Laparoscopy is an operation done to look inside your abdomen with a thin instrument called a laparoscope. Through small holes in your tummy, the doctor looks, examines and operates (if needed) without making large cuts.

In conventional surgery a long incision is made to gain entry into the abdominal cavity and operate. This result in increased post-operative pain, longer stay in hospital, delayed recovery, long and ugly scars, higher chance of wound infection and a higher chance of hernia. The incidence of all these are considerably reduced by a laparoscopic surgery.

Cost of laparoscopic surgery is no higher than open surgery as a slightly increased cost of instruments is offset by reduced hospital stay and early return to work. From the patient point of view it results in less pain and less hospital stay while for the hospital it can produce a faster turnover of patients.

Contrary to some myths, whatever surgery planned to be done by a laparoscopy procedure, is completed by a laparoscopy operation. This may be removal of tumors or the entire uterus. Nothing is left behind and a repeat operation by the conventional route is almost never needed.

Laparoscopic Surgery is no more risky than conventional open surgery. In fact all the research has shown that it has less complications compared to open surgery. There is a small risk of general anaesthesia, infection, bleeding, injury to internal organs. These risks are uncommon, may also occur with open surgery and need to be discussed with your doctor in further details.

Laparoscopy is a commonly performed and is a generally safe procedure. For most people, the benefits in terms of improved symptoms, or from having a clear diagnosis of a problem, are greater than the disadvantages. However the decision would be taken depending on the disease, the doctor and the setup in which the surgery is being performed.

Occasionally (<5?ses) a laparoscopy operation may need to be converted into an open or conventional one. It may be done due to decrease risk, unanticipated difficulties or complications encountered during the course of the operation.

Laparoscopy may be used to investigate causes of gynecological pain or to assess infertility. Sterilization is one of the commonest operations done using a laparoscope. Removal of cysts, ectopic pregnancy, tumors and the uterus may be done by a laparoscopy. In advanced centers more extensive laparoscopy surgeries may be performed.

Any preparations depend on the reason for the procedure. For planned operations, you will have a few blood tests, an ECG and chest x-ray to make sure it is safe for you to have an anesthetic. These should reveal potential problems that may complicate the surgery if not detected and treated early.

A laparoscopy involves one or more cuts approximately 5-10mm in length. The first cut is made around the navel and a hollow needle is inserted through which carbon dioxide gas is used to distend the abdomen. This makes it easier to insert the laparoscope and examine the internal organs. If the surgeon needs to operate or take samples, additional small cuts are made for specially designed long, thin instruments. The operation is done on visualizing internal organs on a TV monitor. At the end of the procedure, the instruments are removed, the carbon dioxide gas is allowed to escape and the cuts are closed with stitches.

The duration of the operation depends on the type of operation attempted and the disease inside the abdomen. It varies from 30 minutes for simple procedures to several hours for more complicated operations.

There may be some discomfort in the abdomen for a day or two after laparoscopy due to the presence of some carbon dioxide gas. If the surgery is uneventful, feeding can be started on the same day once the patient has recovered completely from the effects of anesthesia. Before you go home you will be given advice about caring for the surgical wounds and when you will need to come back for a follow-up appointment or to have stitches removed. Complete recovery may take longer if any surgery has been carried out. It is important to follow the advice of your surgeon about physical activity, rest and returning to work.

Following a relatively minor laparoscopic procedure like sterilization, diagnostic laparoscopy, lap and dye test women can be discharged on the same day but for more advanced procedures three to four days in hospital would be the norm.

Usually rest for a week from the day of surgery should suffice in most cases. But it would be advisable for the surgeon to advice you based on your progress. Rest does not mean absolute bed rest but taking things a little easy while involving oneself in daily household activities.

It has become very common operation nowadays and is being done in almost every reputed hospital with minimal complication rates.

A laparoscopy for infertility usually consists of inspecting the reproductive organs and checking for any disease, which could explain the infertility. Usually immediate correction is attempted. A dye test may be done to check for the patency of the fallopian tubes. Often a hysteroscopy is also done concomitantly to assess the uterine cavity.

The uterus may be removed through the vaginal passage. Alternately they may be cut into small pieces or sliced into long strips of tissue and removed from the abdomen incisions.

Fever and chills could indicate infection. Incision site changes like swelling, bleeding or discharge may be seen. Abdomen distension and bloating needs urgent evaluation. Headaches, muscle aches or feeling dizzy. Difficulty urinating and frequency of urination.

A hysteroscopy is an operation done to evaluate the inside of the uterine cavity and if necessary operate on the same.

A narrow telescope with an illuminated lens at its end is introduced in the uterine cavity through the cervix or neck of the womb. For clear vision, the uterine cavity needs to be distended, which is done with gas or some fluid.

Yes, operations performed through a hysteroscope are major surgeries. Complications may range from anesthetic problems to fluid overload issues. However, hysteroscopy for diagnostic purposes may be performed on an outdoor basis.

Hysteroscopy for diagnostic purposes is usually performed to assess the cause of sub fertility or find out the cause of abnormal bleeding. It may also be done to remove polyps, resect septae, release adhesions and retrieve lost IUCDs.

Most minimally access surgery units perform hysteroscopy operations in addition to laparoscopy operations.

Hysterectomy essentially means the removal of the uterus or womb. It essentially means the end of menstrual cycles and natural childbearing.

No. Surgical menopause occurs only when ovaries are also removed surgically along with the uterus. However, many women go into menopause within 2 - 3 years of hysterectomy even if ovaries are not removed during hysterectomy.

Removal of the uterus may be done by the vaginal, abdominal or laparoscopy route. All routes may not be applicable or safe in every case and it is best to make a decision in consultation with your doctor.

