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Gynecologic Surgery

Many women have more complex gynecologic concerns and health conditions that may need medical management, treatment or inpatient or outpatient surgery. VHC OB/GYN providers offer a full range of gynecologic services, from annual exams and routine medical screenings, to management of more complex GYN problems and conditions. Our care team can help you with the following conditions:

  • Abnormal Bleeding – Abnormal bleeding can have many causes, including structural issues or hormonal dysregulation. We can diagnose and manage abnormal bleeding through exams and simple tests.
  • Endometriosis – Endometriosis is a condition in which tissue that normally is located within the uterus grows on other organs in the body. This condition can be painful for women, and in some cases, may make it difficult to conceive. There are many ways to manage endometriosis, including pain medication, fertility medication, and/or hormone therapy.
  • Fibroids – Fibroids are benign growths of the uterine tissue, and are very common and occur in up to 85% of women. There are various medical and surgical treatment options for fibroids.
  • Sexually Transmitted Diseases – We can diagnose, manage and/or treat STDs through exams and simple tests.
  • Urinary Incontinence – Incontinence refers to leakage of urine from the bladder. This can be an undesirable symptom of a number of medical conditions or diseases. In women, incontinence can be associated with urges to urinate or with stress or physical activities. We will work with you to diagnose and treat or manage urinary incontinence.
  • Vaginitis – A yeast infection is an inflammation of the vagina that can cause pain, frequent urination, and itching. After diagnosis, it is usually treated through medication.

Minimally Invasive Care

Whenever possible, your surgeon will use a laparoscopic (minimally invasive) technique. This approach may use no incisions or only a few tiny incisions and reduces pain, scarring and recovery time.

One type of minimally invasive surgery is robotic surgery. During this advanced treatment, your surgeon controls a robot's "arms," which can move and bend more fully and precisely than human hands.

Common GYN Conditions

Urinary Tract Infection (UTI)

A urinary tract infection (UTI) is a bacterial or fungal infection of the bladder that may progress to an infection of the kidneys.

UTI Symptoms

Signs of a UTI may include:

  • Burning with urination
  • Feeling like bladder is not completely empty
  • Frequent urination
  • Blood in the urine
  • Low back pain and fever

UTI Diagnosis and Treatment/Cure

To diagnose a UTI, your doctor may ask you to leave a urine sample so that a culture and sensitivities may be run to identify the bacterial organism and the antibiotics that will work on that bacteria. You may be prescribed antibodies, which treat the UTI within 24 to 36 hours. For symptomatic relief of a UTI, patients may use over the counter cranberry pills, and make sure to stay hydrated.

Yeast Infection

A yeast infection is a fungal infection of the vagina and/or the vulva.

Yeast Infection Symptoms

Signs of a yeast infection may include:

  • Thick white discharge
  • Itching
  • Burning or stinging sensation
  • External discomfort with urination

Yeast Infection Diagnosis and Treatment/Cure

Yeast infections can be diagnosed through a speculum exam with a microscopic evaluation of the discharge. To treat a yeast infection, patients can use over-the-counter medications, such as monistat. In some cases, your doctor may prescribe you anti-fungal medication. Most over the counter vaginal anti-itch creams can provide symptomatic relief of a yeast infection.

If you think you had a yeast infection and monistat didn’t work, you should contact your doctor. Some infections of the vulva/vagina can mimic the symptoms of a yeast infection.

HPV

HPV is a family of viruses that are sexually transmitted that can cause genital warts, or can cause cell changes that may lead to cervical cancer.

HPV Symptoms

HPV causes changes of the cervix typically do not cause symptoms. However, in some causes, genital warts may develop. These are small fleshy growths on the external genitalia that are typically non-painful.

HPV Diagnosis and Treatment

HPV of the cervix is diagnosed through routine Pap screening. Moderate to severe cervical changes caused by HPV and diagnosed by Pap test can be monitored and may be removed by LEEP (Loop Electrosurgical Excisional Procedure) or cone biopsy. Both of these are outpatient procedures that remove abnormal cells from the cervix.  HPV causes changes of the cervix typically do not cause symptoms. However, in some causes, genital warts may develop. These are small fleshy growths on the external genitalia, that are typically non-painful.

Warts caused by HPV can be removed through a variety of mechanisms, such as prescription topical creams, in-office chemical removal of warts, surgical removal with laser or ultrasound.

