What is "Vaginal pH?"

The pH of a healthy vagina ranges from 3.8 to 4.5.  pH is a way to describe how acidic a substance is. It is given by a number on a scale of 1-14. The lower the number, the more acidic the substance.  The pH of the vagina can be obtained either in the doctor's office or at home with a vaginal pH test kit which determines how acidic or alkaline the vagina is when the vaginal pH test is conducted.  Knowing your vagina's pH is very important for optimum vaginal health. When your vagina's pH is within the 3.8 to 4.5 range, there is a healthy balance of vaginal flora or bacteria that keeps the vaginal yeast cells in check. When the vagina's pH is out of this health pH range of 3.8 to 4.5, the vagina's healthy flora decreases and the amounts of bad bacteria increases, upsetting the natural balance of the vagina.  The end result is vaginal odor and vaginal yeast infections. 

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What is a Vaginal pH Test?

A vaginal pH test measures the pH of your vagina and the vaginal secretions/discharge. 

Why should I have my vagina's pH measured?  

The vaginal pH test will help your doctor determine if your vaginal symptoms (i.e., itching, burning, unpleasant odor, or unusual discharge) are likely caused by an infection that needs medical treatment. The test is not intended for HIV, chlamydia, herpes, gonorrhea, syphilis, or group B streptococcus.

How accurate is the vaginal pH test? 

Home vaginal pH tests showed good agreement with a doctor's diagnosis. However, just because you find changes in your vaginal pH, doesn't always mean that you have a vaginal infection. pH changes also do not help or differentiate one type of infection from another. Your doctor diagnoses a vaginal infection by using a combination of: pH, microscopic examination of the vaginal discharge, amine odor, culture, wet preparation, and Gram stain.

Does a positive vaginal pH test mean you have a vaginal infection? 

No, a positive test (elevated pH) could occur for other reasons. If you detect elevated pH, you should see your doctor for further testing and treatment. There are no over-the-counter medications for treatment of an elevated vaginal pH.

If test results are negative, can you be sure that you do not have a vaginal infection? No, you may have an infection that does not show up in these tests. If you have no symptoms, your negative test could suggest the possibility of chemical, allergic, or other noninfectious irritation of the vagina. Or, a negative test could indicate the possibility of a yeast infection. You should see your doctor if you find changes in your vaginal pH or if you continue to have symptoms.

How is the vaginal pH test conducted? 

The doctor (or you, if done at home) places the pH paper inside your vagina and against one of the "walls" of the vagina for a few seconds.  He/she then compares the color of the pH paper to the color on the chart (provided with the test kit). The number on the chart for the color that best matches the color on the pH paper is the vaginal pH number.

Is the vaginal pH home test similar to my doctor’s test? 

Yes. The home vaginal pH tests are practically identical to the ones sold to doctors. But your doctor can provide a more thorough assessment of your vaginal status through your history, physical exam, and other laboratory tests than you can using a single pH test in your home.

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What is Gynecologic Urology?

Gynecologic Urology, also referred to as Uro-gynecology, is a subspecialty within the field of Obstetrics and Gynecology. Uro-gynecology's specialty is female pelvic disorders such as pelvic organ prolapse (bulges that extend from the uterus into the vagina or extend out of the vagina), urinary incontinence, fecal incontinence and constipation. 

Doctors that complete their residency in Obstetrics and Gynecology, then go onto complete fellowship training in Uro-gynecology, where they spend several years focusing only on Uro-gynecology and female pelvic disorders.


What is Adhesiolysis?

Treatment for the removal of Pelvic Adhesions is through a surgical procedure called "adhesiolysis."  The adhesiolysis procedure may involve cutting and releasing the adhesions during a laparoscopy procedure or treating the adhesions during a laparotomy.

What are Pelvic Adhesions?

Pelvic adhesions are bands of scarlike tissue that form between two surfaces inside the body. Inflammation from infection, surgery, or trauma can cause tissues to bond to other tissues or organs.

Pelvic adhesions are the cause of many gynecological problems including significant pain, infertility and conception. Pelvic adhesions are irritations of a woman's pelvic organs as a result of a "pelvic inflammatory event" or from trauma to the area such as in the case of pelvic or gynecological surgery.

What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse or Pelvic Prolapse, is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapsee in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse, vaginal relaxation or vaginal vault prolapse.

What is Pelvic Prolapse?