?(a) Tumors of the uterus (fibroids); (b) Heavy menstrual bleeding not responding to medicines; (c) Along with ovarian cysts in patients who have completed their family; (d) Cases of uterine prolapse (uterus protruding through the vagina) (e) Severe Infections (f) Advanced Endometriosis (g) Cancers

Hernia is a relatively rare, yet commonly feared, complication seen after any abdominal operation, hysterectomy being no exception. Avoiding strain on the abdominal wall (coughing/constipation) in the immediate postoperative period is the key. However hernia may also occur if the scar is weakened by infection or faulty operative technique. Often women with poor nutrition status may have a weak abdominal wall predisposing them to hernias.

Hysterectomy usually does not affect sex life as most of the length of the vaginal passage is retained after the operation. Normal intercourse is usually advised six weeks after a surgery.

The decision to remove ovaries is usually taken after discussion between you and your doctor. Diseased ovaries are almost always removed. The advantage of retaining ovaries is the continuous production of natural hormones. The disadvantage of retaining ovaries is potential risk of future development of cysts/cancer (~5%) needing surgical removal later.

Hysterectomy by any route carries the risk of anesthesia. Injury to internal organs, bleeding and infection consist the short-term problems. Long-term complications include hernias, fistulas and chronic pain.

There are methods to boost up the hemoglobin levels in the body without administering blood. These include iron IV injections or erythropoietin injections, which are often quite effective. These may be administered two to three weeks before the operation or immediately after an operation in an anaemic woman. See Section on Anemia

Some women feel better with an abdominal belt after any operation on the tummy. Though it may make one feel good by tucking the tummy in, it does not have a lasting effect and is not an alternative to abdominal exercises, which are usually advised six weeks after an operation.

An ovarian cyst is a fluid-filled, sac-like structure found within an ovary. They are most often benign in nature.

Ovarian cysts are caused due to different reasons. One of the most common cysts (follicular) is formed from retained fluid in an unruptured egg. Cysts may also be formed due to infection, endometriosis or malignancies.

Though most ovarian cysts cannot be prevented from forming, the recurrence of endometriosis-related cysts may be reduced with appropriate medicines.

Most cysts do not need an operation. The need for operation would depend on the age of the woman, size of the cyst, symptoms produced, sonographic features and the chances of associated cancer.

Often cysts do not cause symptoms. At other times they may present with features of fullness in the abdomen, painful periods and abnormal bleeding, sudden severe pain with a vomiting sensation, bloating and flatulence etc An ultrasonography examination (preferably from the vaginal route) is the best way to diagnose ovarian cysts.

Ovarian cysts occurring at a later stage in life, having specific sonographic features, (solid areas, septae, fluid in abdomen) and a raised blood CA (non-specific cancer marker) level.

Some cysts like those arising from endometriosis may recur with time. Follicular cysts commonly recur but seldom need an operation.

It is a genetically determined hormonal imbalance in women of the reproductive age group. It may present as excessive weight gain, irregular menstrual cycles, increased body and facial hair or with complaints of sub fertility. Besides hormonal irregularities detected in blood tests, an abdominal sonography may reveal small peripheral cysts in the ovary. These cysts are not cancerous and do not need an operation for removal. See Section on Polycystic Ovary Syndrome

Chocolate cysts are localized collections of tarred blood in the ovary, which over time assumes the appearance of melted chocolate. These cysts are a part of the disease process called endometriosis and are often associated with symptoms of pain and sub fertility. See Section on Endometriosis

Laparoscopic surgery is ideal for the removal of most cysts. However in cases where surgical difficulties are encountered or malignancy is suspected reversion to the open surgery route may be done. See Section on Laparoscopy

This is an abbreviation for the term “Poly Cystic Ovarian Syndrome” which is a collection of complaints such as irregular, prolonged menstrual cycles, abnormal hair growth in unwanted areas, obesity and occasionally hyper-pigmentation in areas such as back of the neck. It occurs due to a hormonal imbalance secondary to a genetic predisposition, environmentally modified.

There is nothing to be terrified dear. First of all, it does not need an operation. One in five women of your age would have similar cysts in the ovaries if all were to undergo an ultrasound. Only seeing a cystic ovary on ultrasound does not mean that you have a serious disorder. More would depend on whether your cycles are irregular, you have excess hair growth on your body and if you were overweight. With this combination you may be suffering from the polycystic ovary syndrome. Even if this condition is diagnosed you can be treated with appropriate medicines and surgical management is rarely indicated for young girls.

Whether it is okay would really depend on how irregular the periods actually are. A few days here and there could be fine, but if menses come once in 2 – 3 months then you definitely need evaluation. You may be overweight or more often an underlying hormonal problem could be responsible which needs to be investigated and treated.

The beauty salons usually use techniques of bleaching, waxing, shaving and electrolysis. If the excess hair growth is associated with a hormonal disorder it should be tackled by medicines. Newer, permanent methods for hair removal such as laser treatments should be opted for only under the supervision of a qualified dermatologist. Rarely, some tumors in the body can give rise to similar features.

Around 30 – 40% of women with PCOS are obese. So just being overweight does not make you a PCOS patient. If you have associated irregular cycles, excess body hair and a multi-cystic picture of the ovary in an ultrasound apart from certain hormonal imbalances, diagnosed by blood tests, the diagnosis is more likely.

Due to interference of release of the egg from the ovary in PCOS, some women may take longer to conceive especially if they have irregular cycles. Generally, the chances of needing treatment for having a baby are higher in PCOS women. However effective medical treatment is presently available for this disorder and one of the easiest approaches is to try losing weight if you are overweight.

Metformin is given to tackle the altered carbohydrate metabolism in the body during PCOS. This medicine also helps in regularizing cycles and to some extent in reducing weight. Separate medicines for suppressing appetite and increasing the basal metabolic rate may be prescribed for highly overweight PCOS women. But the truth is at the end of the day there are no shortcuts and diet modification with a regular exercise regime backed by motivation works best.

