What is cancer of the cervix?

A woman’s cervix (the opening of the uterus at the top of the vagina) is covered by a thin layer of tissue made up of cells. Healthy cells grow, divide, and are replaced as needed. Cancer of the cervix occurs when these cells change. Cancer cells divide more rapidly. They may grow into deeper cell layers or spread to other organs. The cancer cells eventually form a mass of tissue called a tumor.

How long does it take for cervical cancer to develop?

It often takes several years for cervical cancer to develop. During this time, the cells on or around the cervix become abnormal. The cell changes that occur before cancer is present are called dysplasia or cervical intraepithelial neoplasia (CIN).

What is the main cause of cervical cancer?

The main cause of cervical cancer is human papillomavirus (HPV) . There are many types of HPV. Some types of HPV, called “high-risk types,” can cause cancer of the anus, cervix, vulva, vagina, and penis. They also can cause cancer of the head and neck. Other types have been linked to genital warts.

Who is at risk of cervical cancer?

The most important risk factor for cervical cancer is infection with the types of HPV linked to cancer. The following factors increase your risk of becoming infected with HPV:

• Multiple sexual partners
• Having a male sexual partner who has had multiple sexual partners
• Early age at which you first had sex (younger than 18 years)

Other risk factors include the following:

• A personal history of dysplasia of the cervix, vagina, or vulva
• A family history of cervical cancer
• Smoking
• Certain sexually transmitted diseases, such as chlamydia
• Problems with the immune system
• Having a mother who took a drug called diethylstilbestrol (DES) during pregnancy

Is there a screening test for cervical cancer?

Yes. The Pap test checks for abnormal cell changes of the cervix. This allows early treatment of the abnormal cells so that they do not become cancer. An HPV test also is available. It is used along with the Pap test to screen for cervical cancer in some women and as a follow-up test when a woman has an abnormal Pap test result.

What are some of the symptoms of cervical cancer?

The first signs may be abnormal bleeding, spotting, or watery discharge from the vagina. Menstrual bleeding may be heavier than usual, and bleeding may occur after sex. Signs of advanced cancer can include pelvic pain, problems urinating, and swollen legs. If the cancer has spread to nearby organs or the lymph nodes, the tumors can affect how those organs work. For instance, a tumor might press on your bladder or block blood flow in a vein.

How is cervical cancer diagnosed?

If your health care provider suspects that you have cancer of the cervix, a biopsy may be done. For certain abnormal Pap test results that require treatment, the abnormal cervical tissue may be removed and sent to a lab to be studied.

If cervical cancer is diagnosed, your health care provider will assess the size of the cancer and the extent (if any) to
which the disease has spread. This process may include the following tests:

• A pelvic exam (which may include a rectal exam)—An examination in which your health care provider checks the uterus, ovaries, and other organs near the cervix
• Cystoscopy—A test in which the inside of the urethra and bladder are studied with a lighted device

Colonoscopy—A test in which the entire colon is examined with a slender, lighted instrument called a colonoscope

What is staging?

“Staging” is the process of finding out how much the cancer has spread. Most types of cancer have stages from I to IV. The lower the number, the less the cancer has spread.

Some types of cancer, including cervical cancer, have a Stage 0. Stage 0 also is called noninvasive cervical cancer or carcinoma in situ. In Stage 0, cancer cells are present on the top layer of the cervix only. They have not gone into deeper layers of the cervical tissue or other organs. The remaining stages are called invasive cancer. In these stages, the cancer has invaded into deeper layers of the cervix.

What are the types of treatment?

Invasive cancer of the cervix is treated with surgery (hysterectomy), radiation therapy, and chemotherapy (the use of cancer-killing drugs). The type of treatment chosen depends on the cancer stage. You may receive more than one type of treatment.

Is special follow-up required after treatment?

Your health care provider may suggest more frequent cervical cancer screening for the first few years after treatment to make sure that all the cancer cells were removed. Even if your cervix has been removed to treat your cancer, you still need cervical cancer screening. Cells are taken from the upper vagina instead of the cervix.

Reference: The American Congress of Obstetricians and Gynecologists. http://www.acog.org/Patients/FAQs/Cervical-Cancer

BLADDER PROLAPSE (CYSTOCELE/FALLEN BLADDER)

Are you a woman experiencing discomfort or a bulging in the vaginal area, problems with urination and/or painful intercourse? Then perhaps your bladder has shifted out of its normal position. Read on to learn more about bladder prolapse and what treatments are available.

