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Health Corners
Surgeries Specific to Women

If you are a woman, it is likely that you will be faced with the situation of having to undergo a surgery specific to your sex at some point in your lifetime. When surgery is suggested as remedy for your problem, it is advisable to take a second opinion. It also helps to be aware of the benefits and risks of the surgery to be performed. and to read up on what the surgery will mean to you in terms of the actual procedure and the recovery time.

Dilatation and Curettage (D&C)

Dilatation and Curettage (D&C) involves opening the cervix and scraping the inner wall of the uterus to remove tissue. This surgery is done through the vagina.

Why is D&C suggested? Dilatation and curettage is usually recommended when there is:

  • An incomplete miscarriage
  • Abnormal bleeding from the uterus
  • Possible cancer of the uterus
  • Minor disease in the uterus
  • Decision to abort during early pregnancy

Are you at greater surgical risk than normal? You are at greater surgical risk than normal if you are obese (grossly overweight), a smoker, or if you consume excess alcohol, or have suffered recently from chronic anaemia, diabetes mellitus, heart or lung disease. You are also at greater risk if you have been on drugs like cortisone, anti-hypertensive medication, diuretics, insulin or drugs that alter your state of mind.

Hospitalisation You may be asked to remain in the hospital for a day.

What you should expect before the surgery. Some diagnostic tests are done before the surgery, including a pap smear, pregnancy test and blood and hormonal studies.

Anaesthesia Anaesthesia may be local anaesthesia by injection, or general anaesthesia by injection and inhalation with an airway tube placed in the windpipe.

What the surgeon does First, the vagina is cleaned with an antiseptic. The cervix is carefully and gradually opened with an instrument called a dilator. Another instrument called a curette is inserted into the uterus. With the curette, a part of the uterine lining is scraped away. This can be analysed in the laboratory. Some surgeons collect the tissue by a procedure known as suction curettage.

Complications The possible complications of a D&C are infection of the surgical wound, excessive bleeding and accidental injury to the uterus.

Outcome The outcome of this surgery is that tissue is scraped successfully without complications. It takes about 4 to 6 weeks to recover from a D&C.

Postoperative medication and diet After a D&C, it is advisable to wear cotton panties. You will need to wear a sanitary pad, as there is usually slight bleeding during recovery. Don’t use tampons during the recovery period. Take mild pain relievers if you experience pain. There are no dietary restrictions after a D&C.

When will you get back to normal? To help yourself recover, you must start your normal daily activities, including going to work as soon as you feel strong enough. You can start having sex again when the spotting stops completely.

Warning signals to call the doctor You must get medical help if:

  • Vaginal discharge becomes worse or smells unpleasant.
  • There is unusual vaginal swelling or bleeding.
  • Signs of infection develop such as headaches, muscle aches, giddiness or fever.

Caesarian Section

Caesarian section is the delivery of a baby by making an incision in the abdomen and lower part of the uterine wall. This method gets its name from the Roman emperor Julius Caesar, who, it is said, was delivered in this way.

Why is Caesarian Section suggested? Caesarian section is suggested if there is danger to you or your baby from any of the following causes:

  • When the baby's head is too large to pass through the birth canal.
  • When the baby is in the wrong position to pass through the birth canal.
  • When the uterus is not contracting sufficiently.
  • When the placenta is attached abnormally.
  • When normal labour fails in a woman who has had a Caesarian section before.
  • When there is acute herpes genitalis infection.

Are you at greater surgical risk than normal? You are at greater surgical risk than normal if you are obese (grossly overweight), a smoker, or consume excess alcohol, or if you have poor nutrition, suffered from chronic heart or lung disease, placenta previa with excessive blood loss or toxemia of pregnancy. You are also at greater risk if you have been on drugs like anti-hypertensive medication, diuretics, cortisone, insulin or drugs that alter your state of mind.

Hospitalisation You will have to remain in the hospital for 3 to 5 days.

What you should expect before the surgery. Blood and urine studies and a sonogram are done before a caesarian section.

Anaesthesia The type of anaesthesia used could be local anaesthesia or spinal anaesthesia by injection.

What the surgeon does First, an incision in the abdomen followed by one in the uterus is made. The baby and the placenta are removed from the uterus. The uterus is then closed and the abdominal contents are replaced. The abdomen is closed in layers. The skin is closed with stitches or clips, which are usually removed about a week after surgery.

Complications There could be excessive bleeding or infection of the surgical wound. Some patients suffer from post-operative anaemia. Another possibility is endometritis (inflammation of the uterine lining).

Outcome There are usually no complications and the baby is delivered successfully. Recovery takes about a month.

Postoperative medication and diet A hard ridge should form along the incision. As this ridge heals, it will gradually subside. The pain you may feel around the surgical area can be relieved with a heat lamp or a warm compress. You can have a bath as usual, in warm water. The wound can be washed with mild unscented soap. Mild pain relievers can be taken. You will have to be on a liquid diet until your gastro-intestinal tract begins to function again. After that, a balanced diet helps the surgical area to heal and you to recover quickly.

