Currently a secondary procedure is carried out in the laboratory on abnormal Paps. It is a test for Human Papilloma Virus (HPV) high risk types. This test will determine if you are harboring this virus and, if so, which one it is. There are many types of HPV: some that can lead to cancer, some that can cause warts, and some that do both. This additional testing is usually done and its report ready by the time the Pap comes back to your doctor or nurse practitioner, meaning the additional HPV testing results are part of the Pap report.

The real test to judge the merits of a Pap smear result is an office procedure called colposcopy. Some doctors only do this if the Pap report includes a positive result. Some doctors do the colposcopy for any abnormal Pap, even if the culture for HPV is negative. This may be overkill. Those against such overkill can only condemn it for financial reasons, which is why insurance companies try to make the indication for colposcopy only for high-risk HPV detected on culture from an abnormal Pap specimen. Those for this overkill claim that more information is always better than less information and colposcopy has essentially no risk. Also supporting an aggressive rationale for colposcopy is that colposcopy is THE test that you can rely on, not the Pap, which is just a screen.

So why not just do a colposcopy on everyone and by-pass all of this foolishness of an inexact screen? Because that test is more invasive and expensive--about ten to twenty times more. It makes more sense to save that one for the times that the pap comes back unusual (as stated avove).

A pap smear is nothing more than a gentle scraping at the cervix during a GYN exam, sometimes resulting in some mild cramping and spotting. A colposcope, although nothing more than a microscope, evaluates the entire pap smear area stereoscopically, easily guiding the specialist to the areas that caused an abnormal pap--areas that are biopsied with tiny clippings--again, perhaps some mild cramping. These clippings, however, are not the scattered loose cells strewn over a slide as in a pap. Instead they are actual "chunks" (microscopic, of course) of the tissue the way it sits in the cervix. This yields a result of certainty that will be either no cause for concern or a need for treatment.

Treatment
Most of the treatments involve simply eliminating the abnormal tissue. Freezing it (cryosurgery), the old stand-by, is inexpensive compared to laser, which is the newer technique. Both have the same success rate, but freezing requires no anesthetic, is ten times cheaper, and is done right in the office. You drive home.

The laser is done with an anesthetic, usually in a surgicenter as an outpatient. It vaporizes the tissue, sealing off bleeding at the same time. It's advantage is that it can also be used to eliminate vaginal warts, an additional problem from a batch of mixed virus that can also cause abnormal pap smears. Also, the laser doesn't result in the inconvenient discharge cryo causes.

The newest technique is LEEP, or an electrified loop excision that is the best of both laser and cryo--office procedure, cheap, and no general anesthesia. Under a local anesthetic, a small hot wire loop sweeps under the abnormal area superficially, scooping it out and eliminating it. You still drive home.

Cone biopsy is reserved for those cases in which the lesion, on colposcopy, goes up out of site up the birth canal. It's impossible to tell if the unseen lesion may be worse than what's visible. Removal of a donut-shaped end of the cervix is best studied under a microscope after having been removed surgically. Recover from a cone biopsy involves more nagging bleeding than after a LEEP or laser, but the real danger is that the integrity of the cervix to hold in a future pregnancy may have been compromised, putting one at risk for preterm delivery.

Hysterectomy (removal of the uterus (womb), cervix included) can be used to treat dysplasia when there are additional considerations. This is a drastic therapy, of course, and shouldn't be considered in anyone not finished her childbearing. Additional reasonable conditions for this "final" treatment include:

• Abnormal bleeding warranting hysterectomy in a woman finished childbearing
• History of recurrent dysplasia--that is, treatment failures with previous more conservative approaches (laser, LEEP, cryo), in a woman finished childbearing
• Endometriosis, in a woman finished childbearing Pelvic pain warranting hysterectomy, in a woman finished childbearing
• Other malignancy or pre-malignancy changes in the uterus or ovaries

Essure procedure is the first and only FDA approved female sterilization procedure to have zero pregnancies in the clinical trials. The Essure procedure is permanent and is NOT reversible. Therefore, you should be sure you do not want children in the future.

