Genitourinary Medicine
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What does the word Genitourinary mean?

Genitourinary is a word that refers to the urinary and genital organs.

What is Genitourinary Medicine?

Genitourinary medicine is a combination of different medical practices that includes andrology, gynecology and urology. One of the primary specialties/diseases that a genitourinary doctor handles is sexually transmitted diseases.

The Female Genitourinary System

The female Genitourinary system is made up of the womb (uterus), ovaries, cervix, fallopian tubes, vagina and vulva.

The female urinary organs like those in the male, form the excretory system of liquid waste. The urinary organs as excretory system serve the purpose of waste disposal for the body. The excretory system excretes toxins, excess water, and other solutes. In addition the excretory system regulates blood pressure, metabolism, and blood composition and volume.

The female reproductive system which includes the Genitourinary system, performs the reproductive function in women in their child bearing age.

Uterus (Womb)

A muscular organ, shaped like an upside down pear. Its inner lining is called the endometrium. The neck, or entrance to the womb is the cervix, which has a small hole in its centre, called the os. 

Listed below are some of the common conditions, treatment and procedures involving the Uterus. 

• Dilatation and Curettage (D and C)

• Endometrial Cancer

• Endometriosis

• Menstruation and associated conditions

• Hysteroscopy

• Hysterectomy

• Pelvic Prolapse

• Pelvic Organ Prolapse

• Prolapsed Uterus

• Uterine Cancer

• Uterine Fibroids

Ovaries

Two small almond shaped glands that contain eggs (ova). The ovaries are responsible for the female sex hormones. 

Below are some of the common conditions, treatment and procedures involving the ovaries. 

• Polycystic Ovarian Syndrome

• Hormone Replacement Therapy

• Infertility

• Ovarian Cancer

Cervix

The continuation from neck of uterus which has a small hole in its centre, called the os. Below are some of the common conditions, treatment and procedures involving the cervix. 

• Pap Smear

• Pelvic Inflammatory Disease (PID)

• Cervical Cancer

Fallopian Tubes

These are two small tubes that connect the Ovaries on either side to the uterus in the centre. These tubes carry the egg (ovum) from the ovary to the womb. Below are some of the common conditions, treatment and procedures involving the Fallopian tubes. 

• Ectopic Pregnancy

• Salpingectomy

Vagina

A muscular canal around 7.5 cm long that extends from the neck of the womb to the external female genitalia or vulva. 

Below are some of the common conditions, treatment and procedures involving the vagina. 

• Bacterial Vaginosis

• Prolapse

• Vaginal Relaxation

• Vaginal Vault Prolapse

• Vaginal Yeast Infection

Bladder

The urinary bladder is a musculomembranous sac which acts as a reservoir for the urine; and as its size, position, and relations vary according to the amount of fluid it contains. It receives urine from the kidneys through the ureters and is dispensed from the bladder through the Urethra.  

• Female Urinary Incontinence

• Interstitial Cystitis

• Urodynamics

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What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse or Pelvic Prolapse, is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapsee in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse or vaginal vault prolapse.

What is Pelvic Prolapse?

Pelvic Prolapse is another term used for "Pelvic Organ Prolapse."  Pelvic Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse or vaginal vault prolapse.

What are the symptoms that indicate a woman is suffering from  Pelvic Organ Prolapse?

• Loss of bladder control.

• Loss of bowel control.

• Increasing need and frequency to urinate - and then difficulty in completely emptying your bladder.

• The feelings that your of pelvic or vaginal heaviness, bulging, fullness and/or pain, or a feeling that something is "dropping."

• Recurrent bladder infections.

• Excessive vaginal discharge.

• Pain or lack of sensation during sex

But Pelvic Organ Prolapse is a real, common and treatable problem. Consider this:

About half of all women over age 50 suffer from some degree of Pelvic Organ Prolapse.

One in 10 women undergo surgery for Pelvic Organ Prolapse by age 80.

What is Pelvic Reconstruction?

Pelvic Reconstruction is a surgical procedure performed by gynecologists or uro-gynecologies to repair pelvic organ prolapse and vaginal vault prolapse, among types of prolapse, and to correct the problem(s) and relieve the symptoms. 

Typically, Pelvic Reconstruction is performed vaginally and uses an implant to reinforce the strength of the weakened pelvic tissues. 

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis. 

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

What is Colpopexy?

Colpopexy is the surgical suturing of the prolapsed vagina to a surrounding structure - such as the abdominal wall or the sacrum, which is then called Sacral Colpopexy or Sacrocolpopexy 

What Is Sacral Colpopexy (Sacrocolpopexy)?

Sacral Colpopexy, also referred to as also referred to as also referred to as also referred to as Sacrocolpopexy, is the preferred surgical procedure for treating and correcting Vaginal Vault Prolapse with excellent results. Sacral Colpopexy (Sacrocolpopexy) has a very high rate of success  and the surgical procedure involves suturing a synthetic mesh that connects and supports the vagina to the sacrum, or tailbone. The Sacrocolpopexy operation is performed from the abdomen to support the vagina to the ligament on the spine (after previous or present surgery to remove the uterus) by using a synthetic mesh.

