SECOND EDITION
Editors Sabaratnam Arulkumaran DCH FRCS FRCOG FAMS MD PhD Hon: FACOG FSLCOG FSOGC
Professor and Head, Division of Obstetrics and Gynecology St George's Hospital Medical School,
London, United Kingdom
V Sivanesaratnam MBBS (S'pore) FRCOG FICS FACS FAMM FAOFOG
Consultant Gynecologist/Gynecologic Oncologist University of Malaya Specialist Centre,
Kuala Lumpur, Malaysia
Formerly, Professor, Head and Senior Consultant, Department of Obstetrics and Gynecology University of Malaya,
Kuala Lumpur, Malaysia
Alokendu Chatterjee FRCOG FICS
Formerly, Professor and Head, Department of Obstetrics and Gynecology NRS Medical College and Hospital,
Calcutta Salt Lake City, Kolkata, West Bengal, India
Pratap Kumar MD DGO FICS FICOG FICMCH
Professor and Head, Department of Obstetrics and Gynecology Kasturba Medical College,
Manipal Karnataka, India
Foreword Shirish S Sheth
Jitendar P Vij
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Essentials of Gynecology
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2005
Second Edition: 2011
9788184489101
Typeset at JPBMP typesetting unit
Printed at
5Contributors
- Akhila Vasudeva md dgo
- Assistant Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- AP Manjunath md
- Assistant Professor
- Department of Obstetrics and gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- e-mail: manjunath@obgyn.net
- Arun Nagrath ms ficog ficmch ficmu miac
- Professor
- Department of Obstetrics and Gynecology
- SN Medical College
- Agra, India
- Behram S Anklesaria md dgo dfp ficog atmf (usa)
- Professor and Head
- Department of Obstetrics and Gynecology
- LG Hospital and NHL Medical College
- Ahmedabad, India
- Claudine Domoney naps trustee
- Specialist Registrar in Obstetrics and Gynecology, UK
- Consultant Obstetrician and Gynecologist
- Chelsea, Westminster, UK
- Dev Kumar Menon b med sci (hons) bmbs mrcog
- Department of Obstetrics and Gynecology
- University Malaya Medical Center
- Kuala Lumpur, Malaysia
- e-mail: DrMenon2000@yahoo.co.uk
- Edwin Chandraharan mbbs ms (obs and gyn) dffp (uk) mrcog
- Clinical Lecturer
- Division of Obstetrics and Gynecology
- St George's Hospital Medical School
- London, United Kigdom
- Jaideep Malhotra md ficog ficmch
- Director
- MNMH (P) Ltd.
- Agra, India
- Consultant
- Apollo Pankaj Hospital
- Agra, India
- Vice-President
- Elect FOGSI 2010
- Jayaraman Nambiar md dgo
- Assistant Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- e-mail: drramnambiar@yahoo.co.in
- K Jayakrishnan md dgo dipnb
- Director
- KJK Hospital
- Nalanchira, Thiruvanathapuram, Kerala, India
- e-mail: kjkhospital@vsnl.com
- Krishnendu Mukherjee ms frcs frcs (ed)
- Consultant and Surgeon
- Belle Vue Clinic
- 26, Beadon Street, Calcutta, India
- e-mail: krishmukh@usa.net
- Lim Boon Kiong mbbs (mal) mrcog
- Associate Professor and Consultant
- University of Malaya Medical Center
- University of Malaya, Kuala Lumpur, Malaysia
- Mahalakshmi Gorti md mrcog
- Specialist Registrar
- Department of Obstetrics and Gynecology
- St Richard's Hospital
- Chichester, UK
- Meenu S Handa mbbs dgo
- Registrar
- Department of Obstetrics and Gynecology
- LG Hospital and NHL Medical College
- Ahmedabad, India
- Muralidhar V Pai
- Associate Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- e-mail: mvpai@mahe.manipal.edu
- N Pandiyan mbbs md
- Gynecologist and Obstetrician
- RA Puram
- Chennai, India
- Chief Consultant in Andrology and Reproductive Sciences
- Apollo Hospitals, 21, Greams Lane
- Off Greams Road
- Chennai, India
- e-mail: gautham1@eth.net
- Narendra Malhotra md dgo fics ficog ficmch
- Professor and Head
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- Nozer Sheriar md dnbe fcps ficog dgo
- BDP Parsee General Hospital
- Bomanji Petit Road
- Cumballa Hill
- Mumbai, India
- Onnig Tamizian mbbs mrcog
- Specialist Registrar
- Department of Obstetrics and Gynecology
- Kings Mill Hospital
- Nottingham
- United Kingdom
- P Manjula mbbs md
- Karnataka
- Paul Tay Yee Siang md mrcog mb bch
- Department of Obstetrics and Gynecology