PCOS if uncontrolled can lead to diabetes, increased cholesterol levels and heart disease later in life. The risks of endometrial cancer and breast cancer are also increased.

Though extensive research is on, the actual cause of PCOS is not certain. It is generally believed that effects of environmental factors along with a genetic predisposition are probably responsible.

There is a risk of your sister being affected above the general population risk. If overweight, she should be advised to lose weight.

Laparoscopic ovarian drilling is an operation done in a select group of PCOS women. It is usually reserved for PCOS women who find it difficult to conceive and only after initial medical treatment has failed.

Fibroids are benign (non-malignant) tumors arising from the uterus. They would be seen in as many as 1 in 5 women after the age of forty, if all were to undergo an ultrasound of the lower abdomen. Even after extensive research, we have not been able to ascertain why fibroids are formed but genetic and environmental factors are suspected to be partly responsible.

Fibroids often do not cause any problems and are picked up incidentally on scans done for some other purpose. Sometimes, especially when encroaching on the uterine cavity, fibroids can cause heavy menstrual bleeding and painful periods. Occasionally large sized fibroids may present as a hard lump in the lower tummy or with pressure symptoms on the bladder (frequent, scanty urination) or rectum.

Most fibroids do not need an operation just because they are there. Large fibroids felt on the tummy, fibroids causing heavy menstrual bleeding and pain not responding to medicines are most to need an operation for removal.

Rarely about 3 to 4 in 1000 fibroids may turn malignant. For all practical purposes, all fibroids are benign.

Some small fibroids may spontaneously disappear with time. Many stay the same size throughout and shrink once menopause sets in. Some fibroids (~ 20%) have a propensity to grow and multiply.

Fibroids are often not the cause of infertility and some other associated factor should always be investigated. Some fibroids may however block fallopian tubes or impede with implantation and may need to be removed before infertility treatment is commenced.

Most often fibroids do not interfere with pregnancy. Occasionally they may result in severe pain following degeneration needing treatment. In advanced pregnancy they may be responsible for abnormal positions of the baby, cause interference with delivery of the baby and result in increased bleeding after delivery.

Operations for fibroids essentially involve removing just the tumor(s) from the uterus or removing the uterus and tumor together. These operations may be done using the laparoscopic approach or by the conventional open surgery route. Contrary to WHAT some believe most fibroids can be removed entirely by a laparoscopic operation. The success of the procedure depends on the skill of the surgeon, the number of fibroids and the facilities available. Alternately, blood supply to fibroids, may be cut off by blocking supplying blood vessels.

Unfortunately medicines are not yet available to dissolve fibroids or make them vanish! GnRH injections may however be used to shrink fibroids either before surgery or to temporarily reduce symptoms.

Unfortunately fibroid formation cannot be prevented as far as research available today suggests.

Taking painkillers or analgesics would be the obvious answer. Most of the pain during periods in the teenage period, gradually decrease with age. Before painkillers, for mild pains a hot water bath or hot fomentation may give considerable relief.

Pain during periods is possibly due to the release of prostaglandins. Often painful periods are transient in nature and settle with age. Occasionally due to various diseases like endometriosis and infections, the pain may get progressively worse. What starts initially around the time of periods may last the entire month causing considerable discomfort.

There are roughly two types of pain during periods. One type occurs during the bleeding phase, which is common and usually not associated with disease. In the second type where pain starts well before the period begins and ends later, could be associated with diseases like pelvic inflammatory disease and endometriosis.

Increasing need for painkillers could possibly but not necessarily be suggestive of a gynecologic disorder. It would be wise to check with your doctor.

Only when conventional analgesics are not able to control pain or the need of medicines becomes prohibitively high with possible harm, is an operation considered. Also abnormalities diagnosed during pelvic examination or in the course of an ultrasound could warrant a surgery for further evaluation.

Chocolate cysts get the name for the altered blood retained in the cysts, which looks like chocolate when the cysts rupture. These cysts are associated with a disease called endometriosis. Though the cysts may be an incidental finding, often it is associated with painful periods and lower tummy heaviness persisting throughout the cycle.

Yes, it is indeed a possibility. A chronic infection or a non-gynaecological problem may be present. You need to be evaluated by a doctor.

It all depends on the degree of the disease. In severe cases it can adversely affect the chances of fertility. Surgery combined with medical therapy and use of artificial reproductive techniques is usually necessary for women with endometriosis finding it difficult to conceive.

Unfortunately, endometriosis has a high recurrence rate, sometimes years after the original disease was first detected. Besides this the pain may warrant long-term treatment in women with endometriosis.

Only some features of the disease like chocolate cysts are visible on ultrasound. Other features like adhesions cannot be seen. It also needs to be understood that mild disease inside the body can present with severe symptoms and it is always not always proportional.

30% women do not recognize heavy period bleeding. Passing of clots, prolonged bleeding for over a week and flooding are rough indicators of heavy bleeding. The most predictive indicator however is blood haemoglobin estimation. Normal values should be between 12 and 14gm%.

When heavy bleeding is significant enough to cause anaemia or severely interferes with one’s quality of life it should be treated. Abnormal heavy bleeding may need investigation and treatment when suspected to be associated with malignancy.

Hormonal imbalance is one of the most common reasons for heavy bleeding. Besides this, tumours of the uterus, infections, endometriosis, malignancies could also cause heavy bleeding.

Simple haemoglobin estimation is useful to assess the severity of the situation. Thyroid function tests and an ultrasonography done through the vaginal route are useful assessment tools. Sometimes a biopsy of the inner uterine wall may be required to find out the cause.

The principles are to find out the cause. Start appropriate treatment to arrest the bleeding and give medicines to boost up the haemoglobin.

Medicines may be hormonal or non-hormonal. Among the non-hormonal medicines tranexamic acid is the most popular and effective. A variety of hormonal agents may be offered ranging from progesterone derivatives to oral contraceptive pills.

