Somatic Cell Reprogramming

According to Jacob Hanna from the Jacob Hanna Lab, reprogramming of adult somatic cells into pluripotent stem cells may provide an attractive source of stem cells for regenerative medicine. It has emerged as an invaluable method for generating patient-specific stem cells of any cell lineage without the use of embryonic stem cells.

A revolutionary study in 2006 showed that it is possible to convert adult somatic cells directly into pluripotent stem cells by using a limited number of pluripotent transcription factors and is called as iPS cells. Currently, both genomic integrating viral and nonintegrating nonviral methods are used to generate iPS cells. However, the viral-based technology poses increased risk of safety, and more studies are now focused on nonviral-based technology to obtain autologous stem cells for clinical therapy. In this review, the pros and cons of the present iPS cell technology and the future direction for the successful translation of this technology into the clinic are discussed.

Mere months after Kyoto University researchers announced in 2007 that they had discovered how to turn skin cells into induced pluripotent stem cells (iPS cells), Jacob Hanna used these new types of cells to cure mice of sickle-cell anemia, in which a genetic defect causes bone marrow to make defective red blood cells. Hanna, a fellow at the Whitehead Institute, took skin cells from a diseased mouse and reprogrammed them create iPS cells, which behave like embryonic stem cells, readily turning into any cell type in the body. He then corrected the sickle-cell genetic defect and prodded the iPS cells to develop into the type of marrow stem cell that manufactures a mouse’s blood cells. These healthy cells were transplanted back into the mouse, whose immune system accepted them as the animal’s own tissue. The treated mouse began producing healthy red blood cells on its own.

Hanna’s work was a turning point for iPS research, says George Daley, director of the Stem Cell Transplantation Program at Boston’s Children’s Hospital and a professor at Harvard Medical School: “It was a beautiful demonstration of a mouse model of a human disease, and really demonstrated the potential of iPS cells.”

Before iPS cells can be used to treat diseases such as sickle-cell anemia in humans, a lot of work has to be done to make sure they won’t cause adverse side effects and to improve the efficiency of deriving them from skin cells. Hanna is now developing simulations to understand what happens when cells are reprogrammed, and he’s searching for new types of human stem cells that could be easier to turn into adult cells.–Nidhi Subbaraman

Genetically modified pigs for biomedical applications have been mainly generated using the somatic cell nuclear transfer technique; however, this approach requires complex micromanipulation techniques and sometimes increases the risks of both prenatal and postnatal death by faulty epigenetic reprogramming of a donor somatic cell nucleus. As a result, the production of genetically modified pigs has not been widely applied.

We provide a simple method for CRISPR (clustered regularly interspaced short palindromic repeats)/Cas9 gene editing in pigs that involves the introduction of Cas9 protein and single-guide RNA into in vitro fertilized zygotes by electroporation. The use of gene editing by electroporation of Cas9 protein (GEEP) resulted in highly efficient targeted gene disruption and was validated by the efficient production of Myostatin mutant pigs. Because GEEP does not require the complex methods associated with micromanipulation for somatic reprogramming, it has the potential for facilitating the genetic modification of pigs.

Jacob Hanna / Jacob Hanna Lab

Direct Cell Reprogramming

Research Findings at the Lab

Understanding Cellular Reprogramming by Jacob Hanna

In 2006, a development was made that makes it possible for scientists to reverse cellular differentiation and produce induced pluripotent cells via epigenetic reprogramming of somatic cells. The Jacob Hanna Lab is at the forefront of exploring the spectacular changes that occur in the cells during epigenetic reprogramming and knowing how these molecular changes can be related to in-vivo procedures.

The lab has already pinpointed two chromatin regulators that are vital in epigenetic reprogramming. One chromatin is key in the process, while the other multi-component complex is described as an obstacle which, if removed, could make reprogramming faster and better synchronized.

Working Out Naïve and Primed Pluripotent States

Pluripotent cells can be found in either naïve or primed state. Naïve pluripotent state is established in mature blastocyst. Primed pluripotent state, on the other hand, is established in the post-implantation epiblast. Only naïve cells can meaningfully contribute to the chimera or organism made up of genetically different cells.