What is bladder prolapse?

Under normal conditions in women, the bladder is held in position by a “hammock” of supportive pelvic floor muscles and ligaments. When these muscles and tissues are stretched and/or weakened, the back of the bladder can sag through this layer of muscles and ligaments and into the vagina, resulting in bladder prolapse, also referred to as a cystocele. In severe cases, the sagging bladder will appear at the vagina’s opening and can even protrude (drop) through it. Bladder prolapse can be very bothersome, can be associated with problems emptying the bladder, urinary tract infections or incontinence (unwanted loss of urine), and can usually be corrected.

What causes bladder prolapse?

Prolapse can develop for a variety of reasons, but the most significant factor is stress on this supportive “hammock” during childbirth. Women who have multiple pregnancies or deliver vaginally are at higher risk. Other factors that can lead to prolapse include: heavy lifting, chronic coughing (or other lung problems), constipation, frequently straining to pass stool, obesity, menopause (when estrogen levels start to drop) and previous pelvic surgery.

What are the symptoms for bladder prolapse?

Symptoms associated with prolapse include: frequent urination or urge to urinate; stress incontinence; not feeling bladder relief immediately after urinating; frequent urinary tract infections; discomfort or pain in the vagina, pelvis, lower abdomen, groin or lower back; heaviness or pressure in the vaginal area; painful intercourse; or tissue protruding from the vagina that may be tender and/or bleeding. Mild cases of prolapse may not cause any symptoms.

How is bladder prolapse detected?

Prolapse can usually be detected with a pelvic examination. However, a voiding cystourethrogram may be required. This test involves a series of X-ray pictures that are taken during urination which will show the shape of the bladder and will help identify obstructions blocking the normal flow of urine. Other X-rays and tests may also be required to find or rule out problems in other parts of the urinary system, including urodynamics, cystoscopy andfluoroscopy.

What are the treatment options for bladder prolapse?

For mild prolapse cases, behavior therapies such as Kegel exercises (which help strengthen pelvic floor muscles) may be enough. Other treatments for more advanced cases can includeestrogen replacement therapy, and a pessary (vaginal support device) to provide better support for the organs. Surgery is usually required for bothersome cases that cannot be managed with a pessary.

If prolapse is left untreated, over time the condition may get worse. In rare cases, severe prolapse can cause urinary retention (inability to urinate) which may lead to kidney damage or infection. 
 
Reference: Urology Care Foundation. The Official Foundation of the American Urological Association. http://www.urologyhealth.org/urology/index.cfm?article=118

What things should I think about when choosing a birth control method?

To choose the right birth control method for you, consider the following:

• How well it prevents pregnancy
• How easy it is to use
• Whether you need a prescription to get it
• Whether it protects against sexually transmitted diseases (STDs)
• Whether you have any health problems

Do I need to have a pelvic exam to get birth control from my health care provider?

A pelvic exam is not needed to get most forms of birth control from a health care provider except for the intrauterine device (IUD), diaphragm, and cervical cap. If you have already had sex, you may need to have a pregnancy test and STD test before birth control can be prescribed.

Which birth control methods are the best at preventing pregnancy?

The following table shows all of the birth control methods and how well they protect against pregnancy.

Which birth control methods also protect against sexually transmitted diseases (STDs)?

The following table shows all of the birth control methods and how well they protect against pregnancy.

The male latex or polyurethane condom gives the best protection against STDs. The female condom provides some protection. With all other methods, you also should use a male or female condom to protect against STDs.

What is the birth control pill?

The birth control pill is a pill that you have to take every day at the same time each day. It contains hormones that prevent pregnancy. There are many types of birth control pills. Your health care provider can help you choose the right one for you.

If you miss a pill, you need to know what to do. Read the directions that came with your pack of pills. You also may want to contact your health care provider.

Effectiveness of Birth Control Methods*

HIV = human immunodeficiency virus; IUD = intrauterine device

*Other methods include fertility awareness-based methods and the lactational amenorrhea method (LAM) that can be used during the first 6 months of breastfeeding. Discuss these options with your health care provider.

What is the skin patch?

The patch is a small (1.75 square inch) adhesive patch that is worn on the skin. It contains hormones that are slowly released into your body through the skin. A new patch is worn for a week at a time for 3 weeks in a row. During the fourth week, a patch is not worn, and you will have your menstrual period.

What is the vaginal ring?

