Eliminating cervical cancer is about more than just spending money. It requires reckoning with the many intangibles that get in the way of this cause. Widespread adherence to patriarchal value systems, for instance, not only threatens women’s health and well-being, but discourages them from freely pursuing the means to a cure. Persons with cervixes must confrontnot only archaic notions about their worth, but also many other hidden barriers to prevention. These include the fear and superstition that arise from lack of knowledge and medical misinformation, a lack of appreciation for self-care, the burden of unpaid work, and the vulnerability resulting from racial and gender inequality. Challenging these societal factors will increase the volume of women’s voices and ultimately save thousands of lives. But until society is ready to acknowledge and address these barriers – the patriarchal structures thwarting women’s autonomy and decision-making power, the stigma associated with this disease, the religious intolerances and traditional values contrary to its prevention – a cancer that strikes only those with a cervix will continue to kill.

In 1980 Irish fertility was 1.66% of the Western European average, however families were smaller, and fewer women were giving birth in their forties. Despite the limitations of the 1979 Act, the 1980s saw a marked increase in access to contraception, by single and married adults, and major advances in family planning training for doctors. However, surveys of mothers in maternity hospitals indicate that many pregnancies were unplanned, and access to information and contraceptives remained patchy in provincial Ireland. Legal restrictions were gradually eased from the mid-1980s, and by 1995 condoms were available without restriction, partly to counter the threat of HIV. Sterilisation was never banned in Ireland, and by the 1980s male sterilisation was readily available, but access to tubal ligation, even in cases of acute medical need proved much more difficult. In some hospitals, including Dublin maternity hospitals, the ethics committees, which were formed in the early 1980s at the behest of the Catholic hierarchy, and the hostility of nursing and other non-medical hospital staff prevented doctors from carrying out the procedure, prompting some to resort to hysterectomy.

With a lifetime prevalence of up to 75%, uterine fibroids are the most common benign tumour of the female reproductive system. Fibroids present the most common indication for hysterectomy and are associated with high health-related costs. They can severely affect the quality of life of these women and may diminish fertility. This chapter provides an overview of the aetiology, prevalence, diagnosis and treatment options for uterine fibroids. As the reproductive phase is shifting ever further back into the life of a woman, conservative therapy options are becoming increasingly important.

Despite the efforts for conservative treatment for several benign entities, hysterectomy is the therapeutic cornerstone. The current chapter presents an overview of the surgical techniques, as these are applied via different surgical approaches: abdominal, vaginal and minimal access. Special emphasis is given to the potential complications encountered during the postoperative period. Several issues of controversy are also discussed and suggestions have been made according to the current guidelines. It is evident that hysterectomy should always be included in a training curriculum with the surgical skill being maintained via a minimum number of procedures performed yearly. Route selection is very important in reducing possible complications. In the same direction, whenever possible, an enhanced patient recovery scheme should be applied.

A 40-year-old gravida 1, para 1001 presents with worsening pelvic pain. Her symptoms have been present for over 15 years and are progressing. Most recently, she has daily symptoms described as sharp, stabbing, intermittent pelvic pain. Her menstrual cycle exacerbates the pain. In addition to dysmenorrhea, she reports deep dyspareunia and a history of infertility. She denies any bowel or bladder dysfunction. Menarche was early at age 10. Menses occur every 25 days, with an 8- to 10-day duration with heavy bleeding and dysmenorrhea. Past treatments include combined oral contraceptive pills, gonadotropin-releasing hormone (GnRH) agonist following laparoscopy-proven endometriosis, and she is currently in her fourth year of a levonorgestrel-containing intrauterine device (IUD). She has no significant past medical history. Her past surgical history is significant for operative laparoscopy 12 years ago with excision of endometriosis (pathology confirmed) and adhesiolysis to improve fertility. She is not taking any medications and is allergic to sulfa (rash). She is a non-smoker, drinks alcohol socially. She is happily married and works for a non-profit organization. Her daughter is 10 years old and healthy. Due to her increasing pelvic pain she now requests hysterectomy.

Cervical cancer is the fourth most common cancer of women, with a wide range of variation of incidence across the globe. It continues to be a major public health problem particularly in countries with poorly resourced healthcare. Persistent infection with high-risk HPV and ineffective clearance of HPV are central to causation of cellular changes at the squamocolumnar junction, leading to the development of invasive cancer. A global initiative of preventative vaccination, screening and treatment has developed to eradicate cervical cancer as a public health problem. Diagnosis of early invasive cancer is seen in well-established screening programmes. This chapter reviews the management of early invasive and recurrent cervical cancer.

A 45-year-old women presents to the emergency room complaining of vaginal bleeding and fevers at home to 38.3°C. She is six days post-op from a robotic hysterectomy, bilateral salpingectomy. The patient had normal return of bowel and bladder function and has been taking ibuprofen 600 mg every 6 hours alternating with oxycodone/acetaminophen 5/325 mg every 6 hours as needed for pain relief. She states that she really felt good for the first few days with only some light spotting since the procedure. Over the last 24 hours, she has noticed an increase in the discharge and stated it is now foul smelling. Her pain level and fatigue have increased over the last 12 hours, and she rates the pain in her abdomen as a 5 out of 10.

Ovarian cancer is the second most common gynaecological malignancy but is the most common cause of gynaecological cancer death. Ovarian cancer screening has not been proven to be associated with statistically significant reduction in mortality from ovarian cancer. However, evidence demonstrates that prophylactic bilateral salpingo-oophorectomy significantly reduces the risk of developing gynaecological and breast cancer in women who carry BRCA1 and BRCA2 mutations.

Moreover, there is 4–20% incidence of histological diagnosis of occult ovarian malignancy found after prophylactic surgery. Identifying and counselling patients with hereditary conditions that predispose them to higher chance of breast and gynaecological cancer is extremely important. Clinical information should include protective measures, fertility implications, surgical premature menopause and its short- and long-term implications and availability of hormone replacement therapy.

Laparoscopic extensive myomectomy, hysterectomy for large myomas, laparoscopic treatment of endometriosis or treatment of cancer of the uterus are advanced laparoscopic gynaecological procedures. Since they can be very challenging, many special pre-, intra- and postoperative aspects need to be considered. This chapter aims to give insights into the different advanced laparoscopic gynaecological procedures. The preoperative arrangement, the intraoperative setting, key operative steps and the postoperative course are described in detail. An overview of common intraoperative complications like ureter injuries, bladder injuries, gastrointestinal injuries, vascular injuries and pneumoperitoneum-linked complications is given. Some typical postoperative complications like wound-healing problems, bleeding and gastrointestinal lesions are described together with possible treatment options.