Tag Archives: best Pregnancy Doctor in delhi

DOCTOR

In nothing do men more nearly approach the gods than in giving health to men.

― Cicero (106 BCE – 43 BCE)

My take on ‘Being a doctor: How is it really like?’ was published by The Times of India on Doctors’ Day, 01 July 2016.

After forty-two years as a specialist doctor, what is my life like? Better in some ways, and inferior in other ways to what it was when I was a young doctor.

As a young doctor I had little responsibility. I had Seniors to advise me, to correct my errors, to take responsibility for bad outcomes, and to face the patients and relatives with catastrophic news. “The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him,” the Seniors repeatedly told me. For thirty-two years now, I am that ‘Senior.’

I don’t have eighty or hundred-hours-a-week work. I am on call 24×7. Sacrificing family life and personal interests comes with the job. I sometimes miss weddings and social events. My day is unpredictable, I never know when I will be finished working. I have piles of paperwork, the consumer court peering over my shoulder. After ten years of training to become an expert, and thirty-two years as an expert, I still have to work hard – peruse journals, participate in world and international conferences, seminars, and workshops – to keep up with the rapidly-evolving medical technology and knowledge.

FIGO World Congress, Oct 14 – 19, 2018, at  Rio De Janeiro, Brazil.

But medicine has rewards which far outweigh the negatives. I work on the most complex machine the world has known: the human body. I am challenged every day. Every patient is special: I regularly encounter unique situations. Interacting with the family of a healing patient, and when I save a life, is the moment that seals a bond between me and the patient and his family. That is the moment I realize I can positively impact a patient’s life; that I make a difference. That moment is my reward.

Robotic surgery, North shore University, New York, USA 

Medicine is the most challenging and intellectually satisfying calling. But it is demanding. It is not for the faint hearted or the weak kneed or the weak minded. It is only for persons who have a passion for medicine.

I began with a quote. And I end with a quote:

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.

Francois Marie Arouet Voltaire

Prof Dr. Kenneth Hatch, University of Arizona, Tuscan, USA, is the pioneer of laparoscopic gynec surgery

INFERTILITY IN WOMEN

INFERTILITY IN WOMEN

SYNOPSIS 

In India, infertility affects one in six couples in urban areas; and about 27.5 million couples actively trying to conceive. Women contribute to about 50% of all infertility cases. In women, common causes of infertility  are ovulation-problems, damage to Fallopian tubes or uterus, or cervix-problems. Diagnosis is mainly by urine and blood tests, ultrasound, laparoscopy and hysteroscopy. Treatment is hormones, medication and minor surgery. Safe sex, hygiene and healthy life style and diet may reduce the probability of infertility. With assisted reproductive technology (ART), most of the women can achieve pregnancy. Infertility and its treatment have psycho-social impact which may need counselling and psychotherapy.

 

INFERTILITY IN WOMEN

Infertility is a loss. It’s the loss of a dream. It’s the loss of an assumed future. And, like every loss, it will be grieved.

INTRODUCTION

In India, infertility affects one in six couples in urban areas; and 10-14% of the population overall; about 27.5 million couples actively trying to conceive suffer from infertility.

If a couple is unable to conceive despite trying for one year, they are diagnosed as infertile. Cause of infertility can be either in male or in female partner. When it is in female partner, it is called female infertility. Female infertility factors contribute to about 50% of all infertility cases; and female infertility alone cause about one-third of all infertility cases.

In a few cases the infertility remains unexplained, or idiopathic, that is, its cause remains unknown.

CAUSES

In males, more than 90% of infertility is due to low sperm counts, poor sperm quality, or both. The remaining cases can be for several reasons: anatomical problems, hormonal imbalance, and genetic defects.

In women, common causes of infertility  are ovulation-problems, damage to Fallopian tubes or uterus, or cervix-problems. Also, as a woman ages, her fertility tends to decrease, and this can cause infertility.

Ovulation problems may be caused by one or more of the following:

Damage to the Fallopian tubes or uterus can be caused by one or more of the following:

DIAGNOSIS

One or more of the following tests/exams are used to evaluate fertility:

  • Urine and blood test to check for infections or a hormone problem, including thyroid function
  • Pelvic exam and breast exam
  • Test of cervical mucus and tissue to determine if ovulation is occurring
  • Laparoscopic examination to view the condition of organs and to look for blockage, adhesion or scar tissue.
  • HSG, which is an x-ray used in conjunction with a dye inserted into the fallopian tubes to check for blockage of the Fallopian tubes.
  • Hysteroscopy that uses a tiny telescope with a fibre light to look for uterine abnormalities.
  • Ultrasound to look at the uterus and ovaries. May be done vaginally or abdominally.
  • Sonohystogram combines an ultrasound and saline injected into the uterus to look for abnormalities or problems.
  • Tracking your ovulation through fertility awareness will also help your infertility specialist to assess your fertility status.

