This is done in the office and can be reviewed with you by your doctor prior to the procedure. Currently a secondary procedure is carried out in the laboratory on abnormal pap smears. It is a test for Human Papilloma Virus (HPV) high risk types. This test will determine if you are harboring this virus and, if so, which one it is. There are many types of HPV: some that can lead to cancer, some that can cause warts, and some that do both. This additional testing is usually done and its report ready by the time the pap smear comes back to your doctor, meaning the additional HPV testing results are part of the pap smear report. A pap smear is nothing more than a gentle scraping at the cervix during a GYN exam, sometimes resulting in some mild cramping and spotting.

If your pap smear or HPV screening returns abnormal, your doctor may recommend a colposcopy procedure. A colposcope, although nothing more than a microscope, evaluates the entire pap smear area, easily guiding the specialist to the areas that caused an abnormal pap smear–areas that are biopsied with tiny clippings–again, perhaps some mild cramping. The results from this testing will help guide the doctor in their recommendation for treatment or monitoring. Depending on the results of your colposcopy, your provider may recommend a procedure to remove a small portion of the cervix called a LEEP procedure. This procedure will remove many of the abnormal cells and help to prevent progression of the HPV infection.
For more information, visit ASCCP.org

The thought that your body can heal itself remains one of the focal philosophies of Osteopathic Manipulative Treatment. Osteopathic Manipulation Treatment, or OMT, is a form of treatment that uses physical diagnosis and hands-on therapy to help the body restore its normal structure and function. OMT incorporates various techniques applied to the musculoskeletal system (the joints and surrounding soft tissues, muscles, their surrounding fascia, and bones) intended to relieve stress and tension in these tissues and restore the body’s normal homeostasis.

OMT is performed in your physician’s office and is typically performed by Osteopathic Physicians who have been specially trained in manipulative therapy. This type of therapy is often combined with other medical treatments and medications to aid in the holistic treatment of the patient. The treatments range from indirect (passive) treatments including stretch and massage, to direct (active) treatments including muscle activation and spinal adjustments. Osteopathic manipulation can help patients of all ages in the treatment of numerous medical conditions. It has a number of different uses, including easing pain, promoting healing, and increasing mobility. For OB/GYN patients, OMM can also help with menstrual pain and postoperative care, as well as pregnancy issues including low back pain, carpal tunnel, headaches, and postpartum discomforts. Before performing any OMT, the physician will take your history and perform a physical exam to determine which problems you are experiencing and if OMT will benefit you, or if you will need other medical imaging or treatment related to your complaint. During treatment, the physician will explain each step, what they find on physical exam, and why a certain treatment may be beneficial. Questions are encouraged and the physician will make every attempt to make the patient comfortable, including alternate positioning for the comfort of pregnant patients. Immediately following treatment, it is important to avoid strenuous activity and drink water. Follow-up, if needed, will allow for evaluation of the patients response to treatment, as well as maintenance therapy.

3D/4D ultrasound is a fun and exciting way to see your baby before her or she is born. We recommend this between 28-32 weeks of pregnancy and drink plenty of water for the day or two before your ultrasound in order to help with getting better pictures. Please let our helpful front desk staff know if you would like to schedule this ultrasound.

NovaSure endometrial ablation is a one-time, 5-minute procedure that gently removes the lining of the uterus—the part that causes the bleeding. The NovaSure procedure can reduce or stop bleeding altogether. Women with heavy or long-lasting periods who do not wish to have children in the future may be candidates for the NovaSure procedure. Your doctor can decide if the NovaSure procedure is right for you. If you’re sure you don’t want any children in the future, and your doctor rules out more serious causes of heavy bleeding, you may be a good candidate for the NovaSure procedure. Please see novasure.com for more information.