The lab takes a closer look at how naïve and primed pluripotent cells are regulated both in mice and humans. Firstly discovered by Hanna lab, scientists are now able to maintain the naïve condition of human pluripotent cells, which can greatly benefit research on cross-species chimeric embryos in mice and potentially other animals. Present efforts on this matter also focus on shedding light on naïve and primed cellular states across multiple species.

Cross-Species Chimerism in Human and Mouse

At Jacob Hanna Lab, they have found that human stem cells that have been produced in naïve cellular state can be introduced into mouse blastocyst. This finding is instrumental in cross-species chimeric embryos. The result of this investigation may have wide-ranging impact on human disease modeling.

This is the first of a series of featured labs that we will be publishing here on The Stem Cell Podcast website.

The Stem Cell Podcast

This is a preview of Episode 02 of The Stem Cell Podcast

In this episode our science roundup includes novel poop pills, anti-acne bacteria, and Eric Kandel’s RB-AB 48 Alzheimer’s target.

We then get into some hot stem cell papers, including one by Dr. Jacob Hanna’s group recently published in Nature describing a method for 100% reprogramming efficiency. And finally we end with our signature rant about our pathetic government and the shutdown.

The common practice of reprogramming somatic cells to a stem cell state involves introducing four transcription factors: Oct4, Sox2, Klf4, and Myc.  Problem is, there’s another transcription factor lingering in adult cells, and it appears to be the cause of the abysmal reprogramming frequency that has frustrated researchers.

Those four transcription factors that can de-differentiate cells simultaneously recruit the transcriptional repressor Mbd3.  Unfortunately for scientists trying to make stem cells, Mbd3 puts the brakes on reprogramming.  Its job is to keep cells in their differentiated state.  This is an incredibly important job for both successful development and long-term health, but it is at odds with the efforts of stem cell scientists.

Jacon Hanna Lab

Stem Cell Studies

Stem cells are undifferentiated biological cells that can differentiate into specialized cells and can divide (through mitosis) to produce more stem cells. We found an expert in this field named Jacob Hanna from the Jacob Hanna Lab.

 

Focus on Pluripotent Stem Cell Studies and Epigenetic ReprogrammingDr Jacob Hanna

The research being done at Jacob Hanna Lab zeroes in on investigating cellular reprogramming processes which involve generating induced pluripotent stem cells from somatic cells. Reprogramming requires eliminating and remodeling epigenetic marks like DNA methylation. By using exogenous small molecules or transcription factors, epigenetic reprogramming can be artificially induced. This will create induced pluripotent stem cells that can be used for biomedical and stem cell therapy research, without the need of embryos.

 

More About Stem Cell Research
They are found in multicellular organisms. In mammals, there are two broad types of stem cells: embryonic stem cells, which are isolated from the inner cell mass of blastocysts, and adult stem cells, which are found in various tissues. In adultorganisms, stem cells and progenitor cells act as a repair system for the body, replenishing adult tissues. In a developing embryo, stem cells can differentiate into all the specialized cells— ectoderm, endoderm and mesoderm (see induced pluripotent stem cells)—but also maintain the normal turnover of regenerative organs, such as blood, skin, or intestinal tissues.

There are three known accessible sources of autologous adult stem cells in humans:

  1. Bone marrow, which requires extraction by harvesting, that is, drilling into bone (typically the femur or iliac crest).
  2. Adipose tissue (lipid cells), which requires extraction by liposuction.
  3. Blood, which requires extraction through apheresis, wherein blood is drawn from the donor (similar to a blood donation), and passed through a machine that extracts the stem cells and returns other portions of the blood to the donor.

Stem cells can also be taken from umbilical cord blood just after birth. Of all stem cell types, autologous harvesting involves the least risk. By definition, autologous cells are obtained from one’s own body, just as one may bank his or her own blood for elective surgical procedures.