A scene of longing that gets at what infertility is like

TREATMENT

Female infertility is most often treated by one or more of the following methods:

  • Taking hormones to address a hormone imbalance, endometriosis, or a short menstrual cycle
  • Taking medications to stimulate ovulation
  • Using supplements to enhance fertility
  • Taking antibiotics to remove an infection
  • Having minor surgery to remove blockage or scar tissues from the fallopian tubes, uterus, or pelvic area.

PREVENTION

Usually nothing can be done to prevent female infertility caused by genetic problems or illness.

But several things can be done to reduce the possibility of infertility:

  • Take steps to prevent sexually transmitted diseases
  • Avoid illicit drugs
  • Avoid heavy or frequent alcohol use
  • Adopt good personal hygiene and health practices
  • Have annual check-ups with your GYN once you are sexually active

You must contact your doctor in case of any of the following symptoms:

  • Abnormal bleeding
  • Abdominal pain
  • Fever
  • Unusual discharge
  • Pain or discomfort during intercourse
  • Soreness or itching in the vaginal area

Some couples want to explore more traditional or over the counter efforts before exploring infertility procedures. However, do consult your fertility specialist about these.

ASSISTED REPRODUCTIVE TECHNOLOGY (ART)

In recent years, several medical procedures have become available to treat infertility. Collectively, these procedures are called assisted reproductive technology (ART). A few of these procedures are, in vitro fertilization (IVF),  intracytoplasmic sperm injection (ICSI), cryopreservation of gametes or embryos, and/or may involve the use of fertility medication. ART includes “all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman.”

With ART and other fertility treatments, it is now highly probable for almost all couples to have a baby.

 

PSYCHO-SOCIAL IMPACT OF INFERTILITY 

Psycho-social impact of infertility is often overlooked because the focus is on physical causes of infertility. But this impact is important. And although it affects both the male and the female partner, the impact on women is greater.

Emotional Impact

Women are astonished, sad and angry when they first find out about their infertility.  As the treatments progresses, they are:

  • stressed
  • depressed
  • confused
  • worried
  • angry
  • upset
  • sad
  • pressured
  • grieved
  • suffer loss of:
    • self-esteem
    • self-confidence
    • sense of control over one’s destiny

Side effects of medication, money worries, and uncertain outcomes heighten the infertility-related stress.

Treatment failure, differences between partners on when to stop seeking treatment, decisions on adoption or living childless, cause further stress.

Coping with Stress

Counselling, Psychotherapy, Medications and Relaxation techniques such as mindfulness meditation, deep breathing, guided imagery, and yoga help cope with the psycho-social impact.

Other ways to cope with stress is to accept your feelings and to know that it happens to most women undergoing infertility treatment; to allow yourself to be angry, to cry to grieve; to stay connected to, and to communicate with, family and friends and your partner; to share with them your questions and fears.

Long invigorating walk, new hobby, listening to soothing music may also help. Also, cut down on intake of sugar, salt, saturated fats, and white flour; reduce or eliminate from diet chemical additives, alcohol, and caffeine, including colas, coffee, black tea, and hot cocoa.

If you feel stressed, angry and frustrated during infertility treatment, remember you are not alone. Everyone undergoing such treatment feels that way. The difference is only in the degree to which one is affected.

CONCLUSION

With ART and other fertility treatments, it is now highly probable for almost all couples to have a baby.

Still, fertility is God’s gift to women. And to men. But the gift is not equitable. A few have more of it, a few have less of it, and a few have none of it.

Fertility treatment is often a long and arduous journey. It generates psycho-social pressures. But don’t lose hope. Don’t give up. Even miracles take a little time.

Art work made from think glass medication vials, Q-caps (used to administer fertility meds), and gauze, along with ceramic pieces and glue. Titled ‘Letting Go,’ made by Denise after infertility treatment failed and she decided to live childless.

ABNORMAL VAGINAL DISCHARGE (LEUCORRHOEA)

SYMPTOMS

Women often feel embarrassed to speak about vaginal discharge, leucorrhoea, though it usually is a harmless, natural, occurrence. Except when the discharge, which normally is clear and white and odorless, becomes yellow, green or grey, or white and curdy like cottage cheese, or frothy, or foul-smelling usually a fish-odor.