Why Is Sacrocolpopexy Performed? 

Sacrocolpopexy is performed to treat severe protrusion or bulge(s) of the vagina after removal of the uterus.

A woman's vagina that has one or more of these vaginal protrusion(s) may experience one or more of the following:

• The vaginal lump/bulge or protrusion feels uncomfortable or causes pain.  
• Difficulty with urination (e.g. unable to completely empty the bladder) 
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels) 
• Pain 
• Infection 
• Bleeding 

The objective of the Sacrocolpopexy operation is to relieve the woman's symptoms and to restore her vagina and her vaginal anatomy (as much as possible) and recover her sexual function.

Are there any risks associated with Sacrocolpopexy surgery? 

Sacrocolpopexy surgery is a very common and relatively safe operation with excellent prognosis and outcomes.  However, like any surgical procedure, there are complications which may occur. Possible complications from Sacrocolpopexy surgery may include:

• Bleeding 
• Infection 
• Injury to surrounding tissues (e.g. nerve or blood vessels, ureter, intestines) 
• Formation of blood clot(s) in the legs or lungs 
• Recurrence of problem
• Slow return of bowel or bladder function 
• Erosion of synthetic material through vaginal mucosa 

What Happens Before Sacrocolpopexy Surgery? 

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health for Sacrocolpopexy surgery. 

2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing. 

3. You will be admitted to the hospital one day before Sacrocolpopexy surgery. 

4. You will be given preparations to clear your bowels.

5.  Your pubic hair surrounding your vulva will be shaved. 

6. You will not be allowed to eat or drink after midnight on the day before the surgery. 

7. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled. 

8. If you are on aspirin, please keep your doctor informed. You must stop taking aspirin at least one week before Sacrocolpopexy surgery. 

What happens during the Sacrocolpopexy surgery? 

The surgery is done under general or regional anesthesia. The anesthesiologist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube / drain may be inserted into the abdomen to monitor the bleeding.

Another tube will be inserted into the urethra as there may be difficulty in urination after the Sacrocolpopexy procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What happens after Sacrocolpopexy surgery? 

1. Immediately after the operation, you may experience one or more of the following:

• Tiredness - You should rest and gradually increase your mobilization until you feel fit to return to your normal activities. 

• Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort. 

• Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal. You will need to wear a menstrual pad during the recovery period, but you will not be permitted to use tampons for obvious reasons.

2. One day after surgery, you will usually be allowed to drink and eat. You will be encouraged to move around. Blood chemistries and normal follow-up visits will be performed. 

3. The catheter that was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.

4. You may be discharged on the third or fourth day after surgery if the doctor is pleased with your progress and the outcome of the Sacrocolpopexy procedure. 

5. You should refrain from:

• Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor. 

• Using tampons, douching, sexual intercourse and driving for 4 weeks. 

• Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacrocolpopexy surgery.

6. You should (immediately) return to the hospital or notify your doctor if you notic any of the following:

• Heavy vaginal bleeding 
• Foul smelling vaginal discharge 
• Severe abdominal distension and / or pain not relieved by painkillers 
• High fever 
• Pain associated with passing urine 
• Difficulty in passing urine 
• Constipation 

Follow-up doctor visits after Sacrocolpopexy surgery 

You will be examined by your doctor (at your doctor's office) at approximately; 2 weeks, 4 weeks, six months and and one year after Sacrocolpopexy surgery. 

It is important to keep your follow-up appointments to ensure the best possible results.

What is "Colposuspension" surgery?

Age and vaginal childbirth takes it toll on women's pelvic organs.  

"Female Urinary Incontinence" is one of the problems most (over 50%) women who have delivered babies vaginally have to contend with.  Women with Female Urinary Incontinence "leak" urine when they strain,  cough, laugh or run. This condition is also called "stress urinary incontinence" meaning the stress of physical activity, not emotional stress is causing her to "leak" urine.  

The problems associated with female urinary incontinence are corrected in the the "floor" of the woman's pelvis by several methods or types of surgeries - one of which is called Colposuspension. 

A woman's pelvic floor is a sheet of special muscles and ligaments that stretch across the inside of the female pelvis. Women can feel it "tighten" when they try to hold back the flow of urine - or when they strain,  cough, laugh or run. The uterus and bladder are located above the pelvic floor. The vagina and the opening of the bladder (the urethra) pass through the pelvic floor. If the pelvic floor weakens, the uterus and bladder "drop" down. The control of the urine is thereby weakened. 

Colposuspension surgery strengthens the pelvic floor to lift, or "suspend" the uterus and bladder back up to their correct position within the woman's pelvis

Colposuspension comes from the Greek word for vagina - "colpos."