Adult stem cells are frequently used in various medical therapies (e.g., bone marrow transplantation). Stem cells can now be artificially grown and transformed (differentiated) into specialized cell types with characteristics consistent with cells of various tissues such as muscles or nerves. Embryonic cell lines and autologous embryonic stem cells generated through somatic cell nuclear transfer or dedifferentiation have also been proposed as promising candidates for future therapies. 

How to Get Rid of Herpes Forever

Genital herpes is an infection of the genitals (penis in men, vulva and vagina in women) and surrounding area of skin. It is caused by the herpes simplex virus. Antiviral medicines such as aciclovir, famciclovir, and valaciclovir are used to treat genital herpes infection. They do not clear the virus completely from the body, so the symptoms may come back (recur). They work by stopping the virus from multiplying, which reduces the duration and severity of symptoms. You can find out here How to get rid of herpes forever!

 

Genital herpes is an infection of the genitals (penis in men, vulva and vagina in women) and surrounding area of skin. The buttocks and anus may also be affected. It is caused by the herpes simplex virus.

Genital herpes is usually a sexually transmitted infection. Many people who are infected with this virus never have symptoms but can still pass on the infection to others. If symptoms occur, they can range from a mild soreness to painful blisters on the genitals and surrounding area.

This leaflet just discusses antiviral medication for genital herpes. See separate leaflet called Genital Herpes for more general details on genital herpes infection.

There are three antiviral medicines that are currently usually used to treat genital herpes:

  • Aciclovir
  • Famciclovir
  • Valaciclovir

They all come in different brand names. They work by stopping the herpes virus from multiplying. They do not clear the virus from the body. If an antiviral medicine is started early in an episode of symptoms, it tends to reduce the severity and duration of symptoms during an episode of genital herpes.

It is thought that these medicines all work as well as each other when used to treat genital herpes.

Further episodes of symptoms (recurrences) tend to be milder and usually last just a few days. You usually have 7-10 days of symptoms rather than 10-28 days that can occur with a first episode. Antiviral medication is often not needed for recurrences. Painkillers, salt baths, and local anaesthetic ointment (such as lidocaine) for a few days may be sufficient to ease symptoms. However, an antiviral medicine may be advised for recurrent episodes of genital herpes in the following situations:

  • If you have severe recurrences. If you take a course of an antiviral medicine as soon as symptoms start, it may reduce the duration and severity of symptoms. You may be prescribed a supply of medication to have ready at home to start as soon as symptoms begin. This kind of “as needed” treatment tends to be prescribed if you are getting severe attacks of genital herpes fewer than six times a year. There are a number of different options of courses of treatment to take, ranging from one to six days in length, and with different daily regimes.
  • If you have frequent recurrences. You may be advised to take an antiviral medicine every day. In most people who take medication every day, the recurrences are either stopped completely, or their frequency and severity are greatly reduced. A lower maintenance dose rather than the full treatment dose is usually prescribed. A typical plan is to take a 6- to 12-month course of treatment. You can then stop the medication to see if recurrences have become less frequent. This type of continuous treatment can be repeated if necessary. This type of daily treatment tends to be prescribed if you have severe attacks of genital herpes more than six times per year.
  • For special events. A course of medication may help to prevent a recurrence during special times. This may be an option even if you do not have frequent recurrences but want to have the least risk of a recurrence – for example, during a holiday or during exams.

A specialist will normally advise about what to do if you develop genital herpes whilst you are pregnant, or if you have recurrent genital herpes and become pregnant. This is because there may be a chance of passing on the infection to your baby.

A first episode of genital herpes whilst you are pregnant

If you develop a first episode of genital herpes within the final six weeks of your pregnancy, or around the time of the birth, the risk of passing on the virus to your baby is highest. In this situation there is about a 4 in 10 chance of the baby developing a herpes infection. The baby may develop a very serious herpes infection if he or she is born by a vaginal delivery.

Therefore, in this situation your specialist is likely to recommend that you have a caesarean section delivery. This will greatly reduce the chance of the baby coming into contact with the virus (mainly in the blisters and sores around your genitals). Infection of the baby is then usually (but not always) prevented.

