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Intrauetrine device

Overview of Intrauterine Device

What is an Intrauterine Device?

It’s an effective long-term contraception method that does not require replacement for long periods and does not interfere with sexual activity. The intrauterine system releases progesterone to prevent pregnancy.

The Technique of Insertion of IUD

The insertion of an IUD is relatively simple and easy. First, a thorough pelvic examination is performed to determine the position and size of the uterus. The presence of any uterine, tubal, or ovarian pathology precludes the insertion of the device. The vagina and cervix are inspected through a speculum. Any vaginal or cervical infection must be treated and cured before a device is inserted. The cervix is grasped with a vulsellum or allis forceps. The device is mounted into the introducer, and the stop on the introducer is adjusted to the length of the uterine cavity. The introducer is then passed through the cervical canal, and the plunger is pressed, which is called the push-in technique. In comparison, the withdrawal technique has less chance of uterine perforation. 

Mechanism of Action:

  • The presence of a foreign body in the uterine cavity renders the migration of spermatozoa difficult.
  • A foreign body within the uterus aggravates uterine contractility through prostaglandin discharge and surges the tubal peristalsis so that the fertilized egg is propelled down the fallopian tube more rapidly than in normal, and it reaches the uterine cavity before the development of chorionic villi.
  • The device causes leukocyte infiltration in the endometrium.
  • Copper T elutes copper, which brings about peculiar enzymatic and metabolic changes in the endometrial tissue, which are ruinous to the proselytism of the fertilized ovum.
  • Progestogen carrying device causes a mutation in the cervical mucus, which hinders sperm penetration and its local action. It also induces endometrial atrophy. It prevents ovulation in about 40%

Uses of IUD:

  •  contraceptive.
  • Postcoital contraception.
  • Excision of uterine septum and Asherman’s syndrome.
  • Hormonal IUD in menorrhagia and dysmenorrhoea.
  • In menopausal women Hormonal replacement therapy
  • It can also be used to counteract endometrial hyperplasia.


  • Pregnancy is suspected. 
  • Lower genital tract infection. 
  • Presence of fibroids. 
  • Menorrhagia and dysmenorrhoea. 
  • Heart disease.
  • Scarred uterus.
  • LNG IUD in breast cancer. 
  • Abnormally shaped uterus. 
  • Septate uterus.


With the advancements in new devices, acceptability and compliance have been improved. The complications are:


  • Difficulty in insertion.
  • Vasovagal attack.
  • Uterine cramps. 


  • Expulsion. 
  • Perforation. 
  • Spotting menorrhagia.
  • Dysmenorrhoea. 
  • Vaginal infection. 
  • Actinomycosis. 


  • PID – 2 to 5% does not prevent the transmission of HIV.
  • Pregnancy.
  • Ectopic pregnancy. 
  • Perforation. 
  • Menorrhagia. 
  • Dysmenorrhoea.

Misplaced IUD:

The causes if the IUD is not seen are :

The uterus has enlarged through pregnancy. 

Thread has curled inside the uterus. 

Perforation has occurred, or the IUD is buried in the myometrium. 

It has been expelled. 

Plain Radiograph or pelvic ultrasound will show whether the IUD is still inside or it has been expelled. Abnormal shape or location of IUD on radiograph indicates likely perforation.

If you are facing any Gynaecologist problem abnormal vaginal bleeding and are seeking a test and diagnosis, you can consult with Dr Sarah Hussain, the leading Female Gynaecologist in London. Request a call for treatment.

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Transvaginal ultrasound

Gynecologist in London

Transvaginal defines “through the vagina.” It is an internal examination. It uses high-frequency sound waves to create images of internal organs to examine female reproductive organs and also used to identify the abnormalities. Transvaginal ultrasound is called endovaginal ultrasound. 

Transvaginal ultrasound detects uterine gestational sac 1-week earlier than the transabdominal probe and gives a more precise image because of its proximity to the pelvic organs.  The pregnancy and other gynae issues can be detected by Transvaginal ultrasound. Pulsed Doppler ultrasound can add further information regarding the vascularity of the peri trophoblastic structure and reduce the false-positive findings. The transvaginal ultrasound can also detect uterine pregnancy. 

When is a transvaginal ultrasound performed?

  • To check for cysts.
  • Pelvic pain. 
  • Vaginal bleeding.
  • Abnormal pelvic or abdominal exam. 
  • Ectopic pregnancy. 
  • To verify IUD is adequately placed. 
  • Through Transvaginal ultrasound, fetus heartbeat can be monitored.
  • To observe cervix changes which may lead to complications like miscarriage or premature delivery.
  • Identify the reason behind abnormal bleeding. 
  • Examine the placenta. 
  • Confirm an early pregnancy. 
  • Diagnose a possible miscarriage. 

