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INDIA’S BEST GYNECOLOGIST

DR (PROF) SADHANA KALA, MS, FICOG

‘INDIA’S TOP 8 GYNECOLOGIST’
“at the top of the list is Dr Prof Sadhana Kala”
She is the only one from Delhi in the List

“View the list of best gynecologists in India, with their Review Rating, experience and Services offered. Dr (Prof) Sadhna Kala (Delhi) and Dr. Shobha Venkat (Bangalore) top the list because of their experience, review ratings and service quality.”

 

1. Best Gynecologists in India with Highest Review Ratings (published: 15 November 2017)https://www.elawoman.com/…/best-gynecologists-in-india-with…

 

2. Top 10 Best Gynecologists in India (published: Oct 25, 2017) http://essencz.com/piyalis…/top-10-best-gynecologists-india/

(At the World Congress of Gynecologist, Rio De Janerio, October 2018)

3. Top 10 Best Gynecologists in Delhi
http://essencz.com/piyalis…/top-10-best-gynecolaogist-delhi/

(At the World Congress of Gynecologist, Rio De Janerio, October 2018)

4. Best Gynecologists in Delhi NCR with Highest Ratings and Reviews
https://www.elawoman.com/…/best-gynecologist-in-delhi-ncr-w…

(Robotic Surgery Workshop, New York, 2016)

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CESAREAN VS VAGINAL DELIVERY

The birth of a child is supernatural spiritual event. – Lailah Gifty Akita,
A miracle is really the only way to describe motherhood and giving birth. – Jennie Flnch

SYNOPSIS

A baby may be delivered by a vaginal or a cesarean delivery. But in a given situation, one procedure may be safer for the mother and the baby than the other procedure.

Advantages of the vaginal delivery are that the mother feels it is natural, the recovery period is shorter and she can breastfeed earlier. Disadvantages are that it is a gruelling event and has a higher risk of urinary incontinence; and that the baby may be injured during delivery.

A cesarean may be required in certain situations such as low-lying placenta or breech baby. Mother has longer recovery period; and risk of excessive blood loss and bowel or bladder injury. Baby may have breathing problem and childhood ashthama and obesity.

A successful. VBAC (vaginal birth after a cesarean) is possible. However, there is a small risk of rupture of the uterus. Therefore, suitable doctor and hospital are required.

INTRODUCTION

Between cesarean and vaginal delivery, choose the one which has the least chance of causing injury or morbidity to the baby and the mother. Both procedures have risks. But in a given situation, risks in one procedure are greater than in the other. Aim is to minimize the risk.

For an informed discussion with the therapist, for choosing the optimum delivery method in a given situation, and for giving an informed consent, the expecting mother and her family need to know the pros and cons of the two methods of delivery.

This paper summarizes the pros and cons of the two methods for the mother and for the baby.

INCIDENCE

According to WHO, maternal and new-born deaths decrease as the cesarean rate rises up to 10-15% of the number of deliveries. Higher cesarean rate does not further reduce maternal or neonatal mortality. We may interpret that to mean that in 10-15% cases cesarean is called for; but in 85% of the cases, that is majority of the cases, vaginal delivery is possible. In a few other studies, the death rate continues to reduce till 19% of caesarean rate.

The average caesarean rate in India is 18%. However among the 20% richest population, the rate is 30%. In the United States caesarean rate is about 32% (2017). Clearly, among the rich, more caesareans are being done than are medically needed: rich women choose caesarean rather than vaginal delivery.

VAGINAL DELIVERY

A Mother finds vaginal delivery a more natural experience, feels she is giving birth the way nature intended her to. The other advantages are:

  • A shorter hospital stay (24 – 48 hours) and recovery time compared with a cesarean.
  • Avoid major surgery and its associated risks, such as severe bleeding, scarring, infections, reactions to anesthesia and longer-lasting pain.
  • Earlier contact with the new-born, hold her baby and begin breastfeeding sooner after she delivers
The disadvantages for the mother are;
  • Labor is a physically gruelling process and is hard work.\
  • A risk that the skin and tissues around the vagina can stretch and tear while the fetus moves through the birth canal. If stretching and tearing is severe, a woman may need stitches or this could cause weakness or injury to pelvic muscles that control her urine and bowel function.
  • Higher risk of bowel or urinary incontinence; more prone to leak urine when they cough, sneeze or laugh.
  • May experience lingering pain in the perineum, the area between her vagina and anus.
  • Increased risk of:
    o anxiety and stress during pregnancy
    o sexual problems post-delivery
    o increased risk of post partum depression
For the Baby the advantages are:
  • Muscles involved in birthing may squeeze out fluid in a new-born’s lungs, making breathing problems at birth less likely.
  • Good bacteria received as the new-born travels through the birth canal may boost its immune systems and protect its intestinal tracts.
  • For the Baby the disadvantage is that in long labor, or if the new-born is large, it may get injured during the birthing, resulting in a bruised scalp or a fractured collarbone.

CESAREAN

In certain medical situations, vaginal delivery may be too risky. Therefore a cesarean may be planned. Typical risky situations are:

  • Twins or other multiples
  • A very large baby in a mother with a small pelvis
  • Baby not in a heads-down position and efforts to turn the baby into this position before birth were unsuccessful.
  • Medical conditions such as diabetes or high blood pressure
  • An infection, such as HIV or genital herpes, that she could pass along to her baby during birth
  • Problems with the placenta during pregnancy

Sometimes an unplanned, or emergency cesarean, may become necessary because the health of the mother, the baby, or both, is in jeopardy. This may happen because of a problem during pregnancy; or after a woman has gone into labor: if labor is happening too slowly or if the baby is not getting enough oxygen (fetal distress).