Hysteroscopy is a powerful way of looking into and evaluating the uterine cavity. This is particularly important since abnormalities of the cavity may prevent implantation and therefore fertility, or may interfere with the normal growth and progression of pregnancy. We recommend hysteroscopy to our patients when:

1. Results of a tubal x-ray (HSG) indicate a uterine abnormality
2. Diagnosis of repeated miscarriage
3. Evidence of an intrauterine growth such as a polyp on sonogram
4. To evaluate postmenopausal bleeding
5. Congenital abnormalities of the uterus
6. Infertility

Laparoscopy is an outpatient surgical procedure usually performed under general anesthesia. The procedure consists of inserting a camera like instrument through a small incision at the belly button (umbilicus) into the abdomen. Carbon dioxide is used to inflate the abdomen pushing the abdominal organs and bowel aside to allow full visualization of the pelvic organs. Small incisions are made along the lower abdomen where graspers and other fine instruments may be inserted to visualize the entire pelvic (or abdominal) cavity for diagnostic purposes.

The fallopian tubes may be inspected and dye passed through the cervix and uterus to evaluate tubal function and patency. Evidence of tubal disease, and blockage, endometriosis, pelvic adhesions and ovarian cysts are a few of the fertility related diagnoses that can be made and, under most circumstances, repaired. Photo-documentation allows for a permanent record of the findings and procedures for the patients edification and the possibility of additional consultation. At the end of the procedure, the carbon dioxide is released, deflating the abdomen, and the incisions are closed. Recovery time is usually around one hour in the recovery room and patients are discharged once they are able to urinate, tolerate fluid intake, and walk with assistance.

Hysterectomy is the surgical removal of the uterus, or womb.

• Why you may need to have a hysterectomy
• How hysterectomy is performed
• What to expect before and after the operation

Remember, no two women undergoing a hysterectomy are alike. The reasons for and the outcome of any surgical procedure depend on your age, the severity of your problem, and your general health. This article is not intended to take the place of your surgeon’s professional opinion. Rather, it is intended to help you understand the basic elements of this surgical procedure. Read this information carefully. If you have questions after reading this material, discuss them openly and honestly with your surgeon.

Why Are Hysterectomies Performed?

Hysterectomy may be performed to treat a variety of gynecological (female reproductive system) problems. It is an elective procedure 90 percent of the time. Today most hysterectomies are done to treat benign (non-cancerous) fibroid tumors of the uterus. While not life-threatening, these growths cause pelvic pain, excessive bleeding or pain during sexual intercourse. Fibroid tumors are common and usually do not require surgery. Other forms of treatment, which preserve the uterus and childbearing capacity, are also available. You should discuss these options with your surgeon.

Endometriosis is a condition in which the tissue lining the uterus becomes displaced and grows in other parts of the abdomen, where it can cause pain. Endometriosis is the second most common reason for a woman to have a hysterectomy.

However, the practice of treating endometriosis by performing hysterectomy has been declining in the last decade because other treatments have evolved. You should discuss these other options with your surgeon first to see if another treatment for endometriosis may be effective for you.

Prolapse of the uterus is another reason why some women decide to undergo a hysterectomy. In this condition, the uterus descends or sags into the vagina due to stretching of the ligaments and fibrous tissue that usually hold it in place. Women with cancer of the uterus or cancer of the cervix require special types of treatment, which may include a simple or radical hysterectomy. These women should seek the counsel of a gynecologic oncologist.

Are All Hysterectomies the Same?

You may hear different names used to refer to this type of operation. That is because there are different types of hysterectomies. A total hysterectomy or panhysterectomy applies only to the removal of the uterus and cervix. When the ovaries and fallopian tubes on both sides of the uterus also are removed, the procedure is called a hysterectomy and bilateral salpingooophorectomy (“salpingo” is from the Greek word for “tube,” while “oophor” is from the Greek word for “bearing eggs,” that is, the ovaries). A radical hysterectomy is a much more extensive procedure and is only performed in special situations such as cancer of the uterus or cervix. It includes removal of the uterus, cervix and surrounding tissue, the upper vagina, and usually the pelvic lymph nodes. A surgeon with special training in gynecologic oncology performs this type of procedure.

Is Hysterectomy Mainly for Older Women?

