prof pd ddr richard schwameis ultrasonic services 1190 vienna

Screening is the most important weapon in the fight against gynecological or malignant diseases, as it allows to treat these diseases before they develop. In other words, screening is used for early detection and prevention of gynecological diseases. During the annual gynecological check-up, a mirror examination with bacteriological and cytological smears and ultrasound of the uterus and ovaries are performed. A breast examination is also performed. For women between the ages of 45 and 69, participation in the mammography screening program is recommended.

If necessary, many other examinations and clarifications can be offered based on the current state of science. For this purpose, various devices of the latest technology are available in our office.

Ovarian cysts are relatively common changes. Almost every woman suffers from an ovarian cyst at least once in her life.

Ovarian cysts are usually diagnosed by transvaginal ultrasound and can be examined in more detail. A distinction can be made between benign (simple) and conspicuous (complex) cysts.

Small, simple cysts occur very frequently in young women during the menstrual cycle. These often do not require further therapy and can be further controlled. However, larger or persistent cysts, painful or complex cysts, as well as changes in the ovary in postmenopause should be clarified in more detail. In this case, surgical clarification is the standard. In most cases, surgical clarification is performed by laparoscopy (buttonhole technique, laparoscopy). In pre-menopausal women, the cyst can be removed in most cases without having to remove the ovaries.

Endometriosis is a benign disease that occurs frequently and is unfortunately often overlooked. It is accompanied by cycle-dependent pain, and from time to time bloody urine or stool may occur. Endometriosis is regularly accompanied by cyst formation on the ovary. These cysts have a relatively typical appearance on ultrasound. Because of this, they are often referred to as ground-glass phenomenon or so-called "chocolate cysts". A common problem associated with endometriosis is infertility. Up to now, endometriosis can only be diagnosed surgically. Therapy consists of surgical sanitation (usually with laparoscopy) followed by conservative treatment.

Myomas are very common, benign tumors of the uterus (womb). They arise from the muscle cells of the uterine wall. Almost every third woman suffers from a myoma. Many women have a fibroid, are symptom-free and therefore do not know about their fibroid. The exact causes of fibroid development are not known. The growth of fibroids depends on female sex hormones. Therefore, fibroids can grow in sexually mature women (before menopause). After menopause, fibroids usually become smaller. Thus, growth of fibroids after menopause is uncommon.

Myomas can take on very different sizes. Therefore, these can also lead to different complaints such as irregular, significantly prolonged or painful bleeding, pressure on the urinary bladder or infertility. In case of discomfort, surgical removal of the fibroids may be necessary. An alternative is also a hormonal treatment with medication.

Hysteroscopy is a procedure in which changes in the lining of the uterus (endometrium) can be examined. In this procedure, a thin camera (about 5mm) is inserted into the uterus through the cervix.
In order to be able to examine changes in the endometrium histologically (with a microscope), a scraping (curettage) is usually performed after the endometrial examination.

If necessary, changes in the uterus (uterine wall), such as polyps or fibroids, can also be treated during endoscopy using electric snares or scissors.

Laparoscopy - also called laparoscopy or buttonhole surgery - is a surgical method that is the absolute standard in many areas of gynecology today. Small skin incisions (5-10mm) are made in the area of the navel and in the lower abdomen. Through these incisions, working channels (so-called trocars) are inserted into the abdominal cavity. This allows a large part of the entire abdominal cavity to be examined and a variety of gynecological operations (ovarian cysts, oophorectomies, removal of the uterus) to be performed. In addition to the buttonhole technique, some procedures can be performed directly through the vagina without a skin incision.

Oncological operations
Oncological operations are sometimes large, long and complicated procedures. Therefore, it is essential to perform them as standardized as possible and in an optimized operative setting. This operative setting includes highly specialized surgeons as well as highly specialized anesthesiologists, nurses and equipment.

Just as in the rest of gynecology, individual oncological therapies can also be performed by buttonhole technique (laparscopy).

Due to my work at the Medical University of Vienna, I regularly perform genetic counseling sessions. In addition, during my time in Germany, I worked with and formulated articles for the Consortium for Familial Breast and Ovarian Cancer.
I would be happy to advise you in this context

Gene panel diagnostics
In about 10-15% of all breast and ovarian cancer cases, a familial and therefore hereditary mutation is the cause of the disease.
In this case, there is a change in a gene (mutation) that is important for the development of cancer. The two most important genes known in connection with the development of breast and ovarian cancer are called BRCA1 and BRCA2. In recent years, however, other genes have also been associated with the development of breast and ovarian cancer (e.g. RAD51C, RAD51C, BRIP1, ...). Provided there is an alteration in one of these genes, the repair of our cells is impaired. As a result, defects in the cell cannot be repaired or can only be repaired insufficiently. Cancer can develop on the basis of these defects.

Therefore, people who carry a change in these genes have a significantly increased risk of developing breast and ovarian cancer during their lifetime.
Both in patients with cancer and in people with a corresponding family history, genetic testing can detect changes in the genes.

Early Detection, Risk-Reducing Surgery
Women who are at increased risk for breast and ovarian cancer are recommended to participate in an intensified screening program for early detection of breast cancer and ovarian cancer.

While the early detection program works relatively well in the breast area, early detection of ovarian cancer is very difficult, and often not possible. Therefore, risk-reducing surgeries are offered in this situation. In order to reduce the risk of developing ovarian cancer, the ovaries together with the fallopian tubes can be removed as a preventive measure.
This surgery reduces the risk of developing ovarian cancer to about 1%, and also significantly reduces the risk of developing breast cancer. In most cases, the risk-reducing removal of the ovaries is performed using the buttonhole technique (laparoscopy).