Sometimes a mother may request for an elective cesarean because she wants to plan her delivery; or because she previously had a complicated vaginal delivery.

In certain situations cesarean is lifesaving. But opening up a woman’s abdomen and removing the baby from her uterus is a major surgery. The risks are:

• often leads to repeat C-sections in future pregnancies,
• longer hospital-stay, two to four days on average.
• longer recovery period, often at least two months; more pain and discomfort in the abdomen as the skin and nerves surrounding the surgical scar need time to heal.
• increased physical complaints such as pain or infection at the site of the incision and longer-lasting soreness.
• increased risk of:
o blood loss and a greater risk of infection, bowel or bladder injury or a blood clot forming during the operation.
o future pregnancy complications, such as placental abnormalities and uterine rupture, which is when the uterus tears along the scar line from a previous cesarean. The risk for placenta problems increases with every cesarean a woman undergoes.
o death during surgery: three time more likely in a cesarean than in a vaginal birth, due mostly to blood clots, infections and complications from anesthesia.
o miscarriage and stillbirth in pregnancy after cesarean.

Baby born by cesarean is at a higher risk of:

• stillbirth
• higher mortality rate than vaginal delivery baby
• more likely to be admitted to the NICU for breathing problems
• higher rate of childhood (up to the age of 12) asthama
• a greater risk of becoming obese as children and as adults (perhaps because women who are obese or have pregnancy-related diabetes are more likely to have a C-section)
• lesser immune system

VBAC

VBAC (vaginal birth after cesarean) is possible under certain conditions. But VBAC is not safe for every woman and can even be life threatening to her. Before attempting a trial of labor after cesarean (TOLAC), remember that the following are contraindications:

• obesity (body mass index 30 or higher; weight over 200 pounds)
• pre-eclampsia (high blood pressure during pregnancy)
• age (usually older than 35)
• previous caesarean was in the last 19 months
• fetus is very large
• the reason for the initial caesarean is recurrent (for example, very small maternal pelvic dimensions). In this case, TOLAC may be dangerous to both mother and baby.
• more than two previous caesareans
• scar is a vertical cut, that is, it goes from top to bottom (high risk it will rupture and harm the baby and the mother and will call for a cesarean)
• additional uterine scars, anomalies, or ruptures

If scar is low and a transverse cut, that is, goes from side to side, then TOLAC may be attempted.

According to ACOG (The American College of Obstetricians and Gynecologists):

• 3-4 out of 5, ie, 60-80% women can have successful VBAC
• transverse cut, risk of rupture, is 0.2 to 1.5%, ie 1 in 500
• VBAC is safer than repeat caesarean
• more than one previous caesarean does not pose any additional risk in VBAC
• genital herpes is acceptable, unless a visible lesion
• no evidence that a large baby requires cesarean. Squatting increases outlet of the pelvis by 10%

Rupture of the uterus is the principal risk of VBAC. The risk is small: less than 1% VBAAC result in rupture. But it is dangerous if it happens. Go for VBAC only if you are prepared to take that risk.

Also be sure to choose a best pregnancy doctor in south delhi and a hospital who can handle the rupture and do a cesarean if needed.

You may wish to attempt a VBAC because if it is successful, you will avoid the disadvantages of a Cesarean.

History

The second Mauryan Samrat (emperor) of India, Bindusara, was born c. 320 BCE by caesarean. His mother accidentally consumed poison and died when she was close to delivering him. Chanakya, his father Chandragupta’s teacher and adviser, cut open the belly of the queen and took out the baby Bindusara, thus saving the baby’s life.

That Julius Caesar was born by caesarean, hence the name caesarean for the procedure, is a myth. Though caesareans were performed in Roman times and Jewish woman are said to have survived such operation. But caesareans usually led to the death of the mother and were usually performed only when woman was dead or supposed to be beyond help. In Great Britain and Ireland, the caesarean-mortality rate in 1865 was 85%.

REFERENCES

1. Vaginal Birth vs. C-Section: Pros & Cons – Live Science
https://www.livescience.com › Health
2. Normal Delivery Vs Cesarean – Risks And Benefits – MomJunction
https://www.momjunction.com › Pregnancy › Giving Birth
3. Why You Don’t Want a C-Section | Fit Pregnancy and Baby
https://www.fitpregnancy.com › … › Why You Don’t Want a C-Section
4. Vaginal Birth After A C-Section (VBAC): Benefits & Risks – WebMD
https://www.webmd.com › Pregnancy › Reference
5. VBAC: Vaginal Birth after Cesarean – American Pregnancy Association
americanpregnancy.org › Labor and Birth

PAIN DURING SEX: VAGINISMUS

VAGINISMUS

SYNOPSIS

A woman may have pain during intercourse, or on insertion of a tampon or a clamp in the vagina. Such pain is often caused by a condition called Vaginismus. Pain can range from just discomfort to so severe that breathing may cease temporarily. A woman may not be able to have intercourse because of vaginismus and this can adversely affect her relationship with her partner.

The cause of vaginismus is not known. It can be physical or emotional or a combination of the two.