Preparation for transvaginal ultrasound: 

  • For the clear picture of pelvic organs, the bladder must not be empty; it must be full.
  • Drink 35 ounces of water or any intake of liquids before an hour. 
  • Remove tampons if you are on the menstrual cycle.

 During a transvaginal ultrasound:

  • There might be a squeak of clamps. 
  • The ultrasound wand is bound up with a lubricating gel and condom and is inserted in the vagina.
  • Latex-free probe cover is used in case of any latex allergy.
  • As the doctor inserts the transducer, the patient might feel the pressure. 
  • Once after the insertion of the transducer sound waves bounce off internal organs to transmit pictures of the pelvis.
  • The doctor turns the transducer in the vagina for an extensive picture of organs.
  • The doctors use a saline infusion sonography. They may insert saltwater into the uterus before the ultrasound to identify the abnormalities.
  • Transvaginal ultrasound can be performed on a pregnant woman also. 


Transvaginal ultrasound helps to diagnose 

  • Cancer in the reproductive organs. 
  • Routine pregnancy. 
  • Cysts.
  • Fibroids.
  • Pelvic infection. 
  • Ectopic pregnancy. 
  • Miscarriage.
  • Placenta previa.

Abnormal Results: 

  • Abnormal growth in ovaries or uterus. 
  • Fibroids a benign tumour that may cause abdominal pain. 
  • Ovarian cysts are common. 
  • Ovarian cancer can be detected through a transvaginal ultrasound.

If you are facing any abnormal gynae symptoms or discomforts, you can consult with Dr Sarah Hussain, the leading Female Gynaecologist in London. Request a call for treatment.

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HYSTEROSCOPY Its types diagnosis and complications

HYSTEROSCOPY: Its types, diagnosis and complications

 It is a method that lets your physician look inside your uterus to diagnose and deal with the reasons for abnormal bleeding. It comprises a rigid telescope having a wide viewing angle and fibre optic illumination cable.

Types of Hysteroscopy:

  • Microhysterosocpe provide magnification of 30-150 times. 
  • Contact hysteroscope is a diagnostic tool without distending medium. It enables assessment of the normality of the endometrial tissue lining and helps to diagnose any early neoplastic change. 

Technique: Hysteroscopy should be performed in the preovulatory phase when the endometrium is thin, and bleeding is less likely to occur. Diagnostic hysteroscopy can be performed under local anaesthesia and sedation, but the therapeutic procedure mandates general anaesthesia. 

Precaution: gas inflating machine used in laparoscopy should not be employed in hysteroscopy since high pressure of the former can cause a gas embolism.

As the distension medium distends the cervical canal and uterine cavity under direct vision, this precaution avoids perforation.

Distension media in Hysteroscopy:

Several distension media are in the recent usage for hysteroscopy. The medium depends on its availability, safety, effectiveness and cost. The popular liquid media includes standard saline 5% dextrose and ringer’s lactate solutions. The media in common usage include carbon dioxide gas delivered through hysteroscopy at a maximum rate of 70%. This will give a clear view of its lining and the opening of fallopian tubes. More sophisticated pressure systems are available for use during prolonged hysteroscopic operative procedures like myomectomy, septum cutting or endometrial ablation.

Typical appearance of the Endometrium:

It looks thin and pale with a smooth surface and minimal vascularisation: the glands are not easily seen. 

At ovulation, the endometrium appears oedematous, and the glands are seen. 

Increased vascularity causes oedema, and the endometrium looks pink with glands seen in the luteal phase.

Diagnostic Indications: 

  • A biopsy can be taken from suspicious areas. Endocervical polyp can also be identified and removed. 
  • The presence of the fundus seen laparoscopically indicates it is a septate uterus. In a bicornuate uterus, the fundus is absent. 
  • Selective biopsies are required for endometrial tuberculosis to confirm the diagnosis or curettage done – the presence of caseous areas, ulcers on the endometrial lining.
  • Hysteroscopy confirms the uterine synechiae and extent of adhesions.
  • Though ultrasound can locate a misplaced IUCD, a hysteroscope determines whether it is embedded in the endometrium and allows safe retrieval.
  • A fibroid polyp is firm, permanent and of various size paler than a mucus polyp usually sessile, immobile and is caused by folds of endometrium in hyperplasia. 
  • The decision regarding the feasibility of tubal surgery can be taken cannulation, and adhesiolysis is also possible.
  •  When hysterosalpingography shows blockage of the corneal end of the tube, the hysteroscope enables the fallscope to be inserted into the cornual end.