What is "Urethropexy"?

Urethropexy is a surgical procedure where the support of a woman's urethra is re-supported through sutures that surround the urethra's pelvic floor  and vaginal tissues to her pubic bone.

What is the Vaginal Vault and Where is the Vaginal Vault Located?

As previously stated, Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons. Vaginal Vault Suspension is the surgical procedure that corrects and repairs Vaginal Vault Prolapse.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward the introitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). 

Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

Vaginal Vault Suspension is a surgical procedure that may be selected to correct/repair Vaginal Vault Prolapse.

What is Vaginal Vault Suspension?

Vaginal Vault Suspension is the surgical procedure that repairs Vaginal Vault Prolapse and also provides support for the apex or "vaginal vault" of the vagina to pelvic structures.

What is a Trachelectomy?

A trachelectomy, also referred to as a cervicectomy, is the surgical removal of the cervix. 

In this surgery, the uterus itself is saved or preserved, and therefore this type of surgery preserves a woman's chance of becoming pregnant and having children.  The trachelectomy surgical alternative - as opposed to the more radical hysterectomy which removes the uterus in addition to the cervix - is typically elected by younger women with early stage cervical cancer.

What Everyone Needs to Know About Reconstructive Pelvic Surgery.

Reconstructive pelvic surgery is an area of surgery dealing with a woman's pelvis, and includes gynecology and uro-gynecology.  Pelvic reconstructive surgery is many times very complex surgery that may require not just the removal of certain organs or tissues in a woman's pelvis, but may also include the resection of areas and putting her organs and tissues back together in a way that makes her more functional, with less/no pain and feels better. 

What is Pelvic Inflammatory Disease?

Pelvic inflammatory disease, or "PID" is an infection of a woman's pelvic organs which include the uterus, fallopian tubes, and ovaries. 

Bacteria causes pelvic inflammatory disease. Bacteria can move upward, from a woman's vagina or cervix - which is the opening to the uterus, or womb - into her fallopian tubes, ovaries and uterus, which then cause an infection. Many types of bacteria can cause pelvic inflammatory disease. But bacteria found in two common sexually transmitted diseases - chlamydia and gonorrhea - are the most frequent causes of pelvic inflammatory disease. 

After a woman becomes infected, it can take from a few days to a few months to develop pelvic inflammatory disease. 

The major symptoms of pelvic inflammatory disease are lower abdominal pain and abnormal vaginal discharge. 

Other symptoms of pelvic inflammatory disease may include one or more of the following; fever, pain in the right upper abdomen, pain during vaginal intercourse, and irregular menstrual bleeding.  

Pelvic inflammatory disease, particularly when caused by chlamydia, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs. 

Untreated, pelvic inflammatory disease causes scarring and can lead to infertility, tubal pregnancy, chronic pelvic pain, and other serious problems. 

Pelvic inflammatory disease is more common and more aggressive in HIV+ women than in uninfected women. Pelvic inflammatory disease may become a chronic and relapsing condition as a woman's immune system deteriorates. 

Women can play an active role in protecting themselves from pelvic inflammatory disease disease by following these steps and precautions: 

*  Call your doctor if you have discharge with odor or bleeding between cycles. 

*  Use either male or female condoms during sex. 


What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction, which is also referred to as outlet obstruction or outlet delay, refers to a condition in which the pelvic floor muscles of a woman's lower pelvis - that surround the rectum, do not function normally. It is not known why these muscles fail to work properly in some women, but they can make the passage of stools difficult even when everything else seemingly is normal.

What Causes Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction find that muscle pain occurs when muscles are tense, strained, traumatized and/or otherwise inflamed. Their pelvic muscles are no exception. Causes of pelvic floor dysfunction can include:

*  Chronic faulty posture with weak core musculature 
*  Trauma (fall on tailbone, old tailbone fracture, auto accident)
*  Inflammation or infection
*  Pelvic organ disease (endometriosis, irritable bowel syndrome, interstitial cystitis) 
*  Repetitive motion injuries such as those from gymnastics, volleyball, soccer, ballet or ice
    skating
*  Abdominal muscle wall weakness or hernias 
*  Chronic constipation
*  Pregnancy or complicated vaginal delivery 
*  Abdominal or pelvic surgery such as a hysterectomy 

Do I have Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction often have changes in their spine and/or pelvis.  Symptoms or conditional might include; scoliosis, short leg, swayback or a "torsioned" sacrum. The most common symptoms of pelvic floor dysfunction include one or more of the following:

*  Vaginal pain 
*  Pain with urination 
*  Urinary urgency and frequency 
*  Rectal pain 
*  Pain during vaginal intercourse 
*  Pain with sitting, standing, walking 
*  Pain and/or difficulty getting up from a seated or lying down position
*  Hip pain often with loss of range of motion in hips 
*  Deep pain in lower back radiating to legs, thighs, groin, hips 
*  Abdominal and lower abdominal/intestinal pain
*  Pelvic pressure or a feeling like your vagina or uterus are "falling out."
*  Involuntary loss of urine or stool 

What are Pelvic Adhesions?