If the bleeding is due to hormonal imbalance then treatment may consist of a Mirena coil, which is a hormonal device kept in the uterus to control bleeding locally. It is very effective and cuts down the necessity of a hysterectomy in many cases. For women who have completed their family, treating the inner uterine lining with heat (balloon ablation) or x-rays (radiofrequency ablation) often controls bleeding.

Anaemia is the scientific term used for a decrease in the oxygen carrying capacity of the blood. It is suspected by symptoms of tiredness, malaise, palpitations etc and confirmed by low haemoglobin values (<11g%).

Anaemia is very common in the community. Seven out of 10 women in India are anaemic. The incidence is higher in rural areas compared to the urban population.

The signs of anaemia include fatigue, tiredness, malaise, palpitations and feeling irritable. There can also be signs of decreased appetite and difficulty to sleep.

A diet rich in iron consists essentially of meat (liver, kidney, beef), cereals (bran wheat, soya flour, wheat germ), nuts (cashew, almonds, hazelnut) and beans (soyabeans and red kidney beans) besides figs, apricots and malt bread.

Haemoglobin estimation in the blood would help. It is a simple blood test available in almost all laboratories. A value less than 11gm% should definitely be considered abnormal. Values less than 8gm% indicates a severe form of anaemia and needs to be addressed urgently.

The most common cause is from nutritional deficiencies – iron and folic acid. Here comes the role of an iron-rich diet. Excessive blood loss during menses or through the bowels (dark stools or fresh blood) may be responsible in some cases. Intestinal worm infestations and malaria may be the cause of anaemia in endemic populations. A variety of blood disorders could also present as anaemia.

To tackle anaemia it is important to know the cause. Usually if there is an obvious source of blood loss from the body it needs to be minimized. In mild cases, a diet rich of iron may be helpful, but in severe cases in addition to diet, iron supplements are necessary. Though oral medicines are the first line, in some cases injections may be required. In extreme cases, blood transfusion may be necessary.

It is true that there are a variety of iron tablets available in the market and often we are lost for choice. All irons are not tolerated equally in an individual. Usually your doctor knows best and it would be useful to follow his advice in this case.

Oral Iron may occasionally cause severe gastrointestinal side effects, which would be difficult to tolerate in some individuals. Iron in an injectable form, may be taken deep in the muscle or as an infusion through the veins. However, injections are painful, expensive and can lead to adverse reactions in some cases. Usually by trial and error, different iron salts may be tried out for tolerability, before resorting to injections.

Chronic blood loss – through periods, urine or stool, often unnoticed could be responsible. Worms in stool could be another source for chronic blood loss. It is also important to ensure that you are not suffering from any blood diseases e.g. Thalassemia carriers.

Abstinence is the only 100% reliable contraception. Most of the hormonal contraceptives (oral, injectable, implants) come close to 100% (>99%)

The problems of an unwanted pregnancy are abortion and its complications or the additional burden of maintaining an unwanted pregnancy. If you are unmarried add to it the social pressures from family and friends. For the unmarried and brave be ready for the ostracism faced by a single mother if your partner ditches you.

Condoms are one of the best contraceptives for preventing sexually transmitted diseases though not as effective in preventing a pregnancy. Assuming you or your partner may have other sexual partners it is always prudent to be safe and use condoms during intercourse.

Often it is difficult to describe what infrequent means and realizing that the timing of the act is often unpredictable, contraception or protection should be planned well in advance. i-pill/unwanted 72 are emergency contraceptives and meant for use when pills are forgotten, condoms burst or when the safe period is calculated incorrectly. It works for a single act of intercourse with a 90?ficacy and is actually a backup method and not an alternative method for regular contraception.

Douching or washing of the genitalia is no guarantee that all the sperms will be washed out. There are still chances of becoming pregnant, as some sperms would have crossed in before you washed and you can really never be sure that all the sperms have been washed off, as they cannot be seen.

Of course if you had sex you may be pregnant even if you were using protection, as nothing is 100%. The first thing to do in that case is to get your urine tested for pregnancy. This may be done by picking up a pregnancy test kit at any chemist shop. It is not always essential to take a morning sample, if tested after a week of the missed period. Pregnancy can be detected as early as a couple of days after the missed period date. Instructions of testing are clearly inscribed over the packet.

Yes. There are medicines, which can be prescribed to induce abortions. This should always be done under the supervision of a doctor and are most effective (>95% completion rate) in the first two months of pregnancy.

Done in the first seven weeks the efficacy is close to 99%. Till 9 weeks it is still reliable in up to 95?ses. Thereafter the efficacy falls. Yes the process is painful but usually well tolerated with oral analgesics. Hospitalization is often not necessary but hospital backup should be available in an emergency.

By ‘cheap’ place I presume you mean the illegal and untrained care providers. This leaves you at a risk of complications like severe bleeding, uterine perforation, bowel injury and infection in the short term and chronic pain and sub fertility in the long run. You may actually die from the procedure. One Indian mother dies every 40 minutes due to an illegal abortion.

One way is waiting for the next period, which makes it pretty clear and simple. Alternately, an ultrasound examination could reveal an empty womb/uterus, three weeks after the procedure confirming completion. Pregnancy tests can remain positive for several weeks after an abortion and are not good guides.

Due to the hormonal changes that occur during growing up, women tend to put on weight especially around the hips. This along with the breast development gives a woman the curves in her body.

It is perfectly normal to get attracted to boys during the phase of adolescence and there is no reason to feel guilty about it.

Developing acne is a common occurrence in early adulthood. It is often due to the hormonal effects the woman undergoes. This makes the skin oily and predisposing to dirt collecting under the skin pores. The best thing would be to clean the face with a simple face wash repeatedly. It is also important not to pick the acne as it can leave ugly scars and spread dangerous infection to the brain.