The Essure procedure is different than the traditional method of a surgical tubal ligation. With Essure there is no cutting into the body. Instead, an Essure trained doctor inserts spring-like coils, called micro-inserts, through the body’s natural pathways (vagina, cervix, and uterus) and into your fallopian tubes.

The procedure can be performed in your doctor's office without general anesthesia and mild cramping is typically the only discomfort. Patients receive local anesthesia with or without sedation during the sterilization which takes just a few minutes.

During the first 3 months following the procedure, your body and the micro-inserts work together to form a tissue barrier that prevents sperm from reaching the egg. During this period, you will need to use another form of birth control, similar to the requirements after a vasectomy.

After 3 months, you will need an Essure Confirmation Test, a special type of x-ray to confirm that your tubes are completely blocked and you can rely on the Essure micro-inserts for birth control.

Unlike birth control pills, patches, rings, and some forms of IUDs, Essure does not contain hormones to interfere with your natural menstrual cycle. Your periods should more or less continue in their natural state.

Hysteroscopy is a powerful way of looking into and evaluating the uterine cavity. This is particularly important since abnormalities of the cavity may prevent implantation and therefore fertility, or may interfere with the normal growth and progression of pregnancy. We recommend hysteroscopy to our patients when:

1. Results of a tubal x-ray (HSG) indicate a uterine abnormality
2. Diagnosis of repeated miscarriage
3. Evidence of an intrauterine growth such as a polyp on sonogram
4. To evaluate postmenopausal bleeding
5. Congenital adnormalities of the uterus
6. Infertility
7. Sterilization (see Essure procedure)

Fertility related diagnoses that can be made include:

Submucosal myomas Uterine polyps Adenomyosis (growth of the glands of the endometrium into the muscle wall of the uterus) Scarring of the uterine lining (Asherman's Syndrome) Presence of a uterine septum or bicornuate formation Other congenital abnormalities of the uterus Based on the findings a definitive reparative procedure can be planned.

Laparoscopy is an outpatient surgical procedure usually performed under general anesthesia. The procedure consists of inserting a telescope like instrument through a small incision at the belly button (umbilicus) into the abdomen. Carbon dioxide is used to inflate the abdomen pushing the abdominal organs and bowel aside to allow full visualization of the pelvic organs. Small incisions are made along the lower abdomen where graspers and other fine instruments may be inserted to visualize the entire pelvic (or abdominal) cavity for diagnostic purposes.

The fallopian tubes may be inspected and dye passed through the cervix and uterus to evaluate tubal function and patency. Evidence of tubal disease, and blockage, endometriosis, pelvic adhesions and ovarian cysts are a few of the fertility related diagnoses that can be made and, under most circumstances, repaired. Photo-documentation allows for a permanent record of the findings and procedures for the patients edification and the possibility of additional consultation.

At the end of the procedure, the carbon dioxide is released, deflating the abdomen, and the incisions are closed. Recovery time is usually around one hour in the recovery room and patients are discharged once they are able to urinate, tolerate fluid intake, and walk with assistance.

Laser Surgery and Laparoscopy
Laser is a tool like any other in the surgeon's collection, and like all tools, it has advantages and disadvantages. Often used in conjunction with laparoscopy, laser is typically employed in the surgical treatment of endometriosis.

Hysterectomy is the surgical removal of the uterus, or womb. This article will explain:

• Why you may need to have a hysterectomy
• How hysterectomy is performed
• What to expect before and after the operation

Remember, no two women undergoing a hysterectomy are alike. The reasons for and the outcome of any surgical procedure depend on your age, the severity of your problem, and your general health. This article is not intended to take the place of your surgeon's professional opinion. Rather, it is intended to help you understand the basic elements of this surgical procedure. Read this information carefully. If you have questions after reading this material, discuss them openly and honestly with your surgeon.

Why Are Hysterectomies Performed?

