Vulval and vaginal skin infections

The vulva (Latin for womb or covering) consists of several layers that cover and protect the sexual organs and urinary opening. The fleshy outer lips of the vulva — the labia majora — are covered with pubic hair and contain fat that helps cushion the area. Inside the labia majora are the thinner, more pigmented and delicate flaps of skin called the labia minora. The labia minora join at the top to enclose the clitoris. The labia majora, labia minora, and clitoris are made up of erectile tissue, that is, tissue that can become engorged with blood.

The area between the labia minora, the vestibule, contains the openings to the urethra and the vagina, as well as the Bartholin’s glands, which are located on either side of the vaginal opening and produce lubricant for the vestibule. The flesh between the vaginal opening and the anus (not part of the vulva but often involved in vulvar skin problems) is the perineum. This is where the incision called an episiotomy is sometimes made during childbirth.

Getting a diagnosis for vulva skin conditionsVulvar skin conditions are highly treatable, but the treatment depends on the specific cause. And identifying the underlying diagnosis can be very challenging.

Tell your clinician about any other past or present medical conditions (including bladder and bowel issues) and any skin problems elsewhere on your body. For example, psoriasis anywhere on the body raises the risk of a vulvar condition known as lichen sclerosus. (This condition and others are described, below, in “Vulvar conditions and their treatment.”) Crohn’s disease, a chronic inflammatory intestinal disease, may cause abscesses or draining fistulas in the vulvar area, and vulvar skin problems are often one of its early symptoms. A mouth condition called lichen planus is another cause of vulvovaginal problems. (The term “lichen,” as applied to skin disorders, refers fancifully to skin lesions that resemble lichen on rocks.) Long-term treatment with oral steroids, immune suppressants, or antibiotics can affect vulvar skin and raise the risk infection.

Your clinician will want to know how you care for your vulvar skin, which can help identify possible sources of irritation. Even if you can’t pinpoint a change, that doesn’t mean your standard routine isn’t the culprit. Sometimes vulvar problems are the cumulative effect of long-term practices.

It’s often what you’ve done day after day, year after year, that causes the problem. If you wear abrasive clothing and engage in abrasive activities like bicycling or spinning class and wear tight workout clothes that expose your vulva to sweat or to detergent or soap residue, eventually it might catch up with you.

Report all the symptoms that concern you, including itching, burning, soreness, discharge, bumps, and any rashes the vulva. It will also help if you can provide a history of your symptoms and recall what seems to make them better or worse. Your clinician will examine the vulva, perhaps using a magnifying glass, and insert a speculum to inspect the vagina. She or he may test the pH (acid-base balance) of the vagina and take samples of secretions to examine under the microscope or culture for yeast. Remember, even if you’re seeing an experienced clinician, several visits may be needed to diagnose and improve certain vulvovaginal conditions.

The problem with self-treatment

When vaginal or vulvar itching occurs, women usually assume it’s a yeast infection and treat it with an over-the-counter antifungal cream. Often this does the trick, but not always. Instead, the cause of the symptoms might be dry skin, a sexually transmitted disease or bacterial infection, a less common strain of yeast that required special medication, or irritation by and allergic reactions to common products such as soaps, creams, and lotions.

If yeast isn’t the problem, an antifungal cream isn’t the solution. And if your skin is already irritated, you may exacerbate the problem by introducing preservatives (such as alcohol or propylene glycol) and other ingredients contained in many antifungal remedies. That’s why it’s important to see your gynecologist or dermatologist if a problem persists after you’ve tried a standard antifungal cream.

Another common response of women faced with a vaginal discharge or itch is to wash the vulvar skin vigorously, on the assumption that this will disinfect the area or remove irritants. But aggressive cleansing can add to the irritation. Until the problem is diagnosed, it’s best to follow a gentle skin care routine (see “Gentle vulvar care”). In fact, gentle cleansing applies whether you have a vulvar skin condition or not: Wash the area gently with your fingertips or a soft cloth and pat dry with a soft towel. Don’t use a rough washcloth, and don’t rub.

Vulvar skin conditions and their treatment

Several vulvar skin conditions are familiar from other areas of the body but may be difficult to recognize when they appear on the vulva. These include the following:

Eczema. This inflammatory skin condition disrupts the skin’s surface, causing red patches and thin cracks, weeping, and crust formation. On the vulva, crusts are less likely, but eczema may initiate a cycle of vulvar itching and scratching that leads to lichen simplex chronicus — thickened and intensely itchy skin. If eczema affects an area of the vulva called the vestibule, it may cause stinging and burning. Sometimes eczema appears in early childhood and its cause is unknown. More often, it begins with exposure to an irritant or allergen (see “How irritating”).

To diagnose vulvar ecz

Many things can cause an allergic reaction or irritate vulvar skin. Here are some of the leading suspects:

Irritants (on exposure, can cause immediate stinging or burning)

  • Soap, bubble baths and salts, detergent, shampoo, conditioner
    Adult or baby wipes
    Panty liners and their adhesives
    Nylon underwear, chemically treated clothing
    Vaginal secretions, sweat, and urine
    Douches, yogurt
    Spermicides, lubricants
    Perfume, talcum powder, deodorants
    Alcohol and astringents

Allergens (symptoms may not appear until several days after exposure)

  • Benzocaine
    Neomycin
    Chlorhexidine (in K-Y Jelly)
    Imidazole antifungal
    Propylene glycol (a preservative used in many products)
    Fragrances
    Tea tree oil
    Latex (in condoms and diaphragms)

Adapted from The V Book, by Elizabeth G. Stewart, M.D., and Paula Spencer (Bantam Books, 2002).

ema, the clinician will ask about your symptoms; your history of eczema, allergy, and related conditions; your vulvar cleansing habits; and any products the vulva has been exposed to. During the exam, she or he will look for redness, scaling, cracking, and thickening.