Pelvic Prolapse is another term used for "Pelvic Organ Prolapse."  Pelvic Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown. 

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse or vaginal vault prolapse.

What are the symptoms that indicate a woman is suffering from Pelvic Organ Prolapse?

• Loss of bladder control.

• Loss of bowel control.

• Increasing need and frequency to urinate - and then difficulty in completely emptying your bladder.

• The feelings that your of pelvic or vaginal heaviness, bulging, fullness and/or pain, or a feeling that something is "dropping."

• Recurrent bladder infections.

• Excessive vaginal discharge.

• Pain or lack of sensation during sex

But Pelvic Organ Prolapse is a real, common and treatable problem. Consider this:

About half of all women over age 50 suffer from some degree of Pelvic Organ Prolapse.

One in 10 women undergo surgery for Pelvic Organ Prolapse by age 80.

What is Pelvic Reconstruction?

Pelvic Reconstruction is a surgical procedure performed by gynecologists or uro-gynecologies to repair pelvic organ prolapse and vaginal vault prolapse, among types of prolapse, and to correct the problem(s) and relieve the symptoms. 

Typically, Pelvic Reconstruction is performed vaginally and uses an implant to reinforce the strength of the weakened pelvic tissues. 

What is a Prolapsed Uterus?

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis. 

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

What is Perineoplasty?

Perineoplasty, also known as "Perineorrhaphy,"is one of the fastest growing elective medical procedures and is the reparative or plastic surgery of the perineum which helps women with problems with vaginal opening laxity or looseness - medically referred to as "Vaginal Relaxation."  Many also incorrectly call this procedure "vaginoplasty" or "vaginaplasty."

Perineorrhaphy is the reconstruction of the muscles and tissues at the opening of the vagina and has successfully decreased the vaginal "introitus" or size of the vaginal opening. Perineorrhaphy does NOT reduce sexual sensation, in fact, properly performed, Perineorrhaphy INCREASES sensation for the woman as well as her husband.

What is Colporrhaphy? 

Colporrhaphy is the surgical repair of the vaginal wall. This includes repairing many types of vaginal surgery, including the repairs of the vagina in a "Pelvic Organ Prolapse," "vaginal prolapse," "Vaginal Vault Prolapse," or the repair of a "cystocele" in the vaginal wall(s) or vaginal vault or a rectocele. A cystocele occurs when the bladder protrudes into the vagina, and a rectocele when the rectum protrudes into the vagina.

In the Colporrhaphy procudeure, a uro-gynecologist, or gynecological surgeon, places a vaginal speculum inside the vagina, which spreads/keeps the vagina open, for the doctor to inspect and repair the vagina. The vaginal wall is cut opened to reveal an opening in the supporting structures, or fascia and the defect is closed and then the vagina is repaired by suture and closed, and the speculum removed. 


Who performs the Colporrhaphy and where is it performed?

Colporrhaphy is usually performed in a nearby hospital operating room by a uro-gynecologist, urologist or gynecological surgeon.


What is Colpopexy?

Colpopexy is the surgical suturing of the prolapsed vagina to a surrounding structure - such as the abdominal wall or the sacrum, which is then called Sacral Colpopexy or Sacrocolpopexy 

What Is Sacral Colpopexy (Sacrocolpopexy)?

Sacral Colpopexy, also referred to as also referred to as also referred to as also referred to as also referred to as Sacrocolpopexy, is the preferred surgical procedure for treating and correcting Vaginal Vault Prolapse with excellent results. Sacral Colpopexy (Sacrocolpopexy) has a very high rate of success  and the surgical procedure involves suturing a synthetic mesh that connects and supports the vagina to the sacrum, or tailbone. The Sacrocolpopexy operation is performed from the abdomen to support the vagina to the ligament on the spine (after previous or present surgery to remove the uterus) by using a synthetic mesh.

Why Is Sacrocolpopexy Performed? 

Sacrocolpopexy is performed to treat severe protrusion or bulge(s) of the vagina after removal of the uterus.

A woman's vagina that has one or more of these vaginal protrusion(s) may experience one or more of the following:

• The vaginal lump/bulge or protrusion feels uncomfortable or causes pain.  
• Difficulty with urination (e.g. unable to completely empty the bladder) 
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels) 
• Pain 
• Infection 
• Bleeding 

The objective of the Sacrocolpopexy operation is to relieve the woman's symptoms and to restore her vagina and her vaginal anatomy (as much as possible) and recover her sexual function.