When will you get back to normal? To help yourself recover, you must start your normal daily activities, including going to work as soon as you feel strong enough. You can drive a car about 3 weeks after you return home from the hospital. You can start having sex again when you feel well enough.

Warning signals to call the doctor You must get medical help if:

  • Bleeding soaks more than one pad an hour.
  • A part of your breast becomes hard, hot or tender to the touch, or looks reddened.
  • Your nipples become sore or cracked.
  • Vaginal discharge or the urge to urinate frequently goes on beyond one month.
  • Pain, red streaks or warm areas appear on the calf of one of your legs.

Tubal Ligation

Tubal ligation is a surgery performed to tie the fallopian tubes to achieve sterilisation in a woman.

Why is tubal ligation suggested? Tubal ligation is suggested when you want to prevent pregnancy in future. It is important to go in for professional counselling before deciding to have your tubes tied. The surgery results in sterilisation that is usually irreversible.

Are you at greater surgical risk than normal? You are at greater surgical risk than normal if you are obese (grossly overweight), a smoker, and are suffering from poor nutrition. You are also at greater risk if you have been on drugs like cortisone, anti-hypertensive medication, beta-adrenergic blockers or drugs that alter your state of mind.

Hospitalisation You may be asked to remain in a hospital for a day.

What you should expect before the surgery. Blood and urine studies.

Anaesthesia The type of anaesthesia used could be local anaesthesia or spinal anaesthesia by injection or general anaesthesia by injection and inhalation with an airway tube placed in the windpipe.

What the surgeon does The surgeon may use any one of several techniques to expose your fallopian tubes for surgery. These include laparoscopy, posterior colpotomy (through the back of the vagina) and minilaparotomy (through an incision just above the pubic hairline). After exposing the tubes, a small section of each tube is cut free and removed. The cut ends are tied. In case an incision is made, the skin is closed with sutures or clips, which are usually removed in a week’s time.

Complications The possible complications after tubal ligation are accidental injury to the bowel and shoulder pain (after laparoscopy).

Outcome The outcome is complete healing without complications and lifelong sterility. Your periods will continue normally. Recovery takes about 2 weeks.

Postoperative medication and diet You can use an electric heating pad, a heat lamp or a warm compress to relieve surgical wound pain. You can have a bath as usual, but wash the wound area with mild unscented soap. If you feel depressed, take professional counselling. You have, after all just been through a major step in your life. Mild pain relieving drugs can be taken. You will be on clear liquid diet until your gastro-intestinal tract starts functioning again. After that a balanced diet is recommended, as this helps healing.

When will you get back to normal? To help yourself recover, you must start your normal daily activities, including going to work as soon as you feel strong enough. Don’t exercise vigorously for about 2 weeks after the surgery. You can start driving a car 3 days after you get back from the hospital. Have sex when your doctor says that healing is complete.

Warning signals to call the doctor You must get medical help if:

  • There is pain, swelling, redness, discharge or increased bleeding in the surgical area.
  • There are signs of infection such as headache, muscle aches, dizziness or a general ill feeling and fever.
  • You have nausea, vomiting, constipation or abdominal swelling.

Hysterectomy_ vaginal

A vaginal hysterectomy is the removal of the uterus, cervix, fallopian tubes and ovaries through an incision in the deepest part of the vagina. This is sometimes accompanied by colporrhaphy, that is, a plastic surgery to repair the weakened bladder and rectal muscles.

Why is vaginal hysterectomy suggested? vaginalian section is suggested if there is danger to you or your baby from any of the following causes:

  • Uterus: Removal of the uterus is suggested if you have cancer (confirmed or suspected), fibroids, chronic bleeding, prolapsed uterus, endometriosis, chronic pelvic infection or severe menstrual pain.
  • Fallopian tubes and ovaries: Removal of the fallopian tubes and ovaries are suggested if you have ovarian cancer (confirmed or suspected), pre-cancerous or twisted ovarian cysts, ovarian pregnancy, ovarian abscess, or damage to ovaries from severe endometriosis.
  • Bladder and rectal muscles, pelvic ligaments: When these require strengthening.

You are at greater surgical risk than normal if you are obese (grossly overweight), a smoker, suffering from iron-deficiency (anaemia), or if you have heart or lung disease or diabetes mellitus. You are also at greater risk if you have been on drugs like cortisone, anti-hypertensive medication, beta-adrenergic blockers or drugs that alter your state of mind.

Hospitalisation On an average, you can expect to be in a hospital from 5 days to a week.

What you should expect before the surgery. A number of diagnostic tests are done before the surgery, including blood and urine studies, X-rays of your kidneys and abdomen, and D&C (Dilatation and Curettage).

Anaesthesia For a vaginal hysterectomy, spinal anaesthesia will be given by injection. General anaesthesia may be given by injection and inhalation. An airway tube is placed in your windpipe for inhalation of anaesthesia.

What the surgeon does The surgeon first separates the vaginal walls 0 from the bladder muscles and rectal muscles. Then the deepest recesses of the vagina are opened. The cervix, uterus, fallopian tubes and ovaries are cut away and removed. The back part of the vagina is then closed with stitches and the bladder muscles and rectal muscles are sewn back in place. The supporting tissue is repaired. A small catheter remains in the bladder for a week to 10 days. The surgeon may perform this operation by laparoscopy.