The ring is a flexible plastic ring that you insert into the upper vagina. It releases hormones into your body. It is worn inside the vagina for 21 days and then removed for 7 days. During those 7 days, you will have your menstrual period. Then you insert a new ring.

What is the birth control shot?

This shot is given in the upper arm or buttock every 3 months. It contains hormones that prevent pregnancy.

What is the implant?

The implant is a small plastic rod about the size of a matchstick that your health care provider inserts under the skin of the upper arm. It releases hormones. The implant protects against pregnancy for 3 years.

What is the intrauterine device (IUD)?

The intrauterine device (IUD) is a small, T-shaped, plastic device that is inserted and left inside the uterus. The IUD must be inserted and removed by a health care provider. Three types are available in the United States. Two contain hormones and last for 3 years and 5 years. The third type is the copper IUD. It lasts for as long as 10 years.

What are spermicides?

These are chemicals that are put into the vagina to make sperm inactive. There are many types of spermicides: foam, gel, cream, film (thin sheets), or suppositories (solid inserts that melt after they are inserted into the vagina).

Frequent use of spermicides may increase the risk of getting human immunodeficiency virus (HIV) from an infected partner. Spermicides should only be used if you are at low risk of HIV infection.

What are condoms?

Condoms come in male and female versions. The male condom (“rubber”) covers the penis and catches the sperm after a man ejaculates. The female condom is a thin plastic pouch that lines the vagina. It prevents sperm from reaching the uterus. Condoms work better to prevent pregnancy when used with a spermicide. Spermicides should only be used if you are at low risk of HIV infection.

What is the diaphragm?

The diaphragm is a small dome-shaped device made of latex or silicone that fits inside the vagina and covers the cervix. You need a prescription for it. A health care provider needs to do a pelvic exam to find the right size of diaphragm for you. It always is used with a spermicide. Birth control methods that need spermicides to work should only be used if you are at low risk of HIV infection.

What is the cervical cap?

The cervical cap is a small, thin latex or plastic dome shaped like a thimble. It fits tightly over the cervix. You need a prescription for it. A health care provider needs to do a pelvic exam to find the right size for you. The cervical cap must be used with a spermicide. Birth control methods that need spermicides to work should only be used if you are at low risk of HIV infection.

What is the sponge?

The sponge can be bought without a prescription at drugstores and other stores. It is a doughnut-shaped device made of soft foam that is coated with spermicide. It is pushed up in the vagina to cover the cervix. Birth control methods that have spermicides should only be used if you are at low risk of HIV infection.

What is emergency birth control?

If you have sex without using any birth control, if the birth control method did not work (for instance, the condom broke during sex), or if you are raped, you can use emergency birth control to prevent pregnancy. Emergency birth control is available in pill form or as a copper IUD. The pills must be taken or the IUD inserted within 5 days of having unprotected sex.

What are the types of emergency birth control pills?

There are three types of emergency birth control pills: 1) the progestin-only pill, 2) regular birth control pills taken in certain amounts, and 3) ulipristal.

Where can I get emergency birth control?

Ulipristal and combination birth control pills are available only by prescription. One type of progestin-only pill (Plan B One- Step) is available on pharmacy store shelves without a prescription to anyone of any age. Another type of progestin-only pill (Next Choice One Dose) is available behind the pharmacy counter without a prescription to anyone 17 years or older if you show proof of age and by prescription if you are younger than 17 years. If you need more information about emergency birth control or need to find a health care provider who can provide a prescription, go to www.not-2-late.com or call the emergency birth control hotline at 1-888-NOT-2-LATE.

Removing a Bartholin Gland Cyst

Removal (excision) of a Bartholin gland cyst is a minor surgical procedure. Because the vulva has an extensive blood supply, removing a Bartholin gland cyst can cause bleeding. This is best treated in a surgical setting.

In the physicians office, you will be given whatever numbing and calming medicine you need for the procedure. If the cyst is painful, your doctor probably will recommend a general anesthetic to put you to sleep.

An excision procedure includes:

• Positioning you on the exam table in the same position used for a pelvic exam or Pap test.
• Cleaning the vulva and vagina with an antiseptic solution.
• Injecting a numbing medicine (local anesthetic) in the vulva area.
• Making a small cut (incision) into the cyst.
• Draining the fluid out of the cyst.
• Removing the entire cyst sac, which is the membrane that contains the cyst.