It must first be considered why are you shy. Usually it is due to a traditional upbringing or in an environment where free mixing of the genders is taboo. To overcome shyness, it would be to worth trying to interact in a group and to do some introspection. You should be careful not to get carried away by peer pressure and indulge in behaviour, which makes you uncomfortable.

Come on, you do not need to have a boyfriend just because a few of your friends may be having one. You must also get out of the mindset that not having a boyfriend makes you pathological. Maintain healthy relationships with members of both sexes and you should just be fine.

An alcoholic is a person who is dependent on alcohol and thus becomes a social liability. You become an alcoholic when you cross the limit. Enjoying wine with food is alright as long as it does not go against your moral, social and family principles.

Taking a few drags!! On the other hand you should influence your boyfriend to stop. Smoking does not make you look cool. It is a dangerous habit having very serious consequences on your health. It affects the lungs, heart besides being responsible for several cancers of the body.

It is important to maintain good hygiene around your private parts. Trim your pubic hair from time to time and wash the area with soap during a bath. Change undergarments regularly and prefer cotton to synthetic varieties. Avoid the use of deodarants or powder in that area as it may be harmful. It you have itching or white discharge along with the smell, you may have an infection and need to consult a gynecologist.

Shaving pubic hair regularly is not recommended but it is important to trim the hair so that dirt does not collect predisposing to infection. Above all maintain good perineal hygiene at all times.

What is in a mole? That could well be your beauty spot. Physical attributes are often not under your control and you could well ignore the comments and not get influenced by them. It would be difficult to explain to your friends but once you start ignoring the comments, they will decrease in time.

Do not worry. You are not alone. There are many girls of your age group who are feeling the same. But think about it for a moment – why will everyone be against you? Have you done some wrong? More often it is about ideas and opinions not matching. Of course you are loved and wanted in this world and you should understand that this is a passing phase of life which would soon be over.

Your parents are not your enemies. After all they brought you into this world and got you to where you are today. At times there will be conflicting view points which can be sorted out with discussions. Before getting angry or upset, you should always think of their view-point on the subject. It is important to confide in your parents and keep them your best friends forever.

That is normal human feeling. Why is she so popular and not me? If there is something special in her, admit it and get over the feelings. Never let the green monster – jealousy eat you up as it can make you do pretty dreadful things. You are special in your own way!

You are not the only one who feels like that. Many of us would love to have a beautiful face and body admired by all. But it is important to admit that God has made us all differently and we must appreciate the special qualities present in each of us, which may not be superficial. Beauty is just skin deep, it is time you look beneath.

Have you broken up or madly in love? Anyway blame it on your age. There are many girls of your age who would be feeling the same. But grow up lady and there are more things to life than boyfriends. You have your studies and responsibilities towards your family and society and your own future at stake. Sort out your priorities, get over it and move ahead.

She is probably smarter than you are and it is time you admit the fact. If you think otherwise show it in the exams. You must accept everyone cannot be first. Study hard and work on subjects where you need more attention to up your grades.

You need help dear. Talk to a psychologist or psychiatrist and seek urgent medical help. There are diseases you could be suffering from which need to be treated before you end up doing something drastic.

I am sure you have some virtues, which she will not have. As no two fingers on a hand are the same, the same goes for sisters. Try to explain it to your father or another close relative who can talk to your mother.

Unfortunately dear we live in a society and there are some principles we need to follow. Also I am not sure at your age you are quite sure of what you actually want and the consequences of the same. Love life, enjoy life but respect the limits.

That cannot be true. It is just the way you have felt or believed. I am sure your teacher will help you. Get involved in sports and extracurricular activities. You will surely get some girls with common interests and that lays the first seeds of friendship.

11 yrs is generally not considered too early. I am sure there are classmates like you too. The worries are your height may not increase much from here. There are rare chances of having a disease inside for which you may need to see your doctor.

Periods can start as late as 16years, but the other signs of maturity like breast development usually appear by then. I am sure there are classmates who have not started their period, which does not make them abnormal. However, if you are very concerned about this delay you can visit a gynecologist and take a medical opinion after a general medical examination.

There are several brands of sanitary napkins available in the market. Try the one that fits you the best, does not irritate your skin and keeps you dry. That should be the right one for you and you can find out the correct size. Make sure you keep stock as periods in your age may be irregular at times.

Though there is no hard and fast rule. It actually depends on the amount of bleeding and what makes you comfortable. Usually on the heavy days you may need to change pads 3-4 times in a day but for the lighter flows 1-2 may do.

It is important to cover the used pads with a newspaper/plastic and dispose them in a bin. This will ensure proper removal avoiding embarrassment. It is important to remember not to flush them in the toilet as they clog the toilet.

Ideally you can do everything you do at other times. It will depend to some extent on how you are feeling in the days leading up to your period. Many women feel some cramps on the day of bleeding when it would be advisable to take things a little easy.

With adequate protection i.e. sanitary napkins that are absorbent and do not leak you can participate in all activities during your periods.

There is no fixed duration of the length of a menstrual cycle it can vary from 21 to 35 days and usually if it comes at a fixed duration i.e. 30 – 32 days in your case that is normal for you and does not need to be viewed as something wrong.

You need to see a doctor if you very often have grossly irregular periods like once every 2 – 3 months. Also if the bleeding is heavy and prolonged, associated with clots or painful enough to take sick leaves often, then you should see a doctor.

Unlike popular belief, less bleeding is not bad. It does not mean that the ‘bad’ blood is jamming up inside. Neither is it an indication that periods will end up. Low thyroid hormone levels are responsible for such a problem in a small section of people.

Pain during periods is usually due to the release of prostaglandins. It is commonly seen in the teenage years, which gradually disappear with age. Sometimes however when the pain increases with time or appears later in life it could be associated with certain gynecological diseases like endometriosis. As gynecologists we are indirectly assured on asking you about period-pain, that since painful periods are usually associated with ovulatory cycles you should not be having too much difficulty in bearing children once you grow up.