However, if you decide against a caesarean section and decide to opt for a vaginal birth, the specialist is likely to recommend that you be given antiviral medication (usually aciclovir). This is given into your veins (intravenously) during your labour and birth. They may also suggest that antiviral medication be given to your baby after he or she is born.

As long as there are two months between your catching the virus and giving birth to your baby, a normal vaginal delivery is likely to be safe for the baby. This is because there will be time for your body to produce protective proteins called antibodies. These will be passed on to the baby through your bloodstream to protect it when it is being born. The specialist may advise that you should be treated with antiviral medication at the time of infection. This helps the sores to clear quickly. In addition, your doctor may advise that you should take antiviral medication in the last four weeks of pregnancy to help prevent a recurrence of herpes at the time of childbirth. Antiviral medicines such as aciclovir have not been found to be harmful to the baby when taken during pregnancy.

acupunctuur rotterdam

All About Acupuncture

What Is Acupuncture?

Acupuncture is a technique in which practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. It is one of the practices used in traditional Chinese medicine. There is plenty of info available – for Acupunctuur Rotterdam click here http://www.acupunctuurleman.nl/.

What is the Effectiveness of Acupuncture

Results from a number of studies suggest that acupuncture may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain. It also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. However, clinical practice guidelines are inconsistent in recommendations about acupuncture.

The effects of acupuncture on the brain and body and how best to measure them are only beginning to be understood. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.

Common Treatments Using Acupuncture

  • For Low-Back Pain
  • For Neck Pain
  • For Osteoarthritis/Knee Pain
  • For Headache

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Here is a Full List of Treatments Using Acupuncture

Acupuncture has been endorsed by the World Health Organization (WHO) of the United Nations and the National Institutes of Health. These bodies have declared acupuncture an effective treatment for the following conditions:

  • Addictions
  • Arthritis
  • Back pain
  • Carpal Tunnel
  • Chemotherapy nausea
  • Depression
  • Digestive (ulcers, nausea, gastritis, irritable bowel)
  • Ear problems (ringing, earaches)
  • Fibromyalgia
  • Headaches
  • Infections, cold, flu
  • Insomnia
  • Menstrual and female disorders
  • Muscle & joint pain (tendonitis, bursitis, sprains)
  • Post-op dental pain
  • Sinusitus
  • Skin Disorders
  • Stroke rehabilitation
  • Urinary problems
  • And many more!

The Process

Your acupuncture provider will give you an exam and ask questions about your pain and how well you are functioning. He or she will also ask about your overall health.

Acupuncture is considered cumulative in nature, meaning one may need to undergo a series of treatments. The first session will include a private conversation with the acupuncturist. Allow at least one hour for the first appointment to accommodate your consultation and session. If your condition requires lengthy discussion, arrange time outside the scheduled appointment to communicate with the acupuncturist.

Treatment takes place in a double or single room with others. Insertion of an acupuncture needle will not feel like an injection or blood draw. Acupuncture needles are flexible, solid and fine enough to tie in a knot (about the size of a human hair). Reaction to and number of sessions can vary. Expect to retain the acupuncture needles for at least 20 minutes. The acupuncturist should be able to predict reaction based on the consultation and the body’s responses to the initial session.

What does it feel like?

You may feel slight pressure when a needle goes in. Most people find that it doesn’t hurt. The area may tingle, feel numb, itch, or be a little sore. Providers believe that this is a sign that the energy flow, or chi, has been accessed.

After the needle is placed, your provider may roll the needle slightly back and forth. Or he or she may use heat or electrical current on the needle.

For More Info – Contact Acupunctuur Rotterdam

STD Symptoms Quiz

About 20 different infections are known to be transmitted through sexual contact. Before we begin make sure to take the STD symptoms quiz if necessary.

More About STD’s

STD-related stigma may be an important barrier to prevention and care. Furthermore, there remains a great deal of misunderstanding about transmission and even what constitutes an STD. The infographic from PhysicianOne Urgent Care covers the most common STDs with the latest statistics, myths, and facts that stress the importance of getting tested.

