Gynecologic surgery includes procedures on the uterus, ovaries, tubes, cervix and vagina. Some interventions are very small and are done inside the uterus or through tiny incisions. Others are larger operations that correct complex problems.
Deciding for surgery is never just about an ultrasound or a lab result. It is about symptoms, impact on daily life, fertility plans and personal preferences. A good surgical plan starts with a clear explanation of the problem and of all available options, including non surgical ones.
In Lisbon, Dra. Joana Faria performs and coordinates gynecologic surgery for benign diseases and infertility in Portuguese, English, French, and Spanish. She works mainly with minimally invasive techniques whenever they are safe and appropriate.
This page gives an overview of gynecologic surgery. For more detail you can also read the pages on benign diseases and infertility surgery, minimally invasive gynecologic surgery, hysteroscopy, laparoscopy and conventional gynecologic surgery.
What it is
Gynecologic surgery is used to diagnose or treat conditions that affect the female reproductive organs. These include, for example, fibroids, uterine polyps, endometriosis, ovarian cysts, tubal problems, heavy bleeding and some causes of infertility and pelvic pain.
There are different types of procedures:
- Hysteroscopic surgery performed inside the uterine cavity through the cervix, without abdominal cuts.
- Laparoscopic surgery performed through small incisions in the abdomen using a camera and fine instruments.
- Conventional surgery through a vaginal approach or a larger abdominal incision when this is safer or technically necessary.
Which technique is best depends on the disease, its extent, your general health and your reproductive plans.
Main symptoms and when to worry
Surgery is usually considered when there are symptoms or findings that do not improve enough with medical treatment alone. Typical situations include:
- Very heavy or prolonged menstrual bleeding that causes anemia or limits daily activities.
- Recurrent pelvic pain or painful periods that do not respond to medication.
- Ovarian cysts or pelvic masses that are large, persistent or suspicious on imaging.
- Uterine polyps or fibroids that distort the cavity and may affect fertility or cause bleeding.
- Tubal disease, endometriosis or adhesions that may contribute to infertility.
You should consider a surgical opinion if your doctor has already tried medical treatment without sufficient relief, if tests show lesions that are growing or if there is any concern about the nature of a mass.
You should seek urgent care if you have intense abdominal pain that appears suddenly, pain with fever and malaise or very heavy bleeding with dizziness or fainting. These signs can indicate emergencies such as torsion, rupture or infection that may require prompt surgery.
Diagnosis: exams and what to expect before surgery
Before deciding on surgery, a detailed evaluation is essential. This helps confirm the indication, choose the best technique and plan a safe recovery.
The preoperative assessment usually includes:
- Clinical history and examination
Discussion about symptoms, medical background, previous surgeries and medicines. Physical and gynecologic examination help to understand the size and position of the uterus and ovaries. - Imaging exams
Transvaginal ultrasound is central in gynecology. Depending on the situation, saline infusion sonography, pelvic MRI or other tests can add useful detail. - Laboratory tests
Blood tests evaluate anemia, clotting, kidney and liver function and, when needed, tumor markers. - Anesthesia consultation
For most procedures, especially those done under general anesthesia, you will meet an anesthesiologist who will review your health, explain the type of anesthesia and answer questions.
During this phase, you will also receive information about preparation, fasting, medicines to stop or adjust and the expected length of hospital stay.
Treatment options and realistic expectations
Not every gynecologic problem requires surgery. When surgery is an option, it is often one part of a broader plan that may also include medication and follow up.
Main treatment paths include:
- Medical management
In some cases, hormonal treatment, pain control or other medicines are tried first. If symptoms improve and exams are stable, surgery may not be necessary. - Minimally invasive surgery
Hysteroscopy and laparoscopy often allow effective treatment with less pain and faster recovery compared with open surgery. Many women go home on the same day or after one night in hospital. - Conventional surgery
Vaginal or abdominal approaches may be safer for very large fibroids, complex adhesions or when cancer is suspected. Recovery is usually longer but the goal is the same: to treat the problem thoroughly and safely.
Realistic expectations are important. Surgery can greatly reduce pain and bleeding and improve fertility in selected situations, but it is not a guarantee of a perfect cycle or a pregnancy in every case. There are also risks such as bleeding, infection, injury to nearby organs and, rarely, the need for additional procedures.
How Dra. Joana Faria approaches gynecologic surgery in practice
Dra. Joana Faria believes that every surgical decision should be shared and informed. Her goal is that you understand why surgery is recommended, what will be done and what alternatives exist.
In daily practice she:
- Starts from your symptoms and priorities, not just from exam results.
- Explains in simple language the anatomy, the problem and the proposed procedure, often using sketches or images.
- Chooses minimally invasive techniques whenever they are safe and offers conventional surgery only when it really adds value.
- Works in close collaboration with anesthesiologists, fertility specialists and multidisciplinary surgical teams when needed.
- Provides clear instructions for preparation and recovery, including when you can return to work, exercise and sexual activity.
The aim is that you feel informed, respected and supported before, during and after surgery, with realistic expectations and space to ask all your questions.
