ovarian cysts

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. Ovarian cysts are quite common in women during their childbearing years. A woman can develop one cyst or many cysts. Ovarian cysts can vary in size.

Different types of ovarian cysts:​

  • benign (not cancerous): most common.
  • Malignant(cancerous): a rare but serious condition

Symptoms of Ovarian Cysts:​

  • Asymptomatic
  • Pelvic Pain
  • Bladder or Bowel pressure
  • Bloating
  • Abnormal bleeding
  • Pain with intercourse​

Diagnosing Ovarian Cysts:​

  • Tumor Markers:CA125,CEA,CA19-9,Roma Index,HCG,AFP,LDH
  • Pelvic exam
  • Ultrasound
  • MRI
  • Diagnostic Laparoscopy​

Treatment options for Ovarian cysts:​

  • Observation & follow up

Ovarian torsion

Ovarian torsion is a rare but serious condition, mostly affecting reproductive age group females and if untreated will have significant morbidity and increased infertility.

Ovarian Torsion Symptoms:

  • Abdominal & pelvic pain
  • Abdominal rigidity
  • Nausea & vomiting
  • Fever​

Risk Factors for Ovarian Torsion:

  • Ovarian Cysts
  • Pregnancy
  • Menopause​

Ovarian Torsion Diagnosis

  • Pelvic exam & History
  • Ultrasound with flow studies
  • Diagnostic Laparoscopy​

There are two primary treatments for ovarian torsion:

  • Laparoscopy: By untwisting and restoring circulation back to ovary we may well be able to salvage the ovary.
  • Surgical removal of the ovary: Loss of One Ovary due to prolonged circulation deficiency

Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome(PCOS)is a disorder of the female endocrine system with varying degrees of presentations.
Many (poly) cysts or fluid-filled structures within the ovaries with varying degree of excess androgen production and frequent anovulation.

Women with PCOS typically experience:

  • Oily skin & hirsutism(excess hair growth)
  • Irregular and fewer periods
  • Acne
  • Central obesity and metabolic disorders
  • Infertility​

Risks if untreated are:

  • Type 2 diabetes mellitus
  • Hypertension
  • Cardiovascular disease
  • Metabolic syndrome
  • Endometrial hyperplasia
  • Treating Polycystic Ovary Syndrome:
  • Weight loss and PCOS Diets
  • Exercise
  • Oral contraceptives
  • Insulin-sensitizing drugs such as Glucophage

Vulvo-Vaginal Dysplasia

Vaginal Intraepithelial Neoplasia, also known as VAIN, is a condition that causes pre-cancerous changes in the cells of the vaginal tissue.
Women over age 50 are at the highest risk for VAIN, but the condition can develop in women of any age.

​Three grades:

  • VAIN 1: One-third of the depth of the surface layer is affected
  • VAIN 2: Two-thirds of the depth of the surface layer is affected
  • VAIN 3: The entire surface layer is affected

​Causes of VAIN:

  • HPV: human papillomavirus (HPV)
  • Immunosuppression: Smoking, Genetic disorders of the immune system.

​Diagnosing VAIN

  • ​Colposcopy & Biopsy
  • Pap smear

​​​VAIN Treatment Options

  • ​Observation unless advance development

​​​Ablation:

  • ​Carbon dioxide laser treatment
  • Diathermy treatment
  • Internal Radiotherapy

​Surgery: Local excision, Partial or total vaginectomy
You will need to schedule routine follow-up exams with your gynecologist.

Normal Vaginal Discharges:

Through the normal course of the menstrual cycle, women’s vaginas can produce a discharge. It is usually a clear or cloudy white discharge and is produced in order to clean itself.

Vaginal discharge concerns:

  • Changes in vaginal discharge
  • Pain during sex
  • Itching, burning, stinging, swelling, or tenderness in the vagina
  • Burning while urinating
  • Vaginitis:
  • Bacterial Vaginosis
  • Yeast infections
  • Gonorrhea
  • Chlamydia
  • Trichomoniasis
  • Allergic reactions

Bacterial Vaginosis vs. Yeast Infection

  • These two conditions are due to an imbalance of normal microorganisms found in your vagina.
  • Yeast infection: usually result in itching or burning and white discharge that resembles cottage cheese.
  • Bacterial vaginosis: causeS a fishy odor, and discharge that has the consistency of yogurt.

Sexually Transmitted Infections:

  • Chlamydia
  • Gonorrhea
  • Trichomoniasis
  • Herpes
  • HPV

All sexually active women and men should get yearly testing depending on their sexual activities.
Atrophic vaginitis: Lack or hormonal deficiencies
Use Condoms, Wear comfortable clothing, perform routine STD screening and annual checkups and avoid self-treating.


A sexually transmitted infection (STI) is an infection spread by sexual contact. There are many STIs. This FAQ focuses on chlamydia, gonorrhea, and syphilis. These STIs can cause long-term health problems and problems during pregnancy. Having an STI also increases the risk of getting human immunodeficiency virus (HIV) if you are exposed to it.
Chlamydia is the most commonly reported STI in the United States. Chlamydia is caused by a type of bacteria, which can be passed from person to person during vaginal sex, oral sex, or anal sex. Infections can occur in the mouth, reproductive organs, urethra, and rectum. In women, the most common place for infection is the cervix (the opening of the uterus).