According to a November 2015 report from the Centers for Disease Control and Prevention (CDC), the incidence of chlamydia, gonorrhea, and syphilis increased in the U.S. for the first time since 2006. Left untreated, STDs can lead to serious health issues including infertility, cervical and other genital cancers, paralysis, liver failure, and death. Bacterial STDs are curable while viral STDS are not; however, the majority of STDs are highly manageable with early detection and treatment.

2016-05-std-testing

STD Centers
There are centers all over that do std testing so finding one shouldn’t be difficult. Getting testing for a sexually transmitted disease is a good and necessary thing to do especially if you have a new partner or multiple partners. You never know what might be out there. Having an STD could really be a bad thing for you in the long run because some can cause damage to your organs and some could actually kill you. So, even if you think it’s impossible to have an STD it’s still wise to get tested.

A lot of people don’t like to get checked because if they have it, they think that people will spread the word that they have one. This isn’t true. Those who administer the testing are extremely professional. They will only disclose this information to those who have to know. Your confidentiality is important. So, if this is stopping you from getting tested, then it shouldn’t be a reason.

It’s pretty simple to have this done. What they will do is they will remove cells from a woman’s vaginal area. This is called a Pap test and it is recommended starting at age twenty five. This is just one of the best ways to find any sort of STD.

For men, it’s a bit different. The way they check for sexually transmitted diseases for men is usually by drawing blood. For men though, unless they are active with men, there are no guidelines as to when you should have tests done. It’s interesting since women have the guidelines that before age twenty five, they should be checking for any sexually transmitted disease.

Both women and men can check for certain STDs with a blood sample. Some diseases like Chlamydia and Gonorrhea simply require a urine sample. Some clinics offer at-home testing kits for urine tests, but usually don’t offer one for blood tests.

You should have testing done if you notice signs that could indicate that you have an infection. You might not know what some of those signs are and some diseases don’t produce any symptoms for a while. If you are wondering what they are here are a few symptoms to watch out for. Some symptoms are: genital sores, unusual discharge from private areas, or abdominal pain with the discharge. These are just some common symptoms, but there are more.

So as you can see, STD testing is important. While men are told that they should test only if they are sexually active with other men, don’t let that stop you. You really should get tested regardless of who you are sexually active with. If you don’t do it for yourself, then do it for your partner or partners.

massage-therapy

Massage Therapy

Massage therapy is manual manipulation of soft body tissues (muscle, connective tissue, tendons and ligaments) to enhance a person’s health and well-being. There are dozens of types of massage therapy methods (also called modalities).

People seek massage therapy for a variety of reasons to reduce stress and anxiety, relax muscles, rehabilitate injuries, reduce pain, and promote overall health and wellness.

At http://www.biocentro.cl/masaje_descontracturante/,  you are not simply going to a massage school – you are studying to be a healthcare professional who provides massage therapy.

Types of Massage Therapy

While there are several types of massage, two fundamental categories are:

  • Relaxation massagealso known as Swedish massage; practiced in settings like spas, wellness centers and resorts
  • Rehabilitative massage – also known as deep tissue, medical, therapeutic or clinical massage; practiced in many settings like clinics, hospitals and chiropractic offices

Masaje Descontracturante

 

 

 

 

 

 

 

 

 

Now days, in addition to “rubbing,” massage therapy, often referred to as bodywork or somatic therapy, refers to the application of various techniques to the muscular structure and soft tissues of the body that include applying fixed or movable pressure, holding, vibration, rocking, friction, kneading and compression using primarily the hands, although massage therapists do use other areas of the body, such as the forearms, elbows or feet.

All of the techniques are used for the benefit of the musculoskeletal, circulatory-lymphatic, nervous, and other systems of the body.

Physical and Mental Benefits

  • relaxes the whole body
  • loosens tight muscles
  • relieves tired and aching muscles
  • increases flexibility and range of motion
  • diminishes chronic pain
  • calms the nervous system
  • lowers blood pressure
  • lowers heart rate
  • enhances skin tone
  • assists in recovery from injuries and illness
  • strengthens the immune system
  • reduces tension headaches
  • reduces mental stress
  • improves concentration
  • promotes restful sleep
  • aids in mental relaxation

For More Information on Massage Therapy Please Visit Us on the Web
http://www.biocentro.cl/masaje_descontracturante/

 

essential-oils

Essential Oils

Essential Oils

Good, all purpose essential oils for skin care include lavender, sandlewood, geranium, and patchouli, plus numerous others depending on your skin type.