There is no definitive medical test to diagnose vaginismus. Diagnosis is based on medical history, gynecological examination and tests to rule out other causes of pain. The condition is rare. Physician may not therefore have adequate experience and misdiagnosis is possible.

Treatment is physical, doing Kegel exercises; or emotional by psychotherapist and sex counsellors; and, usually, both running concurrently.

Treatment success-rate is nearly one hundred percent. Results may take a few weeks to a few months to appear. Kegel exercises should be continued even after the treatment has succeeded.

Woman have satisfying sex life after a successful treatment.
So do not hesitate; do not delay; do not hold back. Speak to your partner; speak to your therapist. Speak now.

INTRODUCTION

A small number of women have pain during intercourse. Such pain is often because of vaginismus, also called vaginism. In this condition, insertion of a tampon, penis or speculum into the vagina causes the pelvic floor muscles to go into a spasm causing mild to severe pain that makes insertion difficult or impossible. The woman is thus unable to have intercourse, or undergo gynecological examination (Pap tests), and this can cause frustration and distress.
A recent study estimated vaginismus incidence at 5% to 47% in people complaining of sexual problems. The wide variation is because of cultural differences and society’s expectations of sexuality.

Different forms of vaginismus are:

• Primary vaginismus is a lifetime condition. But women discover it from the pain they have during their first vaginal penetration – using tampon, having sex, or Pap smear test.
• Secondary vaginismus happens at a later stage in life; before that, woman has no difficulty in having intercourse. It is caused by a specific life-event such as a yeast infection, childbirth, and other such events.
• Global vaginismus is always present, and any object will trigger it.
• Situational vaginismus occurs only in certain situations. It may happen during sex but not during gynecological exams or tampon insertion.

CAUSE 

Vaginismus is idiopathic – that is, its cause is unknown. It can be because of medical factors, or emotional factors, or a combination of the two. It is linked to anxiety and fear of having sex. It can be anticipatory: that is, happens because the person expects it to happen.

The medical/physical factors are:

• vulvar vestibulitis syndrome, a sub-clinical inflammation in which pain occurs only when penetration is attempted.
• urinary tract infections
• vaginal yeast infections
• health conditions, such as cancer or lichen sclerosis
• childbirth
• pelvic surgery
• medication side effects
• any physically invasive trauma (not necessarily involving or even near the genitals)
• vaginismus chronic pain conditions
• Peri-menopause and menopause which cause drying of the vulvar and vaginal tissues because of reduced estrogen. Intercourse may cause “micro-tears” that cause pain and may lead to vaginismus.
• inadequate foreplay
• insufficient vaginal lubrication
• sexual abuse, rape, other sexual assault, or attempted sexual abuse or assault
• development of a medical condition

Emotional factors are:

• generalized anxiety
• anxiety about performance or because of guilt
• Stress
• fear of pain associated with penetration and with the “breaking” of the hymen at the first intercourse, or fear of pregnancy
• harm-avoidance behaviour
• traumatic life events, including rape or a history of abuse, or of witnessing these without being personally abused.
• domestic violence or similar conflict in the early home environment
• negative emotional reaction towards sexual stimulation, e.g. disgust both at a deliberate level and also at a more implicit level
• strict conservative moral education, which can elicit negative emotions
• fear of vagina not being wide or deep enough, and/or fear of partner’s penis being too large
• undiscovered or denied sexuality
• relationship problems, for example, having an abusive partner or feelings of vulnerability
• psychological causes
• a combination of causes

SYMPTOMS

Pain or discomfort during intercourse, or on insertion of tampon or speculum into vagina, is the first sign of vaginismus.

The symptoms vary between individuals. The main symptoms are:
• discomfort that may diminish during intercourse
• minor pain
• burning or stinging pain and tightness that persist
• penetration being difficult or impossible, and extreme pain if entry is forced
• generalized muscle spasm or breathing cessation during attempted intercourse
• long-term sexual pain with or without a known cause
• pain during tampon insertion
• pain during a gynecological examination

Pain subsides on withdrawal, but not always.

Women with vaginismus can and do get sexually aroused. But they may become anxious about sexual intercourse, and therefore avoid sex or vaginal penetration.

DIAGNOSIS

There is no definitive medical test to diagnose vaginismus. The diagnosis is based on medical history, gynaecological check, and teste to rule out other medical conditions that may be causing the problem. It may therefore be necessary to consult several specialists before a reliable diagnosis is made. Misdiagnosis is possible. And often it may be left undiagnosed. This is especially true when the symptoms occur only during intercourse and not during other vaginal insertions.

Many women are hesitant or shy or embarrassed to discuss their sex disorder with physicians, especially male doctors. This is especially true in India. So it may be advisable to consult a female doctor.

TREATMENT

Vaginismus is a treatable condition. The success rate is nearly one hundred percent. Treatment does not require drugs, hypnosis, surgery or any other complex invasive technique.

The aim of treatment is to reduce the automatic tightening of the muscles; and to remove or reduce the fear of pain, or any other fear, related to that may be related to vaginismus.

Treatment is physical: to reduce the automatic tightening of the muscles; and emotional: to reduce the fears that may underlie the problem. Both treatments run concurrently.

Physical

Physical treatment is a combination of pelvic-floor control exercises, insertion or dilation training, pain elimination techniques, and transition steps. Treatment steps can often be completed – in cooperation with the therapist – in the privacy of home and at a pace that suits the patient.