All eczema requires gentle skin care. In simple cases, patients use topical corticosteroid ointments twice a day for two to four weeks and then gradually reduce the frequency until the symptoms are gone. Severe cases may require a short course of a potent corticosteroid ointment.

During treatment, you must stop scratching, so your clinician may prescribe an antihistamine (usually taken at night to prevent daytime drowsiness). A cold pack can also help relieve itching.

Dr. Ruchi Tandon is a Gynecologist, practicing in leading hospitals in South Delhi namely, Max Smart superspeciality hospital, saket and Apollo hospitals. She has experience of over 13 years in handling all vulval skin lesions.

Ovarian cyst in the times of covid 19 pandemic

What are ovarian cysts?

The ovaries are part of the female reproductive system. They’re located in the lower abdomen on both sides of the uterus. Women have two ovaries that produce eggs as well as the hormones estrogen and progesterone.

Sometimes, a fluid-filled sac called a cyst will develop on one of the ovaries. Many women will develop at least one cyst during their lifetime. In most cases, cysts are painless and cause no symptoms.

Types of ovarian cysts

There are various types of ovarian cysts, such as dermoid cysts and endometrioma cysts. However, functional cysts are the most common type. The two types of functional cysts include follicle and corpus luteum cysts.

Follicle cyst

During a woman’s menstrual cycle, an egg grows in a sac called a follicle. This sac is located inside the ovaries. In most cases, this follicle or sac breaks open and releases an egg. But if the follicle doesn’t break open, the fluid inside the follicle can form a cyst on the ovary.

Corpus luteum cysts

Follicle sacs typically dissolve after releasing an egg. But if the sac doesn’t dissolve and the opening of the follicle seals, additional fluid can develop inside the sac, and this accumulation of fluid causes a corpus luteum cyst.

Other types of ovarian cysts include:

  • dermoid cysts: sac-like growths on the ovaries that can contain hair, fat, and other tissue
  • cystadenomas: noncancerous growths that can develop on the outer surface of the ovaries
  • Endometriomas: tissues that normally grow inside the uterus can develop outside the uterus and attach to the ovaries, resulting in a cyst

Some women develop a condition called polycystic ovarian syndrome. This condition means the ovaries contain a large number of small cysts. It can cause the ovaries to enlarge. If left untreated, polycystic ovaries can cause infertility.

Symptoms of an ovarian cyst

Often times, ovarian cysts do not cause any symptoms. However, symptoms can appear as the cyst grows. Symptoms may include:

  • Abdominal bloating or swelling
  • painful bowel movements
  • pelvic pain before or during the menstrual cycle
  • Painful intercourse
  • pain in the lower back or thighs
  • Breast tenderness
  • Nausea and vomiting

Severe symptoms of an ovarian cyst that require immediate medical attention include:

  • severe or sharp pelvic pain
  • Fever
  • Fainting or dizziness
  • Rapid breathing

These symptoms can indicate a ruptured cyst or an ovarian torsion. Both complications can have serious consequences if not treated early.

Ovarian cyst complications

Most ovarian cysts are benign and naturally go away on their own without treatment. These cysts cause little, if any, symptoms. But in a rare case, your doctor may detect a cancerous ovarian mass during a routine examination.

Ovarian torsion is another rare complication of ovarian cysts. This is when a large cyst causes an ovary to twist or move from its original position. Blood supply to the ovary is cut off, and if not treated, it can cause damage or death to the ovarian tissue. Although uncommon, ovarian torsion accounts for nearly 3 percent of emergency gynecologic surgeries.

Ruptured cysts, which are also rare, can cause intense pain and internal bleeding. This complication increases your risk of an infection and can be life-threatening if left untreated.

Diagnosing an ovarian cyst

Your Gynecologist can detect an ovarian cyst during a routine pelvic examination. They may notice swelling on one of your ovaries and order an ultrasound test to confirm the presence of a cyst. An ultrasound test (ultrasonography) is an imaging test that uses high-frequency sound waves to produce an image of your internal organs. Ultrasound tests help determine the size, location, shape, and composition (solid or fluid filled) of a cyst.

Imaging tools used to diagnose ovarian cysts include:

  • CT scan: a body imaging device used to create cross-sectional images of internal organs
  • MRI: a test that uses magnetic fields to produce in-depth images of internal organs
  • Ultrasound: an imaging device used to visualize the ovary

If there aren’t any changes in your condition or if the cyst increases in size, your doctor will request additional tests to determine other causes of your symptoms.

These include:

  • Pregnancy test to make sure you’re not pregnant
  • hormone level test to check for hormone-related issues, such as 
  • CA 125 to screen for ovarian cancer

In covid pandemic era, a complete assessment of ovarian cyst is done. Surgery is done only in cases of emergency and anticipated complications.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi , namely, max smart superspeciality hospital, saket, Apollo hospitals , with clinical experience of over 13 years.

Heavy and painful periods

Heavy flows and achy cramps can be common experiences when many women have their periods. Periods that prevent you from doing everyday activities aren’t normal.

Each woman’s menstrual flow and cycle are different. It may be hard to know if your period is normal, light, or heavy unless you talk with your doctor.

