Gynecological Health Lecture 2024 Latest Edition

There is no universal gynecological "maintenance guideline". 90% of common gynecological problems are caused by over-intervention and cognitive bias. The priority of individualized evaluation is much higher than any popular science and secret recipes from Internet celebrities.

When I was out of the clinic last Wednesday, a 26-year-old girl came in as soon as I sat down. Her eyes were swollen like walnuts. She said that she had saved three months’ salary to buy a package of “pink private parts + ovarian care”. As a result, she came back with itching for almost a week, and her leucorrhea was as yellow as pus. It was found that it was bacterial vaginosis combined with pelvic infection. A good little girl really can’t suffer this.

When it comes to HPV infection, which is the most controversial issue nowadays, two schools of thought on the Internet each hold half the sky. One school says, "If you are infected with HPV, you will get cervical cancer, so you need to cut out the lesions quickly." The traditional clinical path is that as long as the TCT test is normal, even if you are infected with high-risk HPV, you can observe it for 1-2 years. After all, 80% of women with normal immunity can turn negative on their own. Just like a common cold, it will be better as soon as the immunity is improved. There is no need to do invasive tests. However, in the past two years, many doctors specializing in infection have also put forward new opinions: If it is the two highest-risk subtypes of infection, 16 and 18, even if the TCT is normal, colposcopy can be done in advance, especially for women with contact bleeding and family history of cervical cancer. Early screening is better than delaying until something goes wrong. There is no absolute right or wrong between the two options. It depends on the individual's situation and risk preference.

Oh, by the way, when it comes to HPV, we have to mention "cervical erosion", which has been deceived by countless people. A few days ago, a patient came to me with a report from a private hospital, saying that he had to spend 20,000 yuan to repair the cervix, otherwise it would become cancerous. When I looked at the report, it was normal cervical columnar epithelial ectopia, not even inflammation. I was simply deceived. By the way, the disease name "cervical erosion" has been deleted from the obstetrics and gynecology textbooks in 2008. This is a physiological phenomenon related to estrogen levels, just like when you grow breasts during puberty. It is not a disease at all. As long as the annual TCT+HPV screening is normal, no treatment is needed.

After talking about diseases, let’s talk about the nursing pitfalls that everyone is most likely to encounter in daily life. Many people have been taught since childhood that "underwear must be scalded with boiling water to kill mold." In fact, this is not necessarily true. If your own immunity is normal, washing the underwear with soap and drying it in a ventilated and sunny place is enough to kill most of the pathogenic bacteria. On the contrary, if you do not wring it out after ironing and stay in a humid bathroom, you will breed more mold than you can kill. Some people say that disposable underwear is not clean and should not be worn. I wear it myself when I go on business trips and work night shifts. As long as I buy products from regular manufacturers and have sterilization labels, they are much cleaner than the cotton underwear that you hang in the hotel bathroom for three days without drying out. There is really no need to be biased. By the way, there is also private parts lotion. No matter how gentle the advertisements say it is and how it can remove odors, as long as there is no doctor to prescribe it to you, don’t use it blindly. The vagina itself has its own balance of flora. If you use lotion every day, it is equivalent to killing all the good and bad bacteria, which makes you more likely to get sick. I have been a doctor for 12 years and I have never had any problems with washing my private parts.

There is also the menstrual issue that people ask a lot. Many little girls panic when their menstrual period is delayed for three to five days. They look everywhere for home remedies to induce menstruation, or buy progesterone by themselves. It is really unnecessary. The normal menstrual cycle is 21-35 days. It is considered normal if it is within 7 days early or late. Occasionally it is delayed for more than ten days at a time. As long as you are not pregnant, you can wait. Maybe it is because you have stayed up late at night, been stressed, or drank too much ice. Some people say, "Low menstrual flow means poor detoxification and aging quickly." This makes my ears spin. Menstruation is not detoxification at all, but the periodic shedding of the endometrium. The normal menstrual flow is 5-80ml, which can almost soak half a sanitary napkin. There is really no need to pursue "large amounts for clean discharge". I have blindly taken those blood-activating skin care products. I have seen several people who suffered from heavy menstrual flow and anemia. Oh, and everyone has asked a lot about "should uterine fibroids be cut?" The old view was to cut uterine fibroids if they are larger than 5 centimeters, but now there are changes. If you are preparing for pregnancy, and the fibroids grow in the muscle wall or under the serosa and do not protrude into the uterine cavity, even if they are 6 centimeters, you can observe it first. After all, the surgery will leave scars on the uterus, which may increase the risk of uterine rupture during pregnancy. Of course, if the fibroids have caused you heavy menstruation and severe dysmenorrhea, then it should be cut. Again, it depends on your personal situation.

What we are talking about today are all real situations that we encounter every day in clinical practice. There are no fancy terms, they are all real experiences. I really advise all girls, don’t apply it on yourself after reading some popular science, and don’t believe in the nonsense that “one trick can solve all gynecological problems”. Everyone’s physical condition is different. If you really feel uncomfortable, just go to a regular hospital to register. It will be 10,000 times more effective than just guessing and buying skin care products.