Kegel exercises improve control of the pelvic floor muscles.
• To identify your pelvic floor muscles, stop urination in midstream. If you succeed, you’ve got the right muscles.
• If you have difficulty identifying the muscles, insert a vaginal cone in the vagina and use the floor-muscles to hold it in place. That will help you identify the muscles.
• Always empty the bladder before doing Kegel exercises.
• Tighten your pelvic floor muscles, hold the contraction for five seconds, and then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.
• For best results, focus on tightening only your pelvic floor muscles. Do not flex the muscles in your abdomen, thighs or buttocks. Do not hold your breath during the exercise; breathe freely.
• Do at least three sets of 10 repetitions a day.
• You can do the exercises in any position, but it is easier to do them lying down at first.
• You can do Kegel exercises discreetly just about anytime,
• If you have trouble doing Kegel exercises, ask your therapist for help.
• Make Kegel exercises a permanent part of your daily routine.
• Results may take a few weeks to a few months to appear.

Insertion or dilation training begins by the woman touching an area as close as possible to the vagina without causing pain, and moving closer each day. Once she can do that, she should open the vaginal lips or labia. Next insert one finger, then two fingers, then three, and go progressively deeper without causing pain. Next she should learn to use the vaginal dilators (Hegar dilators), also called vaginal trainers, with the help of her therapist. She should insert a plastic dilator, or a cone shaped insert, and leave it in for about fifteen minutes. Next use a larger insert. Next her partner can put his penis next to vagina without entering. Once the woman is comfortable with it, the couple can try intercourse, building up progressively as in the case of insert. Use a lubricating jelly when practicing insertion.

Emotional

Emotional factors often underlie vaginitis. Education, counselling and psychotherapy therefore helps.

Psychological factors underlying vaginismus are fear of painful sex; the belief that sex is wrong or shameful (often the case with patients who had a strict religious upbringing); and traumatic early childhood experiences (not necessarily sexual in nature). Childhood sexual interference, and less positive attitudes about their sexuality, are other contributing factors. Lack of sexual knowledge or (non-sexual) physical abuse do not seem to be factors.

Education to make a woman understand her sexual anatomy and sexual response cycle – happenings during sexual arousal and intercourse and how parts of body work – helps her understand the pain and the processes her body goes through.

Emotional counselling by a counsellor specialized in sexual disorders helps the woman identify, express, and resolve any emotional factors that may be contributing to her vaginismus. Counsellor will teach relaxation techniques, and may use hypnosis, to help woman relax and feel more comfortable with intercourse. Joint counselling of the woman and her partner gives better results.

Pharmacologic

Experimental studies have shown that Botulinum toxin A (Botox) and lidocaine temporarily reduce the hypertonicity of the pelvic floor muscles. Anxiolytics and antidepressants have also been used along with psychotherapy modalities. But results from these types of pharmacologic therapies have not been consistent.

Treatment for primary and for secondary vaginismus is the same. But previous experience with successful penetration may result in a quicker resolution of secondary vaginismus.

Even after any underlying medical condition is corrected, pain may continue if the body has become conditioned to respond in this way.

Vaginismus may sometimes be mistaken for Dyspareunia in which painful intercourse is caused by a physical problem such as cysts, pelvic inflammatory disease, or vaginal atrophy. Vaginismus rarely requires surgery.

RELATIONSHIP

Sexual dysfunction like vaginismus adversely affects relationship and marriage. Therefore be proactive: discuss with your partner your feelings and fears about intercourse; and seek treatment at the earliest. Remember, treatment success rate is nearly one hundred percent; and most women recover and have a satisfying sexual life.
So do not hesitate; do not delay; do not hold back. Speak to your partner; speak to your therapist. Speak now.

REFERENCES:

1. Vaginismus: Cleveland Clinic
https://my.clevelandclinic.org/health/diseases/15723-vaginismus

2. Obstetrics and Gynecology at Baylor College of Medicine in Houston, Texas
https://www.bcm.edu › … › Care Centers › Obstetrics and Gynecology › Conditions

3. Vaginismus: NHS UK
https://www.nhs.uk/conditions/vaginismus/
4. Women’s Health: Sex & Intimacy – WebMD
https://www.webmd.com › Women’s Health › Guide

5. Medical News Today
https://www.medicalnewstoday.com/articles/175261.php

6. Vaginimus: Wikipedia
https://en.wikipedia.org/wiki/Vaginismus

7. What Is Vaginismus?
https://www.healthline.com/health/vaginismus

8. Vaginismus: Practo.com
https://www.practo.com/health-wiki/vaginismus-meaning-symptoms-and…/article

9. Health Direct
https://www.healthdirect.gov.au/vaginismus

10. Sexual Dysfunction in Women; MSD Manual
https://www.msdmanuals.com › … › Sexual Dysfunction in Women

11. Women’s Therapy Centre
https://www.womentc.com/conditions-and-treatments/penetration-pain…/vaginismus/

12. Vaginismus-diagnosis

13. Kegel-exercises: Healthline
https://www.healthline.com/health/kegel-exercises

Best Gynecologist in DelhiBest Gynecologist in South DelhiBest Gynecologist in Lajpat Nagar Delhi

Ban On The Life-saving Drug Oxytocin: What It Means To Us

OXYTOCIN BAN

“Oxytocin is a very vital drug” – Dr Shivani Chaturvedi
“Too much risk for too little benefit?” – Dr (Prof) Sadhana Kala

India has banned formulation of oxytocin by private companies, and its sale by retail chemists, from 31 August 2018.

