Dr. Wilson recently presented a lecture and an instructional video at a conference on Controversies in Obstetrics and Gynecology. She has submitted an abstract and 4 videos for the upcoming American Association of Gynecologic Laparoscopists meeting in November of this year.

Minimally invasive surgery is like anything else. The more you do it, the better you get. We have been able to remove larger and larger fibroid uteri through small incisions. In fact, we can safely say at this point that there is almost no Gynecologic surgical problem that cannot be approached laparoscopically. This includes early stage uterine or ovarian cancer, ectopic pregnancy, ovarian cysts, endometriosis, pelvic prolapse, and large fibroids. We have been seeing referrals from all over Arizona and the United States for laparoscopic surgery. We are proud of our minimally invasive surgical team and of the fact that we are able to spare women unnecessary suffering. We are also proud of our extremely low operative and post-operative complication rate.

If you have a friend who has been told that she needs a large incision for a Gynecologic surgical procedure, please encourage her to seek a second opinion. The surgery may very well be possible laparoscopically, reducing recovery time, post-operative pain, and scarring.

Educational Seminar

Join us on August 7 at 7 p.m. in North Scottsdale to find out if you're a candidate for minimally invasive laparoscopic procedures. Call 480.391.3638 to reserve a seat at our free educational seminar.

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Our patients have been exceedingly generous and have sent checks and donated lots and lots of T-shirts and stuffed animals. I cannot tell you how much these seemingly simple items are appreciated. In the first place, there are no such things as hospital gowns, so we are completely dependent on T-shirts to change the people into before they have surgery. By the way, there are no changing rooms, so we hold up sheets in a circle around the patient while he or she changes. The children get so excited about the stuffed animals. . . it is enough to make you cry. They clutch them as they are going off to sleep for surgery, and again as they are waking up.

We have been collecting throw-away supplies from the hospital and re-sterilizing them. It is shocking to fully realize how much we Americans waste. Just by collecting hospital throw-aways, we have enough drapes, gowns, sponges, suction tubing, and lots more to get us through 200 surgical procedures!

The drug companies have been overwhelmingly generous. We have boxes and boxes of oral contraceptive agents, yeast infection medication, steroid cream, pain relievers, antibiotics, etc.

The surgical equipment companies have also been exceedingly generous. They have donated laparoscopic instruments, adhesion prevention material, orthopedic supplies, antiseptic hand wash (no hot water or soap in Nicaragua), bladder catheters. . . the list is long.

I must say that my faith in humanity is renewed by this experience. Not only are 50 people volunteering their precious time, many of them are taking vacation to make this trip, paying their own plane fare and they are showing up on hot Sunday afternoons to sort and pack supplies. They are excited. We have 13 physicians (3 Gynecologists, a General Surgeon, an Orthopedist, a Plastic Surgeon, a Pediatrician, 2 Internists, and 4 Anesthesiologists). The rest of the team is made up of translators, nurses and aides. Some of us are bringing our teenaged children as aides and translators, so that they can experience the sweetness of unselfish service, and see that there are many people who are drastically less fortunate than they are.

We are staying at a shade grown, ecologically minded coffee plantation that doubles as a resort. Look it up on the Internet: www.SelvaNegra.com. We will be operating at a hospital in Matagalpa, one of the poorest cities in Nicaragua. The hospital is terribly run down and deficient in almost anything we might need. Dr. Jim Tillinghast, who is in charge of this trip, recently made a scouting trip to Matagalpa. He reports that the director of the hospital and the Minister of Health are excited about this trip, because only one other American medical group has visited in a year, and this is, for most people, the only way they receive medical care.

Dr. Tillinghast also reports that the operating room lights are burned out, and there is no way to obtain replacement bulbs. The facilities are dilapidated and supplies are sparce. There are no toilet seats or toilet paper. We plan on turning that operating room into a state-of-the-art facility in one day, however.

I look forward to reporting to all of you once we return.


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Testosterone is a male hormone, but female ovaries produce low levels of testosterone along with estrogen and progesterone. As we age, levels of all 3 hormones drop. It is relatively simple to replace estrogen and progesterone, but achieving adequate levels of testosterone is more difficult. Testosterone pills are available, and Estrogen/Testosterone combination pills are also available (Estratest). Testosterone in oral form, however, does not seem to be very effective. Testosterone cream is available, but again, is not as effective as we would like. Timed-release testosterone pellets seem to achieve the best results, and are simple to place under the skin of the buttocks.

What is the role of testosterone? Testosterone is a "male hormone" that women produce in lower levels than men. It plays a big role in libido, or sexual desire. It also plays a role in sexual responsiveness and orgasmic capacity. In addition, it seems to contribute to energy level and a sense of well-being. Testosterone plays a role in preserving bone mass, as well.