Hysterectomy may be performed to treat a variety of gynecological (female reproductive system) problems. It is an elective procedure 90 percent of the time. Today most hysterectomies are done to treat benign (non-cancerous) fibroid tumors of the uterus. While not life-threatening, these growths cause pelvic pain, excessive bleeding or pain during sexual intercourse. Fibroid tumors are common and usually do not require surgery. Other forms of treatment, which preserve the uterus and childbearing capacity, are also available. You should discuss these options with your surgeon.

Endometriosis is a condition in which the tissue lining the uterus becomes displaced and grows in other parts of the abdomen, where it can cause pain. Endometriosis is the second most common reason for a woman to have a hysterectomy.

However, the practice of treating endometriosis by performing hysterectomy has been declining in the last decade because other treatments have evolved. You should discuss these other options with your surgeon first to see if another treatment for endometriosis may be effective for you.

Prolapse of the uterus is another reason why some women decide to undergo a hysterectomy. In this condition, the uterus descends or sags into the vagina due to stretching of the ligaments and fibrous tissue that usually hold it in place. Women with cancer of the uterus or cancer of the cervix require special types of treatment, which may include a simple or radical hysterectomy. These women should seek the counsel of a gynecologic oncologist.

Are All Hysterectomies the Same?

You may hear different names used to refer to this type of operation. That is because there are different types of hysterectomies. A total hysterectomy or panhysterectomy applies only to the removal of the uterus and cervix. When the ovaries and fallopian tubes on both sides of the uterus also are removed, the procedure is called a hysterectomy and bilateral salpingooophorectomy ("salpingo" is from the Greek word for "tube," while "oophor" is from the Greek word for "bearing eggs," that is, the ovaries). A radical hysterectomy is a much more extensive procedure and is only performed in special situations such as cancer of the uterus or cervix. It includes removal of the uterus, cervix and surrounding tissue, the upper vagina, and usually the pelvic lymph nodes. A surgeon with special training in gynecologic oncology performs this type of procedure.

Is Hysterectomy Mainly for Older Women?

You may be surprised to know that 42, a relatively young age, is the average age of women undergoing hysterectomy. More than three-fourths of all women who have a hysterectomy are between 20 and 49 years of age.

Is There Any Reason to Avoid or Delay Hysterectomy?

It is not sensible to have a hysterectomy in order to prevent cancer of the cervix or uterus. In this case, the risks of having a major operation outweigh any supposed cancer-protection benefits. Furthermore, hysterectomy is not considered to be the first choice for sterilization in most healthy women. Another procedure, tubal ligation, is a cheaper, easier and safer method for most women.

Hysterectomy may not be advisable if your problem has not been adequately diagnosed. For instance, if you have pelvic pain that is not specifically caused by the uterus, a hysterectomy may not relieve your pain. The pain may be due to problems in your digestive, urinary or skeletal systems. In these cases, your doctor will want to do the proper tests and ultrasounds to locate the exact source of your pain. In addition to the tests and ultrasounds indicated, a diagnostic laparoscopy may be helpful in selecting the appropriate treatment.

Similarly, most women with abnormal bleeding, especially menopausal or post-menopausal women, should have an endometrial biopsy (EMB) or a dilatation and curettage (D&C) procedure to rule out uterine cancer before undergoing a hysterectomy. Hysteroscopy (a surgical procedure in which a gynecologist uses a small lighted telescopic instrument to view the inside of the uterus) should not be performed until uterine cancer has been ruled out by D&C or EMB.

Finally, women who are obese, who have diabetes, high blood pressure, or some other chronic conditions, are at increased risk during any type of operation. For these women, hysterectomy should only be considered if reasonable alternatives have been exhausted.

If you have any questions about hysterectomy, ask your doctor. If it would make you feel more confident about your medical treatment, get a second opinion from another physician who is qualified to diagnose and treat your condition. Unless you have a severe pelvic infection or uncontrollable bleeding, you do not have to rush into having a hysterectomy. Even with a diagnosis of cancer, a short delay to seek another qualified opinion is usually safe and worthwhile.