Dr (Prof) Sadhana Kala, Best gynaecologist, Laparoscopic surgeon and best Infertility specialist in Delhi, explained the reason for the ban to SheThePeople.TV. She said, “Oxytocin is misused in the dairy industry to make livestock release milk at a time convenient to the farmer. It is also used to increase the size of vegetables such as pumpkins, watermelons, brinjals, gourds and cucumbers. To prevent such misuse, the govt. has banned the formulation of oxytocin for domestic use by the private manufacturer. The ban is effective from 31 August 2018. For domestic use, oxytocin will be formulated only by KAPL – a public sector company – and supplied to registered hospitals and clinics. Oxytocin in any form or name will not be sold through retail chemist.”

Dr Kala, best Infertility doctor in Delhi, feels, “It is a good move by the govt. But the supply chain will have to be worked out. So that the hospitals and clinics get a regular and uninterrupted supply of oxytocin from KPCL.”

Dr (Prof) Sadhana Kala, Best Laparoscopic Surgeon in South Delhi, said to SheThePeople.TV, “Oxytocin has been widely used for active management of labour since 1969 to augment the insufficient uterine action when labour was slower than average; and to reduce the caesarean section rate. However, recent studies in the UK have shown that in more than two third of the cases oxytocin use was injudicious resulting in disciplinary action and litigation and malpractice settlement; that reduction in caesarean section rate was marginal; and labour was shorter by 1.3 hours. Oxytocin will continue to have a place in childbirth. But the question will remain whether such marginal benefits justify the risk of use of Oxytocin. Too much risk for too little benefit?”

NB:Oxytocin is the first choice drug to prevent bleeding in women after childbirth. – WHO; and is listed as a life-saving drug in the National List of Essential Medicines. – Dr (Prof) Sadhana Kala

PELVIC INFLAMATORY DISEASE (PID)

Every human being is the author of his own health or disease.
– Gautama Buddha

SYNOPSIS

Pelvic Inflammatory Disease (PID) is an infection of the female reproductive organs. It is caused by many types of bacteria. If not treated, it can cause complications such as ectopic pregnancy and infertility. And How Best Laparoscopic Surgery in South Delhi can help you.

PID affects women in reproductive age. Peak incidence is in women of 15 to 24 years age. India is estimated to have at least one million episodes of PID each year.
Risk of PID increases with risky sexual practices: multiple sexual partners, sex with a person having PID, starting sex at a very young age and having sex without a condom.
PID often has no signs or symptoms. But a few of the symptoms that may appear are: pain in lower abdomen or pelvic pain, heavy or foul periods, bowl discomfort and pain in urination.

There is no single test to diagnose PID. It is diagnosed from symptoms and from gynaecological examination. Urine and blood tests, ultrasound, and laparoscopy may also be used. Because of absence of symptoms, and because the symptoms are similar to those of other diseases, PID diagnosis is often delayed. Woman’s recent sexual partners also need to be tested and treated.

A mixture of antibiotics is used for treatment and is successful in most cases. But a few cases may need laparoscopic or surgical intervention. Removal of intrauterine devices (IUDs) is not necessary.

Because of difficulty of diagnosis, and serious consequences of delayed treatment, empirical treatment may be initiated in at-risk women if symptoms of PID appear. Having regular medical care throughout lifetime maximizes the chances of early diagnosis and treatment of PID.

Improved education, routine screening, diagnosis, and empirical treatment of PID will reduce the incidence and prevalence of PID and its long-term sequelae.

INTRODUCTION

PID, if not treated, can cause ectopic pregnancy, infertility, chronic pelvic pain, cancer, peritonitis and tubo-ovarian abscess – the latter two can become life threatening.

In the US, more than one million women have PID, and more than 100,000 become infertile each year because of PID. In industrialized countries PID-incidence is 10 to 13 per 1,000 in women in 15 to 39 years age-group, with a peak incidence of about 20 per 1,000 women in 20 to 24 years age group. India is estimated to have more than one million PID episodes each year.

CAUSE

PID is an infection of the female reproductive organs – vagina, uterus, fallopian tubes, ovaries, and of womb lining (endometrium) and lining of the inside of the abdomen (peritoneum).

It is a bacterial infection. Many types of bacteria can cause it but in about one in four cases it is caused by sexually transmitted infection (STI) such as chlamydia or gonorrhoea. Sometimes normal, harmless, bacteria in the vagina get past the cervix and into the reproductive organs and cause PID. This can happen when the cervix is damaged after childbirth, miscarriage, abortion and inspection of the womb; or by an earlier PID.

In many cases, the cause of PID is unknown.

RISK FACTORS

Any woman can get PID. But the risk of getting it is increased by:
• Being sexually active and younger than 25 years age
• Having multiple sexual partners
• Having a new sexual partner
• Being in a sexual relationship with a person who has more than one sex partner
• Having a history of PID or STI
• Having sex without a condom
• Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms

Having an intrauterine device (IUD) does not increase the risk of PID. Potential risk, if any, is within the first three weeks after insertion.

SYMPTOMS

PID often has no signs or symptoms. But one or more of these symptoms may occur:

• Pain in lower abdomen
• Pelvic pain — especially during a pelvic exam
• Heavy or foul or painful periods with an unpleasant odor
• Unusual vaginal discharge, especially if it’s yellow or green
• Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles
• Pain or bleeding during intercourse
• Fever, sometimes with chills
• Painful or difficult urination
• Bowel discomfort
• Nausea and vomiting

See your doctor if you experience any of the above symptoms.