  • Sepsis usually occurs with myomectomy
  • An allergic reaction is noted with dextran and glycine
  • Bleeding occurs in 1 – 2%, and it can be minimised by performing the surgery in the preovulatory phase
  • organ injury to the bowel and intestine is rare.
  • Anaesthesia complication, more with co2 used as a distending medium.
  • Uterine perforation

Late Complications:

  • Haematometra following cervical stenosis
  • Unwanted pregnancy
  • Cancer endometrium may go unnoticed for a long term
  • Infection may lead to PID

If you have abnormal vaginal bleeding and are seeking a test and diagnosis, you can consult with Dr Sarah Hussain, the leading Female Gynaecologist in London. Request a call for treatment.

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Dyspareunia- Its Symptoms, Causes and Treatment

Dyspareunia is chronic or ongoing discomfort in, during and after the sex in the genital or pelvic region. In both men and women, it is normal and can be induced by different things, such as infections and psychological and physical issues.

Symptoms of Dyspareunia

The symptoms of Dyspareunia is observed in both men and women:

  • The following symptoms can arise from female Dyspareunia:
  • The discomfort of sexual intercourse
  • Penetration pain – including adding insertion of a tampon
  • sensation of burning 
  • Paining agony after hours after sex

Let us discuss the symptoms that arise from male Dyspareunia

  • Genital or pelvic region persistent pain, present during and after intercourse
  • Sensation of burning
  •  irritation over skin
  • Cannot be roused

Causes of Dyspareunia in men and women

There are multiple reasons that cause Dyspareunia in men and women as well. Due to the lack of lubrication, there can be discomfort during penetration. Injury or discomfort from a birth channel can also arise from traumatic intercourse, pelvic procedure, circumcision and wounds that have taken place throughout childbirth.

Other related factors include inflammation, infection of the urinary tract, sexually transmitted diseases such as chlamydia and gonorrhoea, genital eczema, and vaginal disease in women.

Intense pain can lead to Dyspareunia, too, due to certain conditions such as endometriosis, inflammatory pelvic illness, uterine prolapse, uterine fibroids, cystitis, cysts, and stacks. Other medical procedures, such as hysterectomy or cancer chemotherapy, may also result in sex with pain.

Treatment for Dyspareunia

Depending on the patient and the situation, the care may be different. A pelvic examination is done in a medical exam with a gynaecologist or urologist, where the doctor can check for discomfort, skin irritation or anatomy issues. A pelvic ultrasound may also occur. If there are emotional causes for Dyspareunia, these patients will need counselling or sex therapy.

Consult with a professional gynaecologist if you ever have questions about Dyspareunia. You can visit the leading female gynaecologist in London, Dr Sarah Hussain. Ask for a counselling appeal.

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Cervicitis Its Symptoms Causes and Treatment

Cervicitis – Its Symptoms, Causes and Treatment

Cervicitis is an infection or irritant that induces inflammation of the cervix. Positioned in the centre of the vagina, the cervix is the opening to the uterus. Cervicitis often results from STIs, but it may also result from causes that are not contagious. It is necessary to determine the precise cause first in order to treat cervicitis.

Cervicitis can be either chronic or acute. The most common cause of acute cervicitis is an infection and is best treated medically. While chronic cervicitis is not normally infected. Symptoms may be milder, but long-lasting. 

Symptoms of Cervicitis

No symptoms can be observed by women with Cervicitis. Some women may, however, note the following symptoms:

  • Increased vaginal discharge;
  • Pain during sex
  • Discomfort during urination
  • A hot sensation
  • Urinate often
  • Bleeding or marking times
  • Bleeding followed by intercourse Pelvic pain
  • Frequent and painful urination 
  • Uncommon grey or white flush that can smell
  • a sense of pressure in the pelvis
  • Pain on the lower back
  • Pain in the abdomen

Causes of Cervicitis

There are many causes of cervicitis, but the most common is infection. Cervicitis can be the result of:

  1. Bacterial imbalance: Bacterial vaginosis is possible if dangerous bacteria overtake the healthy bacteria in your vagina. This may be an irritant cervix symptom.
  2. Allergies: If someone is allergic to spermicides, showers, or latex in condoms, it may cause the cervix to become inflamed.
  3. Pregnancy: This can impact hormone levels and contribute to cervicitis since the cervix is, at present, much more vulnerable.
  4. Cancer or cancer treatment: Cervical tissue itself may be affected by cancer therapies and by advanced stages of cervical cancer. This is unusual and can lead to cervical problems.
  5. Irritation: Tampons, pessaries or diaphragms can irritate or harm your cervix. Cervicitis can also develop if these objects stay in place longer than directed.

Treatment  of Cervicitis

Cervicitis is generally treated with antibiotics if it is caused by bacterial infections such as chlamydia and gonorrhoea. Antiviral treatment can occur for herpes infections. If an allergic reaction causes your cervical condition, you should extract the irritant by yourself.

If you are experiencing any of the above symptoms as discussed above and looking for the treatment, you can consult with Dr Sarah Hussain, the leading Female Gynaecologist in London. Request a call for treatment.

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