- University Malaya Medical Center (UMMC)
- Jalan University, 50630 Kuala Lumpur, Malaysia
- e-mail: pystay@hotmail.com
- PK Sekharan md
- Former Professor and Head
- Department of Obstetrics and Gynecology
- Institute of Maternal and Child Health
- Medical College, Calicut, Kerala, India
- e-mail sekharan@vsnl.com
- PK Shah md ficog fcps ficmu ficm ch dgo dfp
- Professor and Unit Head
- Department of Obstetrics and Gynecology
- LTM Medical College and LTMG Hospital Sion
- Mumbai-400 022, India
- Pralhad Kushtagi md dnb ficog
- Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- District Maternity and Children Hospital
- Udupi, India
- e-mail: pralhadkushtagi@hotmail.com
- Prashant Nadkarni frcog
- Consultant Obstetrician and Gynecologist
- Infertility Specialist
- Pantai Medical Center
- 8 Jalan Bukit Pantai
- Kuala Lumpur, Malaysia
- e-mail: prashantnadkarni@hotmail.com
- Prashanth K Adiga md
- Associate Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- Pratap Kumar md dgo ficog ficmch
- Professor and Head
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- e-mail: drpratapkumar@hotmail.com
- Premitha Damodaran mbbs mmed (obs and gyn)
- Kiara Gynecology Center
- 64–01, Jalan 27/70 A
- Desa Sri Hartamas, Kuala Lumpur, Malaysia
- e-mail: premitha_prem@yahoo.com
- Rajesh Bhakta md
- Associate Professor
- Division of Reproductive Medicine
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- Rupinder Kaur Ruprai md
- Assistant Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- e-mail: rubyruprai@yahoo.com
- Sabaratnam Arulkumaran dch frcs frcog fams md phd hon: facog fslcog fsogc
- Professor and Head
- Division of Obstetrics and Gynecology
- St George's Hospital Medical School
- London, United Kingdom
- e-mail: sarulkum@sghms.ac.uk
- Sakshi Tomar mbbs md dnb (radiology)
- Consultant Ultrasonologist
- Malhotra Nursing Home
- 84, MG Road, Agra, India
- Sambit Mukhopadhyay mbbs md
- Consultant
- Department of Obstetrics and Gynecology
- Norfolk and Norwich University Hospital
- NHS Trust, Norwich
- United Kingdom
- Sapna Ahuja
- Specialist Registrar
- Department of Obstetrics and Gynecology
- Luton and Dunstable Hospital NHS Trust
- Lewsey Road, LUTON, LU4 0EN
- Sheetal Dholakia md dgo
- 9, Hemniketan, NS Road No. 5
- JVPD Scheme
- Vile Parle, Mumbai 400 056, India
- e-mail: drsheetal@spareage.com
- Siya Sharan Sharma md dnb dgo micog mnams
- Assistant Professor
- Department of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- e-mail: drsiya@yahoo.com
- Sreelakshmi KN mbbs ms (obg)
- PG Diploma in Medicolegal Systems
- Consultant
- Department of Obstetrics and Gynecology
- CSI Lombard Mission Hospital, Udupi (2005–2007)
- Assistant Professor at Kasturba Medical College Manipal
- Karnataka, India
- e-mail: laxmivinyaka@gmail.com
- V Sivanesaratnam mbbs (s pore) frcog fics facs famm faofog
- Consultant Gynecologist/Gynecologic Oncologist
- University of Malaya Specialist Centre
- Kuala Lumpur, Malaysia
- Formerly, Professor, Head and Senior Consultant Department of Obstetrics and Gynecology
- University of Malaya, Kuala Lumpur, Malaysia
- e-mail: sivanes@ummc.edu.my
- Vani Ramkumar md
- Additional Professor of Obstetrics and Gynecology
- Kasturba Medical College and Hospital
- Manipal, Karnataka, India
- e-mail: ram54-vip@zetainfotech.com
- VP Paily md frcog
- Former Professor of Obstetrics and Gynecology
- Medical College, Thrissur
- Vakkanal, East Fort, Thrissur-5
- Kerala, India
- email: pailycom@vsnl.com
- WC Maina mrcog
- Staff Grade
- Obstetrics and Gynecology
- Norfolk and Norwich University Hospital NHS Trust
- Colney Lane
- Norwich
- NR4 7UY
We are fortunate to have lived through a period of historic milestones, and the turn of the millennium. The last millennium saw dramatic technical advances in the field of medicine. The greatest single difference between women in rich countries and women in developing ones is in their reproductive health status, particularly the availability, affordability and access to the same.