How Do I Decide if I Should Have a Hysterectomy?

You will no longer be able to get pregnant after a hysterectomy. Thus, before you choose elective hysterectomy, you must consider both the severity of your problem and your desire to have children in the future.

Although this operation may improve your quality of life by relieving chronic symptoms, such as pain or bleeding, some women are willing to tolerate these conditions.

Ask yourself:

• Do I want to become pregnant in the future?
• How do I feel about not having a uterus?
• What is my husband's (or partner's) attitude toward this operation?

Ask your surgeon:

• What will happen if I don't have a hysterectomy?
• What are the risks of a hysterectomy in my particular case?
• Is my condition likely to improve on its own, stay the same, or get worse?
• Is a hysterectomy medically necessary or recommended to relieve my particular symptoms?

Before your operation, you will be asked to sign a document giving your "informed consent" to the operation. This form lets you know any risks or possible complications that can be caused by the surgical procedure. Some states have specific laws that pertain to hysterectomies. These laws require surgeons to explain the alternatives and the risks of the procedure and are intended to make sure you underastand the potential after-effects of the operation.

How Is Hysterectomy Performed?

The surgeon can remove the uterus through a surgical incision made either inside the vagina or in the abdomen. In both the vaginal and abdominal approaches, the surgeon detaches the uterus from the fallopian tubes and ovaries as well as from the upper vagina.
For patients that qualify, a more minimally invasive approach using laparoscopy or laparoscopic assistance can be used to shorten recovery time.

Abdominal Hysterectomy

When a hysterectomy is performed through an incision in the abdomen, it allows the surgeon to see the pelvic organs easily and gives him or her more operating space than is permitted in a vaginal hysterectomy.

Thus, for large pelvic tumors or suspected cancer, your surgeon may decide to do the procedure abdominally. Patients who have an abdominal hysterectomy require a longer hospital stay than those who have a vaginal hysterectomy. In addition, they may experience greater discomfort immediately following the operation, and will have a visible scar.

However, the surgeon often can make a less-noticeable horizontal incision, called a bikini-cut, that extends along the top of the pubic hairline.

Vaginal Hysterectomy

The vaginal approach to hysterectomy is ideal when the uterus is not enlarged or when the uterus has dropped as a result of the weakening of surrounding muscles. This approach is technically more difficult than the abdominal procedure because it offers the surgeon less operating space and less opportunity to view the pelvic organs. However, it may be preferred if a patient has a prolapsed uterus, if the patient is obese, or in some cases has early cervical or uterine cancer. A vaginal hysterectomy leaves no external scar.

A variation on vaginal hysterectomy is LAVH (laparoscopic-assisted vaginal hysterectomy). A laparoscope is a device the surgeon can use to examine the inside of the pelvis. LAVH is an alternative for women who have ovarian disease but previously had only one choice: an abdominal hysterectomy that leaves a long incision. With LAVH, much of the procedure is done through tiny incisions using a laparoscope. The rest of the procedure then can be finished vaginally.

Laparoscopic Superconvical Hysterectomy, (LSH), the uterus is removed by laparoscopy alone. An instrument called a monceuator converts the uterus into tiny pieces to remove them through the small Laparoscopic incisions. A Total Laparoscopic Hysteerectomy (TLH) is similar to the LSH but the entire uterus and cervix are removed. Certain patients can qualify for these more minimally invasive Hysterectomies and qualification is typically based upon the size of the uterus and the presence or absence of adhesions or scar tissue.

Stages of Recovery

After the operation, you will likely remain in the recovery room for one to three hours. You may be given pain medication, and possibly antibiotics to prevent infection. You will probably be able to walk around your room the day after your operation, depending on the type of procedure you underwent. Most patients go home the third day following an abdominal hysterectomy and by the first or second day after a vaginal hysterectomy, LAVH, LSH or TLH.

