Dr. Tejas Gopalkrishnan

Transgender Physiology Explained By Dr. Tejas Gopalkrishnan: Gender, Sex, Dysphoria & Incongruence 

by with No Comment OBS-GYN
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Estimated reading time: 6 minutes

Some OBG topics are easy to overlook because they don’t feel like the usual exam-heavy chapters. But when a topic has several similar-sounding terms, knowing the exact difference can save you from making a silly mistake in the exam. 

Transgender physiology is one of those topics. 

In a recent session, Dr. Tejas Gopalkrishnan explains the basic terminology around sex, gender, transgender identity, gender dysphoria and gender incongruence. 

Let’s break it down in a way that’s easy to remember. 

First Things First: What Does Transgender Mean? 

A transgender person is someone whose gender identity is different from the sex assigned to them at birth. 

For example, a person may be assigned male at birth but identify as a woman. 

That’s the basic idea. 

But there are several terms around it, and this is where things can get confusing. 

Sex and Gender Are Not the Same 

This is probably the first distinction you should have clear. 

Sex refers to the biological characteristics used to classify someone at birth. 

Gender refers to a person’s identity, how they understand and identify themselves. 

So, when you see a question asking about the difference between sex and gender, don’t treat the two words as interchangeable. 

Sex → assigned at birth 

Gender → identity 

Simple enough. 

What Is Gender Dysphoria? 

Now comes one of the most important terms in this topic. 

A person can be transgender without necessarily experiencing distress about it. 

When there is significant distress or discomfort related to the difference between a person’s gender identity and the sex assigned at birth, it is referred to as gender dysphoria. 

This distinction is important. 

Being transgender and having gender dysphoria are not automatically the same thing. 

For residents, this is one definition worth remembering properly rather than trying to memories it word-for-word. 

Gender Incongruence vs Gender Dysphoria 

These two are often mixed up. 

Gender incongruence describes the difference between a person’s experienced or identified gender and their sex assigned at birth. 

Gender dysphoria refers to the distress associated with that incongruence. 

A quick way to remember: 

Incongruence = difference 
Dysphoria = distress 

That’s the key distinction. 

What Is Gender Expression? 

Here’s another term that sounds similar but means something different. 

Gender expression is how someone expresses their gender outwardly. 

It can include: 

  • Clothing 
  • Hairstyle 
  • Appearance 
  • Behaviour 
  • Pronouns 
  • Other forms of social expression 

One important point: gender expression does not necessarily tell you someone’s gender identity. 

Gender Non-Conformity 

Gender non-conformity refers to behaviour, appearance or expression that doesn’t follow the gender-related expectations of a particular culture or society. 

It doesn’t automatically mean that a person is transgender. 

This is another distinction worth keeping in mind when revising the terminology. 

And What Is Cisgender? 

You will often see cisgender mentioned alongside transgender. 

A cisgender person identifies with the gender that corresponds to the sex assigned to them at birth. 

So, remember it like this: 

Cisgender → identity aligns with assigned sex 

Transgender → identity differs from assigned sex 

Transgender Woman vs Transgender Man 

This is where many students pause for a second. 

Transgender woman 

Assigned male at birth → identifies as a woman 

Transgender man 

Assigned female at birth → identifies as a man 

Don’t overcomplicate it. 

The word woman or man refers to the person’s gender identity, while the “assigned at birth” part tells you the sex assigned at birth. 

What About “Transsexual”? 

You may come across this word in older books or older medical literature. 

Transsexual is a historical term that was used in relation to people undergoing medical interventions as part of a transition. 

The terminology has changed over time, and transgender is generally the broader term used today. 

Why Is This Important for OBG Residents? 

At first, this may look like just another set of definitions to memorise. 

But it has clinical relevance too. 

OBG residents may encounter transgender patients in areas such as reproductive health, contraception, fertility, sexual health, pregnancy and general gynecological care. 

Being familiar with the terminology helps you understand what the patient is actually communicating and approach the consultation appropriately. 

And yes, from an exam point of view, these definitions are also worth knowing. 

Questions can be framed around the difference between gender dysphoria, gender incongruence, gender expression and transgender identity. 

So don’t skip this just because it looks like a “definitions-only” topic. 

Quick Revision Before You Move On 

Here’s the easiest way to revise the whole concept: 

  • Sex: Biological classification assigned at birth. 
  • Gender identity: How a person identifies themselves. 
  • Transgender: Gender identity differs from sex assigned at birth. 
  • Gender incongruence: Difference between experienced/identified gender and assigned sex. 
  • Gender dysphoria: Distress associated with that difference. 
  • Gender expression: How someone expresses their gender outwardly. 
  • Gender non-conformity: Expression that doesn’t follow expected cultural gender norms. 
  • Cisgender: Gender identity aligns with sex assigned at birth. 
  • Transgender woman: Assigned male at birth, identifies as a woman. 
  • Transgender man: Assigned female at birth, identifies as a man. 

The One Thing You Should Remember 

If you’re short on revision time, don’t try to memorise ten separate definitions. 

Just understand the connection: 

Sex → assigned at birth 

Gender identity → how the person identifies 

Incongruence → difference 

Dysphoria → distress 

Expression → how gender is expressed 

Once this is clear, the rest becomes much easier. 

