Tag Archives: top gynecologist in Delhi

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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CANCER SELF SCREENIG VIDEO

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Posted on 12 October

Pl do view and comment. Pl do share and spread the breast cancer AWARENESS because:

• breast cancer is the biggest killer-cancer of women in the world. And in India

• it cannot be prevented. Early detection is the only cure. Late detection is fatal.

 

BREAST CANCER SELF SCREENING

2,68,566 views, 678 shares – in three days – and counting.

Pl do view and comment. Pl do share and spread the breast cancer AWARENESS because:

• breast cancer is the biggest killer-cancer of women in the world. And in India

• it cannot be prevented. Early detection is the only cure. Late detection is fatal.

https://www.facebook.com/Scoopwhoop/videos/254610738572947/

BREAST CANCER

Every woman is at risk of Breast cancer
“The only person who can save you is you” – Sheryl Crow

SYNOPSIS

Breast cancer (BC) is the biggest killer-cancer of women in the world, and in India. In the next fifteen years, BC will kill over twelve lakh women in India. But it doesn’t have to. A few life style changes can reduce the incidence of BC; and early detection can increase the survival rate.

BC was a disease of old age. No longer. Twenty-five years ago, 69% of BC patients in India were age 50 and above. But now only 52% are 50 and above; 48% are less than 50; and a few are in the teens.

Every woman is at risk of BC. It cannot be prevented. The risk increases with age, heredity and genetic predisposition; and the risk reduces with healthy weight, regular exercise and healthy diet.

Early detection is the key to survival. Early detection can be by self-examination of breasts, or by screening by imaging devices such as X-ray, Ultra sound, and MRI. However, confirmation is only possible by biopsy.

Depending on the stage at which the cancer is detected, the treatment can be surgery, radiation, chemotherapy and other adjuvant therapies.

If detected early, BC is treatable. If detected late, it is fatal. Five-year survival rate for Stage 1 BC is 100%; for stage 4 is 22%.

So exercise and eat healthy and you would have done your bit to reduce your cancer risk. And do regular cancer screening and you would increase the probability of early detection and of successful treatment.

INTRODUCTION

Breast cancer (BC) will kill about 80,000 women in India in 2020. For every two women with BC, one will die. Many of these deaths are preventable simply by early detection. But detection is often late and thus fatal. Lack of awareness is the major reason for late detection.

Breast cancer is the most common cancer in women in India, 27% of all cancers, closely followed by cervical cancer at 22%. Incidence of and death due to BC is more than that due to cervical cancer. BC is rising at a rapid rate. By 2030, the number of BC cases will rise to about 200,000 a year and deaths to about 100,000 a year. India has the worst survival rate from BC, and the highest number of women dying from BC, in the world. Even if we start a cancer awareness program today, 20-30 years will pass before its effect becomes discernible.

BC was a disease of old age. Twenty-five years ago, 69% of BC patients were above the age of 50. Now 48% are below the age 50; and 20% of them below the age of 40.

Breast cancer cannot be prevented. But BC incidence can be reduced by a few simple lifestyle changes; and the survival rate can be improved by early detection.

WHAT IS CANCER ?

Our body is composed of many different types of cells. These cells grow and divide in a controlled manner to produce more cells as required by the body. Also, the older cells and the damaged cells die.

However, sometimes, the genetic material of one cell gets damaged or changed [mutation] and the cell becomes immortal: that is, it will not die. When this ancestor cell divides, its descendant cells are also immortal. This gives rise to a limitless number of immortal descendant cells. The number of cells is far in excess of what the body needs. The extra cells then form a mass that is called a tumour.

These immortal cells are called cancer cells. The cancer cells are: immortal; capable of limitless division, and thus of limitless growth in the number of cells; and capable of spreading [Metises] to other parts of the body through blood and lymph system.

There are more than 100 types of cancers. Not all cancers form tumours: cancers of the blood and the bone-marrow [leukaemia], for example, do not form tumours.

