Gynecological Care

USMD physicians take the time to work with you to find the best solution for your gynecological care. Regardless of the procedure, you can be sure our specialists use state-of-the-art technology and techniques to direct your plan of care.

A wide variety of benign (non-cancerous) conditions may affect a woman's reproductive system, which consists of the uterus, vagina, ovaries and fallopian tubes. Most of these conditions affect the uterus, which is the hollow, muscular organ that holds a baby as it grows inside a pregnant woman. Common gynecologic conditions – such as fibroids (non-cancerous growths in the uterine wall), endometriosis (non-cancerous growths of the uterine lining) or prolapse (falling or slipping of the uterus) – can cause chronic pain and heavy bleeding, as well as other disabling symptoms.

Many gynecologic cancers can also affect a woman's reproductive system. The most common types are cervical, endometrial (uterine) and ovarian cancer. The specific type of cancer a woman has, and how advanced it is, will determine her available treatment options.

Thanks to advances in gynecological care, women today have more options than ever. Procedures at USMD include, but are not limited to, the following:

Hysterectomy
When medication and other treatments are unable to relieve symptoms, or if you have a gynecologic cancer – such as cancer of the uterus or cervix – the surgical removal of the uterus may be your best treatment option. This procedure is the second most common surgical procedure for women in the United States. The type of hysterectomy you have will depend upon your medical history and health, as well as the extent of any cancer growth. Surgical options offer varying degrees of invasiveness:

  • Abdominal hysterectomy – An incision is made through the skin and tissue of the lower abdomen to reach the uterus and ovaries. This is sometimes the only option for surgery.
  • Vaginal hysterectomy – Surgery is done through the vagina. With no external incision, recovery time is generally shorter than with abdominal surgery.
  • Laparoscopic hysterectomy – Surgery is done through small incisions in the abdomen while the surgeon views the pelvic organs on a screen via the light-transmitting laparoscope. Recovery time is generally shorter than that of a vaginal hysterectomy.

Laparoscopy
A surgical procedure in which a light-transmitting instrument is used to view the pelvic organs (diagnostic laparoscopy) or perform surgery (operative laparoscopy). Laparoscopy is useful in diagnosing and/or treating endometriosis, adhesions, fibroids, ovarian cysts and fertility-related issues.

Hysteroscopy
A way to look inside the uterus with a thin, telescope-like device inserted through the vagina and cervix. The hysteroscope may help the physician diagnose (diagnostic hysteroscopy) or treat (operative hysteroscopy) a uterine problem.

Myomectomy
Surgical removal of uterine fibroids (myomas). Like some other gynecological care, it may be done as an abdominal, hysteroscopic, laparoscopic or robot-assisted procedure.

Endometrial ablation
Treatment of the lining of the uterus (endometrium) to control or stop excess menstrual bleeding. During the procedure, a thin layer of the endometrium is destroyed with an electrical, laser or thermal energy source.

D & C (dilation and curettage)
A procedure by which a sample of the lining of the uterus (endometrium) is taken for examination and used to diagnose or treat many conditions that cause abnormal uterine bleeding. It also can be used to help detect cancer of the uterus.

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Treatment of abnormal pap smears
When a pap smear or other screening test detects abnormal cervical cells, further evaluation and treatment are necessary. The following procedures are options:

  • Cervical cone biopsy – A surgical procedure in which a small, cone-shaped portion of the cervix is removed to evaluate the abnormality for treatment. The cone biopsy itself might remove all of the suspicious cells, if they are located in the biopsy area.
  • LEEP (loop electrosurgical excision procedure) – A procedure in which a thin, wire loop acts as a surgical knife when an electrical current passes through it. The loop cuts away a thin layer of abnormal surface cells, exposing new, healthy cells.

Endometriosis treatment
Endometriosis is the condition in which endometrium (tissue like that which normally lines the uterus) grows elsewhere in the body. It can be painful and may affect fertility. Treatment includes the following:

  • Laparoscopic surgery – Surgery through small incisions in the abdomen removes or destroys endometriosis lesions and may restore fertility.
  • Abdominal surgery – If the endometriosis is more extensive, a laparotomy may be required. This procedure requires a larger incision and longer recovery time than a laparoscopy. In the most severe cases, a hysterectomy with bilateral salpingo-oophorectomy (removal of the uterus, fallopian tubes and ovaries) may be done to remove all visible areas of endometriosis.

Evaluation of pelvic mass
To distinguish between normal pelvic organs and an enlargement that might represent an abnormality or malignancy, your surgeon may perform abdominal, laparoscopic or robot-assisted surgery. Minimally invasive surgery with the da Vinci® Robot Surgical System allows the surgeon precise control of remotely-operated, flexible instruments while viewing the pelvic organs via a 3-D monitor.

Laser for Condyloma (genital warts) or abnormal vaginal/cervical lesions
Laser surgery may be used when surgical excision is not possible or would be difficult. A laser destroys tissue by focusing a precisely controlled beam of intense light on the condyloma or lesions. As water in the tissue absorbs the light energy, the tissue is destroyed.

Pelvic support procedures
Pregnancy and childbirth may weaken connective tissue and muscles that hold the pelvic organs in place. Procedures to improve this condition include the following:

  • Anterior/posterior repairs – Surgery to repair an anterior wall prolapse (or cystocele – occurs when the bladder drops from its normal place into the vagina) or posterior wall prolapse (or rectocele – occurs when the rectum drops into the vagina).
  • Sacral colpopexy and mesh placement – Surgery to repair a vaginal vault prolapse (when the upper part of the vagina falls in on itself), which may occur after a hysterectomy. The vagina is attached to the sacrum (tailbone) via a piece of mesh that acts like a bridge.
  • Sling – A device that treats stress urinary incontinence associated with an anterior wall prolapse (cystocele) by elevating the urethra and bladder.

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