The other symptoms of Leucorrhoea are:

  • Rashes or sore spots on the genitals
  • Intense itching of the vagina
  • Pain during sex
  • Burning urination and frequent urge to urinate even with very little urine
  • Constipation and other Digestive disturbances
  • Backache, pain in the leg, pain in lower abdomen
  • Irritability and lack of concentration in work
  • Fatigue because of loss of fluids as discharge
  • Headaches

CAUSES

Leucorrhoea may be caused by:

  • Antibiotic or steroid use
  • Bacterial vaginosis (a bacterial infection)
  • STD
  • Pelvic infection
  • Pelvic inflammatory disease (PID)
  • Urinary tract infection
  • Injuries to the cervix or any of the tissues in the reproductive system during pregnancy
  • Diabetes
  • Anemia
  • Birth control pills
  • Douches, scented soaps or lotions, bubble bath
  • In young girls, hormonal imbalance caused by severe mental stress and trauma
  • Overindulgence in sexual activity
  • Improper diet and lifestyle during menstrual cycle
  • Lack of nutrients
  • Improper vaginal hygiene
  • Alcohol and smoking
  • Cervical or endometrial cancer

DIAGNOSIS

The doctor will take your health history, note the symptoms, and may test the discharge and may also do a Pap test to find the cause of the problem.

 

TREATMENT

Treatment will depend on the cause of the problem.

 

PREVENTION

To prevent Leucorrhoea:

  • Keep the vagina clean by washing regularly with a gentle, mild soap and warm water
  • Never use scented soaps and feminine products or douche. Also avoid feminine sprays and bubble baths
  • After going to the bathroom, always wipe from front to back to prevent bacteria from getting into the vagina and causing an infection
  • Wear 100% cotton underpants
  • Avoid too tight clothing

Whenever you feel that the vaginal discharge is abnormal, consult your gynecologist.

 

 

POST MENOPAUSAL BLEEDING

See your doctor if you have vaginal bleeding after menopause. See the doctor even if the bleeding is small, even if it is only once, even if you don’t have any other symptoms. Because such bleeding can be caused by cancer.

CAUSES

The main causes of Postmenopausal Bleeding are:

• Polyps: These are tissue growths inside the uterus or the cervical canal, or on the cervix. They can cause spotting, heavy bleeding, or bleeding after sex. They’re usually not cancer.
• Endometrial atrophy: Endometrium is the tissue that lines the uterus. Low hormone levels after menopause can cause it to get too thin. This may trigger bleeding.
• Endometrial hyperplasia : Too much estrogen and too little progesterone, likely after menopause, can result in thicker endometrium that can bleed. It can also lead to cancer.
• Vaginal atrophy: Low estrogen levels after menopause can cause the vaginal walls to become thin, dry, and inflamed. That often leads to bleeding after sex.
• Cancer: Bleeding is the most common symptom of endometrial or uterine cancer after menopause. It can also signal vaginal or cervical cancer.
• Sexually transmitted diseases: STD like chlamydia and gonorrhea, may cause spotting and bleeding after sex. Herpes sores can also bleed.
• Medications: Bleeding is often a side effect of certain drugs, like hormone therapy, tamoxifen, and blood thinners.
• Other causes: Other possible, though less likely, causes of bleeding can be: clotting problems, infection of the uterine lining (endometritis), bleeding from the urinary tract and thyroid disorders.

DIAGNOSIS

Doctor will take your health-history, do a physical examination, and may do one or more of these diagnostic tests:

• Transvaginal ultrasound: To check for growths and see the thickness of the endometrium.
• Endometrial biopsy: To take a small sample of the tissue lining the uterus. The sample will be examined in a lab for infections or cancerous cells or any other abnormality.
• Hysteroscopy: To look inside the uterus.
• D&C (dilation and curettage): To take a sample of the uterus lining. The sample is checked in a lab for polyps, cancer, or thickening of the uterine lining.

TREATMENT

Treatment depends on the cause of bleeding.

• Estrogen therapy is used to treat vaginal and endometrial atrophy. It may be taken as:
o Pills taken by mouth.
o Vaginal cream put inside the body using an applicator.
o Vaginal ring put it in place by you or the doctor. It releases a steady dose of estrogen for about three months.
o Vaginal tablet inserted daily, or a few times a week, using an applicator.