Testosterone is produced by the ovaries even after they have stopped producing estrogen. In fact, women can produce some testosterone until age 70 or so. How long ovaries produce testosterone seems to vary greatly from woman to woman, however. This explains why some women retain their sex drive and responsiveness long after menopause, and some do not.

Women who undergo ovarian removal along with a hysterectomy seem to suffer from the lack of testosterone most dramatically. The slower process of menopause is less abrupt, but eventually women in their 50's and 60's will feel the effects of low testosterone.

Our practice has been offering estrogen and testosterone timed-release sub-cutaneous pellets for 15 years. The pellets are inserted under the skin of the buttocks every 3 months. Some women choose to have testosterone pellets only, and some opt for the combined estrogen and testosterone pellets, which they feel is easier than taking a daily pill or remembering to change a patch.

The pellets have been extremely popular in our practice. Our patients report that they feel the testosterone effect within 48 hours. If you have had your ovaries removed with your hysterectomy, you feel that your sex drive is unacceptably low, or you simply do not want to have to remember to take your estrogen pill or change your patch, you may want to consider it. Call and request a consultation regarding estrogen and testosterone pellets.


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The reason to remove ovaries at the time of hysterectomy is pure and simple. It virtually eliminates the risk of ovarian cancer. For a Gynecologist, ovarian cancer is a frightening disease because it develops quickly and often does not produce ANY symptoms until it is quite advanced. When ovarian cancer is discovered, it is difficult to treat and most women die of the disease.

One in 70 women will develop ovarian cancer in her lifetime. Only 10% of ovarian cancers are hereditary, so the fact that you have no family history is not protective. If you do develop this cancer, it will probably kill you.

Invariably, during the discussion about removal of ovaries, the concern about taking hormone replacement comes up. Women are fearful that estrogen will cause breast cancer, and are reluctant to remove their ovaries for this reason.

Let me say, once and for all, that there is NO evidence that estrogen causes breast cancer. There is some evidence that the combination of estrogen and progesterone may raise the risk of breast cancer slightly, but estrogen alone does not.

Estrogen has many benefits which unfortunately do not receive adequate press coverage. Estrogen is the most potent drug we know for preventing osteoporosis. Estrogen virtually eliminates hot flushes, night sweats, vaginal dryness, and the moodiness associated with menopause.

So if you have not yet gone through menopause and you choose to have your ovaries removed at the time of hysterectomy, you will need to take estrogen at least for a few years unless you have a medical problem that makes taking estrogen dangerous for you. Prior to surgery, you will receive a prescription for estrogen pills, patches or both. We may need to adjust the dose a few times until we get it right, but most patients experience very few menopausal symptoms in the transition.

It is important to know that women who have breast cancer personally or have a family history of breast cancer have a higher personal risk of developing ovarian cancer. It is also true that a woman with breast cancer has a lower risk of recurrence of the disease if she has her ovaries removed

So how does a woman choose between leaving ovaries in or taking them out? Generally, if a woman is under the age of 40 and does not have a strong family history of breast or ovarian cancer, we recommend leaving ovaries in. After the age of 40, when ovarian function is declining anyway, we recommend giving serious thought to removing them. This does not mean that we think that every 42 year old who is having a hysterectomy should have her ovaries removed, but we want to make sure that she looks at all of the issues and makes an educated choice.


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A. Essure is a small coil that is inserted through the uterus into the fallopian tubes. It causes scarring and blockage of the tubes, therefore rendering the patient sterile. A scope is placed in the uterus, where the entrance to the fallopian tubes are located, and the coils are placed in the tubes. There are a few problems, however. First, the tubes sometimes cannot be easily located. In this case, the procedure has to be halted. Second, the FDA has required that each woman undergoing this procedure have an x-ray of the tubes 3 months after the procedure. This x-ray requires that contrast material be injected into the uterus through the cervix, which can be a painful procedure. The third problem is that insurance companies will not pay for the procedure or the follow-up x-ray. In conclusion, Essure is a great idea, practically speaking, but expensive and complicated.

Q. I have read that some women take their birth control pills everyday without stopping in order to avoid a period. Is this safe? My mother says that it is important to bleed once a month to clean out the uterus.

A. It is not necessary to bleed once a month. Historically, the only reason the pill manufacturers designed the pill the way they did is that women expect to bleed once a month and feel funny if they don't. Many women take their pills continuously and avoid the discomfort and inconvenience of a period. It is perfectly healthy. If you want to avoid a period, simply take your active pills every day. Most women will not bleed at all, but some develop annoying and unpredictable spotting and need to go back to a regular pill cycle with monthly periods.


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