• Sexually Transmitted Disease

  • STD Checks

  • Contraception

  • Delayed Puberty

  • Laparoscopic Sterilization

  • Female sterilization & Reversal 

STD (Sexually Transmissible Disease) Checks

Sexually transmissible diseases are infectious diseases where the primary mode of transmission is through sexual contact.

They may be transmitted from one person to another through blood, semen, vaginal discharge and other body fluids. These infections may also be spread through other nonsexual modes of transmission such as mother to infant during pregnancy or childbirth, sharing of infected needles or infection through blood transfusion.

Sexually transmissible diseases are a major public health concern throughout the world that may increase the risk of other life-threatening conditions including certain cancers and may also cause congenital anomalies in unborn babies of infected mothers.

Causes of sexually transmissible diseases

Sexually transmissible diseases can be caused by various viruses, bacteria or protozoa. Common types of STDs include chlamydia, gonorrhea, hepatitis B, syphilis, genital warts or human papilloma virus (HPV) which may also cause cervical cancer in women, and the human immunodeficiency virus (HIV).

Sexually transmissible disease checks

Sexually transmissible disease checks are diagnostic procedures employed for the identification of the infection. Sometimes, the sexually transmissible infection does not cause any symptoms and the infected person can continue to transmit the infection unaware of the condition.

Early detection of the infection may be helpful for the successful treatment and prevention of further transmission.

Diagnostic procedures for identification of common STDs include blood tests, urine test, body fluid sample test and specific screening tests for people prone to the infection.

Blood and urine tests are helpful in identifying sexually transmissible infections such as advanced stages of syphilis. Fluid sample testing assists in confirming the type of infection and the causative agent.

Screening

Screening refers to the testing of sexually transmissible infections in asymptomatic individuals who are more vulnerable to the infection. Blood and saliva testing is a common screening test for the HIV virus in patients within the age group of 13 -64 years.

Screening test for HIV, hepatitis B, chlamydia and syphilis are mandatory in pregnant women, during the first prenatal visit.  Pregnant women may also be at an increased risk of developing gonorrhea and hepatitis C. Hence, screening tests for gonorrhea and hepatitis C are also recommended during pregnancy.  

Sexually active women, homosexual men and HIV positive individuals are more prone to the other sexual transmissible infections.  Regular screening is advisable for early detection and appropriate management of these infections.

SEXUALLY TRANSMITTED INFECTIONS (STI)

They are infectious diseases caused by bacteria or virus that spread from one person to another by sexual contact.

Adolescents who are sexually active may develop STIs because of lack of sex education and intense sexual experimentation.

Some Common Types of Sexually Transmitted Infections

The most common Sexually Transmitted Infections are

  • chlamydia,

  • genital herpes,

  • AIDS, and

  • Gonorrhea.

Symptoms of STIs

Some of the commonly occurring symptoms include

  • vaginal discharge,

  • pain in the lower abdomen,

  • skin rash,

  • ulcers,

  • blisters around the genital area, and

  • fever.

If Sexually Transmitted Infections are Not Treated

If STIs are not treated, they may lead to more serious problems such as

  • infertility,

  • cancer of the cervix

  • heart damage, and

  • death.

Treatments for Sexually Transmitted Infections

Non-surgical treatment includes

  • antibiotics such as penicillins, cefixime, tetracyclines, azithromycin, or erythromycin and

  • antiviral medications such as acyclovir, famciclovir, and valacyclovir. 

CONTRACEPTION

Contraception, also known as birth control practice, is prevention of pregnancy by interfering with the whole process of conception and implantation. In the current scenario, numerous methods of contraception are in practice and include barrier or hormonal method, withdrawal, natural family planning, abstinence, and sterilization (surgery). Some of these methods are confined to women and others to men, Some  methods are reversible and some are permanent .

Abstinence

Abstinence means not having sexual intercourse. It is the only birth control method that is 100% effective in preventing pregnancy as well as sexually transmitted diseases.

Natural Planning Method

Natural family planning (NFP) or fertility awareness does not require medication, physical devices, or surgery to prevent pregnancy. This method relies on the woman's body physiology to know the time of ovulation. This method involves monitoring different body changes such as basal body temperature or cervical mucus variations. The woman then abstains from unprotected sex for approximately 7 to 10 days when she may have ovulated.

