tell tale sign for a vaginal infection.

Symptoms of Vaginal Discharge:

1. Your vaginal discharge is heavier than usual.

2. The smell seems different and can be quite offensive.

3. The color of your vaginal discharge may also change.

4. Your vagina can swell and become sore.

5. Itching and burning sensations are also felt.

6. Sex is extremely uncomfortable and painful.

What causes a vaginal infection?

Sometimes vaginal discharges happen due to an allergic reaction or irritation caused by the use of products such as vaginal douches and creams.

Vaginal infections which are not contagious in nature can be caused by detergents, fabric softeners, perfumed soaps and vaginal sprays which may change the natural, chemical and bacterial balance of the organ.

Vaginal infections are also quite commonly caused by sexually transmitted diseases such as gonorrhea, Chlamydia, trichomoniasis, human papillomavirus (HPV) and herpes among others.

How can you prevent vaginal infections?

1. Keep your genital area dry and clean – Every time you have a bath, clean your vagina with water and don’t use chemical or vaginal washes which can only make things worse. Vaginal infections can also occur due to the disturbance of the ph level (the balance of alkaline and acidic chemicals) in your vagina. Thus use only water to wash and maintain general hygiene.

2. Avoid wearing underwear made out of nylon and synthetic material – These materials trap heat and moisture in your vagina and can make them smelly and itchy. Cotton underwear is recommended to prevent vaginal infections and also for general health.

3. Eating yogurt or other pro-biotics can prevent vaginal infection – Any healthy vagina has a balance of many forms of bacteria and fungus. If you have pro-biotics such as plain yoghurts or other specially formulated foods, then it will help maintain the balance and prevent infections from happening.

4. Use condoms – Always use either a female condom or ask your partner to use a male condom before engaging in intercourse. This will prevent the passing of sexually transmitted diseases which are a leading cause of vaginal infections.

If you wish to discuss about any specific problem, you can consult the doctor and ask a free question.