Pelvic adhesions are the cause of many gynecological problems including significant pain, infertility and conception. Pelvic adhesions are irritations of a woman's pelvic organs as a result of a "pelvic inflammatory event" or from trauma to the area such as in the case of pelvic or gynecological surgery.

Examples of a pelvic inflammatory event include; fallopian tube infections that might occur from endometriosis, removal of an ovarian cyst, sexually transmitted diseases such as gonorrhea, post surgery infections, and even appendicitis and appendectomies.

As a woman's body's pelvic area recovers from an inflammation, trauma or surgery, it begins the healing process and starts to repair itself.  The woman's body and its' healing process may cause some tissues and structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal woman's healthy pelvis, this space is lined with a tissue called the peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In the pelvis of a non-injured/non-irritated woman, the peritoneum can be very "slippery" with the the organs and structures lying immediately next to each other that "slip" off each other and do not become bonded together. With a woman who has had a pelvic inflammation, trauma or injury, her body's healing process starts a sequence of events that may result in some of the pelvic tissues becoming "stuck" to or "adhering" to tissues or organs next to the inflamed, or injured tissue, and when this occurs, the outcome may be pelvic adhesions.

What is Menorrhagia?

Menorrhagia is the medical term for women (and young girls first starting their menstrual cycles) that excessive menstrual bleeding. Excessive menstrual bleeding is defined as having a period that lasts 7 or more days each menstrual cycle (period) or is so heavy that you saturate your menstrual pad and/or tampon and need to change your feminine hygiene product(s) every one to two hours.  It is very important to inform your doctor if you have excessive menstrual bleeding! 

Women that are suffering from Menorrhagia may experience; anemia, fatigue,  embarrassing menstrual accidents, and feel that you have to restrict your life and social activities to such an extent that you "miss out on life."  Many women prefer to stay close to home so as to avoid embarrassment due to their need to go to the restroom so often so that they can change their feminine hygiene products before they become too saturated and cause even more embarrassment.

How many women have Menorrhagia?

Approximately 1 in 5 women have Menorrhagia.

Are there any treatments or therapies for Menorrhagia?

Yes, there's hope and help for women with Menorrhagia!

Here are a few of the options and therapies you will want to discuss with your doctor.

Hormone therapy - also known as "both control pills," and/or other medications may be prescribed to treat hormone imbalance. Hormone therapy is effective about 50% of the time, and may be required for a long period of time. 

Uterine Balloon Therapy - Also known as Thermal Balloon Ablation) (see below for more information)

Dilation and curettage - also referred to as a "D & C" - is a surgical procedure whereby the doctor scrape the inside of the woman's uterus to remove the lining. For most women with Menorrhagia, a D&C is temporary and reduces excessive bleeding for only a few periods.

Endometrial Ablation is another possible therapy but only if you and your husband don't plan to have children in the future. Typical Endometrial Ablation removes the lining of the uterus with an electrosurgical tool or laser. Like any surgical procedure, there are risks, which include perforation of the uterus, bleeding, infection, or even heart failure due to fluids used to open up or distend the uterus.

Hysterectomy is the surgical removal of the uterus.  As a hysterectomy involves the removal of the woman's uterus, Menorrhagia will no longer be a problem. Hysterectomy is also a surgical procedure and also involves risks. The recovery period after hysterectomy is 3 to 6 weeks. 

Uterine Balloon Therapy 
www.UterineBalloonTherapy.com

What is Perineoplasty?

Perineoplasty, also known as "Perineorrhaphy,"is one of the fastest growing elective medical procedures and is the reparative or plastic surgery of the perineum which helps women with problems with vaginal opening laxity or looseness - medically referred to as "Vaginal Relaxation."  Many also incorrectly call this procedure "vaginoplasty" or "vaginaplasty."

Perineorrhaphy is the reconstruction of the muscles and tissues at the opening of the vagina and has successfully decreased the "introitus" or size of the vaginal opening. Perineorrhaphy does NOT reduce sexual sensation, in fact, properly performed, Perineorrhaphy INCREASES sensation for the woman as well as her husband/partner.

What is Colporrhaphy? 

Colporrhaphy is the surgical repair of the vaginal wall. This includes repairing many types of vaginal surgery, including the repairs of the vagina in a "Pelvic Organ Prolapse," "vaginal prolapse," "Vaginal Vault Prolapse," or the repair of a "cystocele" in the vaginal wall(s) or vaginal vault or a rectocele. A cystocele occurs when the bladder protrudes into the vagina, and a rectocele when the rectum protrudes into the vagina.