Barrier Methods

Barrier Methods are a common  methods that form a physical barrier to obstruct the sperm from entering a woman's uterus. Barrier methods include use of

  • male condom

  • female condom

  • spermicides

  • diaphragm

  • cervical cap, and

  • contraceptive sponge.

The male condom is a thin covering made of latex or polyurethane that is rolled over an erect penis before sexual intercourse to prevent the sperm from entering a woman's vagina.

The female condom is a polyurethane (plastic) tube that has a flexible ring at each end and is inserted into the vagina before sexual intercourse.

Spermicides are chemicals that deactivate or kill sperm and are available as foams, suppositories, and jellies.

Diaphragm is a flexible dome that covers the cervix inside the vagina.

Cervical caps are smaller cups made of latex, rubber or plastic. They should be used in conjunction with a spermicidal gel and are placed in the vagina before sexual intercourse.

Sponge is a soft, round barrier device made of polyurethane foam.

Hormonal methods

In this method, synthetic hormonal preparations containing oestrogen and progesterone that can be administered

  • orally (pills),

  • implanted into body tissue (implants),

  • injected under the skin (injections),

  • absorbed from a patch on the skin (skin patches), or

  • placed in the vagina (vaginal rings).  

These methods work by preventing ovaries from releasing eggs for fertilisation.  

They also thicken the mucus around the cervix, making it difficult for sperm to penetrate. They also thin the lining of the womb decreasing its ability to accept a fertilised egg.

Intrauterine device (IUD)

The intrauterine device (IUD) is a small device made of copper that is inserted into the uterus. It works by thickening the mucus around the cervix and by thinning the womb's lining, making it difficult to accept a fertilised egg.

Withdrawal method

Withdrawal method involves the complete removal of the penis  from the woman's vagina before ejaculation.

Sterilisation

Sterilisation is a permanent solution and is meant for men and women who do not intend to have children in the future. Male sterilisation involves vasectomy, a surgical blocking of the vas deferens, the tubes through which sperm pass into the semen. Female sterilisation involves a tubal ligation, a surgical procedure that blocks the fallopian tubes which carry the eggs from the ovaries to the uterus.

Your Choice

The choice of a particular method of contraception also depends on an individual's age, health, frequency of sexual activity, number of sexual partners, future pregnancy, plans to have children in the future, and certain medical conditions.

Therefore, always discuss with Dr Alexander about the choice of birth control method.

It is necessary to know that most birth control methods prevent pregnancy. However, no method of birth control offers protection against sexually transmitted diseases.

LAPAROSCOPIC STERILIZATION

Sterilization is a permanent method of contraception for women planning not to be pregnant in the future.

Laparoscopic technique is a minimally-invasive procedure and in recent years laparoscopic sterilization has gained popularity owing to its advantages over the traditional approach.

Laparoscopic sterilization is a technique of tubal ligation to block or close the fallopian tubes, the pathway for sperms to reach eggs for fertilization.

Fallopian tubes, located on either side of the uterus, pick up eggs released from the ovaries and transfer them to the uterus. So, if these tubes are closed,  sperms fail to reach the eggs and thus fertilization will not occur.

About the Sterilization Procedure

During the surgical procedure, you will have general anaesthesia administered so that your muscles remain relaxed and no pain is felt. A device that helps move the uterus is slowly inserted into the vagina.   Then, a small incision is made near the belly button through which a laparoscope is passed. The abdomen is inflated so that the surgeon gets an improved view of the internal organs.

A second incision is made at the pubic hairline through which a special device is inserted which is used to grasp the fallopian tubes. Next, the fallopian tubes are sealed off either with an electric current that coagulates the tube (electrocoagulation) or by placing a band or clip over the tubes. In some circumstances, the tubes may also be cut. Once the tubes are sealed, both the laparoscope and grasping device are withdrawn and a small surgical dressing is placed over the incisions on the skin.

Recovery After the Procedure

You may return home after the observation period, once you have recovered. A follow-up visit will be scheduled within the next 2 to 8 weeks. Small amount of vaginal bleeding which may continue for few days after the surgery is considered normal.