Remedies for pain during periods initially consist of a warm bath or applying local heat with a hot-water, rubber bottle, relaxation, yoga, light stretching exercises and avoiding spicy food. If these do not work and the pain interferes with daily life, painkillers/analgesics may be taken.

Painkillers are not harmful when taken in moderation after food. Saving up a few medicines and tolerating severe pain does not make sense. There are no long-term harmful effects.

If the clots are big then there is a cause for worry. The first thing to be done is to check a hemoglobin level to find out whether the bleeding is responsible for lowering the blood levels in the body. If that is the case, you definitely need to see a doctor. Very likely medicines will be offered to reduce the bleeding and investigations would be done to find out the cause.

Prolonged spotting i.e. very slight bleeding around the times of the periods is often due to hormonal imbalance. If responsible for lowering hemoglobin levels or causing discomfort, medical treatment may be offered.

For the first 2 – 3 years after the periods commence there may be some irregularity. However, heavy bleeding every 2-3 months is usually suggestive of a hormonal imbalance and needs medical supervision. Please get yourself checked up by a doctor.

There are changes in the body felt by many women in the days leading up to the periods. Breast pain is just one of them. They are almost always due to hormonal effects and not due to cancer, which many women are afraid of. If the pain is severe medicines may be offered for relief. Sometimes the medicines need to be taken cyclically for a few months.

Feeling bloated around the time of the periods is quite common. It happens most probably due to hormonal changes. The need to see a doctor depends on the degree of discomfort. Taking a salt-restricted diet, avoiding caffeine and chocolates around this time can help to some extent in reducing this discomfort.

The first thing you should ask yourself is, could you be pregnant? Obviously that would be possible only if you have sex. Though you may be using contraception it must be realized nothing is 100% so you just cannot be sure. If you are not sexually active missing a period could be due to several reasons ranging from emotional changes to hormonal changes. If it is a one-off thing we often do not advise investigations. Medicines are usually advised to bring on the period.

Born as a female, periods are an integral part of the experience of being a woman. It marks the transition from a child to an adult. They signify your potential for childbearing, which is one of the enriching experiences of womanhood. Why think of it as messy and bothersome. Boys too have to shave everyday!!

There are legal limits for having sexual intercourse in India. Intercourse before the age of 16 years could be considered as rape even if done with mutual consent. Generally adolescents could have sex when they are physically and mentally ready for it and understand the consequences of their action.

You should not do something against your will. Are you both committed for a long-term relationship? Try to explain to him your reservations and if he is dedicated he should appreciate your concerns. Giving sex to achieve happiness will not work. It is usually the other way.

The guilty feeling of losing virginity haunts many especially when it is done on the sly. You may feel you have cheated the trust of your parents. With a chance of a pregnancy you face the consequences of abortions, their complications and social ostracism. Also are the risks of sexually transmitted diseases including HIV are a reality especially if condoms are not being used.

The risk of pregnancy may be roughly estimated from the time of the cycle intercourse had occurred, maximum risk being in the middle of the cycle. Emergency contraception comes in the picture here. The best-known names are i-pill and Unwanted 72. Taken within 72 hours from the time of intercourse, it reduces the chances of pregnancy by 90%. The other facts to remember are that the emergency pills are not meant for routine use, they are only 90?fective and they are applicable for a single act of intercourse. Also the efficacy decreases from 0- 72 hrs i.e. it is most efficacious if taken closer to the time of intercourse.

The withdrawal method is one of the most unreliable methods of contraception. It has a failure rate of over 25 – 30% i.e. once in 3 - 4 attempts. The safe period is avoiding sex at a time of the cycle when the chances of pregnancy are the maximum. This usually means the middle time of the period roughly 8 – 9 days after the bleeding starts for a period of 10 – 12 days. This is also not very reliable having a failure rate of 15 – 20% and not recommended in isolation.

Oral sex carries the risk of sexually transmitted diseases as in the case of genital penetration. There is no risk of pregnancy however. Whether it is good or bad depends on the way you look at it.

Unless adequate lubrication is used, tears in the mucosa may occur. The risk of sexual transmission of diseases increases, though pregnancy chances are less.

Do not panic. Do not keep pressing to check for secretions as it often stimulates discharge. Among other things like being on certain group of medicines, there may be abnormal hormone levels responsible but often no cause is found. Any way almost never does it have anything to do with cancer. It would be wise to get yourself checked by a doctor.

There is no sure way of knowing or establishing virginity. Regarding hymen rupture and vaginal dilatation they could occur from anything like astride injuries, horse riding and masturbation. It would be difficult to make out. You could do some Kegels exercises for tightening the vagina. Alternately you could have a vaginoplasty to get back the ‘tight fit’.

There are more than one ways where you can show affection to your partner. A kiss, hug or cuddle could be the physical ways. A crafty love letter, a cute gift, a surprise treat could be other ways of showing affection.

It would be wrong if you let it affect your studies or concentration which is bound to occur at your age so take it in your stride and put it off till you are old enough to handle it.

Showing skin and exposing yourself will not earn you the friendship and respect of your friends or boys. Your parents are not old-fashioned. They are just concerned about your safety. You can be trendy, smart and attractive without having to show skin by wearing well-fitted clothes of the right colour and using the right accessories.

Foul smelling discharge is likely to be related to an infection. Get yourself and your partner (if you are sexually active) treated by a doctor. It is likely you will be put through some tests and given some antibiotics. Advice will include preventive measures like maintaining good perineal hygiene and barrier contraception.

Itching near the private parts could be associated with a fungal infection. Topical treatment consists of creams or pessaries to insert inside the vaginal passage. Often oral medicines are used alone or in addition to the topical agents. There are different reasons for these infections – it could be due to poor genital hygiene, through sexually transmission, following a course of antibiotics or in association with other diseases like diabetes.