Complete recovery from abdominal hysterectomy usually takes six to eight weeks because the incision is typically 5 inches long. During your recovery, you can expect a gradual increase in activities. Avoid all lifting during the first two weeks of your recovery period and get plenty of rest. In the weeks following the surgical procedure, you can begin to do light chores, some driving, and even return to work, provided your occupation does not involve too much physical activity.

Around the sixth week following the operation, you can take tub baths and resume sexual activity. Women who have had vaginal hysterectomies generally recover more quickly.

Risks or Complications?

Hysterectomy is regarded as one of the safest operations. Nevertheless, no operation is without risk. Severe complications and even death occasionally occur with this operation.

The uterus is located between the ureters (small tubes which transport urine from the kidneys to the bladder) on each side, the urinary bladder in front, and the rectum behind. All of these structures are subject to injury, especially if the operation is difficult, as can occur with large fibroids, endometriosis or cancer. Bleeding and infection also can occur, but most infections are now avoided by using antibiotics. Blood clots in the legs (DVT-deep vein thromboses) sometimes occur postoperatively and can break off and travel to the lungs causing a sometimes fatal pulmonary embolism (blood clot). These clots largely can be avoided in high-risk patients by using special stockings during the operation or by using blood thinners.

Long-Term Effects

After having a hysterectomy, you will no longer be able to get pregnant and will no longer have menstrual periods. If you were premenopausal (still menstruating) before the operation and have your fallopian tubes and ovaries removed, you will experience all of the symptoms of menopause as your body gets used to different hormone levels. These symptoms may include hot flashes and perhaps irritability and depression. If the symptoms are severe, your doctor may prescribe hormone replacement medication. Hysterectomy usually has no physical effect on your ability to experience sexual pleasure or orgasm.

Following hysterectomy, the ovaries will continue to function; however, the actual occurrence of menopause will be difficult to determine since the uterus has been removed and the patient will no longer have periods. As the age of menopause, approximately age 51, is approached, symptoms such as hot flashes may warrant testing to see if hormone replacement therapy is indicated. If you experience vaginal dryness, it can be remedied by using prescription hormone creams or pills or water-soluble lubricants that you can purchase at the pharmacy.

A sense of loss following the removal of any organ is normal and takes time for adjustment. While depression following hysterectomy does not happen to everyone, it is more common if the operation was done because of cancer or severe illness, rather than as an elective operation.

Additionally, if you are under age 40 or the operation interfered with your plans to have children, depression is more likely to occur. This depression can be temporary, depending on your general outlook on life and the availability of a good support group of family and friends. Most women experience an improvement of mood and increased sense of well-being following hysterectomy. For many, relief from fear of pregnancy results in heightened sexual enjoyment following the procedure.

To treat certain problems of the uterus, your doctor may suggest a procedure called Laparoscopically Assisted Vaginal Hysterectomy (LAVH). LAVH combines laparoscopy and hysterectomy. Laparoscopy is used to look into the abdomen at the reproductive organs. Hysterectomy is surgery to remove the uterus.
What Is LAVH?
LAVH is a special form of hysterectomy — removal of the uterus. The uterus is a reproductive organ in the lower abdomen.

The uterus can be removed in two ways. When it is removed through a cut (incision) in the abdomen, the procedure is called an abdominal hysterectomy. When it is removed through the vagina, it is called a vaginal hysterectomy.

LAVH involves the use of a small, telescope-like device called a laparoscope. The laparoscope is inserted into the abdomen through a small cut. It brings light into the abdomen so that your doctor can see inside.

The laparoscope also can be used before hysterectomy to look at the pelvic organs to help your doctor see what conditions are present.

Reasons for LAVH
Hysterectomy may be offered as a treatment option for problems with the uterus.

Following are reasons to perform LAVH:

Adhesions

Endometriosis

Fibroids
Salpingo-oophorectomy.
If the ovaries and fallopian tubes also are removed during hysterectomy, it is called salpingo-oophorectomy.
The Procedure
Before LAVH, certain steps will be taken to prepare you for the procedure:

Your pelvic area and abdomen may be shaved.