Laparoscopic sterilization is considered to cause permanent loss of fertility. Hence, a well-informed, careful decision should be taken bearing in mind the other alternatives, before you decide to undergo laparoscopic sterilization. It offers a very safe and convenient form of contraception that requires no additional measures to prevent pregnancy. It also does not affect the menstrual cycle.

Laparoscopic procedure is more advantageous than the traditional procedure. The smaller incisions require a shorter recovery period and the risk of complications are minimal. 

DELAYED PUBERTY AND SEXUAL DEVELOPMENT

Puberty is a phase of rapid growth and development that involves physical growth and sexual maturation, along with psychological and social development.

The normal age of puberty in girls is 8-12 years whereas in boys it is 10-14 years. A condition in which puberty is deferred beyond the average age of puberty is called delayed puberty.

Generally, puberty is a result of increased hormonal levels in the body, stimulated by the hypothalamic-pituitary- gonadal axis. This stimulation triggers the hypothalamus to secrete gonadotropin-releasing hormone (GnRH). In response to GnRH, the pituitary gland starts releasing luteinizing hormone (LH), which induces the special cells present in the testes and ovaries to produce sex hormones, i.e. testosterone and oestrogen respectively.

The increased levels of the specific sex hormones are responsible for the development of secondary sexual characteristics.

The signs of puberty in girls include:

  • Breast development

  • Menstrual cycle

  • Appearance of underarm and pubic hair

  • Rapid growth such as increase in height

  • Acne

The signs of puberty in boys include:

  • Deepening of voice

  • Appearance of underarm, chest, facial and pubic hair

  • Rapid growth such as increase in height

  • Enlarged penis and testes

  • Acne

  • Increase in muscle mass

  • Ejaculation in which semen is ejected from the penis

Causes of Delayed Puberty

The delay in puberty and sexual development can occur due to chronic diseases, abnormal chromosomes, and many other factors. In some cases, puberty may take a longer time than the peers, but finally is achieved; this is called constitutional delay.

The possible causes for delayed puberty are as follows:

  • Chronic diseases such as diabetes mellitus, inflammatory bowel disease, kidney disease, cystic fibrosis, Kallmann's syndrome and autoimmune diseases

  • Conditions such as anaemia, hypopituitarism and malnutrition

  • Chronic infections

  • Cancer

  • Chromosomal abnormalities such as Turner syndrome, Klinefelter syndrome, Noonan syndrome and Prader-Willi syndrome

  • Certain radiation therapy and chemotherapy

  • Robust training exercises

Diagnosis for Delayed Puberty

The diagnosis of delayed puberty involves a physical examination, family history and medical history of the child. The bone growth can be assessed by taking X-rays of the wrist bone. Based on the results and underlying condition, other tests may be ordered that include:

  • Chromosomal analysis

  • Hormonal level such as FSH, LH, and oestrogen in girls and testosterone in boys

  • MRI scan of head and pituitary gland for detecting tumours or lesions

  • Ultrasound of pelvic region (female)

  • GnRH stimulation test

  • Diet and nutrition assessment

  • X-rays of the skull

  • Smell and vision tests

Treatment for Delayed Puberty

The treatment of delayed puberty depends on the underlying cause or diseases responsible for delayed puberty.

  • Hormonal replacement therapy is recommended for those who are suffering from chromosomal abnormalities.  

  • Psychological support with certain medications is also recommended in children with delayed puberty.

  • In some cases, surgery may be employed, such as with Turner syndrome in girls, where ovaries of the affected girl are surgically removed to avoid the risk of developing cancer.

LAPAROSCOPIC STERILIZATION

Sterilization is a permanent method of contraception for women planning not to be pregnant in the future.

Laparoscopic technique is a minimally-invasive procedure and in recent years laparoscopic sterilization has gained popularity owing to its advantages over the traditional approach.

Laparoscopic sterilization is a technique of tubal ligation to block or close the fallopian tubes, the pathway for sperms to reach eggs for fertilization.

Fallopian tubes, located on either side of the uterus, pick up eggs released from the ovaries and transfer them to the uterus. So, if these tubes are closed,  sperms fail to reach the eggs and thus fertilization will not occur.