Vaginal discharge with an odor, painful urination or bleeding between menstrual cycles can be associated with STI. If these signs and symptoms occur, stop having sex and see your doctor soon. Prompt treatment of an STI can help prevent PID.

DIAGNOSIS

There is no single test to diagnose PID. It is diagnosed from symptoms and from gynecological examination.

Gynecologist in Delhi will talk about your medical and sexual history and do a pelvic examination to check for any tenderness and abnormal vaginal discharge. This examination may be discomforting, especially if you have PID.

Swabs may be taken from the inside of your vagina and cervix to look for bacterial infection and identify the bacteria responsible. A positive test for chlamydia or gonorrhoea supports the diagnosis of PID. Most women test negative but this does not rule out PID.
Other tests may, therefore, be required to look for signs of infection or inflammation, or to rule out other possible causes of your symptoms. These tests may include:

  •  A urine or blood test
  • A pregnancy test
  • An ultrasound scan, which is usually carried out using a probe passed through the vagina (transvaginal ultrasound)
  • In a few cases, especially the more severe cases, and where there may be other possible causes of the symptoms, such as appendicitis, laparoscopy may be used to look at the internal organs and, if necessary, take tissue samples to diagnose PID. Laparoscopy can also be useful in disproving cases wrongly labelled as chronic pelvic disease.
  • Recent sexual partners also need to be tested and treated to stop the infection recurring or being spread to others.

Diagnosis of PID can be missed or delayed because of absence of symptoms in the earliest, most curable stage. When symptoms do occur, they can be similar to symptoms of certain other diseases, such as appendicitis, food poisoning or food borne illness, ruptured ovarian cyst, diverticulitis, and ovarian torsion. Therefore have regular medical care throughout lifetime to maximize the chances of early diagnosis and treatment of PID.

TREATMENT

If diagnosed early, PID is treated with antibiotics for 10-14 days. A mixture of antibiotics to cover the most likely infections is given as tablets and injections. Complete the antibiotic course and avoid sexual intercourse during the treatment period to ensure the infection clears completely.

Antibiotics alone are successful in 34-75% of cases. Patients who do not improve in 72 hours are re-evaluated for laparoscopic or surgical intervention and for other possible diagnoses. Laparoscopy should be used if the diagnosis is in doubt. Laparoscopic pelvic lavage, abscess drainage, and adhesiolysis may be necessary. Laparoscopy gives direct visualization of internal organs and of the pelvis and obtaining of cultures for more accurate bacteriologic diagnosis. However, laparoscopy is not always available in acute PID; moreover, it is costly and requires general anesthesia.

If surgical treatment is required, attempt is to conserve reproductive potential with simple drainage, adhesiolysis, and copious irrigation or unilateral adnexectomy, if possible. Further surgical therapy is needed in 15-20% of cases so managed.

Most tubo-ovarian abscess (60-80%) resolve with antibiotic administration. Laparoscopy may be used to identify the loculations of pus requiring drainage. Unresolved abscesses may be drained by colpotomy, laparoscopy, or laparotomy. In patients with recurrent PID, dense pelvic adhesions may render surgery difficult.

Removal of intrauterine devices (IUDs) in acute PID cases is not necessary. But close clinical follow-up is mandatory if the IUD is left in place.

More research is needed to optimize PID diagnosis and treatment; and to improve patient and doctor’s compliance to guidelines.

COMPLICATIONS

Untreated PID may cause scar tissue, and collections of infected fluid (abscesses) in the fallopian tubes, which can damage the reproductive organs.

Other possible complications are:

• Ectopic pregnancy. The scar tissue prevents the fertilized egg from moving through the fallopian tube to implant in the uterus thus causing a tubal (ectopic) pregnancy that can cause massive, life-threatening bleeding and that may require emergency medical attention. PID is a major cause of ectopic pregnancy
Infertility. PID may damage the reproductive organs and cause infertility. Delaying the treatment, or frequent PID, dramatically increases the risk of infertility. In the US, 1 in 8 women with a history of PID has difficulty getting pregnant; and 15% of infertility cases are because of PID.
• Chronic pelvic pain. Pelvic inflammatory disease can cause pelvic pain that may last for months or years. Scarring in fallopian tubes and other pelvic organs can cause pain during intercourse and ovulation.
• Tubo-ovarian abscess. PID might cause an abscess — a collection of pus — to form in uterine tube and ovaries. If left untreated, this could develop into a life-threatening infection.

PREVENTION

To reduce the risk of PID:

• Practice safe sex. Use condoms every time you have sex, limit your number of partners, and ask about a potential partner’s sexual history.
• Talk to your doctor about contraception. Many forms of contraception do not protect against the development of PID. Using barrier methods, such as a condom, might help to reduce your risk. Even if you take birth control pills, it’s still important to use a condom every time you have sex to protect against STIs.
• Get tested. If you’re at risk of an STI, such as chlamydia, make an appointment with your doctor for testing. Set up a regular screening schedule with your doctor if needed. Early treatment of an STI gives you the best chance of avoiding PID.
• Request that your partner be tested. If you have PID or an STI, advise your partner to be tested and, if necessary, treated. This can prevent the spread of STIs and possible recurrence of PID.
• Don’t douche. Douching upsets the balance of bacteria in your vagina.