In rare cases, the entire Bartholin gland and duct are removed. This is often recommended for postmenopausal women with Bartholin gland problems because of the risk of cancer, which increases with age. But simply draining a Bartholin cyst and testing the cyst tissue for cancer is also a reasonable first-time treatment.

To lower your risk of infection, do not have sexual intercourse until the area is completely healed. This can take several weeks.

What is bacterial vaginosis?

Bacterial vaginosis is an infection in the vagina that can cause bad-smelling vaginal discharge. “Vaginal discharge” is the term doctors and nurses use to describe any fluid that comes out of the vagina. Normally, women have a small amount of vaginal discharge each day. But women with bacterial vaginosis can have a lot of vaginal discharge, or vaginal discharge that smells bad.

Bacterial vaginosis is caused by certain bacteria (germs). The vagina normally has different types of bacteria in it. When the amounts or the types of bacteria change, an infection can happen.

Women do not catch bacterial vaginosis from having sex. But women who have bacterial vaginosis have a higher chance of catching other infections from their partner during sex.

What are the symptoms of bacterial vaginosis? 

Most women with bacterial vaginosis have no symptoms. When women have symptoms, they often have a “fishy-smelling” vaginal discharge that they might notice more after sex. The discharge is watery and off-white or gray.

Some women can also have other symptoms that are not as common, but can include:

• Bleeding from the vagina after sex
• Itching on the outside of the vagina
• Pain when urinating or having sex

All of these symptoms can also be caused by other conditions. But if you have these symptoms, let your doctor or nurse know.

Is there a test for bacterial vaginosis? 

Yes. Your doctor or nurse will do an exam. He or she will also take a sample of your vaginal discharge, and do lab tests on the sample to look for an infection.

How is bacterial vaginosis treated? 

Bacterial vaginosis is treated with medicine. Two different medicines can be used. They are called

• Metronidazole
• Clindamycin

Both of these medicines come in different forms. They can come as a pill or as a gel or cream that a woman puts inside her vagina. Most women have fewer side effects when they use the gel or cream treatment. But you and your doctor or nurse will decide which medicine and which form is right for you.

It is important that you take all of the medicine your doctor or nurse prescribes, even if your symptoms go away after a few doses. Taking all of your medicine can help prevent the symptoms from coming back.

Does my sex partner need to be treated if I have bacterial vaginosis? 

No. Your sex partner does not need to be treated if you have bacterial vaginosis.

What happens if my symptoms come back?

If your symptoms come back, let your doctor or nurse know. You might need treatment with more medicine.

Some women get bacterial vaginosis over and over again. These women might take medicine for 3 to 6 months to try to prevent future infections.

What if I am pregnant and have symptoms of bacterial vaginosis?

If you are pregnant and have symptoms of bacterial vaginosis, tell your doctor or nurse. You might need treatment with
medicine.

Can bacterial vaginosis be prevented? 

Sometimes. You can help prevent bacterial vaginosis by:

• Not douching (douching is when a woman puts a liquid inside her vagina to rinse it out)
• Not having a lot of sex partners
• Not smoking

Many women experience abnormal vaginal bleeding or spotting between periods sometime in their lives. Vaginal bleeding is considered to be abnormal if it occurs:

• When you are not expecting your menstrual period.
• When your menstrual flow is lighter or heavier than what is normal for you.
• At a time in life when it is not expected, such as before age 9, when you are pregnant, or after menopause.

Abnormal vaginal bleeding has many possible causes. By itself, it does not necessarily indicate a serious condition.

• Because bleeding can mean a problem with pregnancy, possible pregnancy should always be considered in a woman of childbearing age.
• Spotting to minimal bleeding may be normal, but any bleeding during pregnancy needs to be evaluated by your doctor.
  Heavy vaginal bleeding or bleeding that occurs before 12 weeks may mean a serious problem, including an ectopic pregnancy or miscarriage.
  • Heavy vaginal bleeding or bleeding that occurs after 12 weeks also may mean a serious problem, such as placenta previa.
    Ovulation can cause mid-cycle bleeding.
  • Polycystic ovary syndrome (PCOS) is a hormone imbalance that interferes with normal ovulation which can cause abnormal bleeding.
  • Medicines, such as birth control pills, sometimes cause abnormal vaginal bleeding. You may have minor bleeding between periods during the first few months if you have recently started using birth control pills. You also may have bleeding if you do not take your pills at a regular time each day.
• An intrauterine device (IUD) also may increase your chances of spotting or heavy periods.
• Infection of the pelvic organs (vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted infections (STIs) are often the cause of infections. 
• Pelvic inflammatory disease (PID) causes inflammation or infection of the uterus, fallopian tubes, or ovaries, which can cause abnormal bleeding.