Women lose an average of 30-40 ml of blood during a period. Women with heavy bleeding may potentially lose up to 80 mL.

Women who do experience abnormally heavy menstrual bleeding may have a condition called menorrhagia.

This condition causes flows so heavy you need to change your tampon or pad every hour. You may also use more than six or seven tampons a day.

This condition can cause anemia and severe cramps. You may also pass blood clots larger than a quarter during your period.

Because measuring your total blood loss is impractical, the best way to know if your period is unusually heavy is to talk with your doctor.

What causes a heavy period?

Several conditions can cause heavy periods. These heavy periods may occur frequently, or they may be more sporadic.

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A period that’s suddenly very heavy one month
Ectopic pregnancy

The signs and symptoms of an ectopic pregnancy may be confused with a heavy menstrual period.

This type of pregnancy develops outside your uterus and isn’t sustainable. It can cause severe health issues, including heavy bleeding and severe cramping. Left untreated, an ectopic pregnancy is life threatening.

Miscarriage

During and surrounding a miscarriage, heavy bleeding is common and may be mistaken for a very heavy period.

Non-hormonal intrauterine device (IUD)

Heavy menstrual bleeding is a common side effect of a non-hormonal IUD. After a few months with your IUD, you may find that bleeding becomes less severe.

Medications

Blood thinners can lead to blood flow problems and heavier menstrual flow.

A period that’s heavy on the first day

Many women experience heavier bleeding on the first day of a period and lighter bleeding on the last days. A heavy flow that might get in the way of your normal activities is unusual.

Birth control changes

If you recently stopped using hormonal birth control, your periods may be very heavy in the first days as your cycle adjusts to the hormone changes.

Medication changes

Like birth control, medications you take may interfere with your cycle and lead to heavy bleeding on the first day of your period.

A recurring period that’s heavy and painful

If every period is heavy, painful, and difficult to work around, you may have underlying, long-term issues.

Hormone problem

Your body typically balances progesterone and estrogen, the two hormones that play the biggest roles in menstruation.

Too much estrogen, however, can lead to a thickened uterine lining. This can cause heavy bleeding as the lining is eliminated during your period.

An underactive thyroid gland (hypothyroidism) may also cause heavy or irregular menstrual bleeding

Bleeding disorder

Roughly 10-30% of women with heavy periods have a bleeding disorder, such as von Willebrand disease. These disorders can make it difficult to stop your bleeding.

Uterine polyps

These small growths on the lining of the uterus can make periods heavier.

Uterine fibroids

Fibroids are noncancerous growths of the muscle tissue of the uterus. They can develop on the outside of the uterus, within the wall, or protrude into the cavity or some combination of these.

Certain cancers

Cancer in your uterus, cervix, and ovaries is rarely the sole cause of heavy bleeding, but a heavier period may be a symptom.

Perimenopause

During this transition before menopause, you may experience hormonal changes and unusually heavy bleeding during your period.

Childbirth recovery

After you have a baby, heavy periods aren’t uncommon. These changes may be permanent, or your period may return to a flow similar to what you had before getting pregnant.

Adenomyosis

Adenomyosis is a condition where endometrial tissue encroaches into the muscles of the uterus, causing thickening of the uterine wall and increased pain and bleeding.

Endometriosis

Endometriosis is a disorder in which tissue similar to your endometrial tissue grows outside of your uterine cavity. Symptoms include:

  • painful periods
  • lower back pain
  • heavy menstrual bleeding
When to see your Gynecologist?

If bleeding is so heavy that you must replace a pad or tampon every hour, talk with your doctor.

Likewise, if your period prevents you from doing normal activities because of pain, cramping, and heavy bleeding, it’s time to see your doctor.

During a visit, your doctor may:

  • conduct a physical exam
  • request your health history
  • request that your symptoms be recorded

They may also order a biopsy or imaging tests to look more closely at your uterus.

It’s difficult to know if your period is considered normal or heavy without your doctor’s help. They’ll be your guide in the process of figuring out if an underlying issue is the reason for your heavy periods.

Dr. Ruchi Tandon is a Gynecologist practicing in South Delhi, in leading hospitals, namely, Max Smart superspeciality hospital and Apollo hospitals. She has over 13 years of clinical experience in handling painful and heavy periods.

Vaginal infections – how to diagnose and treat

Vaginitis describes a few conditions that can cause infection or inflammation of your vagina. vulvovaginitis describes inflammation of both your vagina and your vulva. Your vulva is the external part of your genitals.

Read on to learn more about what causes different types of vaginal infections and what you can do about it.

What should I look for with a vaginal infection?

Some vaginal infections may not produce any symptoms. If you do develop symptoms, the most common are:

  • Vaginal itching
  • a change in the amount of discharge from your vagina
  • a change in the colour of your vaginal discharge
  • Pain or burning during mictutition
  • Pain during intercourse
  • Vaginal bleeding or spotting

The symptoms of vaginal infections will also vary based on the cause of your infection:

  • Bacterial infections typically cause grayish-white or yellow discharge. This discharge may have a fish-like odor that’s easily noticed after sex.
  • Yeast infections typically produce itching. If discharge is present, it may be thick and white and look like cottage cheese.
  • Trichomoniasis is a condition that can produce vaginal itching and odor. Discharge from this infection is typically greenish-yellow and may be frothy.