All skin types benefit from a regular moisturizer. Jojoba oil is an excellent oil for the face, as it has collagen and elastin-like properties and is readily absorbed. It is not a true oil, but a liquefied wax with a smooth, silky texture.

It is a misconception oily skin doesn’t need a moisturizer. Certain essential oils such as geranium, palmarosa, and lavender, are sebum regulators and help the skin produce a healthy amount of oil.

Essential oils, properly diluted in a carrier oil such as jojoba , hemp, or hazelnut oil, lend their cell regenerating and circulation enhancing properties, and are a natural for skin care.

Lavender, along with patchouli and tea tree oil, is among the few oils that can be applied directly to the skin in small amounts, also referred to as neat application.

Its anti-inflammatory properties also benefit skin conditions like acne and rosacea. Like many essential oils, lavender is also antiseptic, and also stimulates new skin cell growth,

Essential oils can play a significant role in skin and hair care. They are used by application to the skin, diluted in a suitable all natural lotion or organic vegetable oil.

Essential oils possess a wide range of healing properties that can be used effectively to keep you in the best of health as well as looking good. Oils are steamed from plants and have been around for thousands of years.

Aromacological skin treatment relies on the capacity of essential oils to advance cellular renewal through increased circulation, hydration, and waste removal.

They are the most powerful skin beautifiers, enhancers, and anti-aging antioxidants created by Mother Nature herself.

Skin care products are increasingly apt to be based upon, or include, herbs, fruits, and essential plant oils.

The most powerful skin beautifiers, enhancers, and anti-aging antioxidants created by Mother Nature herself are essential oils. Learn how to use essential oils in your daily life and make wonderful blends for family and friends.

Another good tip is to purchase fragrance and lanolin free creams or lotions, and organic carrier oils from which you can create your own skin care products by adding a few drops of your favorite essential oil.

You will find your skin will be younger as you use frugal sense in selecting your fine skin care ingredients.

10 More Essential Oils for Healing

Although there is a long list of essential oils, here are some of the top essential oils.

1. Clove (Eugenia caryophyllata)

Clove essential oil is commonly used as an antiseptic for oral infections and to kill a wide spectrum of microbes to keep disease at bay.

2. Eucalyptus (Eucalyptus Globulus)

Used copiously by the Aborigines for most maladies in their villages, eucalyptus is a potent antibacterial, antispasmodic, and antiviral agent.

3. Frankincense (Boswellia Carteri)

Frankincense essential oil has also been used with much success to treat issues related to digestion, the immune system, oral health, respiratory concerns and stress/anxiety.

4. Lavender (Lavandula Angustifolia)

Well-known for its soothing, calming properties, lavender is wonderful for accelerating healing time for burns, cuts, stings, and other wounds.

5. Lemon (Citrus limon)

Various citrus essential oils are widely used to stimulate lymph drainage, to rejuvenate sluggish, dull skin and as a bug repellant.

6. Oregano (Origanum vulgare)

Oregano is used for respiratory tract disorders such as coughs, asthma, croup, and bronchitis. It is also used for gastrointestinal (GI) disorders such as heartburn and bloating.

7. Peppermint (Mentha Piperita)

Suitable for an abundance of oral and topical uses, peppermint may be the most versatile essential oil in the world.

8. Rosemary (Rosmarinus officinalis)

One amazing healing effect of rosemary that many people are unaware of is its ability to normalize blood pressure. Used for centuries to improve everything from memory and brain function to relieving common aches and pains, rosemary even has a history of stimulating hair growth. But most people don’t think of rosemary mimicking their blood pressure pills!

9. Sandalwood (Santalum album)

Oftentimes used to soothe and heal sore throats, sandalwood is a gentle bactericide that is more potent than most give it credit for.