You will be given an intravenous (IV) line.

You will be given anesthesia (pain relief).
You will not be awake during the surgery. In some cases, an abdominal hysterectomy may be required if an LAVH could not be done.

Benefits
The main reason for LAVH is to allow the uterus to be removed safely through the vagina if a standard vaginal hysterectomy cannot be done.
Risks
There are some risks that may occur with any surgery. These may include:

Bleeding

Infection

Problems from the anesthesia

Blood clots in the veins or lungs

Death (rare)
LAVH can take longer than other types of hysterectomy. This means that you may need more anesthesia than you would with other forms of hysterectomy.

After Surgery
Hysterectomy is major surgery, no matter how it is done. You will have some pain. You may need to stay in the hospital for a 1-2 days.
After you leave the hospital, you will need to rest and take care of yourself.
Make sure you know the warning signs of a problem. Contact your doctor if you have any of the following:

Fever or chills

Heavy bleeding or vaginal discharge

Severe pain

Redness or discharge from the abdominal cuts

Problem with urination or bowel movements

Shortness of breath or chest pain
Finally … If you have problems with your uterus, you and your doctor may decide that a hysterectomy is the best treatment. LAVH may be an option.

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Laparoscopic Supracervical Hysterectomy

A supracervical hysterectomy can be used to treat the same medical conditions as a vaginal hysterectomy, including benign fibroid tumors of the uterus, abnormal uterine bleeding, endometriosis and chronic pelvic pain. As a partial rather than a total hysterectomy, a supracervical hysterectomy removes the uterus but leaves the cervix in place. This saves some of the blood supply and nerve network and provides better long-term support for the pelvic organs.

The main difference between a vaginal and supracervical hysterectomy is that there is no vaginal incision made in a supracervical hysterectomy. A laparoscope — a small tube with a television camera on the end —is inserted into the abdomen through a small incision in the navel, providing an image of the internal organs to guide the surgery. Microsurgical tools inserted through two additional incisions are used to detach the uterus and remove the tissue. The three small incisions are each less than 1/2” long, and a supracervical hysterectomy is usually the least painful form of hysterectomy, with the shortest recovery time required.

What are the advantages of minimally invasive Supracervical Hysterectomy?

Reduced scarring; incisions are ½ inch or less rather than 6 inches as with open surgery

Less blood loss and lower risk of infection

Less trauma to the muscles and other tissue helps preserve sexual response

Shorter hospital stay; 1 day instead of 2-3 days for open surgery

Shorter recovery time; return to work in 2 weeks rather than 6 weeks with traditional surgery

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Total Laparoscopic Hysterectomy (TLH)

A total laparoscopic hysterectomy can be used to treat the same medical conditions as a vaginal hysterectomy, including benign fibroid tumors of the uterus, abnormal uterine bleeding, endometriosis and chronic pelvic pain. A total laparoscopic hysterectomy removes the uterus and the cervix. For this procedure, a patient should have a smaller sized uterus, and is done when removal of the cervix is required but a minimally invasive approach can still be performed.

Like with a vaginal hysterectomy, a vaginal incision is made. A laparoscope — a small tube with a television camera on the end —is inserted into the abdomen through a small incision in the navel, providing an image of the internal organs to guide the surgery. Microsurgical tools inserted through two additional incisions are used to detach the uterus and remove the tissue. The three small incisions are each less than 1/2” long, and a total laparoscopic hysterectomy allows cervical removal with a more minimally invasive approach.

There are otherwise similar advantages to TLH

Reduced scarring; incisions are ½ inch or less rather than 6 inches as with open surgery

Less blood loss and lower risk of infection

Less trauma to the muscles and other tissue helps preserve sexual response

Shorter hospital stay; 1 day instead of 2-3 days for open surgery

Shorter recovery time; return to work in 2 weeks rather than 6 weeks with traditional surgery

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The diagnosis of the type of urinary incontinence a patient has can be determined by urodynamics. Urodynamics is the investigation of functional disorders of the lower urinary tract, i.e. the bladder and the urethra. Symptoms are particularly unreliable in the study of the lower urinary tract, so the purpose of urodynamics is to confirm objectively the pathology that a person's symptoms would suggest.