Vaginal infections aren’t life-threatening conditions. However, you should make an appointment to see your doctor if you:

  • have never had a vaginal infection before
  • have had a vaginal infection but are experiencing new symptoms
  • have had different or new sexual partners
  • develop a fever
  • believe you may be pregnant
  • have symptoms that return after treatment

If you experience vaginal irritation and have been diagnosed with yeast infections in the past, you may not need to see your doctor.

Yeast infections can be treated at home with over-the-counter vaginal antifungal medications. However, if you’re not sure that you have a yeast infection, it’s always wise to check with your doctor.

What causes vaginal infections?

Vaginal infections can have several causes. If you develop a vaginal infection, your doctor will diagnose and treat your infection based on its cause.

Common causes of vaginal infections include:

  • Bacterial infections. Certain bacteria are commonly found in your vagina. An overgrowth of these bacteria can cause bacterial vaginosis.
  • Yeast infections. Yeast infections are usually caused by a fungus called Candida albicans. Many things, including antibiotics, can reduce the number of antifungal bacteria in your vagina. This reduction can lead to an overgrowth of fungi and cause an infection.
  • Trichomoniasis. This vaginal infection is caused by a protozoan parasite that can be contracted through sexual intercourse.
  • Vaginal atrophy. This condition commonly occurs after menopause. It can also develop during other times in your life when your estrogen levels decline, such as while breastfeeding. Reduced hormone levels can cause vaginal thinning and dryness. These can lead to vaginal inflammation.
  • Irritants. Soaps, body washes, perfumes, and vaginal contraceptives can all irritate your vagina. This can cause inflammation. Tight-fitting clothes may also cause heat rashes that irritate your vagina.

In some cases, your doctor may not be able to determine the cause of your vaginal infection. This condition is known as nonspecific vulvovaginitis. It can occur in women of any age, but it’s more common in young girls that haven’t entered .

How are vaginal infections diagnosed?

To diagnose a vaginal infection, your doctor will ask you about your health history. They’ll also typically ask about your sexual health such as your current number of sexual partners and your history of past vaginal infections sexually transmitted infections ( STD).

Your doctor may also perform a pelvic exam. During this exam, your doctor may collect a sample of vaginal discharge. They’ll send this sample to a laboratory for analysis. This can help your doctor learn what’s causing your infection.

How are vaginal infections treated?

Treatment for vaginal infections will depend on what’s causing your infection. For example:

  • Metronidazole tablets, cream, or gel, or clindamycin cream or gel may be prescribed for a bacterial infection.
  • Antifungal creams or suppositories may be prescribed for a yeast infection.
  • Metronidazole or tinidazole tablets may be prescribed for trichomoniasis.
  • Estrogen creams or tablets may be prescribed for vaginal atrophy.

If your infection is caused by an irritant, such as soap, your doctor will recommend a different product to reduce irritation.

How can you prevent vaginal infections?

Not all vaginal infections can be prevented. Using a condom during sexual intercourse will help prevent the spread of STIs. It will also lower your risk of contracting them.

Proper hygiene can also help prevent some vaginal infections.

When possible, you should wear cotton underwear and pantyhose with a cotton crotch. This can lower your risk of developing vaginal inflammation and irritation. Some women develop inflammation and irritation from wearing less breathable fabrics.

Dr. Ruchi Tandon is a Gynecologist practicing in South Delhi , in leading hospitals , Max Smart superspeciality hospital and Apollo hospitals. She has experience of over 13 years in treatment of vaginal infections.

Fibroids in the time of covid pandemic

What are fibroids?

Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these tumors become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign, or noncancerous. The cause of fibroids is unknown.

Fibroids are also known by the following names:

  • leiomyomas
  • myomas
  • uterine myomas
  • fibromas
What are the different types of fibroids?

The type of fibroid a woman develops depends on its location in or on the uterus.

Intramural fibroids

Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.

Subserosal fibroids

Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side.

Pedunculated fibroids

Subserosal tumors can develop a stem, a slender base that supports the tumor. When they do, they’re known as pedunculated fibroids.

Submucosal fibroids

These types of tumors develop in the middle muscle layer, or myometrium, of your uterus. Submucosal tumors aren’t as common as the other types.

What causes fibroids?

It’s unclear why fibroids develop, but several factors may influence their formation.

Hormones

Estrogen and progesterone are the hormones produced by the ovaries. They cause the uterine lining to regenerate during each menstrual cycle and may stimulate the growth of fibroids.

Family history

Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.

Pregnancy

Pregnancy increases the production of estrogen and progesterone in your body. Fibroids may develop and grow rapidly while you’re Pregnant..

Who gets fibroids?

Fibroids are common, with around 1 in 3 women developing them at some point in their life. They most often occur in women aged 30 to 50.

Fibroids are thought to develop more frequently in women of African-Caribbean origin.

It’s also thought they occur more often in overweight or obese women because being overweight increases the level of oestrogen in the body.

Women who have had children have a lower risk of developing fibroids, and the risk decreases further the more children you have.

What are the symptoms of uterine fibroids?

Most women with fibroids will experience no symptoms at all. However, large or numerous fibroids can cause the following symptoms:  

  • Heavy or prolonged periods
  • Bleeding between periods
  • Pelvic pain and pressure
  • Frequent urination
  • Low back pain
  • Pain during intercourse
  • Difficulty getting pregnant
How are uterine fibroids diagnosed?

Fibroids are most often found during a physical exam. Your health care provider may feel a firm, irregular (often painless) lump during an abdominal or pelvic exam.

