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Adolescent

AMENORRHEA

Amenorrhea is absence of period. It is classified into two types – primary and secondary

Primary Amenorrhea

Primary amenorrhea is when a young girl
1. Does not have menses by age of 14yrs and also secondary sexual characteristics (I.e.development of breast and pubic hair.) Or
2. No menses by age of 16yrs despite having secondary sex characteristics
In either of these cases she would need further investigation. There can be many causes for primary amenorrhea. One would need investigations and then appropriate treatment.

Secondary Amenorrhea

Secondary amenorrhea occurs when a woman who has been having normal menstrual cycles stops getting her periods for 6 or more months., but excludes women who are pregnant, breastfeeding, menopausal, using Depo-Provera, or having a LNG-IUS in situ. Secondary amenorrhea may happen in case of

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Secondary amenorrhea occurs when a woman who has been having normal menstrual cycles stops getting her periods for 6 or more months., but excludes women who are pregnant, breastfeeding, menopausal, using Depo-Provera, or having a LNG-IUS in situ.
Secondary amenorrhea may happen in case of

  • Obesity
  • Loss of weight suddenly – due to diet or obesity surgeries.
  • Too much exercise for long periods.
  • Severe emotional stress
  • Cancer treatment
  • Tumors in the brain
  • Tumors in the brain
  • Lining of the uterus is damaged after Dilatation and Curettage. – This happens when it is done repeatedly e.g. multiple terminations of pregnancy.

PCOS

PCOS is an endocrine and metabolic disorder. It is considered in any woman with acne, hirsutism, menstrual irregularity, or obesity.

Patients with PCOS, have anovulation, i.e. they may not produce a follicle cyclically. They may therefore present with primary amenorrhea (i.e. no periods at all), too few periods (oligomenorrhea) or secondary amenorrhea i.e. absence of periods for six months or more. Some may also have excessive, frequent and irregular bleeding (dysfunctional uterine bleeding).

Resistance to insulin, and increase in insulin levels is an important factor in PCOS. Obesity is present in approximately one-half of patients with PCOS. The waist:hip ratio may be greater than 0.85.

The cause of PCOS is unknown, but there is a possibility that PCOS may be a complex genetic disorder in which the genetic factor interacts with various environmental factors and causes imbalance in the hormones.

The diagnosis of PCOS is based upon clinical and biochemical criteria. It is suspected in cases of adolescents with hirsutism, acne, menstrual irregularity, or obesity. The diagnosis is further confirmed if excess androgen is demonstrated by laboratory testing. Androgen panel consists of plasma total testosterone, free testosterone, and another androgens such as DHEA sulfate. Plasma-free testosterone is the single most sensitive test for the detection of androgen excess. DHEA sulfate is the main marker of androgens that come from adrenals. Cortisol and thyroid function tests are indicated in obese patients to exclude other causes of obesity.

Pelvic ultrasound shows the features of a polycystic ovary. i.e. multiple(more than 10) small follicles with increased stroma.

A baseline lipid panel and a glucose tolerance test are important as PCOS is related to insulin resistance. The fasting glucose concentration is poor predictor of the two-hour level in PCOS. Two-hour blood glucose greater than 140 mg/dL indicates insulin resistance and this is important from the treatment point of view.

The treatment of PCOS is based upon the symptoms. The choice of treatment will depend on the individual patient’s symptoms and goals

Period Pains

Most women will have pain during their periods. The pain is usually a painful spasm or cramp. It is felt in lower abdomen, back and thighs. Intensity of the pain may be very variable. It may be a dull discomfort or else it may be severe enough to affect the daily routine of the woman. A typical period pain will start at the start of the period or few hours earlier and it usually settles in by day 1 or 2 of period when the flow of blood begins. This pain happens mainly because the womb is contracting in spasms to open up the neck of the womb. Once it is open and the flow starts, the pain eases away.

This is the typical period pain. It need not cripple you. One can do some back exercises that help to stretch the back. Yoga can be very beneficial. Hot fomentation is also soothing. A good massage can be very relaxing. It is advisable to eat good nutritious food, avoid alcohol and caffeine, take adequate rest and take supplements if necessary.