Most cancers are named for the body part in which they begin: colon cancer, prostate cancer, ovarian cancer, breast cancer and so on.

WHAT IS BREAST CANCER ?

Breast consists of lobules (milk producing glands), ducts (tiny tubes that carry the milk from lobules to the nipple) and blood and lymphatic vessels.
Breast cancer is a malignant tumour that starts in the cells of the breast. It begins in the ducts; sometimes in the lobules; and rarely, in other cells of the breast.

It then spreads through the breast lymph vessels to lymph nodes under the arms and thence to other parts of the body.

WHO IS AT RISK OF BREAST CANCER ?

Every woman is at risk of breast cancer. In India, one in 28 women will get breast cancer. Certain factors increase the risk of BC.

  •  AGE. Cancer is a disease of old age: most cancers begin to strike at age 60 and above. But now cancer is also striking, though only rarely as yet, the teenagers. Risk of breast cancer, for example, is about 0.25% for a 30-year old woman but increases to about 11% in a seventy-year old. In different countries, breast cancer risk in a 70-year old is 54% to 154% higher than in a 30-year old. Thus, as longevity has increased, so has the cancer incidence.
  • HEREDITARY. If first degree relatives [mother/father/brother/sister] had cancer, the risk of cancer is increased.
  • GENETICS. A person can be genetically predisposed to get cancer. A woman who has a family history of breast cancer is statistically more likely to get breast cancer. However, only a small percentage, less than 0.3% of population, is genetically disposed to get cancer. And less than 3-10% of all cancers are because of genetic predisposition. In women with BRCA 1 and BRCA 2, the probability of getting breast and ovarian cancer is more than 75%. Mutations in a few other genes [PTEN, CDH 1, TP 53 etc.] also increase the risk though not as much.
  • OBESITY. In obese postmenopausal women breast cancer risk is twice as much as in the non-obese women.
  •  DIET. Diet contributes to up-to 80% of cancers of colon, prostate and breast; and also contributes to cancers of pancreas, lung, stomach and esophagus. Alcohol, red meat, sugar increase the risk of cancer.
  • SMOKING, night work, no children or child born after age 30, recent use of oral contraceptives (reverts to normal on stopping), HRT, and Chemicals in environment – increase the cancer risk.
  •  MENOPAUSE. Late menopause increases the risk.

REDUCING THE RISK

Healthy weight, physical activity – brisk walking, cycling, swimming – 45-60 minutes five or more days a week, Breast feeding, no red meat, less sugar and less alcohol lowers the risk.

Controversy about whether diet rich in whole grains, fruits, vegetables and legumes and low in total fat (butter, oil), more vitamins, Marine Omega 3 fatty acids (found in seafood (e.g. fish oils) and in walnut, seeds, flaxseed oil etc.), and antiperspirants and bras reduce the risk. Abortion and Breast Implants have no effect.

Selective Estrogen Receptor Modulators such as tamofoxien reduce BC risk but increase the risk of thromboembolism and endometrial cancer.
So eat well and exercise and you would have done your bit to reduce your cancer risk.

EARLY DETECTION

Since cancer-prevention is not possible, the saying, “prevention is the cure” is amended to “early detection is the cure.”

Only about 10% of cancer deaths are because of primary tumour. Most of the deaths are because of metastasis – spreading of the cancer to other parts of the body. Once metastasis happens, it is very difficult to treat. Early detection of cancer is therefore of utmost importance.

Several ways of early detection:

1. SELF-EXAMINATION OF BREASTS
More than 80% cancers are detected by women doing self-examination of breasts. The examination should be done every month, 5-7 days after menorrhoea. Do the examination as shown in the three pictures. Look for the following:

  • Lumps in breast (less than 20% are cancer) or in lymph nodes in armpits.
  • Thickening of breasts
  • One breast becoming larger than other
  • A nipple changing position or shape or becoming inverted
  • Discharge from nipple
  • Constant pain in part of breast or armpit
  • Swelling beneath the armpit or around the collarbone

In case of palpated anomaly, consult your gynecologist.