INCIDENCE

In a 1995 U.S. study, 8 percent of all women in their reproductive years were being treated for PID. The numbers have steadily reduced. In 2015, the annual visits for PID were down to about 90,000 a year.

Enough data on incidence of PID in India is not available. In one study about 11.55% of the study subjects were diagnosed with PID. In the industrialised world, the incidence is 1 to 2 per cent per year among sexually active women. On that basis, India will have about one million PID cases per year.

REDUCING THE INCIDENCE

Because of difficulty of diagnosis, and serious consequences of delayed treatment, it is recommended that empirical treatment should be initiated in at-risk women who have lower abdominal pain, adnexal tenderness, and cervical motion tenderness. That overtreatment be preferred to no or delayed treatment.

Women with PID should be counselled to abstain from sexual activity or use barrier protection strictly and appropriately until their symptoms and those of their partner have fully abated and they have completed their entire treatment regimen.

Improved education, routine screening, diagnosis, and empirical treatment of PID will reduce the incidence and prevalence of PID and its long-term sequelae. Education should concentrate on strategies to prevent PID and STIs, including reducing the number of sexual partners, avoiding unsafe sexual practices, and routinely using appropriate barrier protection. Adolescents, being at an increased risk for PID, should be advised to delay the onset of sexual intercourse until age 16 years or older.

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Best Gynecologist in East of Kailash Serves Superior Gynecological Care for Women

Dr. (Prof.) Sadhana Kala Obstetrics & Gynecologist in East of Kailash, Delhi, is a highly renowned, integrated and the leading Woman Care doctor in Delhi. Our Centre is well equipped with all the facilities that make you feel warm and at home. We strive to maintain the highest standard of consultancy and cater Advise with the most concurrent and innovative knowledge regarding all subjects within the era of Dr. (Prof.) Sadhana Kala Care. Best Gynecologist in East of Kailash delivers a number of services, each woman requires through her life; ranging from her puberty till her midlife. The specialty of Gynecology, Obstetrics, Infertility, and Sexual Health has been our main area of specialization over many years.

Gynecological issues

Dr. (Prof.) Sadhana Kala is a leading provider of comprehensive Obstetrics & Gynecology Services. Our whole cadre collaborates to cater women and expectant mothers the highest standard of multidisciplinary and high-quality care. Our cadre works closely with other specialty areas and solutions should the want arise. We use the updated information and innovative technology to diagnosis and cure patients and are proud to be a part of over many labor and deliveries every year.

Dr. (Prof.) Sadhana Kala caters the full standard of obstetrical services, and also serves superior gynecological care for women, from adolescence through the post-menopausal years. Our years of going through in the multi-cultural community of Best Gynecologist in East of Kailash Delhi give us the knowledge to cater solutions according to a broad range of cultural values and personal preferences. We endeavor to realize your requirements and will provide you the specialized care you expect.

Ameliorating the clinical effectiveness and efficiency is the key to achieve our target of absolute patient satisfaction. Dr. (Prof.) Sadhana Kala makes a positive contribution by regularly organizing training and educational activities relating to health and medicine. The future is unsealed and everyone fears that the work of a lifetime could be in jeopardy. The possibility of losing what took a lifetime to form can only break one’s confidence. During these times, thoughts inevitably turn to what is more valuable in one’s life.

Best Gynecologist in Delhi – Get Variety of Gynecology Conditions Diagnosed

Dr. Sadhana Kala is the best Gynecologist in Delhi holding a degree of MBBS (1971) and MS in Obstetrics and Gynecology (1975). She was a university topper during her academics and has achieved several certificates, Gold & silver medals of Honor, and Distinction in Medical field. She has an experience of working in the medical field for more than 41 years. She is expertized in:

  • Laparoscopic Surgery
  • Hysteroscopic Surgery
  • Infertility
  • High Risk Pregnancy
  • Gynecology Surgery
  • Obstetrics

Gynecologist in Delhi

Laparoscopic Surgery – Laparoscopy is a surgical procedure to examine and diagnose the conditions inside the abdomen. The surgical procedure uses an instrument called a laparoscope (a thin and long tube with a high-resolution camera and a high-intensity light) that makes it possible for us to look us inside the abdominal organs. The instrument is inserted inside the abdominal wall through the small incisions. This surgical procedure lets us see the inside conditions of the organ by monitoring the images on the video monitor.

Hysteroscopic Surgery – It is a type of minimally invasive surgery and as a leading gynecologist in Delhi, Dr. Sadhana has diagnosed many patients with the Hysteroscopic surgery. In the process, a hysteroscope (a tiny telescope) is inserted into the uterus through the cervix. This tiny telescope lets us visualize inside the uterus and analyze the condition like the shape of the uterus, the lining of the uterus, openings to the fallopian tubes, and also looks for any other signs of intrauterine pathology (fibroids or polyps).

Infertility – Based on the 41 years of experience and as the Best Gynecologist in Delhi, Dr. Sadhana has observed that the infertility conditions are most common among the working couples. Either of the partner losses the fertility due to factors like stress, unbalanced lifestyle, unhealthy diet, consuming alcohol, medications, age, and unhealthy sex life. Male infertility can be caused due to the lower sperm counts, sperm damage, or certain diseases, whereas, female infertility can be caused because of uterine problems, ovulation problems, blocked fallopian tube, and uterine fibroids.