In the Colporrhaphy procudeure, a uro-gynecologist, or gynecological surgeon, places a vaginal speculum inside the vagina, which spreads/keeps the vagina open, for the doctor to inspect and repair the vagina. The vaginal wall is cut opened to reveal an opening in the supporting structures, or fascia and the defect is closed and then the vagina is repaired by suture and closed, and the speculum removed. 

Who performs the Colporrhaphy and where is it performed?

Colporrhaphy is usually performed in a nearby hospital operating room by a uro-gynecologist, urologist or gynecological surgeon.

Facts About Female Sexual Dysfunction

       *   43% of all women (and therefore, their husbands/partners as well) are
            suffering from various types of Female Sexual Dysfunction, also called
            "Female Sexual Problems."

       *   50% more women than men, are suffering from Erectile Dysfunction, which
            is referred to as "Female Erectile Dysfunction."

       *   Many people fail to recognize that unless a woman's clitoris is fully erect,
            that she is incapable of reaching an orgasm.

Vaginal Relaxation?

Ladies, is your loose vagina causing you embarrassment or have you lost the joy of intimacy?  

If one or more vaginal childbirths have caused your vagina to become loose, and "not tight", he has probably noticed as well. You can once again, have the "tight vagina" of your youth! 

What you, and he are experiencing, is something called "Vaginal Relaxation," the medical jargon for "loose vagina."

Vaginal Relaxation?

Did you know that over 35 million American women and their husbands are suffering loss of joy and intimacy due to "Vaginal Relaxation?" 

Have you or your husband noticed that the thrill of intimacy you and he used to enjoy has been diminished due to the loss of your vagina's tightness?

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Our Board Certified Physicians have 
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"Vaginal Relaxation" Problems!

Did you know that about 35 million to 40 million American women – and their husbands and partners - are suffering from “Vaginal Relaxation.”?  

“Vaginal Relaxation” is often referred to as a “loose vagina” wherein the vagina is not as tight as it once was, whether due to vaginal childbirth, age, or other vaginal trauma. The vagina has become relaxed, or loose, and now it has become a problem for the woman, as well as her husband/partner.

Some women, as another symptom of Vaginal Relaxation, have problems controlling their urine in certain situations or notice changes in their bowel habits. These symptoms of Vaginal Relaxation are typically related to one or more problems that occur as a result of vaginal childbirth, other vaginal trauma, aging or a combination of the above.  

There is hope!  Women, and their husbands/partners, no longer need to suffer from Vaginal Relaxation.  More and more doctors are treating women and couples suffering from Vaginal Relaxation with treatments – sometimes including surgery – that will help them return to a life without the embarrassment, disappointments and heartache of the symptoms and discomforts associated with Vaginal Relaxation.

What is "Nerve Stimulation" and how does Nerve Stimulation help patients?

There are various types of nerve stimulation, each with its own protocols for treating various ailments and conditions.

One type of nerve stimulation is for treating people with moderate to severe depression.  Depression can be a very serious and life-threatening condition that may require life-long management and treatment.  Treating depression may sometimes have a lower than hoped for success rate and estimates indicate that more than half of all patients with depression have relapses. Anti-depressant drugs and medication may lessen symptoms but may not relieve all of the symptoms in some patients.

Seizures also do not always respond to treatment. Some patients have tried two or more medications and still have seizures, as well as side effects from the drugs, both of which affect their quality of life.

Vagus nerve stimulators are a small medial device that are implanted under the skin of the chest.  A very small wire runs to the patient's vagus nerve, which is then stimulated by the device, in the same manner a pacemaker works.  In general, patients with depression normally experience an improvement in alertness, energy. memory, their depression improves as a result. better mood. These quality-of-life benefits improve over time. 

Vagus nerve stimulators, in general, have proven to be a safe and effective way to control seizures and lessen the severity of depression.   Because Vagus nerve stimulators are used, drugs are usually not required, and there are no side effects that are associated with anti-depressant or seizure-control medications.

See:  www.DepressionHelp.net  for more information about depression.

What is Perineoplasty?

Perineoplasty, also known as "Perineorrhaphy,"is one of the fastest growing elective medical procedures and is the reparative or plastic surgery of the perineum which helps women with problems with vaginal opening laxity or looseness - medically referred to as "Vaginal Relaxation."  Many also incorrectly call this procedure "vaginoplasty" or "vaginaplasty."

Perineorrhaphy is the reconstruction of the muscles and tissues at the opening of the vagina and has successfully decreased the "introitus" or size of the vaginal opening. Perineorrhaphy does NOT reduce sexual sensation, in fact, properly performed, Perineorrhaphy INCREASES sensation for the woman as well as her husband/partner.

What is Vaginal Dryness?

Vaginal dryness is one of the most distressing, and painful problems a woman faces.  Vaginal dryness occurs when the natural vagina secretions decreases within the vagina. The amount of vaginal moisture varies throughout a woman's monthly menstrual cycle. Vaginal dryness is particularly problematical as a woman enters and becomes menopausal.

