Gynecological surgery in Dubai: when it is considered and what to ask

Surgery is rarely where treatment starts

For most gynecological conditions, NICE guidance places medicines, simpler procedures and watchful waiting before an operation. Surgery is considered when these have not helped or do not suit you, or when you prefer it after hearing the options and their risks. A few findings call for surgery sooner, such as an ovarian cyst that looks unusual on a scan.

• Heavy menstrual bleeding: medicines, including the hormonal coil, are usually tried before endometrial ablation (destroying the lining of the womb) or hysterectomy. Ablation is not suitable if you may want a pregnancy in future.
• Fibroids, non-cancerous growths in the muscle of the womb: many cause no symptoms and need no treatment. If they cause heavy bleeding or pressure, medicines are often tried before removing the fibroids alone, blocking their blood supply (embolisation) or hysterectomy, depending on their size, position and your plans for pregnancy.
• Endometriosis: pain relief and hormonal treatment usually come before surgery. Laparoscopy may be used to confirm the diagnosis and remove endometriosis, particularly when medicines do not help or pregnancy is a goal.
• Ovarian cysts: many small, simple cysts settle on their own and are checked with a repeat scan. Surgery is considered when a cyst is large, persists, causes symptoms or looks unusual.
• Pelvic organ prolapse and pelvic floor problems: supervised pelvic floor muscle training, attention to weight and constipation, and a vaginal pessary (a removable support) come before surgery, which remains an option if symptoms stay troublesome.
• Polyps, small growths in the lining of the womb or on the cervix: they can cause irregular bleeding and are usually removed through the cervix during a hysteroscopy, with the tissue sent to the laboratory.

Three main ways to operate: through the cervix, keyhole or open

Hysteroscopy passes a thin telescope through the vagina and cervix into the womb, with no cuts on the abdomen. It is used to look at the lining, take samples and remove polyps or fibroids inside the womb, under local or general anaesthetic. Complications are uncommon: bleeding, infection and, rarely, a small hole in the wall of the womb.

Laparoscopy, or keyhole surgery, is done under general anaesthetic through small cuts in the abdomen, which is filled with gas so the surgeon can see the pelvis on a screen. It is used for endometriosis, many ovarian cysts and some hysterectomies. Compared with open surgery it usually means smaller scars and a shorter hospital stay, but it has its own risks, including injury to the bowel, bladder or blood vessels, and sometimes a switch to open surgery part way through.

Open surgery (laparotomy) uses a larger cut, often low across the abdomen. It may be needed for large fibroids, a much enlarged womb or when a wider view is needed, and it usually means a longer hospital stay and a slower recovery than keyhole surgery.

Some operations, including many prolapse repairs, are done through the vagina and leave no cut on the abdomen; they carry their own risks, including bleeding, infection and effects on the bladder or bowel.

Every operation also carries general risks: bleeding, infection, blood clots in the legs or lungs, and reactions to the anaesthetic. The approach suggested depends on the condition, what needs treating, any previous operations and your general health.

Day surgery means going home the same day, when that is appropriate

Most hysteroscopies and many laparoscopies are planned as day surgery: you go home the same day once you are awake, can drink, pass urine and move about, and your pain is controlled. Whether that is appropriate depends on the operation, the anaesthetic, your health and how you are on the day. Staying overnight is sometimes the sensible choice, and it is not a sign that something has gone wrong.

After a general anaesthetic you need an adult to take you home and stay with you that night, and you should not drive or sign important documents until the effects have worn off. Tiredness, some cramping and light bleeding are common in the following days, as is shoulder-tip pain after a laparoscopy. Ask what to expect after your particular operation.

What to ask and how to prepare before any operation

Agreeing to an operation is a decision you make with your doctor, not one made for you. It helps to write your questions down and to bring someone you trust. Questions worth asking:

• Why is this operation suggested for me, and what is it expected to change?
• What are the alternatives, including medicines, a different procedure or waiting for now?
• What are the common risks, and the serious ones, even if they are rare?
• What is likely to happen if I wait?
• Will it affect my periods, my fertility or a future pregnancy?
• How will I feel afterwards in general, and what help will I need at home?

Before surgery, tell the team about all your medicines and supplements, especially blood thinners, any allergies, past problems with anaesthesia and any chance you might be pregnant. You can take time to decide, ask for a second opinion and change your mind at any point before the operation starts.

Cosmetic genital surgery: normal variation, medical reasons and risks

The size, shape and colour of the labia and vulva vary widely between women, and almost all of this variation is normal. Images online and in the media often show a narrow, edited picture of what is typical.

If the appearance of your genital area worries you, the American College of Obstetricians and Gynecologists (ACOG) advises assessment and reassurance about normal variation before any discussion of surgery, including questions about discomfort and about how much the worry affects daily life and relationships.

Surgery with a medical reason is different from surgery for appearance alone. A medical reason can be repairing an injury from childbirth, or labia that cause ongoing pain, chafing or difficulty with hygiene despite simple measures. For surgery done for appearance alone, ACOG notes that evidence on long-term effects is limited, and the risks include bleeding, infection, scarring, altered or reduced sensation, pain during sex and the need for further surgery.

These procedures are not appropriate for girls and teenagers, whose bodies are still developing; ACOG advises against them before adulthood unless there is a medical reason.