Visit to a Gynecologist in Delhi for Ensuring Complete Women Health

Every woman at some point of life needs to visit a gynecologist. This not only helps in maintaining the general health but also provides quality care and treatment at the most important phase of a woman’s life i.e. pregnancy. Routine checkup ensures that everything is going perfectly fine and if any medical problem occurs it can be cured at an early stage.

There are numerous issues that women have to deal such as anatomy issues, genetic issues etc. Gynecologist in Delhi is an expert in these areas and prescribes the right treatment and medications to help a woman get back on the right track. Some women are afraid of visiting a doctor. It is extremely essential, to be honest with the doctor. Early recognition can make it possible for several types of cancer to be treated as well as sexually transmitted diseases and problems such as infections and endometriosis.

Seeing a gynecologist in Delhi assists you in understanding your body better and suggests you the ways to take good care of your health. To make sure your reproductive organs are in healthy condition a yearly examination by a specialist is the must. If you want to have a baby, have a pain in the reproductive area, need birth control medications, have an infection or getting a positive pregnancy test visiting a gynecologist is a wise decision in all these cases. However, finding a reputable doctor requires some research work. Here are some ways to help you choose the appropriate one for you –

  • Ask family members and friends
  • Ask your general physician
  • Search online
  • Insurance companies as they have the list of the reputable doctors

The questions your gynecologist asks you are to help you to stay well and therefore not being honest is not recommended. As your body changes during puberty and into adulthood, your female provider can help you with every step. Building a strong relationship with your gynecologist over the years will help you to better understand your body and your health. Feeling comfortable enough to have exams will let you know that you have selected the right expert for your reproductive requirements.

Visit Dr. Sadhana Kala in Delhi to Receive Quality Care for Women

Every woman needs to visit a gynecologist at some point in life to receive a full checkup and to ensure that everything is going completely fine. Visiting a gynecologist should not be done only when there is an emergency. You should make a habit of doing so and get regular checkups to stay informed and avoid issues in future. Females go through gynecological problems such as menstruation irregularity, abdominal pain, infection etc. at some point of time. Expert advice from gynecologist in Delhi can help women to maintain good health at the time of pregnancy and birth.

gynecologist-in-delhi

Menstrual Abnormalities –

A healthy woman has menstrual period on time which ensures that there is no need to worry about the reproductive system and woman is capable of pregnancy. But its irregularity can lead to several gynecological problems and can become a great source of immense trouble for women. Menstrual patterns can be influenced by changes in general health, sudden weight loss or weight gain, stressful life situations, metabolic disorders, certain infections, and anatomical and hormonal changes. It is better to visit a gynecologist to get proper treatment for this problem as it can cause severe problems in future.

Pregnancy –

Pregnancy time is the most beautiful experience of a woman’s life. On the other hand, proper care is required at the time of pregnancy. Routine checkup with a gynecologist in Delhi would clear all the doubts and questions you have on your mind regarding child’s birth and pregnancy. This would help you to get more confidence. A gynecologist will provide you tips that are beneficial for you as well as for the unborn infant.

Child Birth –

Becoming a mother is the best achievement for a woman. Seeing your little one after getting conceived is a treasure. It is important to prepare for the delivery under the guidance of expert doctors. Complying with every medication your doctor gives is the must.

Gynecologist in Delhi will take care of your overall health and provides the best help for soon-to-be-mom and unborn child in the early phases of growth.

Visit a Gynecologist in Delhi to Treat Irregular Menses Problem

Menstruation disorder is so common in women that often they do not think to pay any extra attention towards it. Sometimes they irritate or feel ashamed to open up for such things.

irregular-menses-problem

Many fertile women in India suffer from the problem of delay, missed and painful menstrual cycle. When a woman has painful menses, she experiences cramps, pain, and bleeding.  Fatigue, dizziness and general weakness are some of the common symptoms of a painful menstrual cycle. If you are a victim of this or most of the times face similar problems during your periods, then you must contact a gynecologist in Delhi.

The process of menstruation happens for 3 to 5 days every month throughout the reproductive cycle in women. Youngsters may get irritated at small issues during their monthly cycle because their bodies undergo changes. Nowadays, many girls are suffering from delay in their periods or painful menstruation cycle. For this, their lifestyle is responsible to some extent.

A gynecologist in Delhi can assist you having normal periods with no pain. Because a missed or delay menstruation is mainly because of intense exercising, emotional stress or poor intake of food. A large number of women are affected by painful menstruation around the globe. Generally, women experience discomfort and little pain during their menstrual periods.

Dr. Sadhana Kala is an experienced gynecologist who can help you with your abnormal periods, infertility, sexual problems and many other problems you may have. She can guide you on what to eat and what not? Which exercises are best for you and what precaution you need during your monthly cycle? She can guide you to take some medicines so that your professional/business life doesn’t affect.

  Some of the common symptoms a woman will come across during the menstruation problem are –

  • Food craving
  • Fatigue
  • Stress
  • Insomnia
  • Bloating
  • Depression or mood swings
  • Constipation
  • Backache
  • Headache
  • Cramps in the digestive tract.

A woman can control the pain during her menstruation cycle in these ways –

  • Regulate their lifestyle and avoid spicy or irritating foods that cause digestion problem
  • Avoid stress and take regular sleep
  • Eat vegetables and fruits as much as you can
  • Do simple exercises and yoga daily