You may be surprised to know that 42, a relatively young age, is the average age of women undergoing hysterectomy. More than three-fourths of all women who have a hysterectomy are between 20 and 49 years of age.

Is There Any Reason to Avoid or Delay Hysterectomy?

It is not sensible to have a hysterectomy in order to prevent cancer of the cervix or uterus. In this case, the risks of having a major operation outweigh any supposed cancer-protection benefits. Furthermore, hysterectomy is not considered to be the first choice for sterilization in most healthy women. Another procedure, tubal ligation, is a cheaper, easier and safer method for most women.

Hysterectomy may not be advisable if your problem has not been adequately diagnosed. For instance, if you have pelvic pain that is not specifically caused by the uterus, a hysterectomy may not relieve your pain. The pain may be due to problems in your digestive, urinary or skeletal systems. In these cases, your doctor will want to do the proper tests and ultrasounds to locate the exact source of your pain. In addition to the tests and ultrasounds indicated, a diagnostic laparoscopy may be helpful in selecting the appropriate treatment.

Similarly, most women with abnormal bleeding, especially menopausal or post-menopausal women, should have an endometrial biopsy (EMB) or a dilatation and curettage (D&C) procedure to rule out uterine cancer before undergoing a hysterectomy. Hysteroscopy (a surgical procedure in which a gynecologist uses a small lighted telescopic instrument to view the inside of the uterus) should not be performed until uterine cancer has been ruled out by D&C or EMB.

Finally, women who are obese, who have diabetes, high blood pressure, or some other chronic conditions, are at increased risk during any type of operation. For these women, hysterectomy should only be considered if reasonable alternatives have been exhausted.

If you have any questions about hysterectomy, ask your doctor. If it would make you feel more confident about your medical treatment, get a second opinion from another physician who is qualified to diagnose and treat your condition. Unless you have a severe pelvic infection or uncontrollable bleeding, you do not have to rush into having a hysterectomy. Even with a diagnosis of cancer, a short delay to seek another qualified opinion is usually safe and worthwhile.

How Do I Decide if I Should Have a Hysterectomy?

You will no longer be able to get pregnant after a hysterectomy. Thus, before you choose elective hysterectomy, you must consider both the severity of your problem and your desire to have children in the future.

Although this operation may improve your quality of life by relieving chronic symptoms, such as pain or bleeding, some women are willing to tolerate these conditions.

Ask yourself:

• Do I want to become pregnant in the future?
• How do I feel about not having a uterus?
• What is my husband’s (or partner’s) attitude toward this operation?

Ask your surgeon:

• What will happen if I don’t have a hysterectomy?
• What are the risks of a hysterectomy in my particular case?
• Is my condition likely to improve on its own, stay the same, or get worse?
• Is a hysterectomy medically necessary or recommended to relieve my particular symptoms?

Before your operation, you will be asked to sign a document giving your “informed consent” to the operation. This form lets you know any risks or possible complications that can be caused by the surgical procedure. Some states have specific laws that pertain to hysterectomies. These laws require surgeons to explain the alternatives and the risks of the procedure and are intended to make sure you understand the potential after-effects of the operation.

How Is Hysterectomy Performed?

The surgeon can remove the uterus through a surgical incision made either inside the vagina or in the abdomen. In both the vaginal and abdominal approaches, the surgeon detaches the uterus from the fallopian tubes and ovaries as well as from the upper vagina. For patients that qualify, a more minimally invasive approach using laparoscopy or laparoscopic assistance can be used to shorten recovery time.

Abdominal Hysterectomy

When a hysterectomy is performed through an incision in the abdomen, it allows the surgeon to see the pelvic organs easily and gives him or her more operating space than is permitted in a vaginal hysterectomy.

Thus, for large pelvic tumors or suspected cancer, your surgeon may decide to do the procedure abdominally. Patients who have an abdominal hysterectomy require a longer hospital stay than those who have a vaginal hysterectomy. In addition, they may experience greater discomfort immediately following the operation, and will have a visible scar.

However, the surgeon often can make a less-noticeable horizontal incision, called a bikini-cut, that extends along the top of the pubic hairline.