The limitations of self-examination are:

• Only 20% women do self-examination of breasts.
• The tumour/changes are large by the time they are felt and this delay in detection can adversely affect the treatment outcome.

2. IMAGING TECHNIQUES
Early detection of cancer is required and is possible by using Imaging Techniques. Six Imaging Techniques are available:

• X-ray (Mammography)
• Ultra sound (Sonography)
• MRI
• Computer Assisted Detection (CAD)
• CT-scan
• PET

A visual inspection by endoscopy can also be done.

• MAMMOGRAPHY.
X-rays examination. Small neoplasmatic tissue formations can be seen.
• SONOGRAPHY
Sonography is done in addition to Mammography to rule out possible cysts and to estimate the size of the tumour. However, tumours smaller than 5 mm cannot be detected.
• MRI
MRI is used to find out if the breast has been affected by more than one tumour.
• COMPUTER ASSISTED DETECTION (CAD)
CAD is used to point out possibly diseased regions. It is used mainly as a second opinion to the report of the doctor.

LIMITATIONS OF IMAGING

• Imaging techniques magnify the tumour much as the magnifying glass magnifies the letters in a book. Normal letter size, called font, is 12. If the font size is halved, that is made 6, you may still be able to identify the letter. But if the font is reduced still further, say to 3 or 4, you will not be able to identify the letter even with the magnifying glass. In a similar way, the imaging techniques cannot identify tumours that are small.
• The QUALITY of cancer is more important than the QUANTITY. A small tumour can be more dangerous than a large tumour. Imaging can tell the quantity of the tumour, that is, its size, but cannot tell the quality of the tumour.

• Most of the time, Imaging cannot even tell whether a tumour is cancerous or not.

CONFIRMING CANCER

The only absolute way to confirm cancer is by biopsy: a small tissue from the tumour is taken and microscopically examined to check for cancer.

TYPES OF BIOPSY

• Punching Biopsy. Done in a locally-sedated state.
• Needle Biopsy. Done with a syringe and a special needle. As painful as venepuncture.
• Advanced Breast Biopsy Instrumentation (ABBI). Done with X-ray to ensure localisation of target. Only a few doctors are experienced in this technique.

Microscopic examination of biopsy is sufficient; but in a few rare cases specialized lab tests are required.

CANCER TREATMENT

Even small localised tumours have the potential of metastasis and therefore need to be treated. The treatment is surgery, medications (hormonal therapy and chemotherapy), radiation and immunotherapy.

Surgery offers the single largest benefit. Used along with chemotherapy and radiation, the local relapse rate is reduced and the overall survival rate may increase.

SURGERY

  • Mastectomy: remove whole breast.
  • Quadrantectomy: remove quarter breast.
  • Lumpectomy: remove small part of breast.
  • Breast Reconstruction Surgery or breast prostheses: to simulate breast.

Neo-adjuvant, that is prior to surgery, and Adjuvant that is after and in addition to surgery, medication is used as part of treatment. For example, Neo-adjuvant use of aspirin may reduce the mortality from Breast Cancer.

Adjuvant Therapies are:

Radiation (negative effect on normal cells) to kill cancer cells in tumour bed and regional lymph nodes that may have escaped surgery. It reduces the risk by 50 – 66 % (i.e., 1/2 to 2/3 reduction of risk). It is confined to region being treated. But only solid tumour can be treated.

Therapies using drugs/agents etc.

  • Chemotherapy (negative effect on normal cells). Uses drugs, usually two or more drugs in combination, to destroy cancer cells.
  • Targeted Therapy that became available in 1990s that uses drugs that inhibit enzymes.
  • Monoclonal Antibody Therapy in which the agent is an antibody
  • Immunotherapy that uses patient’s immune systems to fight cancer using drugs.
  • Hormone Blocking Therapy. Uses Estrogen Receptors (ER +) Tamoxifen and Progesterone Receptors (PR +) Anastrozole that block the receptors.

