Colposcopy and LEEP:
When a woman has an abnormal pap, it is often indicated to look in more detail to see if there are visible cellular changes on the cervix that may have caused the abnormality. The first step is colposcopy, wherein the cervix is visualized with a microscope and various solutions are applied to demonstrate where the abnormal areas are for more accurate biopsy. LEEP stands for loop electrosurgical excision procedure. It allows for excision of a portion of the cervix in order to both treat more severe, precancerous abnormalities as well as get a portion of tissue to a pathologist for more thorough diagnostic examination under a microscope to make sure that there is not a more severe diagnosis present.
Endometrial or vulvar biopsy:
Sometimes women experience symptoms that may be concerning for autoimmune/inflammatory disorders of the vulva (the area of skin around the vagina including the labia and perineum) or concerning for cancers of this area or the uterus. If you experience persistent external itching or burning sensation, skin changes, irregular vaginal bleeding (including between periods or after intercourse, aka postcoital bleeding) or bleeding after menopause, these symptoms warrant investigation by your gynecologist and may warrant biopsy. Biopsy is where a sample of tissue is taken, usually under local anesthesia, and is sent to a pathologist for further review and diagnosis using a microscope.
This procedure is used to treat heavy menstrual bleeding by freezing the inner lining of the uterus to essentially remove it. The goal is to minimize continued bleeding, though in some women the bleeding may stop all together. This is considered a minimally-invasive technique that may prevent a woman’s need for hysterectomy (removal of the uterus all together). The procedure should not be done if there is concern or high risk of endometrial cancer (cancer of the inner lining of the uterus).
One treatment for pelvic organ prolapse (when there are bulges from the vagina or perineum behind the vagina) that has nearly zero risk is a pessary. Pessaries are devices made to be placed in the vagina to re-support whatever bulges may be present and may allow for delay or avoidance all together of the need for surgical repair. As every woman is different, fittings of various types of pessaries can be done in our clinic to maximize both comfort and support. Additionally, for women who are unable to manage the pessary at home, we offer in-office pessary management visits at a frequency of every 2-3 months depending on the situation.
Minor surgical procedures:
Some small procedures may be completed in the clinic under local anesthesia. These can include examples like treatments for genital condyloma (warts), removal of skin tags, or dealing with incision issues and closure.
Hysterectomy (vaginal, total laparoscopic, supracervical laparoscopic, or abdominal approaches) with or without removal of tubes and ovaries:
Hysterectomy refers to the removal of the uterus and possibly cervix. The potential approaches to the surgery include through the vagina with an incision around the cervix, through laparoscopy (a scope surgery on the abdomen using small incisions and a camera), or an open abdominal surgery. The preferred approaches, if feasible given a specific case, are vaginal or laparoscopic because these allow for a shorter hospital stay and easier recovery. If the tubes and ovaries are also removed, these procedures are called salpingectomy for tubes or oophorectomy for ovaries, or salpingoopherectomy if both are removed. The decision for the latter procedures should be individualized based on discussion with your gynecologist concerning your indications for surgery, age, family history, and willingness to take hormone or estrogen replacement therapy. You can have a hysterectomy and keep your ovaries such that you would continue to produce natural female hormones until the age that you would have otherwise gone through menopause on your own. Please note, if you have Medicare or Medicaid that a special form must be signed at least 30 days before hysterectomy.
Operative laparoscopies (lysis of adhesions, removal of ovarian cysts or tubes/ovaries):
Minimally-invasive surgery is the norm at Advanced Obstetrics and Gynecology, so whenever possible, surgeries on the tubes and ovaries or related structures, including surgical treatment of endometriosis and infertility, are completed through a scope on the abdomen. This approach allows for shorter and possibly no overnight hospital stay as well as less pain and easier recovery postoperatively.
This is an outpatient procedure used to treat heavy menstrual bleeding wherein the inner lining of the uterus (the part that sheds with your period each month) is burned or frozen in an effort to remove it. The goal is to minimize continued bleeding, though in some women the bleeding may stop all together. This is considered a minimally-invasive technique that may prevent a woman’s need for hysterectomy (having the uterus removed all together). The procedure should not be done if there is concern or high risk of endometrial cancer (cancer of the inner lining of the uterus).
Microscopic tubal reanastomosis (reversal of tubal ligation):
Regret is unfortunately one of the leading complications of tubal ligation or sterilization. Fortunately, Advanced Obstetrics and Gynecology can offer potential reversal of tubal ligations in an attempt to restore childbearing capabilities by reattaching the remnants of the tubal segments to restore patency.
Pelvic organ prolapse repair (including vaginal vault suspension) and colpocleisis:
As a woman ages and with the stressors and pressures that her pelvic support goes through over a lifetime, portions of the vagina can begin to bulge down and outward. These bulges, or pelvic organ prolapse, can be treated in a stepwise approach including pelvic floor physical therapy or with pessaries, but treatment often culminates in surgical repair of the prolapse. There are a variety of procedures available to correct these defects or bulges, but the most common approach is through the vagina, leaving no abdominal incisions. Occasionally, additional support is needed beyond your own tissue to achieve a durable repair, so in these cases we may use graft material for additional support. Whenever possible, we prefer to use biologic grafts which will become part of your own tissue. These biologic materials have not been shown to cause the same rate of dramatic complications as the synthetic meshes you may have heard about in the news.
Operative hysteroscopy (removal of adhesions/Asherman’s syndrome, uterine septum, endometrial polyps, or fibroids/leiomyomata):
Problems can also arise within the lining of the uterus that may cause symptoms such as heavier periods or infertility. With advancements in equipment and technique, exploration and removal of these issues can usually be approached through a scope surgery on your uterus. These surgeries typically require no hospital stay and lend themselves to very rapid recovery and minimal pain.
Uterine fibroids, or myomas, are a very common ailment for women. They can cause increased menstrual bleeding, pelvic pressure as they enlarge, or even infertility and are a leading cause for hysterectomy in the United States. However, if you wish to retain your uterus or fertility, the fibroids themselves may be able to be removed in a surgery called myomectomy and the uterus reconstructed at the site of removal to treat your symptoms as well.
Bladder Sling for Urinary Incontinence (Tension-Free Vaginal Tape):
Two of the leading causes of stress urinary incontinence, urethral hypermobility and intrinsic sphincter deficiency, can be treated by placing a sling underneath the urethra (the muscular tube through which you urinate) to re-support and decrease, or hopefully stop altogether, continued incontinence with laughing, sneezing, coughing, or exercise. If you suffer from this issue, make sure to inquire about potential treatments because remarkable improvement may be possible.