Sometimes period pains occur due to problems in the uterus, tubes and ovaries. Some of the common causes are infection, endometriosis, fibroids and ovarian cysts. In this situation it is possible that the pain will start before the cycle and may last through the cycle and may also continue beyond it.

So do not allow period pains to prevent you from leading your life to the fullest. There is a solution for every problem.

Vaginal Infection

Vaginal inflammation and infection can happen to women of all ages but it is most common in women of reproductive years. The vagina normally has certain bacteria and yeast that live in the vagina and are in harmony with the body.
They do not cause any problems. Sometimes the environment of the vagina may change and the balance of the yeast and the bacteria may be disturbed. Under the circumstances the vagina may get inflamed and/or infected.
Various factors predispose to vaginal infection. They are use of antibiotics, pregnancy, breast feeding, menopause, douching, use of spermicides, and sexual intercourse per se. Antibiotics, douching and use of spermicides change the pH of the body and can cause change in the normal flora. During pregnancy, breast feeding and menopause there is alteration in the hormone levels and therefore the flora may change.
Three types of infection commonly occur in the vagina.
Candidiasis
Yeast {fungal} infection is the commonest type of vaginal infection. Most common symptoms are itching and burning in the vulval region. The vulva may be swollen and red. The discharge is typically thick white curd like odorless and sticks to the skin of the vulva.

Bacterial vaginosis
This is caused by overgrowth of bacteria that are normally present in the vagina. Women complain of foul smelling thin watery vaginal discharge with a characteristic fishy odor.

Trichomoniasis
It is caused by an organism called trichomonas vaginalis. It is sexually transmitted. Women complain of greenish yellow discharge, local burning, irritation, redness and swelling.

The diagnosis can be done by examining the discharge under the microscope. The fungus / the trichomonas may be seen in the discharge.

All these infections are treated with local medication and oral tablets. In case of trichomoniasis, the sexual partner should also be treated.

Human Papillomavirus (HPV) Vaccines

What is human papillomavirus (HPV) ?
Human papillomavirus (HPV) is a virus that can be passed from person to person through skin-to-skin contact. More than 100 types of HPV have been found. About 30 of these types infect the genital areas of men and women.

How is HPV spread?
HPV is primarily spread through vaginal, anal or oral sex but sex intercourse is not required for infection to occur. HPV is spread by skin-to-skin contact. Sexual contact with an infected partner, regardless of the sex of the partner, is the most common way the virus is spread.

What disease does HPV Cause?
Approximately 12 types of HPV cause genital warts. Two types, type 6 and type 11, cause most cases of genital warts. Genital warts are growths that may appear on the outside or inside vagina or on the penis and can spread to nearby skin. They also can grow around the anus, on the vulva, or on the cervix. They can be treated with medication that is applied to the area or by surgical removal. The type of treatment depends on where the warts are located. About 15 types of HPV cause cancer of the cervix. They also cause cancer of the vulva, vagina, anus, penis, and the head and neck. Most cases of cervical cancer are caused by just two types of HPV-Type 16 and type 18.

How does HPV cause cancer of the cervix?
The cervix is covered by a thin layer of tissue made up of cells. If one of the cancer-causing types of HPV is present, it may enter these cells. Infected cells may become abnormal or damaged and begin to grow differently. It usually takes several years for cervical cancer to develop. Cervical cancer screening can detect early signs of abnormal changes of the cervix and allows early treatment so that they do not become cancer.

How effective are the vaccines in preventing HPV infection?
The four type vaccine is almost 100% effective in preventing cervical precancer and genital warts caused by four types of HPV. The two type vaccine is almost 100% effective in preventing cervical precancer caused by two types of HPV. The vaccines are most effective if they are given before a women is sexually active and exposed to HPV. If a women is already infected with one type of HPV, the vaccines will not protech against disease caused by that type. However the vaccines can protect against the other types of HPV included in the vaccines.

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