Incidence:  Heavy menstrual bleeding is a frequent cause of the 600,000 hysterectomies performed each year. 

Hysterectomy alternative:  A new method of treatment involves destruction of the lining of the uterus (endometrium) which is often the site of abnormal menstruation.  This procedure is called Endometrial Ablation.

Patient Selection:  Patients with heavy or irregular menstrual bleeding that have failed or can't undergo medical therapy may be candidates for endometrial ablation.  Patients should have completed their family since patients desiring further children aren't candidates for this procedure.

Performance:  This is an outpatient surgical procedure that may be performed under local, regional or general anesthesia.  The cervix is dilated slightly and an instrument is placed into the uterine cavity.  Thermal destruction of the uterine lining occurs with a computer controlling the heating cycle.  It only takes a few minutes to perform this procedure. 

Recovery:  There are fewer complications with endometrial ablation than with hysterectomy. Post-operative recovery is usually rapid involving little or no post-operative pain.

Results:  In some cases the results are immediate but minor bleeding may occur for 6-8 weeks.  Most studies show 90% satisfaction rates with the procedure in properly selected individuals.
 

Urinary Incontinence:  Single Stitch Surgery

Definition:  Urinary incontinence is a common gynecology problem.  It occurs often in women after childbirth and may take several forms.  One of the more common forms is Stress Urinary Incontinence in which involuntary loss of urine occurs after a stress such as a cough, sneeze, or straining.

Treatment:  The classic treatment for Stress Urinary Incontinence was a major operative procedure performed either through the vagina or an abdominal incision.  A newer method of treatment is placement of Tension-Free Vaginal Tape (TVT).

Procedure:  TVT is an outpatient surgical procedure performed under local, regional, or general anesthesia.  The procedure is performed through a tiny vaginal incision.  A mesh-like plastic tape is placed as a sling under the bladder neck.  Usually only a single suture is required to complete the operation. 

Results:  There are fewer complications with this outpatient procedure than with more invasive surgical procedures. Operative times are much shorter and post-operative pain is usually minimal.  Long term results are comparable to the more invasive procedures.
 

Chronic Pelvic Pain (CPP)

What is Chronic Pelvic Pain (CPP):  Pain that has persisted for 3 months or longer is termed chronic pain.  The patient has usually tried a number of medical and surgical remedies that have been unsuccessful in eliminating the sensation of pain.

What causes CPP: The evaluation and management of pelvic pain must encompass a careful investigation.  There are numerous causes of pelvic pain including gynecologic and non-gynecologic sources of the problem. Sometimes, the cause of pelvic pain is not a problem with the female organs themselves.

How can Chronic Pelvic Pain be treated:  Common treatments for CPP include hormones, hysteroscopy, laparoscopy and sometimes partial or complete hysterectomy. 

What can be done when common treatments fail:  Failure to recognize non-gynecologic sources of pelvic pain is sometimes the reason for treatment failure.  Effective treatments may include:

Vulvodynia

By S. Rauls, M.D.

Vulvodynia (pronounced: vul-vo-DIN-ee-a) is a disorder of unexplained vulvar pain with activities such as sitting, urinating, bicycle riding, tampon use, and pain during and after intercourse.  Symptoms may include sensory abnormalities of the vulva and surrounding tissues such as unpleasant burning, rawness, stinging, itching and throbbing in the vulva and surrounding tissue, vaginal opening or perineum.

Vulvodynia can be present from the first attempt at intercourse or tampon use (primary), or can develop later in life (secondary).  If secondary, it usually has an acute onset occurring after a bladder infection, yeast infection, vaginal infection, or after vaginal birth. It can occur in women of any age and may be present at some time in up to 15 % of all women.  Symptoms vary from mild to severe with discomfort even when sitting. If untreated, symptoms can last from months to years.  For the sexually active patient, the torture of intercourse makes this function nearly impossible leading to sexual avoidance.  This sets up a chronic problem of vaginal spasm.  As if the misery of this condition isn't enough, the avoidance of the pain associated with intercourse may lead to relationship difficulties.

Many patients are embarrassed over their symptoms and may be reluctant to mention these problems to their doctor. Furthermore, patients may be frustrated with the lack of improvement from prior treatments.  Finally, a few patients deny they have a chronic problem and seek a simpler more common or understandable diagnosis.

If you are reading this article, you probably have had symptoms for some time.  Even though the problem is very common, vulvodynia is often misdiagnosed.  It is not unusual for patients to have seen several different doctors including gynecologists.  Diagnoses such as chronic yeast infections, chronic vaginitis, endometriosis, chronic pelvic pain, and urethritis are often diagnosed.  The patient has usually tried a multitude of medications with little or varying results.  With each 'flare-up', the patient will require 2 or more rounds of medications and total relief of symptoms is uncommon or inconsistent. 

As with any chronic condition, a long list of different therapies has been tried.  Many of these therapies fail and some are completely useless but are enthusiastically recommended by some patients or physicians as being helpful.

The initial evaluation of vulvar pain includes examination to exclude infectious or inflammatory causes.  This may include examination of the vulva microscopically if indicated.  If vulvodynia is suspected, the tender tissue is carefully "mapped out".  Other tests such as cultures to exclude infectious causes may be indicated.

Some patients respond to antidepressants, nerve blocks or trigger point injections of my own formulation of medications.  These are well tolerated but do not 'cure' the symptoms since stopping therapy will almost always eventually lead to a relapse. I have developed my own therapy for vulvodynia which has proven to be highly successful.   

Many internet 'chat sites' suggest that patients with vulvodynia are doomed to live with these terrible symptoms or that the medical community is unsympathetic and ignorant of the disorder as well as their "miracle cure". However, this has not been the case in my experience.  In my practice, most patients are cured or markedly improved.
 

Although I do not agree with everything included in certain web sites, a list of the more "down to earth" sites is included below:

National Vulvodynia Association

Vulvar Pain Society

Vulvodynia Support

Surgical Services
New techniques now allow for the treatment of many gynecological problems with minimally invasive surgical procedures performed either in the office or an outpatient surgical facility.  These procedures include:

•  Laser Therapy:  Uses intense light in office based settings for treatment of
                         a variety of conditions.

•  RF Resection:    Uses radio frequency current for destruction of abnormal cells that cause
                         an abnormal pap smear.

• Hysteroscopy:    A small lighted tube placed through the cervix into the uterus to
                         diagnose abnormalities.

• Endometrial Ablation: Uses radio frequency or thermal energy to destroy the lining of the
                         uterus to treat bleeding problems.

• Laparoscopy:     A hollow tube inserted through small incisions for access to the pelvis to treat
                         endometriosis, ovarian cysts, or for sterilization.

• Vaginal Tape:     An outpatient procedure whereby a small plastic tape is inserted through
                     tiny incisions to correct urinary loss.

• Cosmetic Services: See liposuction or aesthetic sections.                                  

Advantages of minimally invasive surgical therapy include:

            Quick recovery with less down time

            Less trauma to the body

            Fewer complications

            Smaller scars

            Less post-operative pain

            Outpatient based and less cost

Facilities:  Outpatient procedures
                Jonesboro Surgery Center
                St. Bernard's Outpatient Surgery Center

Hospital procedures:

St. Bernard's Medical Center