The following factors increase the risk of getting chlamydia:

  • Having a new sex partner
  • Having more than one sex partner
  • Having a sex partner who has more than one sex partner
  • Having sex with someone who has an STI
  • Having an STI now or in the past
  • Not using condoms consistently when not in a mutually monogamous relationship
  • Exchanging sex for money or drugs

Chlamydia usually does not cause symptoms. When symptoms do occur, they may show up between a few days and several weeks after infection. They may be very mild and can be mistaken for a urinary tract or vaginal infection. The most common symptoms in women include the following:

  • A yellow discharge from the vagina or urethra
  • Painful or frequent urination
  • Vaginal bleeding between periods
  • Rectal bleeding, discharge, or pain
In women, a chlamydia test can be done on a urine sample or on samples taken with a swab from the vagina, mouth, throat, rectum, or the area around the cervix. You can do a self-swab of your vagina or rectum in an obstetrician–gynecologist (ob-gyn) or other health care professional’s office. A yearly screening test is recommended for women younger than 25 years and for women 25 years and older with risk factors for chlamydia.
Chlamydia is treated with antibiotic pills. Your sex partners (anyone with whom you have had sexual contact in the past 60 days or your last sex partner) also need to be tested and treated. Be sure to take all of your medicine as directed. Chlamydia can be passed to sex partners even during treatment. You should avoid sexual contact until you have finished treatment, and your sex partners should as well. You also should be retested for chlamydia 3 months after treatment.
If left untreated, chlamydia can cause pelvic inflammatory disease (PID). PID can lead to long-term health problems and affect your ability to get pregnant.
Gonorrhea is the second most commonly reported STI in the United States. Gonorrhea and chlamydia often occur together. Gonorrhea also is caused by bacteria that can be passed to a partner during vaginal, anal, or oral sex.
The risk factors for gonorrhea are the same as the risk factors for chlamydia.

Gonorrhea often causes no symptoms or only very mild symptoms. Women with gonorrhea may think they have a minor urinary tract or vaginal infection. Symptoms include the following:

  • A yellow vaginal discharge
  • Painful or frequent urination
  • Vaginal bleeding between periods
  • Rectal bleeding, discharge, or pain
Testing for gonorrhea is similar to testing for chlamydia. In women, tests for gonorrhea can be done on a urine sample or on samples taken with a swab from the vagina, mouth, throat, rectum, or the area around the cervix. A yearly screening test is recommended for women younger than 25 years and for women 25 years and older with risk factors for gonorrhea.
Gonorrhea is treated with two kinds of antibiotics. The recommended treatment is an injection of one of the antibiotics followed by a single pill of the other antibiotic. If the injection is not available, you can take two types of antibiotic pills. This treatment also is effective against chlamydia. Your sex partners also need to be tested for gonorrhea and treated.
If left untreated, gonorrhea can lead to the same long-term health complications as chlamydia, including PID, as well as disseminated gonococcal infection.
Syphilis is caused by bacteria. The bacteria that cause syphilis enter the body through a cut in the skin or through contact with a partner’s syphilis sore. This sore is known as a chancre. Because this sore commonly occurs on the vulva, vagina, anus, or penis, syphilis most often is spread through sexual contact. The genital sores caused by syphilis also make it easier to become infected with and transmit HIV. Syphilis also can be spread through contact with the rash that appears in later stages of the disease.

Symptoms of syphilis differ by stage:

  • Primary stage—Syphilis first appears as a painless chancre. This sore goes away without treatment in 3–6 weeks.
  • Secondary stage—If syphilis is not treated, the next stage begins as the chancre is healing or several weeks after the chancre has disappeared, when a rash may appear. The rash usually appears on the soles of the feet and palms of the hands. Flat warts may be seen on the vulva. There may be flu-like symptoms.
  • Latent infection—In some people, the rash and other symptoms may go away in a few weeks or months, but that does not mean the infection is gone. It still is present in the body. This is called latent infection.
Unlike testing for chlamydia and gonorrhea, routine screening for syphilis is not recommended for women who are not pregnant. All pregnant women should be screened at their first prenatal visit and retested later in pregnancy and at delivery if they are at high risk. Two blood tests usually are needed to diagnose syphilis.
Syphilis is treated with antibiotics. If it is caught and treated early, long-term problems can be prevented. The length of treatment depends on how long you have had the infection. You may have periodic blood tests to see if the treatment is working. Sexual contact should be avoided during treatment. If you are diagnosed with syphilis, you also should be tested for HIV. Your sex partners should be treated for syphilis.
If untreated, syphilis may return in its most serious form years later. Late-stage syphilis is a serious illness. Heart problems, neurological problems, and tumors may occur, leading to brain damage, blindness, paralysis, and even death. At any stage, syphilis can affect the brain, which can lead to meningitis, problems with hearing and eyesight, and other neurologic symptoms.
Telling sex partners that you have an STI and are being treated for it is called partner notification. It is an important step in treatment. When partners are treated, it helps decrease your risk of getting reinfected by an infected partner. You can tell your partners yourself, or you may be able to have the health care department in your state do it. If you choose to have the health department tell your partners, your name will not be used when the partner is told.

