Q: My mother is undergoing bilateral salpingo-oophorectomy, paravaginal defect repair, burch cysto-uretchropexy, vaginal hysterectomy, cystoscopy, posterior colpo-perneorrhathy, and laparotomy. Can you describe these to me in normal words? I am at a loss, and I am worried for my mother. If I could be educated on these, I would feel a lot better. Thank you.

A: Those big, 'doctor-speak' words tell me exactly what your mom is having done! These are the individual components of procedures done for correcting 'pelvic relaxation syndrome', a condition that affects many older women. There is a correlation with many pregnancies, particularly of large infants. There is a genetic factor, too. Salpingo-oophorectomy is excision of the uterine tubes and ovaries. Paravaginal defect repair is the correction of a hernia. Burch urethro-cystopexy is an attachment of the urethra to a strong ligament on each side of the pubic bone. Vaginal hysterectomy is the excision of the uterus via the vagina. Cystoscopy is a visual inspection of the urethra and the bladder. Posterior colpo-perineorrhaphy is the repair of a hernia of the rectum toward the vagina and correction of the lacerations of the space between the vaginal and rectal openings. Laparotomy is an incision into the abdominal cavity.

All of these are standard procedures. The only item that may reasonably be questioned is why these procedures are not being done laparoscopically, rather that via an abdominal incision. Indeed, some surgeons would do the entire procedure, including the hysterectomy, salpingo-oophorectomy, paravaginal ligament repair, the Burch colpo-suspension, and a vaginal vault suspension, via the laparoscope, leaving only the lower portion of the recto-vaginal hernia and the perineal repair, as the surgery is done vaginally. This depends upon surgeon training and skills for this kind of surgical approach. Given the above prescription of surgical procedures, your mom's surgeon seems to have identified the essential set of surgical remedies; and yes, all are necessary for a 'good job'.

I hope that this information is useful to you and good health for your mom!


Q: Is it the first sperm to get to the egg that fertilizes it or do multiple sperm continuously penetrate the egg trying to "break in"?

A: Fertilization is a very complicated biological event that is a 'team effort'. Not only must the sperm reach the ovum, usually, but not always, in the uterine tube. A significant number of sperm carrying their enzymes must reach the ovum to prepare the way for the sperm that finally penetrates the cell membrane. In addition, the open membrane must close immediately, excluding other sperm that are adjacent to it. Only rarely does this closure mechanism fail, leaving two sperm in one egg. There seems to be no favored sperm with exceptional qualities that penetrates the cell membrane, but thousands of sperm are necessary to digest the zona pellucida cells that protect and nourish the ovum. Indeed, the number of sperm necessary for achieving fertilization is very, very large, requiring about 40-50 million to be deposited at the top of the vagina (the lowest number of a normal sperm count in the laboratory is 20mil / ml of semen, of which there is usually about 2.5 ml= 50mil sperm per male ejaculate). Still, in the laboratory, one viable sperm can be injected directly into the ovum to achieve a normal pregnancy. So men with sub-normal sperm counts may be fertile, with help. These considerations emphasize how in-efficient human reproduction is, but since this human endeavor is so important, each sexually active individual is well advised to use contraception with every sexual act, since a conception can occur even when not intended.

I hope that this information is useful to you.

These responses are of educational value only and may not be construed as medical advice or opinion useful for making decisions. Consultation with a qualified physician is advisable before any action is considered based upon this response. WHPU/WLH.