Doctors' Answers to "Frequently Asked Questions" - Gynecology

Links to Related Women's Issues

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Advice on Dealing with Possible Warts [posted 12/04/98]  
Question: My patient is having a small swelling (pea like)above the clitoral area since 1 month which is painful and itching. Below that swelling another 4to5 small swelling appears which were also very itching and painful.doctors here thinking of warts so they advised to use veramal paint. After using the paint the pea shaped swelling sloughed out but after some days below that area another small swelling appears those were also very painful and itching. I   would like your suggestion regarding this case.

Answer: If the treatment for warts worked, probably another wart. However, could be a Bartholin Gland cyst which would need surgical drainage.

Recurrent Vaginal Infections [posted 12/02/98]   see also: FAQ - Vaginal Infections
Question: I've read some of the FAQ regarding recurrent bacterial vaginitis and see I am not alone in my frustration with this condition. I have tolerated course after course of Flagyl (not much fun for a wine lover)only to find myself inflamed and uncomfortable within 2 weeks of finishing the prescription. I eat well, keep a healthy weight, am married to my only sexual partner, wear cotton underwear, etc. etc. etc. Recently, I read that prolonged use of Flagyl is undesirable and I am trying to get pregnant. Three questions... How can I break the vicious vaginitis cycle? What can I treat with OTHER than Flagyl or Metrogel (gives me a horrible yeast infection)? Are these infections and subsequent treatments affecting my ability to conceive and deliver a healthy child? Your help is greatly appreciated.

Answer: Well, as I have mentioned several times, yogurt douches do work. You must use active yogurt (available in health food stores or grow your own with a yogurt machine) use one tablespoon in a pint of warm water and douche daily. This washes out yeast and replaces it with lactobacillus (the bacteria normally found in the vagina-a good friend). Cheap, effective and won't stain your pants-also allows for the wine.

Methroxy for Menstruation Problems [posted 11/25/98]
Question: I had Methroxy prescribed to stop menstruation that won't shut off. Should I expect for the period to get stronger and if so at what point is it expected to quit?

Answer: Usually a very hard period for two weeks or so then back to normal if it works. If not, they usually recommend a D&C. 

Bacterial Vaginousis [posted 11/24/98]
Question:  How is Bacterial Vaginousis caused and what is the cure? Also, how long can you have this ailment without detection and is it necessary to treat? 

Answer: Usually Gardenella Vaginalis species. Treatment is Clindamycin Vaginal Cream and/or metronidazole. Hard to clear up. Most physicians would recommend treatment. 

Polycystic Ovarian Syndrome (PCOS) New Treamtents [posted 11/13/98]
Question: I have heard rumours of "METAFORMIN" (or "Glucophage") being used for the treatment of Polycstic Ovaries. I cannot find any info RE: this experimental plan, any news? I know that it is traditionally a drug for Diabetes, and I do have hypoglycemia. Thanks so much!

Answer: I have had a lot of questions on this, but, I really don't have any information. You might check with the scientific department of the company. Until cleared by the FDA, they cannot recommend it, but, can get you the articles. Bristol-Myers-Squibb 800-321-1335.

Polycystic Ovarian Syndrome (PCOS) [posted 11/11/98]
Question: My ob/gyn mentioned the possibility of having PCOS and performed various tests. She did not say whether I had or did not have this disease/problem. She did state that I had a high level of testosterone and my LH level was high. I am not sure what these mean. I am experiencing facial hair growth, extreme weight gain, very irregular periods. Based on the information that I have gathered from the Internet, I do believe that I have this problem. My question is: will I be able to get pregnant without the use of "fertility drugs"? If I can correct this problem, will my weight also drop? I have gained over 50 pounds in one year. I have watched what I have eaten. I have gone to weight doctors. I am so ashamed of my body!!!! My own husband has a hard time looking at me. I use to model and win numerous beauty pageants. Now, I am the poster child for "Save the Whales". Will any of the medications for this disease help me with infertility and emotionally?

Answer:Infertility, probably, body image no-without an aggressive weight loss regimen. However, it is difficult due to the testerone. The catch-22 of this problem is that testerone causes weight and weight causes testerone.