Are there any risks associated with Sacrocolpopexy surgery? 

Sacrocolpopexy surgery is a very common and relatively safe operation with excellent prognosis and outcomes.  However, like any surgical procedure, there are complications which may occur. Possible complications from Sacrocolpopexy surgery may include:

• Bleeding 
• Infection 
• Injury to surrounding tissues (e.g. nerve or blood vessels, ureter, intestines) 
• Formation of blood clot(s) in the legs or lungs 
• Recurrence of problem
• Slow return of bowel or bladder function 
• Erosion of synthetic material through vaginal mucosa 


What Happens Before Sacrocolpopexy Surgery? 

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health for Sacrocolpopexy surgery. 

2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing. 

3. You will be admitted to the hospital one day before Sacrocolpopexy surgery. 

4. You will be given preparations to clear your bowels.

5.  Your pubic hair surrounding your vagina and on your vulva will be shaved. 

6. You will not be allowed to eat or drink after midnight on the day before the surgery. 

7. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled. 

8. If you are on aspirin, please keep your doctor informed. You must stop taking aspirin at least one week before Sacrocolpopexy surgery. 

What happens during the Sacrocolpopexy surgery? 

The surgery is done under general or regional anesthesia. The anesthesiologist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube / drain may be inserted into the abdomen to monitor the bleeding.

Another tube will be inserted into the urethra as there may be difficulty in urination after the Sacrocolpopexy procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What happens after Sacrocolpopexy surgery? 

1. Immediately after the operation, you may experience one or more of the following:

• Tiredness - You should rest and gradually increase your mobilization until you feel fit to return to your normal activities. 

• Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort. 

• Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal. You will need to wear a menstrual pad during the recovery period, but you will not be permitted to use tampons for obvious reasons.

2. One day after surgery, you will usually be allowed to drink and eat. You will be encouraged to move around. Blood chemistries and normal follow-up visits will be performed. 

3. The catheter that was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.

4. You may be discharged on the third or fourth day after surgery if the doctor is pleased with your progress and the outcome of the Sacrocolpopexy procedure. 

5. You should refrain from:

• Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor. 

• Using tampons, douching, sexual intercourse and driving for 4 weeks. 

• Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacrocolpopexy surgery.

6. You should (immediately) return to the hospital or notify your doctor if you notic any of the following:

• Heavy vaginal bleeding 
• Foul smelling vaginal discharge 
• Severe abdominal distension and / or pain not relieved by painkillers 
• High fever 
• Pain associated with passing urine 
• Difficulty in passing urine 
• Constipation 

Follow-up doctor visits after Sacrocolpopexy surgery 

You will be examined by your doctor (at your doctor's office) at approximately; 2 weeks, 4 weeks, six months and and one year after Sacrocolpopexy surgery. 

It is important to keep your follow-up appointments to ensure the best possible results.

What is "Colposuspension" surgery?

Age and vaginal childbirth takes it toll on women's pelvic organs.  

"Female Urinary Incontinence" is one of the problems most (over 50%) women who have delivered babies vaginally have to contend with.  Women with Female Urinary Incontinence "leak" urine when they strain,  cough, laugh or run. This condition is also called "stress urinary incontinence" meaning the stress of physical activity, not emotional stress is causing her to "leak" urine.  

The problems associated with female urinary incontinence are corrected in the the "floor" of the woman's pelvis by several methods or types of surgeries - one of which is called Colposuspension. 

A woman's pelvic floor is a sheet of special muscles and ligaments that stretch across the inside of the female pelvis. Women can feel it "tighten" when they try to hold back the flow of urine - or when they strain,  cough, laugh or run. The uterus and bladder are located above the pelvic floor. The vagina and the opening of the bladder (the urethra) pass through the pelvic floor. If the pelvic floor weakens, the uterus and bladder "drop" down. The control of the urine is thereby weakened. 

Colposuspension surgery strengthens the pelvic floor to lift, or "suspend" the uterus and bladder back up to their correct position within the woman's pelvis

Colposuspension comes from the Greek word for vagina - "colpos."

What is "Urethropexy"?

Urethropexy is a surgical procedure where the support of a woman's urethra is re-supported through sutures that surround the urethra's pelvic floor  and vaginal tissues to her pubic bone.

What is the Vaginal Vault and Where is the Vaginal Vault Located?