Other less common causes of abnormal vaginal bleeding that may be more serious include:

• Sexual abuse.
• An object in the vagina.
• Uterine fibroids, which are a common cause of heavy periods. 
• Structural problems, such as urethral prolapse or polyps.
• Cancer of the cervix, uterus, ovaries, or vagina.
• Extreme emotional stress and excessive exercise. But excessive exercise more frequently causes an absence of menstruation (amenorrhea).
• Other diseases, such as hyperthyroidism or diabetes.

Heavy bleeding during the first few weeks after delivery (postpartum) or after an abortion may occur because the uterus has not contracted to the prepregnancy size or because fetal tissue remains in the uterus (retained products of conception).

If you are age 40 or older, abnormal vaginal bleeding may mean that you are entering perimenopause. In a woman who has not had a menstrual period for 12 months, vaginal bleeding is always abnormal and should be discussed with your doctor.
Treatment of abnormal vaginal bleeding depends on the cause of the bleeding.

Check your symptoms to decide if and when you should see a doctor

What is an abnormal Pap test?

When your doctor says that your Pap test, or Pap smear, was abnormal, it means that the test found some cells on your cervix  that do not look normal.

A Pap test may be done as part of a woman’s routine physical exam, because it’s the best way to prevent cervical cancer. But having an abnormal test result doesn’t mean you have cancer. In fact, the chances that you have cancer are very small.

What causes an abnormal Pap test?

Most of the time, the abnormal cell changes are caused by certain types of human papillomavirus, or HPV. HPV is a sexually transmitted infection.

Usually these cell changes go away on their own. But certain types of HPV have been linked to cervical cancer. That’s why regular Pap tests are so important.

Sometimes the changed cells are due to other types of infection, such as those caused by bacteria or yeast. These infections can be treated.
In women who have been through menopause, a Pap test may find cell changes that are just the result of getting older.

What increases your risk for an abnormal Pap test?

Certain sexual behaviors, like having sex without condoms and having more than one sex partner (or having a sex partner who has other partners), can increase your risk for getting HPV. And HPV raises your risk for having an abnormal pap test.

HPV can stay in your body for many years without your knowing it. So even if you now have just one partner and practice safer sex, you could still have an abnormal Pap test if you were exposed to HPV in the past.

Smoking or having an impaired immune system also raises your chances of having cell changes in your cervix.

Do abnormal cell changes cause symptoms?

The cell changes themselves don’t cause symptoms. HPV, which causes most abnormal Pap tests, usually doesn’t cause symptoms either.

If a different sexually transmitted infection is the cause of your abnormal test, you may have symptoms such as:

• A discharge from the vagina that isn’t normal for you, such as a change in the amount, color, odor, or texture.
• Pain, burning, or itching in your pelvic or genital area when you urinate or have sex.
• Sores, lumps, blisters, rashes, or warts on or around your genitals

What will you need to do if you have an abnormal Pap test?

You may need more tests to find out if you have an infection or to find out how severe the cell changes are. For example, you may need:

• Colposcopy, a test to look at the vagina and cervix through a lighted magnifying tool.
• An HPV test. Like a Pap test, an HPV test is done on a sample of cells taken from the cervix.
• Another Pap test in about 6 to 12 months.

A colposcopy is usually done before any treatment is given. During a colposcopy, the doctor also takes a small sample of tissue from the cervix so that it can be looked at under a microscope. This is called a biopsy.

Treatment, if any, will depend on whether your abnormal cell changes are mild, moderate, or severe. In moderate to severe cases, you may have treatment to destroy or remove the abnormal cells.

Hysterectomy – Vaginal, Abdominal or Laparoscopy Assisted

Though you are well enough to return home following your surgery, there are a few instructions that will assist you when you return to your home environment.

1. Even though you may feel well, your body needs plenty of rest to heal. Take it easy those first few weeks. Don’t work. Drink plenty of fluids, at least 2-3 quarts per day, especially during the first week. Let your family assist you. Try to sleep at least 8-10 hours per day.

2. Use stairs sparingly, once or twice per day if possible. Don’t lift more than 15 pounds during those first two weeks.

3. Pelvic rest is advised for at least six weeks, or until you have been advised differently by your physcian. Pelvic rest means no sex, tampons, or douching.