So for example if a person complains of a high frequency of urination it might be because of detrusor overactivity. Urodynamics would involve the use of pressure transducers attached to catheters inside the bladder to verify such a pressure pattern. Urodynamics allows for a more accurate diagnosis and can aid in formation of a better treatment plan for your condition.

The ON-Q PainBuster Post-Op Pain Relief System provides continuous infusion of a local anesthetic directly into the patient’s surgical site for effective, non-narcotic post-operative pain relief for up to 5 days

Gets patients on their feet faster

Reduces patient need for narcotics and decreases potential of breakthrough pain

Is simple yet elegant and requires little to no management or intervention by the patient or caregiver

Is completely portable and can be carried in a pouch or attached to a patients’ clothing The ON-Q Soaker Catheter™ is designed to infuse local anesthetic over a wider area than point-source catheters.

Available in 1, 2.5, 5 and 10 inch infusion lengths, the Soaker Catheter is ideal for post-operative pain relief in large incisions The unique design allows for greater versatility in catheter placement and even distribution of medication

How do they work?

The ON-Q System, a market leading post-op pain relief system, uses a small balloon-like pump that is filled with a local anesthetic medicine. The pump is attached to a catheter (tiny tube) that the doctor places near your incision site. The system is very easy to use. The pump automatically delivers the medicine at a slow flow rate. The pump may last anywhere from two to five days. The pump is completely portable, lightweight and can be attached to your gown or clothing or placed in a carrying pouch. When the infusion is complete, the catheter is removed and the pump is thrown away. Depending on your surgery, you may go home with one of these pain relief systems.

What are the benefits?
Benefits of the system over other methods of pain relief include:

Direct pain relief without the side effects of narcotics

Constant pain relief - reduces intense pain spikes

Quicker return to moving around, walking and normal activities

Earlier hospital release

What are the limitations?
The system only supplies supportive (adjunctive) pain relief and may not be 100% effective when used alone. It does not necessarily eliminate all pain.

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* The ACIP advises the director of CDC and the Secretary of Health and Human Services (HHS) on the control of vaccine-preventable disease and vaccine usage. The ACIP is comprised of 15 members appointed by the Secretary of HHS. Recommendations made by the ACIP become CDC policy when they are accepted by the director of CDC and are published in CDC’s Morbidity and Mortality Weekly Report (MMWR).On June 8, 2006, the Food and Drug Administration (FDA) licensed the first vaccine developed to prevent cervical cancer and other diseases in females caused by certain types of genital human papillomavirus (HPV). The quadrivalent vaccine, Gardasil®, protects against four HPV types (6,11,16, 18), which are responsible for 70% of cervical cancers and 90% of genital warts. On June 29, 2006, the Advisory Committee on Immunization Practices (ACIP* ) voted to recommend use of this vaccine in females, ages 9-26 years.

This prophylactic vaccine, made from non-infectious HPV-like particles (VLP), offers a promising new approach to the prevention of HPV and associated conditions. However, this vaccine will not replace other prevention strategies since it will not work for all genital HPV types.

Provisional HPV Vaccine Recommendations

The HPV vaccine is recommended for 11-12 year-old girls, but can be administered to girls as young as 9 years of age. The vaccine also is recommended for 13-26 year-old females who have not yet received or completed the vaccine series.
Ideally, the vaccine should be administered before onset of sexual activity. However, females who are sexually active also may benefit from vaccination. Females who have not been infected with any vaccine HPV type would receive the full benefit of vaccination. Females who already have been infected with one or more HPV type would still get protection from the vaccine types they have not acquired. Few young women are infected with all four HPV types in the vaccine. Currently, there is no test available for clinical use to determine whether a female has had any or all of the four HPV types in the vaccine.