Vaginal Hysterectomy

The vaginal approach to hysterectomy is ideal when the uterus is not enlarged or when the uterus has dropped as a result of the weakening of surrounding muscles. This approach is technically more difficult than the abdominal procedure because it offers the surgeon less operating space and less opportunity to view the pelvic organs. However, it may be preferred if a patient has a prolapsed uterus, if the patient is obese, or in some cases has early cervical or uterine cancer. A vaginal hysterectomy leaves no external scar.

A variation on vaginal hysterectomy is LAVH (laparoscopic-assisted vaginal hysterectomy). A laparoscope is a device the surgeon can use to examine the inside of the pelvis. LAVH is an alternative for women who have ovarian disease but previously had only one choice: an abdominal hysterectomy that leaves a long incision. With LAVH, much of the procedure is done through tiny incisions using a laparoscope. The rest of the procedure then can be finished vaginally.

Laparoscopic Hysterectomy

A laparoscope camera device is inserted into the abdomen and using other small incisions and instruments the uterus and sometimes the ovaries are removed through the vagina and the vagina is then closed using those same instruments. Sometimes, this procedure is done with the aid of the DaVinci Robotic system which improves visualization and manipulation in order to safely complete the surgery with less discomfort and a shorter recovery time. Visit Davincisurgery.com for more information.

Stages of Recovery

After the operation, you will likely remain in the recovery room for one to three hours. You may be given pain medication, and possibly antibiotics to prevent infection. You will probably be able to walk around your room the day after your operation, depending on the type of procedure you underwent. Most patients go home the third day following an abdominal hysterectomy and by the first or second day after a vaginal hysterectomy, LAVH, or TLH.

Complete recovery from abdominal hysterectomy usually takes six to eight weeks because the incision is typically 5 inches long. During your recovery, you can expect a gradual increase in activities. Avoid all lifting during the first two weeks of your recovery period and get plenty of rest. In the weeks following the surgical procedure, you can begin to do light chores, some driving, and even return to work, provided your occupation does not involve too much physical activity.

Around the sixth week following the operation, you can take tub baths and resume sexual activity. Women who have had vaginal hysterectomies generally recover more quickly.

Risks or Complications?

Hysterectomy is regarded as one of the safest operations. Nevertheless, no operation is without risk. Severe complications and even death occasionally occur with this operation.

The uterus is located between the ureters (small tubes which transport urine from the kidneys to the bladder) on each side, the urinary bladder in front, and the rectum behind. All of these structures are subject to injury, especially if the operation is difficult, as can occur with large fibroids, endometriosis or cancer. Bleeding and infection also can occur, but most infections are now avoided by using antibiotics. Blood clots in the legs (DVT-deep vein thromboses) sometimes occur postoperatively and can break off and travel to the lungs causing a sometimes fatal pulmonary embolism (blood clot). These clots largely can be avoided in high-risk patients by using special stockings during the operation or by using blood thinners.

Long-Term Effects

After having a hysterectomy, you will no longer be able to get pregnant and will no longer have menstrual periods. If you were premenopausal (still menstruating) before the operation and have your fallopian tubes and ovaries removed, you will experience all of the symptoms of menopause as your body gets used to different hormone levels. These symptoms may include hot flashes and perhaps irritability and depression. If the symptoms are severe, your doctor may prescribe hormone replacement medication. Hysterectomy usually has no physical effect on your ability to experience sexual pleasure or orgasm.

Following hysterectomy, the ovaries will continue to function; however, the actual occurrence of menopause will be difficult to determine since the uterus has been removed and the patient will no longer have periods. As the age of menopause, approximately age 51, is approached, symptoms such as hot flashes may warrant testing to see if hormone replacement therapy is indicated. If you experience vaginal dryness, it can be remedied by using prescription hormone creams or pills or water-soluble lubricants that you can purchase at the pharmacy.

A sense of loss following the removal of any organ is normal and takes time for adjustment. While depression following hysterectomy does not happen to everyone, it is more common if the operation was done because of cancer or severe illness, rather than as an elective operation.