The vagina has three "compartments" which include the anterior compartment or anterior vaginal wall, the middle compartment or cervix, and the posterior compartment or posterior vaginal wall.  The vaginal vault is typically identified as the area at the top of the vagina, next to and adjacent to the cervix.  The vaginal vault can fall/drop or descend down toward the vaginal introitus, or the entrance of the vagina, after a woman's uterus has been removed through a hysterectomy. 

As previously stated, Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons. Vaginal Vault Suspension is the surgical procedure that corrects and repairs Vaginal Vault Prolapse.

What is a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent to the cervix. It can only “fall” or descend downwards toward the introitus, or the entrance of the vagina, after a woman's womb has been removed (hysterectomy). 

Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.

Vaginal Vault Suspension is a surgical procedure that may be selected to correct/repair Vaginal Vault Prolapse.

What is Vaginal Vault Suspension?

Vaginal Vault Suspension is the surgical procedure that repairs Vaginal Vault Prolapse and also provides support for the apex or "vaginal vault" of the vagina to pelvic structures.

What is a Trachelectomy?

A trachelectomy, also referred to as a cervicectomy, is the surgical removal of the cervix. 

In this surgery, the uterus itself is saved or preserved, and therefore this type of surgery preserves a woman's chance of becoming pregnant and having children.  The trachelectomy surgical alternative - as opposed to the more radical hysterectomy which removes the uterus in addition to the cervix - is typically elected by younger women with early stage cervical cancer.

What Everyone Needs to Know About Reconstructive Pelvic Surgery.

Reconstructive pelvic surgery is an area of surgery dealing with a woman's pelvis, and includes gynecology and uro-gynecology.  Pelvic reconstructive surgery is many times very complex surgery that may require not just the removal of certain organs or tissues in a woman's pelvis, but may also include the resection of areas and putting her organs and tissues back together in a way that makes her more functional, with less/no pain and feels better. 

What is Pelvic Inflammatory Disease?

Pelvic inflammatory disease, or "PID" is an infection of a woman's pelvic organs which include the uterus, fallopian tubes, and ovaries.

Bacteria causes pelvic inflammatory disease. Bacteria can move upward, from a woman's vagina or cervix - which is the opening to the uterus, or womb - into her fallopian tubes, ovaries and uterus, which then cause an infection. Many types of bacteria can cause pelvic inflammatory disease. But bacteria found in two common sexually transmitted diseases - chlamydia and gonorrhea - are the most frequent causes of pelvic inflammatory disease. 

After a woman becomes infected, it can take from a few days to a few months to develop pelvic inflammatory disease. 

The major symptoms of pelvic inflammatory disease are lower abdominal pain and abnormal vaginal discharge. 

Other symptoms of pelvic inflammatory disease may include one or more of the following; fever, pain in the right upper abdomen, pain during vaginal intercourse, and irregular menstrual bleeding.  

Pelvic inflammatory disease, particularly when caused by chlamydia, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs. 

Untreated, pelvic inflammatory disease causes scarring and can lead to infertility, tubal pregnancy, chronic pelvic pain, and other serious problems. 

Pelvic inflammatory disease is more common and more aggressive in HIV+ women than in uninfected women. Pelvic inflammatory disease may become a chronic and relapsing condition as a woman's immune system deteriorates. 

Women can play an active role in protecting themselves from pelvic inflammatory disease disease by following these steps and precautions: 

*  Call your doctor if you have discharge with odor or bleeding between cycles. 

*  Use either male or female condoms during sex. 


What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction, which is also referred to as outlet obstruction or outlet delay, refers to a condition in which the pelvic floor muscles of a woman's lower pelvis - that surround the rectum, do not function normally. It is not known why these muscles fail to work properly in some women, but they can make the passage of stools difficult even when everything else seemingly is normal.

What Causes Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction find that muscle pain occurs when muscles are tense, strained, traumatized and/or otherwise inflamed. Their pelvic muscles are no exception. Causes of pelvic floor dysfunction can include:

*  Chronic faulty posture with weak core musculature 
*  Trauma (fall on tailbone, old tailbone fracture, auto accident)
*  Inflammation or infection
*  Pelvic organ disease (endometriosis, irritable bowel syndrome, interstitial cystitis) 
*  Repetitive motion injuries such as those from gymnastics, volleyball, soccer, ballet or ice
    skating
*  Abdominal muscle wall weakness or hernias 
*  Chronic constipation
*  Pregnancy or complicated vaginal delivery 
*  Abdominal or pelvic surgery such as a hysterectomy 

Do I have Pelvic Floor Dysfunction?