Hysterectomy

Hysterectomy is the surgical removal of the uterus. It is the only way to guarantee that fibroids will not recur. However, a hysterectomy is major surgery, and a woman should consider other less invasive options first. If a woman and her physician decide hysterectomy is the best option, there are less invasive approaches to performing the procedure that may lessen post-operative pain, recovery time, and scarring, compared to the traditional “open” approach.

It's a fact, 70%-90% of the 700,000 hysterectomies done yearly in the U.S. could be performed by way of a minimally invasive procedure, but aren't. What we at Virginia Hospital Center, along with many past and prospective patients would like to know is, why not?

Types of Hysterectomy

  • Total hysterectomy — the uterus and cervix are removed. The ovaries and fallopian tubes may or may not be removed at the same time.
  • Subtotal or partial hysterectomy — the uterus is removed but the cervix is left in place. The ovaries and fallopian tubes may or may not be removed at the same time. Some gynecologists feel that leaving the cervix intact may reduce the chance of pelvic support problems (such as uterine-vaginal prolapse). Leaving the cervix may also help reduce the chance of developing urinary incontinence later in life. If a woman chooses this option, she should continue to have regular annual Pap smears to screen for cervical cancer.
  • Radical hysterectomy — the uterus, cervix and some of the pelvic lymph nodes are removed. The ovaries and fallopian tubes may or may not be removed at the same time. This operation is performed to treat some kinds of cancer.

Different Surgical Techniques

A physician will use one of the following techniques to remove a woman’s uterus:

  • Abdominal or “open” hysterectomy — The “traditional” approach involves removal of the uterus and cervix through an abdominal incision about 4 to 6 inches in length. This approach may be recommended if a woman has large fibroids that have not responded to drug therapy or would be difficult to remove vaginally or laparoscopically. It may also be recommended to treat severe endometriosis (uterine lining tissue that has found its way out of the uterus) or pelvic inflammatory disease. This approach is performed under general or regional (spinal or epidural) anesthesia and requires a hospital stay of 3-6 days and a long recovery period (up to six weeks).
  • Vaginal hysterectomy — An approach that removes the uterus and cervix through an incision deep in the vagina. This is usually the method chosen to treat uterine-vaginal prolapse, and may be used to help treat early cervical or uterine cancer. Vaginal hysterectomy offers a shorter hospital stay (1-3 days) and less recovery time (4 weeks) compared to “open” hysterectomy. In addition, it offers the lack of visible scarring. However, this approach may not be appropriate for very large fibroids. It can be performed under general or regional anesthesia.
  • Laparoscopically assisted vaginal hysterectomy (LAVH) —This technique is similar to the vaginal approach but requires special surgical skills and instruments. A laparoscope (a thin lighted telescope) is inserted through a small incision in the navel. Other thin instruments, used to remove the uterus, can be inserted through tiny incisions. Hospital stay and recovery time is similar to vaginal hysterectomy, and like that approach, the LAVH is usually not performed if large fibroids are present.
  • Laparoscopic Supracervical Hysterectomy (LSH) — This is a recently developed surgical technique that uses laparoscopy alone to remove the uterus, but leaves the cervix intact. During the procedure, a laparoscope, and small surgical instruments are inserted through tiny incisions in the navel and abdomen. Using these instruments, the surgeon is able to carefully separate the uterus from the cervix and then remove it through one of the incisions. A surgical instrument called a “morcellator” makes it possible to cut up large sections of tissue so that they can be removed through the tiny incisions. However, this approach may not be appropriate if a woman has very large or numerous fibroids. Like LAVH, this approach requires special surgical skills.

Fibroids

Fibroids are benign (non-cancerous) tumorous growths of the uterine muscle.

Fibroid Symptoms

Symptoms of fibroids may include:

  • Abnormal or heavy menstrual bleeding
  • Increasing of abdominal girth
  • Constipation
  • Frequent urination
  • Early satiety (feeling full after eating just a little)
  • Pelvic pain/pressure

Fibroid Diagnosis and Treatment

Fibroids are generally diagnosed through a clinical pelvic exam, ultrasound and in some cases, an MRI may be used. Fibroids can be treated through hormonal birth control pills, IUDS, and other injectable medications. Fibroids can be surgically removed if necessary to preserve fertility.

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