Additionally, if you are under age 40 or the operation interfered with your plans to have children, depression is more likely to occur. This depression can be temporary, depending on your general outlook on life and the availability of a good support group of family and friends. Most women experience an improvement of mood and increased sense of well-being following hysterectomy. For many, relief from fear of pregnancy results in heightened sexual enjoyment following the procedure.

The ON-Q PainBuster Post-Op Pain Relief System provides continuous infusion of a local anesthetic directly into the patient’s surgical site for effective, non-narcotic post-operative pain relief for up to 5 days. The ON-Q System, a market leading post-op pain relief system, uses a small balloon-like pump that is filled with a local anesthetic medicine. The pump is attached to a catheter (tiny tube) that the doctor places near your incision site. The system is very easy to use. The pump automatically delivers the medicine at a slow flow rate. The pump may last anywhere from two to five days. The pump is completely portable, lightweight and can be attached to your gown or clothing or placed in a carrying pouch. When the infusion is complete, the catheter is removed and the pump is thrown away. Depending on your surgery, you may go home with one of these pain relief systems.

A vaccine is available to prevent the human papillomavirus (HPV) types that cause most cervical cancers as well as some cancers of the anus, vulva (area around the opening of the vagina), vagina, and oropharynx (back of throat including base of tongue and tonsils). The vaccine also prevents HPV types that cause most genital warts.

Why is the HPV vaccine important?

Genital HPV is a common virus that is passed from one person to another through direct skin-to-skin contact during sexual activity. Most sexually active people will get HPV at some time in their lives, though most will never even know it. HPV infection is most common in people in their late teens and early 20s. There are about 40 types of HPV that can infect the genital areas of men and women. Most HPV types cause no symptoms and go away on their own. But some types can cause cervical cancer in women and other less common cancers — like cancers of the anus, penis, vagina, and vulva and oropharynx. Other types of HPV can cause warts in the genital areas of men and women, called genital warts. Genital warts are not life-threatening. But they can cause emotional stress and their treatment can be very uncomfortable. Every year, about 12,000 women are diagnosed with cervical cancer and 4,000 women die from this disease in the U.S. About 1% of sexually active adults in the U.S. have visible genital warts at any point in time.

Which girls/women should receive HPV vaccination?

HPV vaccination is recommended for 11 and 12 year-old girls. It is also recommended for girls and women age 13 through 26 years of age who have not yet been vaccinated or completed the vaccine series; HPV vaccine can also be given to girls beginning at age 9 years. CDC recommends 11 to 12 year olds get two doses of HPV vaccine to protect against cancers caused by HPV. For more information on the recommendations, please see: https://www.cdc.gov/hpv/parents/questions-answers.html

Will sexually active females benefit from the vaccine?

Ideally females should get the vaccine before they become sexually active and exposed to HPV. Females who are sexually active may also benefit from vaccination, but they may get less benefit. This is because they may have already been exposed to one or more of the HPV types targeted by the vaccines. However, few sexually active young women are infected with all HPV types prevented by the vaccines, so most young women could still get protection by getting vaccinated.

Can pregnant women get the vaccine?

The vaccine is not recommended for pregnant women. Studies show that the HPV vaccine does not cause problems for babies born to women who were vaccinated while pregnant, but more research is still needed. A pregnant woman should not get any doses of the HPV vaccine until her pregnancy is completed.

Getting the HPV vaccine when pregnant is not a reason to consider ending a pregnancy. If a woman realizes that she got one or more shots of an HPV vaccine while pregnant, she should do two things:

• Wait until after her pregnancy to finish any remaining HPV vaccine doses.
• Call the pregnancy registry [800-986-8999 for Gardasil and Gardasil 9, or 888-825-5249 for Cervarix].

See much more information at https://www.cdc.gov/std/hpv/stdfact-hpv.htm

Please note that telehealth services are currently not included in coverage. However, video calls may be eligible for insurance coverage. We recommend contacting your insurance provider to verify coverage details.