Complications The possible complications of a vaginal hysterectomy are excessive bleeding and infection of the surgical wound. The muscles supporting the bladder and rectum may require a second repair. There could be accidental damage to the bladder, rectum or ureter. Urinary retention is also a possible complication.

Outcome The probable outcome of a vaginal hysterectomy is a shortening of the vagina that will not cause problems for long. There will be permanent sterility. It will take about 6 weeks to recover completely from surgery.

Postoperative medication and diet You will need to use sanitary pads and not tampons to absorb post-operative bleeding. Your doctor will prescribe pain relievers and most probably supplemental female hormones as well. Vaginal creams or medicated douches will be given if vaginal discharge has an unpleasant odour. You will be on clear liquid diet until your gastro-intestinal tract starts functioning again. After that a balanced diet is recommended, as this helps healing.

When will you get back to normal? To help yourself recover, you must start your normal daily activities, including going to work as soon as you feel strong enough. You can start driving a car about 2 weeks after you get back from the hospital. Have sex as soon as you are able to.

Warning signals to call the doctor You must get medical help if:

  • Bleeding (vaginal) that soaks more than one sanitary pad per hour.
  • A frequent urge to urinate that persists more than a month.
  • Excessive vaginal discharge that persists more than a month.
  • Increased pain or swelling in the surgical area.
  • Headache, muscle aches, dizziness or a general ill feeling and fever (these are signs of infection).
  • Abdominal swelling or pain.

Hysterectomy_ Abdominal

An abdominal hysterectomy is removal of the uterus by abdominal surgery. Sometimes, the gynaecologist also decides to remove the cervix, fallopian tubes, and ovaries. A hysterectomy is done if there are malignant tumours or benign growths causing pain and bleeding. After this surgery, you cannot bear children. That is why it is avoided in younger women. However, there is no effect on sexual activity. What is described below is hysterectomy with removal of cervix, fallopian tubes and ovaries as well.

Why is hysterectomy suggested? abdominalian section is suggested if there is danger to you or your baby from any of the following causes:

  • Uterus: Removal of the uterus is suggested if you have cancer (confirmed or suspected), fibroids, chronic bleeding, prolapsed uterus, endometriosis, chronic pelvic infection or severe menstrual pain.
  • Fallopian tubes and ovaries: Removal of the fallopian tubes and ovaries are suggested if you have ovarian cancer (confirmed or suspected), pre-cancerous or twisted ovarian cysts, ovarian pregnancy, ovarian abscess, or damage to the ovaries from severe endometriosis.

Are you at greater surgical risk than normal? You are at greater surgical risk than normal if you are obese (grossly overweight), a smoker, suffering from iron-deficiency (anaemia) or if you have heart or lung disease or diabetes mellitus. You are also at greater risk if you have been on drugs like cortisone, anti-hypertensive medication, beta-adrenergic blockers or drugs that alter your state of mind.

Hospitalisation On an average, you can expect to be in a hospital from 5 days to a week.

What you should expect before the surgery. A number of diagnostic tests are done before the surgery, including blood and urine studies, X-rays of your kidneys and abdomen, and D&C (Dilatation and Curettage).

Anaesthesia For an abdominal hysterectomy, general anaesthesia will be given by injection and inhalation. An airway tube is placed in your windpipe for inhalation of anaesthesia.

What the surgeon does First, an incision is made in your abdomen and the abdominal organs are examined. Then, the uterus, cervix, fallopian tubes and ovaries are cut away and removed. The vagina is closed with stitches at its internal end. Then the surgical wound is closed, layer by layer. A catheter may be inserted in your bladder. This could stay for several days. The surgeon could also perform this operation by laparoscopy.

Complications The possible complications after a hysterectomy are excessive bleeding, infection of the surgical wound and accidental injury to the bladder or ureter.

Outcome The probable outcome of the surgery will be a shortening of the vagina, which won’t cause a problem for long. Permanent sterility is the most important result. You will take about 6 weeks to recover completely from an abdominal hysterectomy.

Postoperative medication and diet You will need to use sanitary pads and not tampons to absorb post-operative bleeding. Your doctor will prescribe pain relievers and most probably supplemental female hormones as well. You will be on clear liquid diet until your gastro-intestinal tract starts functioning again. After that a balanced diet is recommended, as this helps healing.

When will you get back to normal? To help yourself recover, you must start your normal daily activities, including going to work as soon as you feel strong enough. You can start driving a car about 2 weeks after you get back from the hospital. Have sex as soon as you are able to.

Warning signals to call the doctor You must get medical help if:

  • Bleeding (vaginal) that soaks more than one sanitary pad per hour.
  • A frequent urge to urinate that persists more than a month.
  • Excessive vaginal discharge that persists more than a month.
  • Increased pain or swelling in the surgical area.
  • Headache, muscle aches, dizziness or a general ill feeling and fever (these are signs of infection).

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