Are you still prepared to hang around with him is my question? If you believe in a monogamous relationship you need to protest and confront him. If you want to carry on, it would be wise to use barrier protection like condoms before every sexual act.

They are not the same. HIV (Human Immunodeficiency Virus) is the viral infection, which over time may result in the disease AIDS (Acquired immunodeficiency Syndrome) where the immune system of the body is compromised making it susceptible to various infections.

HIV spreads most commonly by the sexual route. Both heterosexual and homosexual relationships could spread the infection. All kinds of sexual activity – oral, anal or genital can result in any of the sexually transmitted infection including HIV. Mother-to-child transmission and sharing of body fluids are also responsible. Transfusion of HIV contaminated blood and sharing needles as in cases of drug abusers are other reasons for spread. HIV does not spread by touch or sharing objects of daily use.

Yes you could have an infection. It would be worth getting yourself and your partner evaluated at a clinic. It is likely both of you would be given medicines for relief of your problems.

There are government-approved centers where you can check your HIV status. Alternately you can have your blood sample tested from a private clinic. The initial test result if positive, would need to be confirmed, by another special test.

HIV does not mean death. A fraction of patients with the infection eventually go on to have the disease i.e. AIDS. There is no absolute cure for the disease. However medicines are available to reduce the viral load to a minimum and limit symptoms arising from advanced disease.

Staying in a sexual relationship with a single partner would be ideal. Barrier contraception or condoms should be used during intercourse. Avoid sharing of needles or using contaminated needles. Ensure that transfused blood is screened for the virus.

It is good you think about and feel for the HIV cause. There are NGOs doing good work for people living with AIDS and you can definitely be of help. Contact their websites for ways in which you can contribute.

An obvious query is how old are you. Presuming you are 16 yrs there are less chances for the breast to grow from now. Cremes and medicines do not work in increasing your bust size. Your breasts should not come in the way of your self-esteem as there are other things you have in your personality, which others do not. Cherish the assets you possess instead of bothering over what you do not have. You could wear padded bras to give your bosom a fuller look. Plastic surgery is an option for those of you getting into modeling or the entertainment industry.

Though you may see ads on television and in newspapers or magazines, it must be stressed that nothing works scientifically. Giving estrogen hormones to increase the breast may work a little but will have some side effects on the periods. It is important to accept the way God has made you and accept your body as it is. Besides small can be beautiful. There are other girls who may feel that their breasts are too big!!

During the initial development of the breast a little asymmetry may appear which clears up with time. Asymmetry may exist later in life too but should be accepted if mild. Plastic surgery is the last resort and often not advised from medical point of view. This asymmetry would not interfere with your future ability to breastfeed.

Unfortunately or rather fortunately, there is no standard. As all women do not look the same, their breast sizes too are different. It is important to accept what you possess.

The initial stage of breast development occurs usually between the ages of 8 and 13 years. Later during pregnancy further breast development occurs.

Usually your mother or an elder sister is the best person to guide you in this regard. It marks the transition from a girl to a young lady. Apart from the size and material, the bra should fit you snugly and keep you comfortable.

There are no medicines to shrink large breasts. Accepting them as a part of your body is the key. It should not affect your self-esteem and your interaction with others. Alternately you may consider yourself blessed and there are many out there who would be glad to be in your place. Do not consider plastic surgery for correction unless they are causing you to develop a complex. Taking an opinion from a properly qualified doctor in this regard would be reassuring.

Why just think of breasts? What is striking in a woman is her personality and her body is just a part of it. Do not think what others think of you because it does not matter in the long term. Remember no one can make you feel inferior without your consent.

Blame it on testosterone. For many boys what appeals in a woman at first instance is her body. But more than boys actually staring at your breasts, it is more likely that you are thinking that way. Young lady, think beyond breasts and you will feel much better.

Cyclical breast pain especially around the time of periods is something seen in 20-30% women at some time of their reproductive life. It is likely to be hormonal fluctuations around the time of menstruation and does not need medication if bearable. Only if you are in unbearable discomfort you should consult a gynecologist and take appropriate medicines.

By crash dieting I presume you mean eating nothing or very little if at all. Your body needs some nutrients for daily activity, which are not stored and need to be replenished everyday. Besides this a certain amount of roughage is necessary for clear evacuation of bowels. Crash dieting is scientifically unhealthy and can make you sick and deficient in essential nutrients. If you want to lose weight, cut down on the carbohydrates and fats and start a regular exercise schedule.

No dear you are not. Though you have not mentioned your height. Assuming it to be 5 feet 4 inches you should be around 45 kg. You have a misconception, which needs to be cleared by a dietician and doctor.

Of course it is wrong. Have you heard others doing the same? Forced vomiting after food besides loss of nutrients will corrode your food pipe and teeth. You will not gain weight if you take a nutritious diet and engage in regular physical activity. All this vomiting and laxatives are pretty unnecessary.

A good reference would be referring to the chart catering to Indian women.

Wake up good friend. Assuming a height of five and a half feet you are still at least 10 – 12 kg overweight. You should simply adjust your dietary habits cutting down on junk food, carbohydrate and fats. You should also adopt an exercise regime or engage in an outdoor sport. Losing weight is important to keep you healthy.

Lose weight my dear. It is not easy but you have to have the determination to lose weight first. Diet and exercise will do the trick and no magic pill will work. Also do not get easily affected of what people talk about you. When you cannot stop all from talking change yourself.

There are no shortcuts for losing weight. You need to gradually lose weight and not lose weight fast. Weight lost too fast is also gained fast. Slow and steady remains the key. Diet control and avoiding high calorie food is helpful but exercise is needed too to burn calories. To make exercise fun, convert it into a game of table tennis or badminton. Better still learn swimming or join a dance class!!

No one in this world is perfect and it is time you understand this. It would be ideal to accept yourself as you are and others will follow suit. Plastic surgery should be reserved as a last resort or for the entertainment industry. All surgeries are associated with certain risks and you must understand that.