To significantly reduce the risk of developing hereditary breast cancer, the glandular tissue of both breasts can be removed (prophylactic bilateral mastectomy). This can reduce the risk of developing breast cancer by 90%. In order to preserve the aesthetics of the breast, skin-saving methods and incisions are used today. Plastic reconstructive steps allow reconstruction of the breasts often within the same operation.

All questions about femininity, contraception and sexuality explained sensitively.

Currently, a variety of hormonal and non-hormonal contraceptive methods (contraception) are available. Which contraceptive method is best for you depends on many factors such as your personal expectations and wishes, your age, and your personal history. Contraceptive methods differ from each other in terms of their safety, method of use, and duration of use. In addition, the potential positive side effects, risks and side effects vary between contraceptive methods.

Basically, we distinguish between hormonal and non-hormonal contraceptive methods.
The choice of a contraceptive method should be made only after a detailed consultation.

Hormonal contraceptive methods
The "birth control pill" is still one of the safest contraceptives and the most commonly used method to avoid pregnancy. There are a variety of preparations which differ mainly in their composition and dosage. There are both combination preparations, which contain progestogens and estrogen, and monopreparations (minipill), which contain only progestogens.

Another very safe method of contraception is the hormonal IUD. This is one of the safest methods of contraception. The IUD is made of soft plastic and is inserted into the uterus in the same way as a conventional coil. It combines the effects of two proven contraceptive methods: the pill and the IUD. In contrast to the conventional IUD (copper or gold IUD), the IUD contains a small hormone depot that continuously releases small amounts of progestin into the uterus. This hormone prevents the uterine lining from building up and thus prevents an egg from nesting. In addition to the frequent absence of menstrual bleeding, another advantage of this method is that only very small amounts of the corpus luteum hormone enter the bloodstream. Thus, the hormonal IUD is associated with a very low rate of side effects. The hormone IUD is available in different sizes and dosages.

The three-month injection is administered every three months under the skin (subcutaneously) in the abdomen or thigh area and contains a high-dose, long-acting progestogen (luteal hormone). The three-month injection prevents ovulation on the one hand and on the other hand causes a change in the lining of the uterus. This ensures very safe contraception.

The vaginal ring is a flexible plastic ring that is inserted into the vagina by the woman herself. Therefore, no insertion into the uterus is necessary, as is the case with the IUD, for example. Similar to the combined pill, the vaginal ring contains estrogen and progestin. However, the release into the body occurs evenly.

Non-hormonal contraceptive methods
The copper IUD is a very widely used contraceptive method. It consists of a soft plastic rod covered with a thin copper thread. The copper IUD is a very safe contraceptive method that can remain in the uterus for up to five years.

The gold coil and the copper ball are further developments of the copper coil with a comparable mechanism of action.

Condoms are still the only contraceptive that simultaneously protects against infection with sexually transmitted infections and against unwanted pregnancy. However, the reliability of contraception is limited due to possible application errors.

Tubal ligation or tubal removal: The ligation or removal of the fallopian tubes is a surgical permanent pregnancy prevention. In this procedure, permanent infertility is induced during an operation (usually laparoscopy) on the introducers. Until about 2015, tubal ligation (ligation) was the standard. Since then, however, removal of the fallopian tubes (tubectomy) has been recommended because removal of the fallopian tubes can also significantly reduce the risk of developing cancer. Removal of the fallopian tubes is considered the safest method of contraception and can be considered after the desire to have children has been completed. Hormone production and sexual life are not changed by tubal removal.

Infertility diagnostics
In Austria, about one in six couples has difficulty in fulfilling their desire to have a child. The diagnosis of an unfulfilled desire to have children is complex and should be carried out step by step and carefully. In principle, both the man and the woman must be examined in order to identify possible causes.

Hormonal disorders
The hormones of the female body are usually in a very balanced state. If this balance is impaired, cycle disorders, infertility or bleeding abnormalities may occur. Through a clinical examination as well as a laboratory test, a cause for the complaints can usually be found quickly and an appropriate treatment can be started.

Menopause, hormone replacement therapy
The transitional phase of hormonal change that takes place in the years before and after is called the climacteric (menopause). With the decrease of female sex hormones in the blood, there may be physical changes that can cause discomfort. If menopausal symptoms are pronounced, hormone replacement therapy may be considered to alleviate discomfort that may result from the hormonal changes that occur during menopause as a result of a relative hormone deficiency (osteoporosis, hair loss, hot flashes, mood swings, fatigue).

Bleeding irregularities
Bleeding irregularities often occur during menopause. Originally, different - hormonal as well as non-hormonal - factors are responsible for it. Depending on the cause, both conservative and surgical treatment options are available.

Relaxed and healthy through menopause. I will be happy to advise you about possible therapeutic approaches.

Preparation phase
Part of the preparation for pregnancy should be a balanced diet and a conscious lifestyle. In advance, the vaccination status should be ascertained and, if necessary, booster vaccinations should be carried out. In addition, folic acid should be taken before conception. In some situations, it is also advisable to take a blood sample including hormone status already when planning a pregnancy.

Pregnancy care
The examinations provided for in the parent-child passport program are an opportunity for the early detection and timely treatment of diseases as well as for monitoring the child's developmental status. The parent-child passport will be available digitally from 2024. The preventive examinations recommended in it include the performance of blood tests, ultrasound examinations, cancer smear tests, and a sugar load test.

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