The book Essentials of Gynecology is the work of leading experts in the field, detailing the methodology for clinical practice and modus operandi for appropriate treatment for the disease. The contributors are experienced professionals, who have distilled their wealth of expertise to provide invaluable guide for the problems faced in day-to-day practice and emphasize practical aspects. Utmost care has been taken to include essentials ranging from embryology to cancer detection, suited to all different geographical regions.
The substance as presented, invites readers to appreciate and engage themselves in a rational and logical approach to problems. The contents of this treatise will reiterate the importance of the art of clinical practice and the principles involved in scientific management. I hope it would become a springboard for some to rise to great heights in managing the selected subjects.
Shirish S Sheth
Consultant Gynecologist
Breach Candy Hospital
Sir Hurkisondas Hospital
Past President, FIGO
11Preface to the Second Edition
Gynecology is a science dealing with the diseases of woman's reproductive organs. It has always been fascinating to explore the health issues of a woman starting right from birth up to the menopause. This book takes the life cycle approach starting from sex differentiation, abnormal development of reproductive organs to pediatric, adolescent and geriatric health. This is followed by the description of menarche, normal and abnormal menstruation and menstrual problems. The issues, related to contraception and subfertility are also dealt with in details.
The publication of the new edition (second edition) of this book is testimony to the fact that the book has been a bestseller. In this new edition, a few chapters have been added based on the valuable feedback from the students and professors. Some of them include, “Instruments Used in Obstetrics and Gynecology”, “Ultrasound and Color Doppler in Gynecology”, “Genital Tuberculosis”, and “Endoscopy in Gynecology”. The editors of this book truly believe that this addition would further help in adding worth to this edition.
The contributors for each chapter have especially been selected based on their expertise and experience, which has helped in providing the best in-depth knowledge and experience. This has led to the setting of high standards for many chapters. A large number of colored figures have been incorporated to enable easy understanding of the subject, helping to create an imprint in the reader's mind, so that the subject matter will remain embedded therein for years to come.
Since this is a contributory book, repetition of certain facts and topics is likely to occur in order to present a continuous flow of the subject matter. The contributors have tried their best to rectify this in this new edition.
We have no doubt that this book will be of great value to both undergraduates as well as the practitioners in the field. With the progress in time and further advancements in the field of medicine, there are likely to be changes in the clinical practice and the editors would certainly make efforts to provide this in the future editions as well. The readers are kindly requested to communicate any mistake and omissions to the publishers or the editors, so that they can be incorporated in the next reprint/edition.
Sabaratnam Arulkumaran
V Sivanesaratnam
Alokendu Chatterjee
Pratap Kumar
13Preface to the First Edition
Gynecology has always been a fascinating subject looking at the health issues of a female from birth to the menopause. This book takes the life cycle approach starting in sex differentiation, abnormal development of reproductive organs to pediatric and adolescent health. This is followed by menarche, menstruation and menstrual problems. The issues related to contraception and subfertility are dealt with in detail. Sexually transmitted diseases and pelvic inflammatory diseases are described followed by benign and malignant neoplasms of the reproductive tract. Menopause and cancer screening is discussed based on the current data and available evidence. There is little doubt that gynecological problems are increasingly managed medically and by minimally invasive surgery and where possible by out-patient procedures. Detailed descriptions of these are provided including the latest in technology.
The contributors for each chapter have specially been selected based on their expertise and experience. A large number of figures have been included to make the subject easy to understand and to make an “imprint” in the reader's mind, so that the subject matter will remain for years to come. We have no doubt that this book will be of great value to those interested in the subject.
There are bound to be some overlap of subject matter due to the contributory nature of the book and the need to repeat certain basic facts to provide a continuous flow of the subject matter. No book is perfect and ageless. With progress of time, there will be changes in practice and the editors would provide this in the next edition. The readers are kindly requested to communicate any mistakes and omissions to the publishers or the editors, so that they can be incorporated in the next/reprint edition.
Sabaratnam Arulkumaran
V Sivanesaratnam
Alokendu Chatterjee
Pratap Kumar