• Progestin therapy: Progesterone is lab-made. It is used to treat endometrial hyperplasia. It can be a pill, or a shot, or a vaginal cream, or an intrauterine device.
• Hysteroscopy is used to remove polyps, and thickened parts of the uterine lining.
• D&C (dilation and curettage) is used to remove polyps or thickened areas of the uterine lining.
• Hysterectomy is a surgery to remove part or all of uterus. It is a treatment for endometrial or cervical cancer. It may also be needed in cases of precancerous form of endometrial hyperplasia. In some cases, ovaries, fallopian tubes, or nearby lymph nodes may also need to be taken out.
• Radiation, chemotherapy, and hormone therapy if needed for cancer treatment after surgery.
• Medications to treat cervical or uterine infections and sexually transmitted diseases.

Do not ignore postmenopausal vaginal bleeding. It may be cancer. And early detection is the cure for cancer. See your doctor.

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.

 

DEPRESSION IN PREGNANCY

Depression, suffering and anger are all part of being human. – Janet Fitch

Depression is the inability to construct a future. – Rollo May

SYNOPSIS

Depression is a mood disorder, a biological illness, which affects 14-23% of women during pregnancy. Depression makes a woman feel sad, bleak, helpless, anxious, irritable, fatigued and lacking in energy.

Depression can be treated. Left untreated, it can lead the woman to poor nutrition, drinking and smoking causing the babies to be born premature, less active, and have developmental problems. Antenatal depression is a strong precursor to Postpartum Depression.

Depression treatment is psychotherapy, medication, and self-care. Cognitive behavioural therapy (CBT) is the often used psychotherapy. A woman can do it herself after suitable instructions. Medication is antidepressants. These pose a very small risk to fetus. A few supplements are also claimed to help. But these should not be taken without doctor’s advice. Self-care involves proper diet, adequate sleep, exercise, and pregnancy-yoga.

Several women have depression during pregnancy. So you are not alone. Do not therefore hesitate to speak to your doctor at the first appearance of the symptoms of depression.

INTRODUCTION

Pregnancy is a joyous period for women. But for a few the joy is clouded by mood swings. We all have transitory mood swings. But if these last a few weeks or a few months, then these signal depression.

DEPRESSION

Depressions are biological illnesses caused by changes in brain chemistry. Such changes may be triggered by the hormonal changes during pregnancy. This is called antenatal depression. But except in name, it is similar to clinical depression.

SYMPTONS

Symptoms of depression vary from person to person. But if you have one or more (usually five) of the following symptoms for most of the day, nearly every day, for two weeks or more, it signals depression:

  • feelings of sadness, bleakness, hopelessness, and anxiety;
  • lack of interest or pleasure in doing anything;
  • feeling tired or having little energy;
  • difficulty concentrating;
  • difficulty remembering.
  • feeling emotionally numb.
  • extreme irritability.
  • sense of dread about everything, including the pregnancy.
  • feelings of failure, or guilt.
  • trouble getting to sleep, waking up in the night or sleeping too much;
  • overeating or decreased appetite.
  • weight loss/gain unrelated to pregnancy
  • low self-esteem, or feelings of guilt or failure
  • fidgeting a lot, or moving and speaking very slowly
  • loss of interest in sex.
  • thoughts of suicide or self-harm may occur.
  • inability to get excited about the pregnancy, and/or baby
  • feeling of disconnection with the baby, and an inability to form/feel a bond with the developing baby.

RISK

Anyone can have depression. But the following factors, or a combination of these, increases the risk of getting depression:

• Family history of depression. Risk of suicide also goes up.
• Personal history of depression or anxiety in the past – like during an earlier pregnancy or after the birth of a previous child. Also the risk of postpartum psychosis, a rare but very serious condition that involves hallucinations, increases.
• Life stress events, such as financial problems, the end of a relationship, the death of a close friend or family member, or a job loss.
• Lack of support like having relationship problems or an unsupportive partner or having your baby on your own, or if you feel isolated from friends or family
• Unplanned pregnancy finding out you’re pregnant when you didn’t plan to be.
• Domestic violence and emotional abuse that tend to get worse when you’re pregnant.
• Infertility treatments
• Complications in pregnancy

TREATMENT

Antenatal depression is treatable with psychotherapy, medication, and self-care.

Psychotherapy:

Cognitive behavioral therapy (CBT) is the often used psychotherapy. It helps the mother recognize her emotions and counter her negative thoughts. She is encouraged to do CBT herself after step by step instructions in CBT through books and talks, or she may be advised do it in sessions with a therapist.