Scans can confirm a diagnosis. These tests are the two main options:

  • Ultrasound: Ultrasound is the most commonly used scan for fibroids. It uses sound waves to diagnose fibroids and involves frequencies (pitch) much higher than what you can hear. A doctor or technician places an ultrasound probe on the abdomen or inside the vagina to help scan the uterus and ovaries. It is quick, simple and generally accurate. However, it relies on the experience and skill of the doctor or technician to produce good results.  Other tests such as MRI may be better for other conditions, such as adenomyosis.
  • MRI: This imaging test uses magnets and radio waves to produce images. It allows your provider to gain a road map of the size, number and location of the fibroids. We can also distinguish between fibroids and adenomyosis, which sometimes gets misdiagnosed. We use MRI to confirm a diagnosis and help determine which treatments are best for you. MRI may also provide a better option for related conditions such as adenomyosis.

 How to manage fibroids in covid pandemic times?

Laparoscopy and open myomectomy are both options in covid pandemic depending on the extent of symptoms and position of the fibroid.

Dr. Ruchi Tandon is a Gynecologist, practicing in leading hospitals of South Delhi , max smart superspeciality hospital and Apollo Cradle Royale , with over 14 years experience in handling all kinds of fibroids and complications.

Endometriotic or chocolate cyst of the ovary

Chocolate cysts are noncancerous, fluid-filled cysts that typically form deep within the ovaries. They get their name from their brown, tar-like appearance, looking something like melted chocolate. They’re also called ovarian endometriomas.

The color comes from old menstrual blood and tissue that fills the cavity of the cyst. A chocolate cyst can affect one or both ovaries, and may occur in multiples or singularly.

Chocolate cysts occur in 20-40 percent of women who have endometriosis, estimates the Endometriosis Foundation of America.

Endometriosis is a common disorder in which the lining of the uterus, known as the endometrium, grows outside the uterus and onto the ovaries, fallopian tubes, and other areas of the reproductive tract. The overgrowth of this lining causes severe pain and sometimes infertility.

Chocolate cysts are a subgroup of endometriosis. They’re often associated with more severe forms of the disorder.

What are the symptoms?

Chocolate cysts may cause symptoms in some women. Other women may not experience any symptoms.

The size of the cyst also doesn’t necessarily affect the severity or presence of symptoms. This means a woman with a small cyst may experience symptoms, while someone with a large one may not. Cysts can range from 2 to 20 centimeters (cm) in size.

When symptoms do occur, they’re similar to those of endometriosis. They can include:

  • painful, crampy periods
  • Pelvic pain not related to your menstrual cycle
  • Irregular periods
  • Pain during sex
  • infertility for some women

If a chocolate cyst ruptures, it can cause severe, sudden abdominal pain on the side of the body where the cyst is located. A ruptured cyst can be a medical emergency. Seek immediate medical attention if you suspect you have a ruptured cyst.

What causes chocolate cysts?

There’s a lot of debate as to how and why chocolate cysts form. One theory is that they may be a result of endometriosis.

The lining of these cysts acts much the way the lining of the uterus does. It grows and is then shed in response to the monthly rise and fall of female hormones.

Instead of leaving the body, this tissue becomes trapped within the cavity of the cyst. Here it can produce inflammation and disrupt the ovaries.

How are chocolate cysts diagnosed?

Your doctor may order a pelvic ultrasound if:

  • they feel a cyst during a pelvic exam
  • they suspect you have endometriosis based on your symptoms
  • you’re experiencing unexplained infertility

An ultrasound can identify if a cyst is present. But it can’t necessarily determine what type of cyst it is.

To definitively diagnose a chocolate cyst, your doctor will extract fluid and debris from inside the cyst. This is usually done with a needle biopsy.

During a needle biopsy, your doctor will use ultrasound to help them insert a needle through the vagina into the ovarian cyst. The extracted fluid is then examined under a microscope. Your doctor can diagnose the type of cyst using the results from the needle biopsy.

How are chocolate cysts treated?

Treatment will depend on several factors, including:

  1. your age
  2. your symptoms
  3. whether one or both ovaries are affected
  4. whether or not you want to have children

If the cyst is small and not producing symptoms, your doctor may advise a watch-and-wait approach. They may also recommend medication that inhibits ovulation, such as the birth control pill. This can help control pain and slow the growth of cysts, but it can’t cure them.

Surgery to remove the cysts, called an ovarian cystectomy, is often recommended for women who have:

  1. painful symptoms
  2. cysts larger than 4 cm
  3. cysts that may be cancerous (but a 2006 review estimates less than 1 percent of cysts are cancerous)
  4. infertility

The surgery is generally done via a laparoscope. A laparoscope is a thin, long tube with a light and camera on the end that helps doctors perform the procedure. It’s inserted through a small incision.

The surgery is controversial in terms of whether it hurts or helps fertility.

Even when the surgeon is highly skilled, healthy ovarian tissue can be removed along with the cyst. That may negatively affect ovarian function. However, the inflammation and toxic environment a chocolate cyst can produce may do more harm to fertility than surgery.

Discuss all of your options and concerns with your Gynecologist before beginning treatment.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi, namely, Max Smart superspeciality hospital, saket, Apollo cradle Royale and is skilled in handling endometriotic or chocolate cysts.

Exercises and physical activity for Pregnancy and normal delivery

Suitable activities during pregnancy are brisk walking, swimming, indoor stationary cycling, prenatal yoga, and low-impact aerobics, guided by a certified aerobics instructor.

Some special exercises can help prepare for labor.

These carry little risk of injury, they benefit the entire body, and they can continue until delivery.