What is a "Vaginal Moisturizer"?

Vaginal moisturizers, provided by numerous companies, and a variety of brand names, are products designed to relieve the pain and discomfort of vaginal dryness. These products are applied or inserted, into the vagina, one or more times per day, depending on the amount of vaginal dryness she may be experiencing.

A vaginal moisturizer may or may not be a vaginal lubricant.  Vaginal lubricants are normally used as an aid for intercourse and used on a short-term basis to help a woman that is not able to produce enough vaginal moisture to permit her to comfortably (and painlessly) engage in intercourse.  

A menstruating woman's vaginal moisture changes from day to day, and varies depending upon her hormones that control the production of vaginal moisture.  A woman can experience vaginal dryness even during times of menstrual bleeding, especially when using tampons, as tampons can remove the natural moisture her vagina produces which can cause irritation and pain.

What is Female Sexual Arousal Disorder?

Female Sexual Arousal Disorder or simply "FSAD" occurs when a woman is unable to attain and maintain a full and complete erection of her clitoris along with sufficient vaginal lubrication during intercourse to be able to reach an orgasm.  

Female Sexual Arousal Disorder may also be diagnosed when the woman has no desire for sexual intercourse. 

Female Sexual Arousal Disorder affects up to 43 percent of all women, or an estimated 90 million women. Most women (more than 1/2) with FSAD are postmenopausal. Some women with Female Sexual Arousal Disorder describe the condition as being "unable to get turned on," or being continually disinterested in sex. Female Sexual Arousal Disorder has  also been called "frigidity." Other symptoms of Female Sexual Arousal Disorder may include dyspareunia and vaginismus, both of which involve pain during intercourse.

The woman and her husband/partner should both be seen as this is a "couple's problem" that is typically best resolved with both partners in treatment.  Their doctor will also insure that this  is not the result of another psychological disorder which could be a primary problem. 

If the husband/ partner of a patient with suspected Female Sexual Arousal Disorder feels that this is a problem within the relationship, that concern should be sufficient for the individual to seek psychological consultation.

What is Female Erectile Dysfunction?

Female Erectile Dysfunction occurs when a woman is unable to attain, and maintain a complete erection of her clitoris through orgasm.

If the husband/partner of a patient with suspected Female Erectile Dysfunction feels that this is a problem within the relationship, his concern should be sufficient for the individual the couple to seek medical and/or psychological consultation to determine the cause of her Female Erectile Dysfunction. 

What Are Female Sexual Problems?

Female Sexual Problems are also referred to as "Female Sexual Dysfunction."  A woman may have one or more Female Sexual Problems that we are just now learning that may be related to a number of factors.  

Typically, Female Sexual Problems are labeled generically as "Female Sexual Dysfunction" until such time as her doctor or therapist may be able to make a proper diagnosis.  

Female Sexual Problems may be a cause of significant distress to both her and her husband. 

If the husband/partner of a patient with suspected Female Sexual Problems feels that this is a problem within the relationship, his concern should be sufficient for the individual to seek psychological consultation. 

What is Female Orgasmic Disorder?

Female Orgasmic Disorder is defined as a sexual dysfunction that is characterized by a persistent or recurrent delay or absence of orgasm following the excitement phase of the female sexual response cycle, causing significant distress or interpersonal problems, and not being attributable to a drug or a general medical condition. 

Female Orgasmic Disorder is directly related with the woman's inability to attain and maintain a fully-erect clitoris.  

Without a full erection of the clitoris, a woman cannot reach an orgasm.

What is Hypoactive Sexual Desire Disorder?

Hypoactive Sexual Desire Disorder or "HSDD" has been defined as a deficiency or absence of sexual fantasies and desire for sexual activity. Hypoactive Sexual Desire Disorder is considered a disorder if it causes distress for the woman or husband.  The woman and her husband should both be seen as this is a "couple's problem" that is typically best resolved with both partners in treatment.  Their doctor will also insure that this  is not the result of another psychological disorder which could be a primary problem. 

If the husband/partner of a patient with suspected Hypoactive Sexual Desire Disorder feels that this is a problem within the relationship, his concern should be sufficient for the individual to seek psychological consultation.

What is menopause?

Menopause is a normal change in a woman's life when her period stops. That's why some people call menopause "the change of life" or "the change." During menopause a woman's body slowly produces less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row.

What is hormone therapy for menopause?

Hormone therapy for menopause has also been called hormone replacement therapy (HRT). Lower hormone levels in menopause may lead to hot flashes, vaginal dryness and thin bones. To help with these problems, women are often given estrogen or estrogen with progestin (another hormone). Like all medicines, hormone therapy has risks and benefits. Talk to your doctor, nurse, or pharmacist about hormones. If you decide to use hormones, use them at the lowest dose that helps. Also use them for the shortest time that you need them.

What are the symptoms of menopause?