Medication

She may also need antidepressants. Not enough evidence is available that these are completely safe to take in pregnancy. A few of these pose a very small risk of birth defects that include fetal heart and skull abnormalities. Doctor weighs the risks and benefits to the mother and to the baby to decide on antidepressants. If the mother was on mental health medication before pregnancy, she should not stop these without asking the doctor. Also, she should not start any medication, including herbal medication, without asking the doctor.

Supplements

Several supplements such as St. John’s wort, SAMe, Saffron extract, 5-HTP and DHEA are being marketed as being helpful in depression. These seem to help some people but sufficient evidence is not available for their efficacy. A few of these can interfere with prescription medications or cause dangerous interactions and may be unsafe. Consult your doctor before taking any supplements or herbal medication.

Acupuncture 

Acupuncture is claimed to help relieve depression. But the evidence for its effectiveness is ambiguous or outright contradictory. The World Health Organization has recognized acupuncture as effective in treating mild to moderate depression. – Dr. Andrew Weil in ‘Depression, Health, World, Organization.’

Self-care

Diet, sleep, and physical activity are just as important as medication and therapy — sometimes more so.

Diet and nutrition.

Diet is so important to mental health that a new field of medicine called nutritional psychiatry has grown around it. Many foods have been linked to mood changes, the ability to handle stress and mental clarity.

• Foods to avoid are:

o Alcohol: it depletes serotonin, which makes people prone to anxiety, depression and panic attack.
o Caffeine: It lowers serotonin and increases the risk for anxiety, depression, and poor sleep. Reduce intake of coffee, tea, and hot cocoa.

• Foods to take are those rich in:

o B12 and folate. These prevent mood disorders and dementias. Sources: beetroot, lentils, almonds, spinach, liver (folate); liver, chicken, fish (B12)
o Vitamin D. Its deficiency is associated with different mood disorders. Sources: sun exposure; breakfast cereals, breads, juices, milk; high-quality supplements.
o Selenium. It decreases depression. Sources: cod, Brazil nuts, walnuts, poultry.
o Omega-3 fatty acids. These improve cognitive and behavioral function. Low levels of omega-3 fats leads to mood swings and depression. Sources: cod, haddock, salmon, halibut, nut oils, seeds, walnuts, and algae; high-quality supplements
o Endorphins. These enhance mood and promote a sense of well-being. Source: dark chocolate

Sleep

Lack of sleep (insomnia), or disturbed/obstructive sleep (apnea) are linked to depression. People with insomnia are 10 times more likely to have clinical depression and 17 times more likely to have clinical anxiety, and people with apnea are five times more likely to have clinical depression, than people who sleep normally. To help get sleep, lower room temperature, follow a schedule, avoid naps during the day, listen to relaxing music, try a low carb/high fat diet and eat 3-4 hours before sleep time, exercise, and practice yoga and meditation.

Exercise

Exercise releases endorphins, natural cannabis-like brain chemicals, and other natural brain chemicals, that enhance your sense of well-being. Depression causes tiredness and lack of energy. It may therefore be difficult to begin exercising. So begin with a walk for five or ten minutes and gradually increase to 30-45 minutes a day for three to five days a week. Results will appear after a few weeks because exercise is a long term treatment. Therefore pick up an exercise – walking, cycling, swimming – that you enjoy.so you will continue to do it

YOGA

Yoga focuses on the balance between your mind, body and breath. This balance is created through:

• physical exercises and postures (asanas)
• breathing exercises (pranayama)
• relaxation
• meditation

Yoga improves your physical, mental and emotional wellbeing. It helps you to:

• Improve your circulation, muscle tone and flexibility; to keep the body supple and relieve tension around the cervix by opening up the pelvic region. This prepares to-be-mothers for labor and delivery.
• Alleviate the effect of common symptoms such as morning sickness, painful leg cramps, swollen ankles, lower-back pain and constipation.
• Stay mentally agile through relaxation, breathing and meditation.
• Train you to breathe deeply and relax consciously, helping you to face the demands of labor and childbirth.
• Feel calm, and ease muscle tension.
• Recover faster post-delivery.

If you are already doing Yoga, you may continue to do pregnancy yoga during pregnancy. Since most miscarriages happen during the first trimester, you may, as a precaution, decide not to do Yoga during that period. Although there is no evidence that doing yoga, or any other exercise, during the first trimester will harm your pregnancy.

If you have never before done Yoga, then do not begin it in the first trimester. Begin in the second trimester, after 14 weeks of pregnancy. Join a pregnancy Yoga class. Your instructor will start you gently and slowly and modify the posture to suit the stage of your pregnancy.