Experimental Cancer Treatment
1. Gene Therapy
2. Ultrasound Energy.

Alternative Medicine.

Patients with good prognosis are offered less invasive treatment – e.g. lumpectomy + radiation + hormone.
Patients with poor prognosis are offered more aggressive treatment – extensive mastectomy + radiation + chemotherapy + adjuvant medication.

TREATMENT SUCCESS RATE

If the cancer is detected early, that is at Stage 1, prognosis is excellent and usually chemotherapy is not required.

If detected in Stage 2 & 3 prognosis is progressively poorer with a greater risk of recurrence. Surgery, chemotherapy, and radiation are required.

If detected in Stage 4, that is metastatic cancer (spread to distant sites), prognosis is poor. Surgery, radiation, chemotherapy, and targeted therapies are used. But the 10-year survival rate is 5% without treatment and 10 % with optimal treatment.

In India, more than 60% of the BC’s are diagnosed at stage III or IV. Hence the low survival rate.

For Consultation with Best Gynecologist in Delhi  contact us : +91-9999886583, +91-9999889464

PSYCHOLOGICAL AND EMOTIONAL ASPECTS

Cancer patients need psychological and emotional support. Besides the family, such support can be provided by support groups who are trained and experienced in providing such support. ‘Cancer Sahyog’ is one such support group in India.

CONCLUSION

Cancer is a 3200 year old disease. It is endogenous, a part of life-process. So it can neither be eradicated, nor prevented, nor cured.

As yet.

Over the past 2000 years, the survival rate for many cancers has improved dramatically: life expectancy increased by 20-30 years. But for a few other cancers – metastatic pancreas cancer, metastatic breast cancer, in-operable gallbladder cancer – improvement has been marginal: life extended by just a few months.

Late detection of cancer is fatal. The causes for late detection are many but lack of awareness is the principal cause. Other main causes are: patient being shy, social stigma and doctors’ ignorance because of which the treatment is delayed. An awareness program with Best Gynecologist in south Delhi will address all these issues.

Present state of our knowledge makes us believe that cancer prevention or cure is not possible because cancer is a product of the processes essential to the life process.

Will some radical discovery in the future make cancer prevention and cure possible? We don’t know. But we can always hope.

Because as Richard Clauser, Director, National Cancer Institute, USA, says about the future of cancer cure, “There are far more good historians than there are prophets.”

REFERENCES

1. India still has a low breast cancer survival rate of 66%: study: For every 2 women newly diagnosed with breast cancer, one woman dies of it in India https://www.livemint.com/Science/UaNco9nvoxQtxjneDS4LoO/India-still-has-a-low-breast-cancer-survival-rate-of-66-st.html
2. Epidemiology of breast cancer in Indian women: Breast cancer epidemiology: https://www.researchgate.net/publication/313545712_Epidemiology_of_breast_cancer_in_Indian_women_Breast_cancer_epidemiology
3. Epidemiology of breast cancer in Indian women
https://www.ncbi.nlm.nih.gov/pubmed/28181405
4. BREAST CANCER INDIA
Correct information is .. half the war won already
http://www.breastcancerindia.net/statistics/trends.html
5. Breast Cancer Survival Rates
https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html
6. The Top 5 Cancers Affecting Women Top 5 Cancers Affecting Women
https://www.everydayhealth.com/womens-health/cancers-affecting-women-today.aspx https://www.everydayhealth.com/womens-health/cancers-affecting-women-today.aspx https://www.everydayhealth.com/womens-health/cancers-affecting-women-today.aspx
7. The Emperor of All Maladies: A Biography of Cancer – a book by Siddhartha Mukherjee, a physician and oncologist. Available at Amazon and at Flipcart

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

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.