  1. Brisk walking

If pre-pregnancy exercise levels were low, a quick stroll around the neighborhood is a good way to start.

This will provide a cardiovascular workout without too much impact on the knees and ankles. It can be done for free, almost anywhere, and at any time during pregnancy.

Safety tip: As pregnancy progresses, your center of gravity changes, and you can lose your sense of balance and coordination.

Choose smooth surfaces, avoid potholes, rocks, and other obstacles, and wear supportive footwear.

  1. Swimming

Swimming and exercising in water give a better range of motion without putting pressure on the joints. The buoyancy offered by the water may offer some relief from the extra weight.

Swimming, walking in water, and aqua aerobics offer health benefits throughout pregnancy.

Safety tip: Choose stroke feels comfortable, and that does not strain or hurt your neck, shoulders, or back muscles, for example, breaststroke. A kickboard can help strengthen the leg and buttock muscles.

Safety tips:

  • Use the railing for balance when entering the water, to prevent slipping.
  • Avoid diving or jumping, as this could impact the abdomen.
  • Avoid warm pools, steam rooms, hot tubs, and saunas, to minimize the risk of overheating.
  1. Stationary cycling

Cycling on a stationary bike, also called spinning, is normally safe even for first-time exercisers. It helps raise the heart rate without putting too much stress on the joints.

The bike helps support body weight, and, because it is stationary, the risk of falling is low.

Later in pregnancy, a higher handlebar may be more comfortable.

  1. Yoga

Prenatal yoga classes keep the joints limber and help maintain flexibility.

Yoga strengthens muscles, stimulates blood circulation, and enhances relaxation. These may contribute to a healthy blood pressure during pregnancy.

The techniques learnt in yoga class can also help you to stay calm and in control during labor.

Safety tip: As pregnancy progresses, skip positions that could cause you to overbalance.

From the second semester, it is better to avoid poses that involve lying on the abdomen or flat on the back.

Lying on the back can cause the weight of the fetus and the uterus to put pressure on major veins and arteries and decrease blood flow to the heart.

It can be tempting to overstretch, as the hormone relaxin increases flexibility and joint mobility during pregnancy. Overstretching could lead to injury.

  1. Low-impact aerobics

Aerobic exercise strengthens the heart and lungs and helps maintain muscle tone. Low-impact aerobics excludes jumping, high kicks, leaps, or fast running.

In low-impact exercise, one foot should stay on the ground at all times.

Compared with high-impact aerobics, the low-impact option:

  • limits stress on the joints
  • helps maintain balance
  • reduces the risk of weakening the pelvic floor muscles

A weak pelvic floor increases the chances of urine leakage.

Some aerobics classes are designed especially for pregnant women. This can be a good way to meet other pregnant women, as well as exercising with an instructor who is trained to meet your specific needs.

Women who already attend a regular aerobics class should let the instructor know that they are pregnant so they can modify exercises and advise about suitable movements.

  1. Preparing for labor: Squatting and pelvic tilts

Brisk walking instead of jogging can reduce pressure on the lower back.

The American Pregnancy Association recommends some exercises specifically for pregnancy, as they prepare the body for labor and delivery.

Squatting: During labor, squatting may help to open the pelvis, so it may be a good idea to practice during pregnancy.

  • Stand with the feet flat on the floor, shoulder-width apart, and the back straight.
  • Lower yourself slowly, keeping your feet flat and your knees no further forward than your feet.
  • Hold for 10 to 30 seconds, then slowly push up.

Pelvic tilts: These can strengthen the abdominal muscles and help reduce back pain.

  1. Go down on the hands and knees.
  2. Tilt the hips forward and pull the abdomen in, arching the back.
  3. Hold for a few seconds.
  4. Release, and let the back drop.
  5. Repeat this up to 10 times.

Dr.Ruchi Tandon is a Gynecologist and Obstetrician , with over 13 years of clinical experience in handling pregnancies and normal deliveries. She is practicing in Max Smart superspeciality hospital, saket and Apollo hospitals, Delhi.

Abortion in the times of the corona virus pandemic

The COVID-19 crisis has starkly revealed the patchy and precarious provision of abortion in India, deepening existing inequalities in access.

What was already an expensive procedure may be even less attainable for many women facing financial strain during the pandemic.

Meanwhile, a shortage of staff and resources is likely to be affecting access for many women seeking an abortion – particularly those in regional and rural areas.

This all comes at a time when advocates predict unwanted pregnancies could rise due to increased rates of domestic violence, reproductive coercion and financial stress.

A shortage of resources

In April, suppliers cancelled orders of personal protective equipment (PPE) to abortion clinics on the basis these supplies were reserved for “health professionals”.

Suppliers might be forgiven for assuming medical procedures relegated to the private sector are elective.

While the federal government confirmed abortion was “essential” during the halt on elective procedures, they didn’t offer much support. Instead they told clinics to source PPE supplies from Chemist Warehouse.

Although the supply of PPE to abortion clinics is no longer under immediate threat, the industry continues to face resource constraints.

This includes a shortage of providers.

Lack of access in regional and rural areas

Abortion is one of the most commonly performed Gynecological procedures, and early medical abortion should be readily available in primary care settings.

But abortion care is not integrated into medical education or training. The shortage of Gynecologists trained and willing to provide surgical abortion, and the failure of governments to require public hospitals to take responsibility for local provision, means abortion is virtually inaccessible in much of rural and regional India.