Avoid these:

• Lying on your back after 16 weeks.
• Breathing exercises that involve holding your breath or taking short, forceful breaths.
• Strong stretches or difficult positions that put you under strain.
• Lying on your tummy (prone).
• Upside-down postures (inversions).
• Back bends.
• Strong twists.

A study published in Obstetrics & Gynecology in December 2015 found no evidence of fetal distress in any of the 26 postures attempted. These included downward facing dog and savasana. But avoid any poses that feel uncomfortable.

The Art of Living recommends only nine asanas (postures) for pregnancy Yoga. These include Shavasana (Corpse Pose) and Yoga Nidra (Yogic sleep).

You may restart postpartum yoga six weeks after a vaginal delivery; and a longer period after a Caesarean section as advised by your doctor. The postpartum asanas help combat back and neck aches and also help breastfeeding mothers.

ADDITIONAL

To help yourself handle depression:

• Talk about your concerns with your partner, family and friends. They may offer you a proper perspective or practical help. And simply talking about your problems makes these seem more manageable.
• Take time to relax. Give yourself some “me time.” Read, take a calming bath, lunch out with friends, watch an entertaining movie or play. In short do anything that takes your mind away from your concerns and gives you physical and mental relaxation.

DOWNSIDE

Untreated depression can lead to poor nutrition, drinking and smoking. These can cause premature birth, low birth weight, and developmental problems. Babies of ‘depressed’ mothers may be less active, have lower attention span, be more agitated, have behavioral problems and delayed cognitive and language development as compared to babies born to normal mothers.

Antenatal depression is a strong precursor to Postpartum Depression: a major depression in the weeks and months after childbirth. It affects mother’s health and quality of life and also the well-being of the baby. It can cause bonding issues with the baby and can contribute to sleeping and feeding problems for the baby.

CONCLUSION

If you have symptoms of depression, remember, you are not alone. Between 14-23% of women struggle with some symptoms of depression during pregnancy. Antenatal depression can be treated and managed. Most women recover with a few weeks, or a few months, of treatment.

So do not feel shy. Speak to your pregnancy doctor in south Delhi at the first appearance of the symptoms of depression.

REFERENCES

1. Depression During pregnancy
https://www.babycenter.com/0_depression-during-pregnancy_9179.bc#articlesection1
2. Depression In pregnancy

3. Facing Depression During Pregnancy
https://www.webmd.com/baby/features/facing-depression-during-pregnancy#1
4. Depression during pregnancy: You’re not alone
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by- Antenatal depression
5. Antenatal depression
https://en.wikipedia.org/wiki/Antenatal_depression
6. Prenatal Yoga for women to do during pregnancy | The Art of Living …https://www.artofliving.org/in-en/yoga/yoga-for-women/yoga-and-pregnancy
7. Introduction to Pregnancy Yoga – Verywell Fit
https://www.verywellfit.com › Fitness › Yoga › Yoga and Your Health
8. Pregnancy yoga for beginners – BabyCentre UK
https://www.babycentre.co.uk/a1033238/pregnancy-yoga-for-beginners
9. The Complex Relationship Between Sleep, Depression & Anxiety …
https://sleepfoundation.org/excessivesleepiness/…/the-complex-relationship-between-sl…
10. Depression & Sleep – National Sleep Foundation
https://sleepfoundation.org/sleep-disorders-problems/depression-and-sleep
11. Can Acupuncture Treat Depression? – Scientific American
https://www.scientificamerican.com/article/can-acupuncture-treat-depression/
12. Natural remedies for depression: Are they effective? – Mayo Clinic
https://www.mayoclinic.org/…/depression/…/natural-remedies-for-depression/faq-200.
13. Depression and anxiety: Exercise ease symptoms – Mayo Clinic
https://www.mayoclinic.org/diseases…/depression/in…/depression…exercise/art-20046.
14. Exercise is an all-natural treatment to fight depression – Harvard Health
https://www.health.harvard.edu/…/exercise-is-an-all-natural-treatment-to-fight-depress..
15. 20 Simple Ways to Fall Asleep as Fast as Possible – Healthline
https://www.healthline.com/nutrition/ways-to-fall-asleep

Best Pregnancy Doctor in South DelhiBest Pregnancy Doctor in Greater Kailash DelhiBest Pregnancy Doctor in Lajpat Nagar Delhi | Best Pregnancy Doctor in East of Kailash Delhi

sadhana-kala.

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

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