About the Sterilization Procedure

During the surgical procedure, you will have general anaesthesia administered so that your muscles remain relaxed and no pain is felt. A device that helps move the uterus is slowly inserted into the vagina.   Then, a small incision is made near the belly button through which a laparoscope is passed. The abdomen is inflated so that the surgeon gets an improved view of the internal organs.

A second incision is made at the pubic hairline through which a special device is inserted which is used to grasp the fallopian tubes. Next, the fallopian tubes are sealed off either with an electric current that coagulates the tube (electrocoagulation) or by placing a band or clip over the tubes. In some circumstances, the tubes may also be cut. Once the tubes are sealed, both the laparoscope and grasping device are withdrawn and a small surgical dressing is placed over the incisions on the skin.

Recovery After the Procedure

You may return home after the observation period, once you have recovered. A follow-up visit will be scheduled within the next 2 to 8 weeks. Small amount of vaginal bleeding which may continue for few days after the surgery is considered normal.

Laparoscopic sterilization is considered to cause permanent loss of fertility. Hence, a well-informed, careful decision should be taken bearing in mind the other alternatives, before you decide to undergo laparoscopic sterilization. It offers a very safe and convenient form of contraception that requires no additional measures to prevent pregnancy. It also does not affect the menstrual cycle.

Laparoscopic procedure is more advantageous than the traditional procedure. The smaller incisions require a shorter recovery period and the risk of complications are minimal.

TUBAL REVERSAL RECONSTRUCTIVE SURGERY

Sterilization is a permanent method of contraception for women desiring not to become pregnant in the future. Laparoscopic technique is a minimally invasive procedure and in recent years laparoscopic sterilization has gained popularity owing to its advantages over the traditional approach. Laparoscopic sterilization is a technique of tubal ligation to block or close the fallopian tubes, the pathway for sperm to reach eggs for fertilization.

Fallopian tubes, located on either side of the uterus, pick up eggs released from the ovaries and transfer them to the uterus. If these tubes are blocked, sperm fail to reach the eggs and fertilization will not occur.

Sterilization Reversal Surgery

Reversal after sterilization is a surgical procedure to restore fertility by restoring the normal functionality of the fallopian tubes that were blocked during sterilization.  

About 5-10% of women may require reversal of sterilization, due to various reasons such as having a new partner and desire for additional children. Women whose tubes were removed during the sterilization cannot have a reversal.

Factors influencing reversal of sterilization

The major factors that may affect the results of reversal after sterilization are as follows:

  • Age

  • Condition of the tubes

  • Regularity of the menstrual cycle

  • Fertility of partner

  • Problem with other parts of the reproductive system

Prior to the reversal surgery, patients should undergo a screening that includes:

  • Physical examination

  • Medical history

  • Series of laboratory tests

  • Review of the medical reports of sterilization methods

  • Evaluation of the partner’s fertility

Procedure for Sterilization Reversal Surgery

Reversal after sterilization is a safe procedure that involves the following steps:

  • The operation is performed under general anesthesia

  • A small incision, approximately 10-12 cm in length, is made across the lower abdomen and a laparoscope is inserted.

  • The fallopian tubes are identified and isolated.

  • Magnification and microsurgical techniques are used to repair the fallopian tubes.

  • The ends of the tubes are trimmed to remove any damaged tissue.

  • The inner open space of the tube, called the lumen, is exposed.

  • These openings are then fused using microscopic sutures, followed by the suturing of the outer covering of the tubes called serosa.

  • The repaired fallopian tubes are placed back into their respective positions and the incision is closed.

Postoperative care after Sterilization Reversal Surgery

The procedure may take a few hours and the patient is usually discharged on the same day of the procedure. Patients are advised to follow the instructions given by their surgeon, along with recommended diet and prescribed medications. Patients can perform their routine activities such as driving, walking etc., after a few days of the surgery. Complete recovery of the patient may take a few days to a few weeks.

Risks and complications Sterilization Reversal Surgery

The possible risks associated with reversal of sterilization include:

  • Infection

  • Bleeding

  • Scarring of the tissue

  • Chances of ectopic pregnancy