An episiotomy involves making a surgical incision to assist in vaginal delivery by enlarging the birth canal.

Most are done in 2 ways:

1. Medio-lateral episiotomies are either a right or left side vaginal cut. This will engage more muscles, have deeper tissues involved, it take longer to heal.
2. Midline episiotomies are intended to be a cut straight down cut to the anus, but avoiding the anal sphincter and rectum.  This is less extensive and generally heals faster. (more…)

What are the risks and benefits associated with episiotomy?

The following risks are frequent;

1. If the area is not approximated with good surgical technique, the wound edges may not heal easily.
2. Tight suture healing leads to formation of granulation tissue, spotting, and pain in some cases.
3. A poorly healed end may be formed after an episiotomy, usually at the 6 o’clock position at the base of the vagina.  It causes severe pain with placing of a tampon, finger, or penis. (more…)

Vaginal dryness occurs mostly due to a hormonal imbalance in the female reproductive system as well as in the tissues and membranes of the vagina.  This symptom is mostly associated with menopause.  Additional causes of vaginal dryness are childbirth,  breastfeeding, stress, birth control pills, medications, and other less common gynecological problems. (more…)

When does the Perimenopause interval start?

Perimenopause is a natural part of aging, the interval in which you are in a transition leading up to menopause.  It signals the ending of your reproductive years.  In most women, perimenopause can occur two to seven years before menopause. As the average age of a non-smoking American female is 51 (smokers average 49), the perimenopause usually starts in the mid to late 40’s.  The duration varies from two to eight years including the first year after your final period.  (more…)

Viewing each menstrual irregularity individually and in detail:

Amenorrhea

Yes, even absence of menstruation is a problem.

Amenorrhea is of 2 types, primary and secondary. Primary is when the menstruation never occurs in the first place, and secondary is when it had occurred in the past but then it stops. Gestational amenorrhea is the normal absence of menstruation during pregnancy. (more…)

So, what about ovulation?

Doesn’t menstruation mean I am ovulating and that I can get pregnant?

Possibly. Ovulation may begin with menarche or it may not. When there is no ovulation, you are going through anovulatory cycles.

Pregnancy it has been known to occur even before the menarche. You need to understand that menarche may happen without involving the release of ova at all. The blood flow is from the uterine tissue disintegration and that may happen without ovulation. This is why you need to realize that there are many stops where essentially anything can go wrong, resulting in menstrual irregularities. (more…)

Now we will move to the understanding of a normal menstrual cycle.

The ovarian cycle and the uterine cycle

The ovarian cycle and the uterine cycle are two different things happening together and dependent on one another. The ovarian cycle is happening in the ovaries and the uterine cycle in the uterus. The blood flow is due to the effects of the menstrual cycle on the uterine cycle, resulting in a uterine blood flow. (more…)

Now, after much talk about perimenopause and menopause, we will take a u-turn and answer some very basic questions about your body.

The first question that brings you to us, or any physician, regarding your reproductive system is (usually) a menstrual irregularity. There might be many questions on your mind pertaining to the seriousness of the issue. (more…)