Women with pelvic floor dysfunction often have changes in their spine and/or pelvis.  Symptoms or conditional might include; scoliosis, short leg, swayback or a "torsioned" sacrum. The most common symptoms of pelvic floor dysfunction include one or more of the following:

*  Vaginal pain 
*  Pain with urination 
*  Urinary urgency and frequency 
*  Rectal pain 
*  Pain during vaginal intercourse 
*  Pain with sitting, standing, walking 
*  Pain and/or difficulty getting up from a seated or lying down position
*  Hip pain often with loss of range of motion in hips 
*  Deep pain in lower back radiating to legs, thighs, groin, hips 
*  Abdominal and lower abdominal/intestinal pain
*  Pelvic pressure or a feeling like your vagina or uterus are "falling out."
*  Involuntary loss of urine or stool 

What are Pelvic Adhesions?

Pelvic adhesions are the cause of many gynecological problems including significant pain, infertility and conception. Pelvic adhesions are irritations of a woman's pelvic organs as a result of a "pelvic inflammatory event" or from trauma to the area such as in the case of pelvic or gynecological surgery.

Examples of a pelvic inflammatory event include; fallopian tube infections that might occur from endometriosis, removal of an ovarian cyst, sexually transmitted diseases such as gonorrhea, post surgery infections, and even appendicitis and appendectomies.

As a woman's body's pelvic area recovers from an inflammation, trauma or surgery, it begins the healing process and starts to repair itself.  The woman's body and its' healing process may cause some tissues and structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal woman's healthy pelvis, this space is lined with a tissue called the peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In the pelvis of a non-injured/non-irritated woman, the peritoneum can be very "slippery" with the the organs and structures lying immediately next to each other that "slip" off each other and do not become bonded together. With a woman who has had a pelvic inflammation, trauma or injury, her body's healing process starts a sequence of events that may result in some of the pelvic tissues becoming "stuck" to or "adhering" to tissues or organs next to the inflamed, or injured tissue, and when this occurs, the outcome may be pelvic adhesions.

What is Menorrhagia?

Menorrhagia is the medical term for women (and young girls first starting their menstrual cycles) that excessive menstrual bleeding. Excessive menstrual bleeding is defined as having a period that lasts 7 or more days each menstrual cycle (period) or is so heavy that you saturate your menstrual pad and/or tampon and need to change your feminine hygiene product(s) every one to two hours.  It is very important to inform your doctor if you have excessive menstrual bleeding! 

Women that are suffering from Menorrhagia may experience; anemia, fatigue,  embarrassing menstrual accidents, and feel that you have to restrict your life and social activities to such an extent that you "miss out on life."  Many women prefer to stay close to home so as to avoid embarrassment due to their need to go to the restroom so often so that they can change their feminine hygiene products before they become too saturated and cause even more embarrassment.

How many women have Menorrhagia?

Approximately 1 in 5 women have Menorrhagia.

Are there any treatments or therapies for Menorrhagia?

Yes, there's hope and help for women with Menorrhagia!

Here are a few of the options and therapies you will want to discuss with your doctor.

Hormone therapy - also known as "both control pills," and/or other medications may be prescribed to treat hormone imbalance. Hormone therapy is effective about 50% of the time, and may be required for a long period of time. 

Uterine Balloon Therapy - Also known as Thermal Balloon Ablation) (see below for more information)

Dilation and curettage - also referred to as a "D & C" - is a surgical procedure whereby the doctor scrape the inside of the woman's uterus to remove the lining. For most women with Menorrhagia, a D&C is temporary and reduces excessive bleeding for only a few periods.

Endometrial Ablation is another possible therapy but only if you and your husband don't plan to have children in the future. Typical Endometrial Ablation removes the lining of the uterus with an electrosurgical tool or laser. Like any surgical procedure, there are risks, which include perforation of the uterus, bleeding, infection, or even heart failure due to fluids used to open up or distend the uterus.

Hysterectomy is the surgical removal of the uterus.  As a hysterectomy involves the removal of the woman's uterus, Menorrhagia will no longer be a problem. Hysterectomy is also a surgical procedure and also involves risks. The recovery period after hysterectomy is 3 to 6 weeks.