Gynecology
Question: I am 25 years old female living in Korea and diagnosed that I have bacterial vaginosis. My gynecologist just said I have gram positive. And that's all. And she prescribed me amoxicillin for more than 2 week. But as far as I know, metronidazole is the first choice for bacterial vaginosis. I don't know whether I can describe my condition but I have ulcers(3spots) in my vagina. It has been a month and the condtion doesn't seem to improve though I attend hospital and take amoxicillin for more than 2 weeks. I think I should be prescribed metronidazole for my unimproven condition.

Answer: Correct.

Gynecology
Question: I am 40 years old, NKA, and had a tubal ligation at age 24. I am a smoker and have never or ever wanted to take "the pill." I have recently been having irregular periods, with heavy bleeding. I am seeing a Nurse Practitioner. A pelvic sonogram 2 years ago showed a right ovarian cyst (5 mm). I just had a ultrasound that showed the cyst is still there, but has not gotten any bigger. In addition, I have 4 small fibroids. The Nurse put me on Progesterone to stop the bleeding, and it works. However, the heavy bleeding returned again and I again took the Progesterone. On my Pelvic sonogram it showed my Uterine lining thickness to be 11 instead of 5 0r 6. If I continue to take the Progesterone how can that lining shed? Will continuing to take the Progesterone monthly hurt me?

Answer: The build up of the lining is generally thought to be unopposed estrogen, not progesterone. The progesterone is an attempt to slough the lining, not increase it. Birth control pills or a D&C are the next options. This is a common problem with the onset of menopause, as the balance between estrogen and progesterone starts to shift. Most women will experience this problem in the transition to menopause.

Venereal warts
Question: My friend has venereal warts, but she will not go to a gynecologist to have them treated. What can she expect to happen to her as the disease worsens? Can she become blind? What is the progression? Do people die from this? Is it contagious? She is not sexually active.

Answer: Venereal warts are due to a virus. This is usually human papillomaviruses. Some of the sub-groups increase the risk of cervical and penile cancer and some advocate typing the virus as well as treatment. They will not lead to blindness or systemic disease other than the risk of cancer locally, which is a long term risk. There is no perfect way to eliminate the virus. Cryotherapy and different local chemical preparations are used with long term surveillance to ensure that early lesions are detected and treated. Usually, these are sexually transmitted. There may be some women who have this transmitted at birth from their mothers (this theory has been less well validated).

Gynecology
Question: I had a endometrial biopsy 2 weeks ago and I was curious as to what are they looking for?

Answer: I would recommend in the future that you ask your physician prior to the procedure. In general, they are looking for endometrial cancer (cancer of the lining of the uterus).

Gynecology
Question: Since June of 1996 I have had an unusual vaginal discharge. I have visited the doctor twice and the treatment has been flagyl for what was diagnosed as gardnerella. Having had gardnerella previously, I did not think that this was an accurate diagnosis but took the medicine as prescribed. I have had no results. This is my condition. It varies throughout the month. I sometimes have vaginal dryness followed by a stage of either clear mucous that would be comparable to that produced by the nose with a viral infection. Sometimes it is comparable to that produced from the nose with a bacterial infection, i.e. thicker, white. It looks in the toilet much like the mucous plug lost just before the onset of labor. This discharge can be all that is produced or it is produced with a more normal milky type of discharge. Some months have different than others in how much of these odd discharges I experience. I have not had any bleeding between periods. I am currently on my period. For the first time I am experiencing a very odd period. I am producing large clots with the consistency of liver. I had a pap smear in November which came back normal. I am 28 years old. I have one child born five years ago. I have no history of difficult periods or unusual conditions. I am going to the doctor again this week but am looking for any suggestions about what I might be dealing with

Answer: First, has a culture been done? Second, if this is not gardenella, has any other anti-biotic regimen been tried? Usually we try a broad spectrum antibiotic along with flagyl. Usually a floxin type drug.

Menses Problems
Question: I am currently taking daily doses of the following: 1200 mg Lithium, .075 Xanax, and 25 mg Mellaril. Are any of these medications capable of creating a cessation of my period or continuous spotting but no actual period? It's causing me to feel quite ill at ease. During the last 2 months I have been having symptoms of PMS but no period. The Gynecologist has recommended Provera, but I don't feel comfortable taking any more medication.

Answer: Lithium is not known to cause endocrinologic problems except for hypothyroidism. Hypothyroidism is a potential cause of a decreased period. Have your physician check your thyroid levels. Xanax should have no effect. Mellaril is also a potential cause of amennorhea. About the only way to test mellaril is to stop the drug for several weeks, which is something you may not be able to do.



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