Every woman's period will stop at menopause. Some women may not have any other symptoms at all. 

As women begin reaching the age of 40, their bodies are preparing for menopause, or the stopping of their monthly menstrual periods.  Menopause never happens all at once.  As young ladies approach their first period and monthly menstruation, her body's hormones are "transitioning" to producing hormones levels that will support monthly menstruation for about the the next 35 years. Similarly, as women reach their 40's, their bodies' hormone levels begin to change, and in preparation of menopause. 

Women will know they are approaching menopause, as they will notice the following symptoms:

• Changes in your period - time between periods or flow may be different.

• Hot flashes ("hot flushes") - getting warm in the face, neck and chest.

• Night sweats and sleeping problems that lead to feeling tired, stressed or tense.

• Vaginal changes - the vagina may become dry and thin, and sex may be painful.

• Thinning of your bones, which may lead to loss of height and bone breaks (osteoporosis).

Who needs treatment for symptoms of menopause?

• For some women, many of these changes will go away over time without treatment.

• Some women will choose treatment for their symptoms and to prevent bone loss. If you choose treatment, estrogen alone or estrogen with progestin (for a woman who still has her uterus or womb) can be used.

What are the benefits from using hormones for menopause?

Hormone therapy is the most effective FDA approved medicine for relief of hot flashes, night sweats or vaginal dryness.

Hormones may reduce your chances of getting thin, weak bones (osteoporosis) which break easily.

What are the risks of using hormones?

For some women, hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, breast cancer, and gall bladder disease. For a woman with a uterus, estrogen increases her chance of getting endometrial cancer (cancer of the uterine lining). Adding progestin lowers this risk.

Should I use estrogen just to prevent thin bones?

You can, but there are also other medicines and things you can do to help your bones.

Should I use hormone therapy to protect the heart or prevent strokes?

No, do not use hormone therapy to prevent heart attacks or strokes.

Should I use hormone therapy to prevent memory loss or Alzheimer's disease?

No, do not use hormone therapy to prevent memory loss or Alzheimer's disease.

Do hormones protect against aging and wrinkles or increase my sex drive?

Studies have not shown that hormone therapy prevents aging and wrinkles or increases sex drive.

How long should I use hormones for menopause?

You should talk to your doctor, nurse or pharmacist. Again, hormones should be used at the lowest dose that helps and for the shortest time. (For example, check if you still need them every 3-6 months.)

Does it make a difference what form of hormones I use for menopause?

The risks and benefits may be the same for all hormone products for menopause, such as pills, patches, vaginal creams, gels and rings.

Are herbs and other "natural" products useful in treating symptoms of menopause?

At this time, we do not know if herbs or other "natural" products are helpful or safe. Studies are being done to learn about the benefits and risks.

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Labia Reduction Surgery
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What is Labia Reduction Surgery?

More and more women are seeking "female genital surgery" to correct problems relating to their vulvas whether they are unhappy with the looks of their vulva or if their elongated labia minora are causing them pain or embarrassment - female genital surgery can correct these problems.

Some of the more common reasons given by women to seek female genital surgery include;  

• labia minora (smaller lips of the vulva) are uneven, mis-shapen or elongated

• one of the labia minora lips is longer than the other

• labia minora feel "floppy"   

• no longer able to wear a bikini or favorite swimsuit because you are afraid that your labia minora may "fall out" of the bikini

• long labia minora cause pain during intercourse or when wearing tight jeans.

• clitoral hood has excess skin which is either unsightly or interferes with sexual pleasure

• too much skin surrounding your clitoris

• after childbirth, my vagina seems too loose, and intercourse doesn't feel the same

• your vagina feels like it is "gaping" open  

• intercourse is no longer pleasurable, for you - or for him and doesn't feel as good as it once did 

What you, and he, are experiencing, is something called "Vaginal Relaxation" the medical term for having a "loose vagina."

These are just some of the complaints we regularly hear from women who want to improve their vulva and how it looks (and feels) - and what we call "cosmetic gynecology." 

Cosmetic gynecology may be what you have been looking for!  Look great, feel great, we can help you have the labia minora, vagina or vulva you always dreamed of!

Vaginal Dryness
www.VaginalDryness.net

What is Vaginal Dryness?

Vaginal dryness is one of the most distressing, and painful problems a woman faces.  Vaginal dryness occurs when the natural vagina secretions decreases within the vagina. The amount of vaginal moisture varies throughout a woman's monthly menstrual cycle. Vaginal dryness is particularly problematical as a woman enters and becomes menopausal.

What is a "Vaginal Moisturizer"?

Vaginal moisturizers, provided by numerous companies, and a variety of brand names, are products designed to relieve the pain and discomfort of vaginal dryness. These products are applied or inserted, into the vagina, one or more times per day, depending on the amount of vaginal dryness she may be experiencing.