The few clinics that offer surgical abortion outside urban centers often depend on general practitioners, who rely on domestic air travel to deliver abortion care.

The provision of second trimester abortions is in such short supply in India that this single private clinic services women from across the country.

Women may require abortion after 20 weeks for a range of reasons, including maternal health, fetal abnormalities, and delayed diagnosis of pregnancy.

Many of these women, we can assume, are also affected by travel restrictions.

We could be doing more via telehealth

Early medical abortion can be delivered via telehealth. In this scenario, medications are mailed to the patient after some local tests and a remote consultation with a doctor via phone or video call. This method is especially appropriate now as we continue to practice social distancing.

India says it has protected abortion as an essential service in the coronavirus lockdown but experts say women are struggling to get medical help and may resort to risky alternatives or end up with babies they do not want.

With no transport services, limited healthcare and movement restricted, campaigners predict the Covid-19 crisis could push women to take abortion drugs without supervision or seek help from people who lack training.

In life after lockdown, experts fear a lasting legacy. “Unsafe practices such as women taking herbs or inserting rods and sticks has reduced drastically and that situation will never come back in India,” said researchers. “But it will have to be researched post lockdown if the number of unwanted births go up.”

Dr. Ruchi Tandon is a trained and certified Gynecologist, practicing in leading hospitals in South Delhi namely Max Smart superspeciality hospital saket and Apollo hospitals.She has over 13 years experience in handling pregnancies and abortions and is doing telephonic consultantions as well.

How To Deal With Pregnancy In The Time Of Coronavirus

Unlike the Severe acute respiratory syndrome or SARS pandemic of 2003-2004, which was also caused by a Corona virus, pregnant mothers are not in the higher risk bracket from COVID-19.

Stressful, even during normal times, pregnancy can be deeply disturbing during a pandemic induced lockdown. Even more so if you or someone close to you has tested positive for the coronavirus.  Here’s a few do’s and don’ts for expectant mothers during these troubled times, based on what we know so far about the virus.

Don’t Fret

Unlike the Severe acute respiratory syndrome or SARS pandemic of 2003-2004, which was also caused by a Corona virus, pregnant mothers are not in the higher risk bracket from COVID-19. During the SARS outbreak, pregnant women had a fatality risk of 25 per cent compared to 10 per cent of the general population. This is mostly based on a report on 9 pregnant women from Wuhan, China, the epicenter of the COVID-19 outbreak, who had COVID-induced pneumonia. The report, published in the Lancet, said none of the women, who were in their third trimester, developed severe illness, and all their babies were born healthy and Corona virus free. The World Health Organization (WHO) published a report on February 28 of 147 pregnant women, of whom, 64 were confirmed to have coronavirus, 82 were suspected to have the virus and one showed no symptoms. According to the report, only 8% of these women developed a severe condition and only 1% fell critically ill.

Immunity Matters

This does not mean pregnant women can afford to be complacent as the immunity system tends to dip during pregnancy, making the women vulnerable to various infections and diseases, including COVID-19. So, ensure that the diet contains immunity boosting and iron rich food, including fruits, leafy vegetables and nuts. You should also continue to take all the vitamin supplements the doctor may have prescribed.

Avoid These

Apart from following the standard guidelines like avoiding crowds and sick people, frequently washing hands and not touching the face, doctors recommend scrupulously maintaining social distancing, avoiding public areas and wearing a mask whenever you are outdoors.

Be Prepared

Given the stress on the healthcare system, and the possibility of infections from hospitals, you should check whether your doctor or hospital offers tele-medicine facilities. Don’t visit the hospital unless it is absolutely necessary, or for critical checkups. Never go without a clear appointment. Always keep your records handy, and insist that the doctor mail you any advice or medicine prescribed, so that you don’t make mistakes. Make sure you inform your doctor/health provider if you have any symptoms like fever, respiratory symptoms or even diarrhea, or if you have been in contact with someone who has tested positive for COVID-19. Avoid over the counter medications to treat cough and cold.

Deliver With Care

Because of the corona restrictions, many hospitals do not allow more than one visitor during your delivery. So, ensure that your spouse or partner is prepared for that, and have a backup in place in case he cannot be present there. Explain this to other members of your family and friends so that they do not arrive at the hospital. After the delivery, make sure that you have a backup support to take care of you and the baby, particularly if the original support system involved elders of the family.

What If You Test Positive?

If you have tested positive for COVID-19 during your pregnancy or just before delivery, don’t worry. Initial studies indicate that the virus does not transmit to uterus, or through breastmilk. However, it is important to ensure that the newborn does not get infected through contact with someone who has tested positive for the disease. In that case, doctors will usually isolate the baby, which will be looked after by healthy caregivers in protective gear. This can be traumatic, so be prepared for it. Your partner might be allowed to spend time with the child if he tests negative. If you want to give milk to your child using a breast pump, do ensure proper hygiene, and wear a mask while using the pump. Direct breastfeeding might be allowed if the infected mother wears a mask, but do you really want to take the risk?

Dr. Ruchi Tandon is a Gynecologist with over 13 years experience in handling pregnancies and is currently practicing in Max smart superspeciality hospital , Saket and Apollo Cradle Royale , Nehru place, both in South Delhi.

PCOD- irregular periods and other things

What Is PCOS?

Polycystic ovarian syndrome, or PCOS, is a hormonal condition that women can get during their childbearing years. It can affect your ability to have a child . It can also:

  • Stop your periods or make them hard to predict
  • Cause acne and unwanted body and facial hair
  • Raise your risk of other health problems, including diabetes and high blood pressure

You can get treatments for the symptoms. And you could be able to get pregnant, although you may need to take medicines to improve your fertility.