Remember the MJ song ‘Black or White’. Dark skin is the last thing, which should give you an inferiority complex. Think about Halle Berry and Naomi Campbell!! It’s the quality or skin texture you should concentrate on. Change what you can i.e. the complex and leave the dark skin. Start thinking beyond skin colour. Learn to match the colours you wear with your skin tone, be lively, smile often and nobody will comment on your colour then.

Stay away from the fairness crèmes, there is no scientific basis for their use as skin colour is genetic and also depends on the production of melatonin a chemical produced by skin cells in response to sunlight. Use a sunscreen instead if you have to as it will prevent tanning. There are many takers for dark skin and you should not worry. There are more important things in life you would probably be involved with than your complexion. Accept it.

Menopause occurs when the function of the ovaries stops permanently. This results in a loss of hormones, which used to act on the uterine wall leading to a permanent stoppage of menstruation.

In Indian women, menopause occurs around the age of 48 years. However, it is not unusual to have cyclical periods in the early fifties. In 1% of women, premature menopause is seen before the age of forty.

Menopause may occur naturally with age, following the surgical removal of the ovaries or post radiation therapy as a part of cancer treatment.

Hot flashes, irritability, mood swings, depression, sleep disturbances, vaginal dryness, decreased libido, painful intercourse, incontinence of urine, frequent passing of urine etc

Long-term problems of menopause are closely associated with problems, which occur due to old age. These include thinning of the bones (osteoporosis) and an increased predisposition to fractures. Cardiovascular diseases and strokes increase after menopause.

Many short term problems of menopause seriously adverse the quality of life in women thus necessitating treatment. Urinary tract infections and atrophic vaginitis also need appropriate treatment. Osteoporosis, the silent killer, if not treated early may present later in life with a hip fracture.

It is not necessary to treat every menopausal woman with medicines. The use of hormones would generally be reserved for symptomatic women. For most others meditation, yoga, light exercises, nutritious diet, avoiding spices and caffeine could be useful in controlling mild symptoms.

Most of the symptoms of menopause are attributed to the low level of the ovarian hormone – estrogen. HRT or hormone replacement therapy essentially means replacing the deficient hormones to alleviate the symptoms. There is an analogy to the thyroid gland where in cases of deficiency, thyroid hormone is substituted.

Hormone therapy is an excellent and effective treatment for menopausal symptoms. However, it should always be administered under supervision of a doctor. Side effects include a slightly higher risk of breast cancer, blood clots in the body, strokes and heart disease especially after prolonged (>5 years) unsupervised use.

Premature menopause is the cessation of menstruation before the age of forty. Due to early deficiency of estrogen the risk of osteoporosis is high. Early replacement of hormones and regular calcium intake is necessary.

Cancer is rapidly increasing in India and most of us are sitting ducks. Just talking about cervical cancer, in India it is seen that 200 women die every day i.e. one woman every 7 minutes.

Indian women are most prone to Cancer of the Cervix (neck of the womb); Breast cancer comes second; other cancers affecting women are those involving the ovaries and uterine wall.

Many cancers detected early have a near complete recovery. Cancers detected in the late stage after spreading to other organs generally carry a poor prognosis.

General measures of preventing cancer would include a healthy lifestyle – avoiding tobacco use, minimizing alcohol and food with preservatives, living in a pollution-free environment and maintain a healthy diet and regular exercise regime. Inspite of all this, cancer can often not be prevented. For cervical cancer over the last few years a vaccine with 75% protection has been developed.

Screening is a procedure adopted to pick up cancer in a healthy population of subjects who have no problems. It helps in early detection increasing treatment options and improving life expectancy. The most popular screening for cervical cancer is the Pap smear. Cancer of the uterus and ovary may be suspected by a sonography done by the trans-vaginal route.

The Pap smear essentially is a scrape from the neck of the womb to collect cells and observe them under the microscope for signs of cancer. It is not painful but may cause some discomfort much like a pelvic examination. Done when there is no menstrual bleeding, it usually takes just a few minutes. All sexually active women should have regular Pap smears every 3 years.

Early signs of cervical cancer include blood-stained discharge intermittently during the cycle or after intercourse or menopause. Often however there may not be any symptoms and that is the reason why regular Pap smears are advised.

One important thing for cancer is early evaluation and treatment. For most early cancers surgery is the first treatment offered. In later stages surgery is avoided or complemented with chemotherapy and radiotherapy. Whatever be your case, you need urgent evaluation preferably in a multispecialty cancer hospital where all modalities of care would be available.

Vaccines are inactivated viral/bacterial particles, which on inoculation in the body helps in providing protection against when the active organism invades the body. The Human Papilloma Virus (HPV) is responsible for most cervical cancers and the vaccine helps in protecting against the virus.

The HPV Vaccine is safe for use in all healthy women. The Indian Academy of Paediatricians (IAP) and the Federation of Obstetrics and Gynaecological Societies of India (FOGSI) recommend its use.

As HPV infection is acquired through the sexual route, the vaccine should be ideally given to women before sexual debut. Recommended age is 10 to 25 yrs. Women after engaging in sexual intercourse may still be offered the vaccine with limited benefits.

As HPV also causes cancers and warts in the male reproductive organs, they may also be offered the vaccines.

Three doses over a period of six months, 0/1/6 or 0/2/6 depending on the vaccine you opt for. There is no particular time for giving the vaccine

The Vaccine should be administered by a doctor in the deltoid muscle of the upper arm in the sitting/lying down position. Usually there are no adverse effects except some local irritation in some women

CervarixTM (GSK) and Gardasil ® (MSD)

Each dose of the Vaccine costs between Rs 2500 - 3000

The vaccine prevents 75% of cervical cancers. Screening in the form of regular pap smears still need to be done after vaccination.