Regenerative, Aesthetic and Functional Gynaecology

This consultation is based on the growing need of modern women to claim quality of life and beauty for themselves.
Complaints about the genital tract are common to all ages. Examples include pain during sexual intercourse, lack of lubrication, frequent urinary and vaginal infections, vulvar itching and burning, involuntary leakage of urine and prolapse of the pelvic organs.
Discomfort at morphological changes to the vulva can also arise at any age. Hypertrophies and asymmetries of the vulvar lips, as well as changes in colour, appear with some frequency. In some cases of weight loss, the labia majora become flaccid and show excess skin. The same can happen after having children or entering the menopause.
We can also talk about vaginal recovery after childbirth. With the right help, recovery is much quicker and more effective.
In addition to the problems already mentioned, this consultation can treat other aesthetic and clinical problems such as lichen sclerosus, correction of episiotomy or caesarean section scars, vulvar condylomas and bleeding during intercourse without associated cervical disease.
In short, this consultation aims to treat the causes of genital discomfort and restore pleasure in life and self-esteem.

Uterine Myoma

A uterine myoma (also known as a fibroid, leiomyoma or fibromyoma) is a benign tumour that grows in the tissue of the uterus and very rarely becomes malignant. It can be isolated or several small tumours can appear, occurring in between 20% and 50% of women of childbearing age.

Depending on their location, fibroids can be intramural, subserosal or submucosal. The former, which grow in the wall of the uterus, are the most common. The second are located in the endometrium and tend to cause more blood loss. The third grow on the outer wall of the uterus.

In many cases, myoma can go unnoticed without manifestations. In around 30% of women, they cause symptoms, such as abnormal uterine bleeding, very heavy and prolonged periods, and can lead to anaemia. The risk of developing them increases with age, family history, eating habits and obesity.

In Portugal, uterine fibroids affect between 30 and 60 per cent of the general female population. In women of reproductive age, the incidence is between 20 and 40 per cent. But it is estimated that around two million have this condition.

Symptoms

The most common symptoms are pain in the back of the legs, a feeling of pain or pressure in the pelvic region, abundant and prolonged menstrual periods and blood loss between periods, constipation or gas due to compression of the abdomen, an increase in its volume that can be mistaken for excess weight or pregnancy, pain during sexual intercourse, pressure on the bladder with a constant feeling of wanting to urinate, incontinence or inability to empty the bladder.

Sometimes they can cause polyps to grow in the endometrium, which aggravate the pain and menstrual blood loss. If these are abundant and prolonged, anaemia can occur, with tiredness, difficulty breathing and paleness.

Fibroids can interfere with the implantation of fertilised eggs, causing infertility. In pregnancy, they can affect blood flow to the placenta, causing miscarriage or premature labour. Pregnancy has a variable and unpredictable effect on fibroid growth, but they rarely increase during this period.

Causes

Their causes have yet to be identified. It is known that they develop in women of reproductive age and do not appear before the body is able to produce oestrogen.

Fibroids grow faster when the body receives additional doses of oestrogen. After the menopause, they stop growing and begin to reduce in size due to the loss of this hormone. All this suggests that the hormonal environment is important in the development of this disease.

Genetic factors also play an important role in the development of uterine myoma. In fact, first-degree relatives of women with myoma have a two-and-a-half times greater risk of developing it.

Diagnostics

Diagnosis is based on gynaecological examination and tests such as ultrasound or MRI, which confirm the presence, location and size of the myoma.

Treatment

Treatment depends on various factors, such as age, general state of health, severity of symptoms, personal history and location of the fibroids. In the absence of manifestations, the doctor may choose not to treat and maintain regular surveillance.

In the past, the most common treatment was removal of the uterus (hysterectomy). Nowadays there are other options. As a rule, therapy is indicated when the myoma grows to the point of compressing other organs, such as the bladder, when it grows too quickly, when it causes abnormal bleeding or when it is associated with infertility. Treatments can include hormones which, used in combination, help to reduce its size before surgery.

Fibroids can be removed through the uterus (hysteroscopy), by laparoscopy (insertion of surgical instruments through small holes in the abdomen) or by open surgery when they are larger.

In this case, the walls of the uterus can be weakened, making it necessary to have a caesarean section in the event of a later pregnancy.

Removing the myoma while preserving the uterus is important for women who want to become pregnant, but in around 25 per cent of cases the disease can reappear. When it is necessary to remove the entire uterus (hysterectomy), the woman can no longer become pregnant.

Prevention

Although researchers continue to study their causes, little scientific evidence is available on how to prevent them. Preventing uterine fibroids may not be possible. However, by making healthy lifestyle choices, such as maintaining a normal weight and eating fruit and vegetables, you can reduce your risk. Some studies suggest that the use of oral contraceptives may be associated with a lower risk of fibroids.

Labioplasty / Nymphoplasty

Labioplasty is a surgical procedure that reduces and remodels the vaginal lips when they are too large, sagging, irregular or asymmetrical. In other words, with this surgery, also known as nymphoplasty, or vaginal labia reduction surgery, excess skin is removed from the labia and clitoral hood, whenever necessary.

It’s a simple, short-term operation performed under light sedation and local anaesthetic. The stitches are spontaneously absorbed by the body and the outer ones fall off spontaneously. As the area is hidden by the labia majora, there are no apparent scars. Some discomfort and oedema are to be expected in the post-operative period, which is why it is recommended to rest in the immediate post-operative period and follow all the recommendations given to you by your plastic surgeon.