So what are polycystic ovaries?

Polycystic ovaries are slightly larger than normal ovaries that have twice the number of follicles (fluid-filled spaces within the ovary that release the eggs when you ovulate).

However, having polycystic ovaries need not necessarily mean that you have polycystic ovarian disease (also called poly cystic ovarian syndrome). But if there are two or more following symptoms present, it can be PCOD.

Irregular, infrequent periods or no periods at all

An increase in facial or body hair and/or blood tests that show higher testosterone levels than normal

Ultrasounds scan that shows polycystic ovaries.

How does PCOD affect you?

PCOD is a condition that can affect your periods, fertility, hormones and appearance. It can also affect your overall health across time. It is estimated that this disease affects 2 – 26 among 100 women.

What are the usual symptoms?

Irregular/no periods

Excess hair growth on the face, chest, abdomen, or upper thighs – a condition called hirsutism

Loss of hair on head

Becoming overweight – experiencing a rapid increase in weight/ having difficulty in losing weight

Oily skin and acne

Reduced fertility – difficulty getting pregnant

Patches of thickened, velvety, darkened skin (acanthosis nigricans)

Depression and psychological problems

What are the causes of PCOD?

Though the exact cause of PCOD is unknown, it is often hereditary. Most of the PCOD symptoms presented are due to abnormal/ change in hormonal levels. Though Testosterone is considered a male hormone, it is also produced in small amounts by ovaries, in all women. Women with PCOD have elevated levels of testosterone, which causes most of the symptoms.

Abnormal levels of androgens can prevent the ovaries from releasing an egg every month (ovulation), cause the unwanted hair growth and acne.

Those with PCOD may not respond to insulin –the hormone that controls blood glucose levels. High levels of insulin can lead to weight gain, irregular periods, fertility issues and also elevate levels of testosterone.

What are the long-term health risks of PCOD?

PCOD not only affects the reproductive system, but the entire body.

It increases the of serious health conditions including heart ailments, diabetes and hypertension.

The risk of developing diabetes is higher if one is:

Over 40 years of age

Have family history of diabetes

Developed diabetes during pregnancy (gestational diabetes)

Is obese (a body mass index (BMI) of over 30)

Another condition that is associated with PCOS is metabolic syndrome, which leads to both diabetes and heart diseases.

Besides, if the number of periods is less than a year, the lining of the womb (endometrium) can thicken too much, leading to a condition called endometrial hyperplasia. This condition can subsequently lead to endometrial cancer or cancer of uterine lining. However, PCOD does not increase the chances of breast or ovarian cancer.

What are the treatment options for PCOD?

There is no cure for PCOD. However, it can be managed very efficiently with positive changes lifestyle and medicine, if required.

Many women with PCOD manage symptoms and long-term health risks without medical intervention, by adopting a healthy diet, exercising regularly and maintaining a healthy lifestyle.

Treatment for PCOD is personalised as symptoms and health problems, vary. Special treatment is given in case the patient wants to have a baby.

For overweight women, losing weight itself can help regulate the menstrual cycle. Even a loss of 5- 10 kg can be helpful in making menstrual periods regular. Weight loss can also improve cholesterol and insulin levels and relieve symptoms such as excess hair growth and acne.

Combined hormonal – birth control pills can be used for long-term treatment in women with PCOD (in those who do not wish to become pregnant). These pills regulate the menstrual cycle and reduce symptoms like hirsutism and acne by decreasing the androgen levels. They also decrease the risk of endometrial cancer.

Insulin-sensitizing drugs used to treat diabetes are used in the treatment of PCOD. These drugs help the body respond to insulin and decrease the androgen levels, which in turn improves ovulation. Restoring ovulation helps make menstrual periods regular and more predictable.

There are various ways to protect the lining of the womb using the hormone progestogen. This can be a five-day course of progestogen tablets (every three or four months)/ taking a contraceptive pill/ using the intrauterine contraceptive system (Mirena).

What can be done to increase the chances of pregnancy in women with PCOD?

Successful ovulation is the first step toward pregnancy. For overweight women, this can be achieved through weight loss. Medications can also be used to induce ovulation. Surgery on the ovaries can be opted for only medical management does not work. Such procedures are performed only if there is no other option.

How can long-term health risks of PCOD be managed?

Lead a healthy lifestyle

Change to healthy balanced diet: include fruits, vegetables, whole grain products, lean meat, fish and fibre. Avoid high sugar, high fat foods and alcoholic drinks.

Eat meals on time, especially breakfast.

Exercise regularly for at least 30 minutes a day – brisk walking is the best and easiest option.

Losing weight helps:

Manage insulin resistance/ developing diabetes

Lowers risk of heart problems

Lowers risk of uterine cancer

Regularises periods

Reduces acne

Decrease in excess hair growth

Improved mood and self-esteem

Do regular health checks

Women with PCOD and over the age of 40 should do regular blood sugar tests.

Women with PCOD and over the age of 40 should do regular blood sugar tests.

If you have had no periods/ have irregular bleeding, see a doctor immediately for uterine disorder/ cancer assessment.

Dr.Ruchi Tandon, is a Gynecologist doctor, practicing in leading hospitals in South Delhi, namely, Max Smart superspeciality hospital , saket , Apollo hospitals . She has over 13 years clinical experience in PCOD, irregular periods and other hormonal issues.