A vaginal moisturizer may or may not be a vaginal lubricant.  Vaginal lubricants are normally used as an aid for intercourse and used on a short-term basis to help a woman that is not able to produce enough vaginal moisture to permit her to comfortably (and painlessly) engage in intercourse.  

A menstruating woman's vaginal moisture changes from day to day, and varies depending upon her hormones that control the production of vaginal moisture.  A woman can experience vaginal dryness even during times of menstrual bleeding.

__________________________________________________________________________________

Vaginal Odor
www.VaginalOdor.net 

I have a Vaginal Odor ( VO) problem, what do I do? 

All menstruating women's vaginas go through monthly changes wherein their vagina's smell or scent changes from one day to the next, and throughout her monthly menstrual cycle. The amount of vaginal secretions, cervical mucous and vaginal moisture, changes from one day to the next, and throughout the monthly menstrual cycle.  This is due to the flow of hormones that produce these changes throughout her cycle and also the reason for her monthly menstruation, if she has not conceived. 

Vaginal odor problems can be related to many things related to her menstrual hygiene, vaginal hygiene, and/or feminine hygiene, but may also be an indication of a medical condition that may need immediate treatment.  

Here are some of the signs and symptoms related and possible causes of V.O. (vaginal odor):

Vaginal odor may be the result of an inflammation of her vagina.  The vaginal inflammation is often a result of infection in or around the vagina or vulva, called the vulvovaginal area. Sometimes this condition is referred to as vulvovaginitis.

Causes of Vaginal Odor

Bacterial Vaginosis 
Chlamydia  
Genital Herpes  
Gonorrhea 
Lymphogranuloma Venereum ("LGV") 
Pelvic Inflammatory Disease ("PID")
Sexually Transmitted Infection(s)
Syphilis 
Trichomonas
Vaginal Yeast Infection (candida)
Vulvovaginitis 


Bacterial Vaginosis leads to vaginal odor, what causes it?

Bacterial Vaginosis (BV) is a type of vulvovaginitis. Bacterial Vaginosis occurs due to an overgrowth of one or more organisms that are normally present in your/your wife's vagina. 

Many times, when a woman begins taking antibiotics, these antibiotics kill off the natural organisms in her vagina.  This may cause some organisms in her vagina to multiply, and these organisms produce chemicals that cause a fish-like odor characteristic of BV. Vaginal odor may be more acute, and stronger after sexual intercourse. 

Many times, while a woman may believe that vaginal douching prevents or helps prevent vaginal odor, especially after menstruation, douching actually disrupts the normal flora, or naturally occurring organisms that normally live in the vagina.  Vaginal douching, therefore,  may actually increase the risk of vaginal infection.

Signs and symptoms of Bacterial Vaginosis include(s): 

*  Grayish-white vaginal discharge
*  Vaginal itching or irritation
*  Vulva/labial redness, irritation, swelling and redness

Treating Bacterial Vaginosis is normally started after a visit to the ob-gyn who may  prescribe medication(s) - usually antibiotics.

Other causes of vaginal odor include the following:

Poor vaginal, menstrual or feminine hygiene methods.

Not changing tampons, or menstrual pads frequently enough.

"Losing" or forgetting a tampon in the vagina, which may lead to a vaginal infection. 

Rarely, an advanced tumor of the cervix or vagina will cause a vaginal odor problem.

Vaginal Hygiene is an area that focuses its studies, resources, and recommended products on proper Vaginal Hygiene, and overcoming Vaginal Hygiene problems. Whether you are concerned about menstruation, whether you should consider douching, vaginal odors, vaginal dryness, menstrual odors during menstruation, or general feminine hygiene information, this site is for you.

What is Gardnerella or Gardnerella Vaginalis?

Gardnerella or Gardnerella Vaginalis is an infection in the vagina caused by bacteria of the Gardnerella Vaginalis strain, often in combination with various anaerobic bacteria. This bacterial strain, "Gardnerella Vaginalis" is also the cause of "bacterial vaginosis" or "BV." 

A vaginal infection caused by Gardnerella often produces a gray or yellow discharge with a "fishy" vaginal odor that increases after washing the vulvovaginal area with alkaline soaps. 

Gardnerella Vaginalis is one of the most common causes of bacterial vaginitis - also called bacterial vaginosis, or "BV." 

Typically, the woman will see her family physician or gynecologist with complaints of a strong vaginal odor that is "fishy" smelling, along with a vaginal discharge which is gray to white in color.  The vaginal odor or fishy smell may be released on application of 10 percent potassium hydroxide to the vaginal secretion on a glass slide during a vaginal exam by the physician.

The normal vaginal pH is 3.7 - 4.5.  Women with Gardnerella typically have a vaginal pH above 4.5 

Gardnerella Vaginalis symptoms include:

• Vaginal Discharge that is white or gray in color. 

• Vaginal odor that smells like fish and is especially noticeable after sex.

• Vaginal pH above 4.5
  

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