You can take steps to avoid getting chlamydia, gonorrhea, and syphilis. These safeguards also help protect against other STIs, including HIV:

  • Use condoms consistently.
  • Limit your number of sexual partners.
  • Ask about your partner’s sexual history. Ask your partner whether he or she has had STIs.
  • Avoid contact with any sores on the genitals.
  • Get tested every year for chlamydia and gonorrhea if it is recommended for your age group. If your ob-gyn or other health care professional does not offer you this screening, ask to be tested.

Obesity & weight Loss

Obesity and weight loss are one of the most common health concerns affecting Americans today. Although women of all sizes can be healthy, an excess of body fat is correlated with an increased risk of many chronic diseases, including diabetes, heart disease, and hypertension.

When making a commitment to lose weight, many women have an ideal weight in mind. Setting goals can help you stay motivated, but studies show that losing even a little weight can have a positive impact on your health.

BMI evaluation:

Your BMI is calculated by dividing your mass in kilograms by your height in meters squared.

  • Under 18.5 – Underweight
  • 18.5-24.9 – Normal weight
  • 24.9-29.9 – Overweight
  • 29.9-34.9 – Obese (class I)
  • 34.9-39.9 – Obese (class II)
  • 40 and above – Morbidly obese / Extreme obesity (class III)

Physical findings:

  • Blood pressure, heart rate, and body temperature.
  • Measuring the circumference of the waist. Women with a waist greater than 35” and men with a waist greater than 40” have increased health risks.
  • Blood Tests: cholesterol levels, liver function, thyroid function, and blood sugar.
  • Causes of Obesity:
  • Diet and eating habits: Excessive eating and high-calorie foods and beverages.
  • Sedentary lifestyle
  • Genetics
  • Other diseases or conditions: Thyroid disease & Cushings disease
  • Medications: antidepressants, antipsychotic medications, anti-seizure medications, and steroids.
  • Age
  • Sleep disorders
  • Quitting smoking
  • Pregnancy
  • Culture & socioeconomic reasons
  • Obesity health disorders & risks:
  • High cholesterol
  • Type II diabetes
  • High blood pressure (hypertension)
  • Stroke
  • Heart disease
  • Metabolic syndrome
  • Sleep apnea and other respiratory disorders
  • Cancer, especially breast, cervical, ovarian, endometrial, and uterine cancers. Risk of rectum, colon, liver, pancreatic, kidney, and gallbladder cancer is increased as well.
  • Infertility
  • Irregular periods
  • Gallbladder disease
  • Osteoarthritis
  • Nonalcoholic fatty liver disease – inflammation of the liver due to an excess of fat
  • Treating Obesity

Behavioral:

  • Tracking and reducing calorie intake
  • Replacing high-calorie foods with healthy options, such as fruits and vegetables
  • Choosing plant-based foods and lean proteins
  • Limiting the intake of added sugars, high-carbohydrate, and full-fatty foods
  • Making exercise a part of your normal routine
  • Medication:
  • Xenical, Belviq, Contrave, and Saxenda are among the more popular weight loss drugs. For patients who have:
  • A BMI of 30 or greater
  • A BMI of 27 or greater, plus an additional diagnosis of an obesity-related condition, such as high blood pressure or diabetes.
  • Weight loss surgery

If the patient has:

  • A BMI of 40 or greater
  • A BMI of 35 or greater, plus an additional diagnosis of an obesity-related condition
  • Committed to making drastic diet and lifestyle changes
  • Maintaining a Healthy Weight after Weight Loss
  • Unfortunately, it can be extremely difficult to keep excess weight off once it is lost. It’s very common for patients to regain weight after a few months of successful weight loss. This is why it is important to commit to lifestyle changes and forming new, healthy habits for the rest of your life.
  • Regular exercise is one of the best ways to maintain a healthy weight. Try to get at least an hour a day of aerobic exercise. This can be as simple as taking daily walks or playing outside with your children or grandchildren. Enlist the support of your family and friends to help you make healthy choices and encourage you in your weight loss goals.

Genetic Testing for Cancer

The personal risk for some hereditary cancers can be determined by genetic testing.

Genetic Testing: BRCA1 or BRCA2

  • 7% of breast cancers.
  • 10-15% of ovarian cancers.
  • Hereditary Breast and Ovarian Cancer (HBOC) Syndrome, an 87% chance of developing breast cancer, and a 63% chance of developing ovarian cancer by age 70.
  • Lynch syndrome is also associated with a higher risk for developing ovarian, stomach, pancreatic, renal, urinary tract, biliary tract, small bowel, and brain cancers.
  • Recommended options include:
  • Frequent checkups
  • Cancer risk-reducing alterations
  • Surgical removal of the affected tissue-prophylactic mastectomy or oophorectomy