10. Tea Tree (Melaleuca alternifolia)

Tea Tree oil is a wound healer with a rich history of use as a local antiseptic for burns and cuts as well to treat a wide spectrum of bacterial and fungal infections (including athletes foot and jock itch).

Some of the most common ways to use essential oils include:

  • Massaging them (blended with a carrier oil) into your skin

  • Adding them to bathwater

  • Using them in a hot compress

  • Heating them in a diffuser

  • Rubbing a drop onto pulse points in lieu of perfume

Gynecology - TLV Medical Center

Gynecological Research and Definitions

Determining What a Gynecologist Does and When To Go and See One

Article by TLV Medical Center

In some countries, women must first see a general practitioner (GP; also known as a family practitioner (FP)) prior to seeing a gynecologist. If their condition requires training, knowledge, surgical procedure, or equipment unavailable to the GP, the patient is then referred to a gynecologist. In the United States, however, law and many health insurance plans allow gynecologists to provide primary care in addition to aspects of their own specialty. With this option available, some women opt to see a gynecological surgeon for non-gynecological problems without another physician’s referral.

As in all of medicine, the main tools of diagnosis are clinical history and examination. Gynecological examination is quite intimate, more so than a routine physical exam. It also requires unique instrumentation such as the speculum.

The speculum consists of two hinged blades of concave metal or plastic which are used to retract the tissues of the vagina and permit examination of the cervix, the lower part of the uterus located within the upper portion of the vagina.

Gynecologists typically do a bimanual examination (one hand on the abdomen and one or two fingers in the vagina) to palpate the cervix, uterus, ovaries and bony pelvis. It is not uncommon to do arectovaginal examination for complete evaluation of the pelvis, particularly if any suspicious masses are appreciated. Male gynecologists may have a female chaperone for their examination. An abdominal and/or vaginal ultrasound can be used to confirm any abnormalities appreciated with the bimanual examination or when indicated by the patient’s history.

Some of the more common operations that gynecologists perform include:

  1. Dilation and curettage (removal of the uterine contents for various reasons, including completing a partial miscarriage and diagnostic sampling for dysfunctional uterine bleeding refractive to medical therapy)
  2. Hysterectomy (removal of the uterus)
  3. Oophorectomy (removal of the ovaries)
  4. Tubal ligation (a type of permanent sterilization)
  5. Hysteroscopy (inspection of the uterine cavity)
  6. Diagnostic laparoscopy – used to diagnose and treat sources of pelvic and abdominal pain; perhaps most famously used to provide a definitive diagnosis of endometriosis.
  7. Exploratory laparotomy – may be used to investigate the level of progression of benign or malignant disease, or to assess and repair damage to the pelvic organs.
  8. Various surgical treatments for urinary incontinence, including cystoscopy and sub-urethral slings.
  9. Surgical treatment of pelvic organ prolapse, including correction of cystocele and rectocele.
  10. Appendectomy – often performed to remove site of painful endometriosis implantation and/or prophylactically (against future acute appendicitis) at the time ofhysterectomy or Caesarean section. May also be performed as part of a staging operation for ovarian cancer.
  11. Cervical Excision Procedures (including cryosurgery) – removal of the surface of the cervix containing pre-cancerous cells which have been previously identified on Pap smear.

Diseases Treated by a Gynecologist

Examples of conditions dealt with by a gynecologist are:

  • Cancer and pre-cancerous diseases of the reproductive organs including ovaries, fallopian tubes, uterus, cervix, vagina, and vulva
  • Incontinence of urine
  • Amenorrhoea (absent menstrual periods)
  • Dysmenorrhoea (painful menstrual periods)
  • Infertility
  • Menorrhagia (heavy menstrual periods); a common indication for hysterectomy
  • Prolapse of pelvic organs
  • Infections of the vagina (vaginitis), cervix and uterus (including fungal, bacterial, viral, and protozoal)
  • Other vaginal diseases

There is some crossover in these areas. For example, a woman with urinary incontinence may be referred to a urologist.

For a Gynecologist in Tel Aviv visit TLV Medical Center