Tag Archives: Dr Sadhana Kala

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.

 

 

MEDICAL YOGA

June 21 is International Yoga Day

Yoga: for the young

Yoga is a 5000-year old practice that originated in India. it is mostly thought of as a practice to enhance flexibility, balance, muscle tone, body-strength, endurance and mindfulness. But multiple studies in recent years have shown that it is also useful in the prevention and treatment of certain medical conditions. And also has important psychological benefits.

Medical Yoga (MY), योग चिकित्सा, is a combination of poses (योगासन), breathing techniques (प्राणायाम), meditation (ध्यान) and mindfulness (सचेतन). It is holistic. It takes into account the patient’s mind, body and spirit; and their family, support network, work situation, and culture. It is tailored to an individual just as medical treatment is. It is prescribed by persons trained in MY. It is therefore different from the yoga taught by persons who are trained yoga teachers but are not trained yoga therapist.

Yoga: for the old

MY is natural, low-tech, inexpensive, safe and avoids the potential adverse effects of medication. It is therefore preferred by patients as an alternative approach to wellness. Because of its medical and wellness benefits, many healthcare providers have begun to incorporate yoga in their practice as a supplement or complement to medical treatment. And MY has emerged as a Complementary and Alternative Medicine (CAM) practice.

The American Heart Association says yoga helps to lower blood pressure, increase lung capacity, improve respiratory function and heart rate, improve circulation, boost muscle tone, and enhance cardiovagal function. A study has suggested that even a short-term yoga-based program may reduce the risk for cardio vascular disease (CVD). Another study has suggested that yoga therapy could be of great benefit as an adjunct to medical treatment in patients with heart failure. Especially because patients with severe and/or decompensated heart failure may not tolerate well physical exercise; but they may tolerate well yoga, particularly gentle asanas, breathing exercises and meditation.

Yoga: for the old

The American College of Rheumatology says that exercise and physical activity is an effective treatment program for patients with both osteoarthritis and rheumatoid arthritis; and has a vital role in promoting joint health without worsening disease. Yoga is helpful here. Also, for chronic low back pain (CLBP), Yoga is more effective than physical exercise to improve pain, back function, spinal mobility, depression and anxiety; and, in short term, to improve the functional disability.

Research has shown that meditation helps reduce chronic stress and anxiety. In the brain, it increases cortical thickness and gray matter in areas controlling emotional regulation and executive functioning that includes planning, problem solving and emotional regulation. It also increases levels of oxytocin, the “bonding hormone,” thus helping with feelings of connectedness and “being seen and heard;” it helps sleep quality and regulation; it helps increase alertness and positive feelings, and decrease negative feelings of aggressiveness, depression and anxiety; it helps build resilience, and ability to  cope with stress and anxiety. MY is strong adjunct and complement to medications and psychotherapy to prevent, cure, and/or ameliorate chronic stress and anxiety.

Yoga: for the middle-age

Studies have shown that meditation and Yoga helps prevent premature aging and a broad range of aging-related diseases, including cardiovascular disease, cancer, stroke, dementia, obesity, osteoporosis, Alzheimer’s, macular degeneration, acquired immunodeficiency syndrome (AIDS), and osteoarthritis.

A controlled trial in 2008, with a follow up in 2013, showed that comprehensive lifestyle changes – yoga, meditation, breathing, stress management and a healthy whole-food, plant-based diet – reduced withering with age, aging, disease and premature morbidity.

Yoga: for all ages

Research till date has shown multiple health-benefits of Yoga. Ongoing research is adding to the current list of benefits. But the research till date has small sample sizes, non-standardized methodologies and short follow-up periods.  Larger, standardized, studies are needed.

MY should therefore be used as a supplement or complement, not a replacement, to medical treatment.

Yoga is not easy or quick. It demands time, patience and perseverance. But it is worth devoting these. Because the benefits are immense. And in truth, yoga doesn’t take time – it gives time.

Desert Yoga

 

 

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

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

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

Blog 01

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

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

Gynecological issues

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

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

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Gynecologist in Hauz Khas Provides You Best Parental Care

A woman’s life is specified by unique changes that happen with time: from accomplishing menarche, conception, pregnancy, childbirth, and menopause. These changes do bring about troubles, directly or indirectly linked to the reproductive system and hence needs a particular branch of medication that focuses on these areas.

Gynelogical issues in women

Gynecology consists medical and surgical procedures, for the complete spectrum of diseases including the female reproductive system, whereas Obstetrics is the surgical specialty that deals with the care of mother and child, before, during and after the child takes birth.

Infertility is the special branch of medical study that deals with the infertility problems in both men and women and includes diagnosis of infertility, therapeutic techniques are to improve fertility and embryology services such as in vitro fertilization (IVF).

An annual visit to the gynecologist is an important part of keeping up with your body’s life changes. Our exams and treatment options are tailored to fit your healthcare needs. We provide annual exams for women from adolescence to menopause and beyond in addition to services and counseling related to birth control, menopause and sexually transmitted diseases. The doctor also has training and experience in both major and minor gynecological surgeries.

Gynecologist in Hauz Khas, Delhi offers women’s health services across South Delhi. We are committed to catering women with the best quality of healthcare through each and every stage of life, from adolescence to post-menopause. Dr. (Prof.) Sadhana Kala, the best Gynecologist in Delhi lead assistants and medical support all dedicated to maintaining the best level of care for our women patients.

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Dr. (Prof.) Sadhana Kala, Best Gynecologist in Hauz Khas, is specially trained to perform minimally invasive surgeries when appropriate for our patients. She is trained in the utilization of the robotic system. These less intrusive surgical techniques cater significant benefits over traditional methods. Minimally invasive surgery enables our patients to benefit from less pain, fewer complications and shorter recovery time.

Blog 02

Gynecologist in New Friends Colony for Treating Women Health Issues

Gynecology can be a very in-depth field and all women are advised to get routine and typical regular checkups to assure that their health is 100% and they are free of charge from disorders. A specialist of Gynecology really should often be professional and be sure ladies patients are always treated with respect, full esteem and kept comfortable. When a woman is fishy of issues with female organs she needs to right away look, aid and care from a Gynecologist in New Friends Colony.

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When a lady is worried about finding herself pregnant, the most efficacious physician to talk with would be the Best Gynecologist in New Friends Colony. There isn’t anything worse for a woman than the fear of a disorder with her private organs; a Gynecologist in New Friends Colony can help diagnose if anything is present and the best way to proceed forward.

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FEMALE GYNECOLOGIST IN DELHI

Gynecology was a field that was preponderantly filled with male doctors. As years went by, it was recognized that plenty of the patients did not feel much comfort with being treated by them. But in the recent times, there has been a substantial rise in the number of female gynecologists in the field. This condition does not connote that the male doctors are not pretty competent, but its roots from the fact that women feel a bit embarrassed, humiliated or held back when they want to ask a question related to their condition. This, in turn, forecloses them from telling the Gynecologist what problems they are suffering from, leading to a misdiagnosis on the part of the gynecologists. Dr. (Prof.) Sadhana Kala is a female Gynecologist in Delhi, New Friends Colony for women who are in need of a female doctor to assist them for their condition.