4. Please advance your diet slowly. Avoid fatty foods or dairy products until your appetite and bowel functions have returned to normal. Gas and constipation can usually be remedied with over the counter preparations such as Milk of Magnesia, Colace, Mylicon or Fibercon.

5. Some vaginal bleeding or serous discharge is normal following surgery. However, heavy vaginal bleeding like a period or foul smelling discharge should prompt you to call the office for assistance.

6. Although some postoperative pain is unavoidable, this pain should be adequately relieved by medications prescribed. Should you not receive adequate relief, please call the office for assistance.

7. Abdominal incision should not require any special care, except for avoiding immersion in the tub. Showers are perfectly acceptable. Pat incision dry and even use a blow dryer. Should the incision show signs of drainage, redness, bleeding or gaping, please call the office.

8. Remember that you should be seen in 1-2 weeks from the time of discharge from the hospital. Please be sure to call for your appointment.

You have just had a procedure called a Hysteroscopy, D&C, or Endometrial Ablation with or without biopsy or removal of tissue from the uterus. Now that your procedure is over, you may eat or drink anything you like. Take it easy for the next 48 hours. Most women find it best to avoid strenuous activities; be guided by how you feel. It is important that you read over these instructions and follow them to the letter. Do not hesitate to call us if you are having a problem.

PRECAUTIONS AND WHAT TO EXPECT

1. Use sanitary pads only — NO TAMPONS– for one week.
2. Do not have intercourse or douche for one week.
3. Take showers only. No tub baths for one week.
4. You will likely experience cramps for which you can take Advil, 2 pills every 4 hours as needed or a pain prescription that was given to you.
5. Bleeding is unpredictable after these procedures. Small clots and bits of tissue are normal. Brown discharge is normal as is bleeding off and on for several days or even weeks. Some women will not bleed at all which is normal.
6. After an ablation, you may expect discharge for 3-4 weeks.
7. It is important that a follow up visit be scheduled for 2 weeks after your procedure. Please call our office as soon possible to schedule this appointment. Any tissue removed during your surgical procedure will be sent to pathology for analysis. These results will be discussed with you at your 2 week post operative appointment.

BE SURE TO REPORT THE FOLLOWING

1. Your bleeding is very heavy, i.e. heavier than the heaviest day of your menses.

2. Your temperature is 100 degrees for two days in a row or greater than 100.4 at any time.

3. You have a foul smelling discharge.

4. You have severe pain, unlike menstrual cramps.

You have just had a procedure called laparoscopy. This is usually performed for sterilization, diagnostic purposes, treatment of endometriosis, treatment of adhesions, treatment of ectopic pregnancy, treatment of ovarian cysts, and many other conditions as well. What was done to you, how many incisions you have and how fast you will recover, depends on what exactly was done inside your body. Sterilization procedures usually will heal quite a bit faster than other procedures. You should limit your activities for the next 48 hours. Do no strenuous activities for the next 10 days.

PRECAUTIONS AND WHAT TO EXPECT

1. You will have one or more incisions. Keep the dressings clean and dry. You may change them as often as you like. You may keep your incisions uncovered after 24 hours.

2. SHOWERS ONLY. No baths or soaking the incision for the next 2 weeks. If your incision gets wet in the shower, pat them dry when you get out.

3. You may have vaginal bleeding. This is normal.

4. You will likely have some abdominal pain for which a pain prescription has been given to you.

5. Neck and shoulder pain is common after laparoscopy. In some patients, this is worse than their abdominal pain. This is normal and is best treated with Advil, 3 pills every 6 hours. If you are unable to take Advil medications, take your pain pills. This will usually go away in 24 hours or so, with or without treatment.

6. You may eat and drink as you please.

7. Take your usual medications that have been prescribed (such as blood pressure pills, etc).

8. No intercourse for one week.

9. Sanitary pads only, no tampons for one week.

10. Do not drive for at least 24 hours. You should not drive until you are off narcotic pain medications and you feel well enough to safely operate your vehicle.

11. IT IS IMPORTANT THAT A TWO WEEK FOLLOW UP APPOINTMENT IS MADE AND KEPT. Please call our office to schedule this appointment as soon as possible.

BE SURE TO REPORT IF:

1. Your temperature is greater than 100.4 degrees.

2. Your pain is severe and not controlled with pain pills.

3. Your incisions are bleeding excessively. Note that bruising and light drainage is normal.