Sometimes Less is Best in Women’s Healthcare…

Staying healthy should be one of our top priorities. To do so, we need to focus on the basics of health maintenance, especially good nutrition, daily fitness, stress reduction, self-assessment, preventive care and the mind-body connection. These aspects of healthcare deserve more emphasis and effort on the part of all of us. Patients and clinicians are finding that many of the problems we treat in women’s healthcare can be successfully treated with less. Less invasive surgery, fewer drugs, lower doses, simpler tests, and reduced hospital care are all common trends, but we need a more aggressive approach to prevention.

Options in women’s health surgery have dramatically improved over recent years. Pelvic pain, cysts, fibroids, endometriosis and even early cancers can be treated with minimally-invasive surgery such as laparoscopy. When hysterectomy would have been recommended in the past, there are now a variety of less invasive options. One of these is known as the LASH procedure, where only the upper portion of the uterus is removed with small incisions, leaving the cervix and ovaries. This option preserves the natural hormone production of the ovaries, and the strength of the pelvic floor. Keeping the ovaries and cervix help relive some of the concerns regarding better sexual response after gyn surgery.

When a patient decides to have a LASH procedure, then a number of other fix-up or repair procedures can be done at the same time. The goal of this surgery is no menstrual problems (no period at all), less pain, better pelvic support, better bladder function and potentially improved sex. The recovery time is one-half of what is required for even laparoscopic hysterectomy and the surgery is done as an outpatient. When bladder leakage or vaginal tightness (support) is the problem, then patients are finding much improved and less invasive treatments are available. There are new and improved repair procedures that use small incisions and a vaginal approach, and there are also laparoscopic "fixes" that use small stitches to strengthen the pelvic muscle floor, using the existing ligaments.

Many patients get improved pelvic floor tone and/or bladder control with the E-Stim electronic pelvic floor therapy. This new technology uses painless electronic signals, directed by computer control, to stimulate and strengthen the pelvic floor and bladder control muscles. The treatment is done with the addition of biofeedback techniques to help patients maintain pelvic floor strength for a long-lasting benefit. This treatment plan is done in the office in a once-weekly, six-week protocol. Patients with a variety of issues have found success using E-Stim. These problems include urinary leakage, weak vaginal muscles, pelvic pain, painful sex and other pelvic floor weakness issues.

Another example of "less is better" relates to the frequency of doing Pap tests. The newer liquid-based Pap smears are proven superior to traditional “dry smears”, so now patients may be able to have that specific test done less often than was done in the past. This is especially true for women with one or no sex partner, who have been monogamous and have no history of an abnormal Pap.

Of course, an annual gyn exam, including thyroid, chest, lung, skin, heart, breast, pelvic and rectal exam is very important, even with no Pap being done. Since the Pap is done primarily for cervix cancer testing, the test may be done less frequently for low risk individuals. The rest of the pelvic exam, including vaginal tone, hormone status, pelvic floor support, uterus, ovary, tube and rectal assessments, are critical on a once yearly basis and twice yearly for in higher risk individuals.

Other important check-ups include annual digital mammogram and monthly self-breast exam for all women at age 40. Rectal exam and colonoscopy are critical to good health maintenance beginning at age 50, or earlier if patients have a higher risk category. Cardiovascular health risks should also be assessed at annual exams, and diet, exercise, appropriate testing and lab work should be recommended, as well as lifestyle changes. —Michael Swor, M.D.

Swor Women's Care
1617 S. Tuttle Avenue #1A
Sarasota 941-330-8885
Visit us at: www.sworcare.com