Want More Such Important OBG Topics? 

This session is just a small glimpse of the important concepts and exam-relevant discussions covered in Conceptual OBG. 

If you want more such sessions that help you understand the topic instead of simply memorising it, download the eConceptual app and subscribe to Conceptual OBG. 

More concepts. More clarity. Better revision. 
 
Click Here to Watch full Session: Transgender Physiology Explained | Gender, Sex, Dysphoria & Incongruence | Dr. Tejas Gopalkrishnan 

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Dr. Aditya Nimbkar

Suturing in OBGYN Made Easy Suture Packets, Needles & Practical Exam Tips – Part 1 By Dr. Aditya Nimbkar

by with No Comment OBS-GYN
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Estimated reading time: 5 minutes

Suturing is one of the most fundamental yet most confusing topics for OBGYN residents—especially during exams and early OT postings. Different packets, unfamiliar markings, multiple brands, and endless viva questions often make sutures feel more complicated than they really are. 

In this first part of a two-part series, Dr. Aditya Nimbkar simplifies suturing in OBGYN by breaking down commonly used suture materials, how to read suture packets, and how to answer suturing questions confidently in exams. 

Why Sutures Matter More Than You Think?

If there is one skill that stays with you throughout residency and beyond, it is suturing. From LSCS and episiotomy repair to hysterectomies and laparoscopic vault closure, the right suture makes a significant difference to healing, infection rates, and patient comfort. 

This session focuses on the most frequently used sutures in obstetrics and gynecology, starting with Vicryl and moving on to silk and Mersilene. 

Understanding a Suture Packet: What to Read First 

Before using any suture, always understand what the packet is telling you. Every suture packet contains critical information: 

1. Suture Size (US Gauge System) 
  • 1, 2, 3 → thicker sutures 
  • 1-0, 2-0, 3-0, 4-0 → progressively thinner sutures 

Think of 1-0 as the center point: 

  • Numbers without zeros → thicker 
  • Numbers with more zeros → thinner 
2. Suture Length 
  • Usually mentioned in centimeters 
  • Common lengths: 70 cm or 90 cm 
3. Needle Details 

Each packet also mentions: 

  • Needle length (e.g., 20 mm or 30 mm) 
  • Needle shape (half circle, 3/8 circle) 
  • Needle type 
  • Round body (used for uterus, muscle) 
  • Tapered tip 
4. Absorbable vs Non-Absorbable 

Clearly mentioned on the packet and extremely important for exams. 

The Three Golden Points to Describe Any Suture in Exams 

Whenever you are shown a suture in viva, always describe it using three fixed parameters: 

  1. Natural or Synthetic 
  1. Absorbable or Non-absorbable 
  1. Monofilament or Multifilament (Braided) 

If you remember just this framework, your suturing viva will almost always go well. 

Vicryl (Polyglactin 910): The Gold Standard 

Vicryl is one of the most commonly used sutures in OBGYN. 

Key Features 
  • Synthetic 
  • Absorbable (Delayed absorbable) 
  • Multifilament (Braided) 
Strength & Absorption 
  • Loses 50% strength in ~3 weeks 
  • Loses 75% strength by 5–6 weeks 
  • Completely absorbed in 50–70 days 
  • Absorbed by hydrolysis 
Advantages 
  • Excellent tensile strength 
  • Easy handling 
  • Ideal for: 
  • Uterine closure after LSCS 
  • Episiotomy repair 
  • Vaginal tears 
  • Abdominal & vaginal hysterectomy 
  • Laparoscopic vault suturing 
  • Multilayer myomectomy closure 
Disadvantage: Wicking 

Because Vicryl is braided, it allows capillary spread of fluids and bacteria, a phenomenon known as wicking. This makes it less suitable in infected fields and unsuitable for skin closure. 

Rating: 9/10 

A reliable, versatile, and time-tested suture. 

Vicryl Plus: Added Infection Protection 

Vicryl Plus is essentially Vicryl with a key upgrade. 

Vicryl Rapid: Designed for Fast Healing Areas 

Episiotomy wounds heal quickly, so prolonged suture presence causes discomfort and dyspareunia. Vicryl Rapid was developed to address this. 

Key Features 
  • Gamma-irradiated 
  • 50% strength lost in 5–6 days 
  • Completely absorbed in 2–3 weeks 
Ideal Use 
  • Episiotomy repair 
  • Vaginal lacerations 
Not Suitable For 
  • Uterine suturing 
Rating: 8/10 

Perfect for perineal repairs, limited elsewhere. 

Silk (Mersilk): A Suture of the Past 
Characteristics 
  • Natural 
  • Multifilament 
  • Practically non-absorbable 
  • Loses 50% strength after 1–1.5 years 
Why It’s Rarely Used Now 
  • Stays in tissue for years 
  • High risk of: 
  • Foreign body granuloma 
  • Chronic inflammation 
Rating: 5/10 

Given mostly out of respect for its historical importance. 

Mersilene Tape: Still Very Relevant 

Mersilene tape is entirely different from silk, despite the similar name. 

Key Features 
  • Synthetic 
  • Permanent 
  • Multifilament 
  • Made of polyester 
  • Silicone-coated for smooth passage 
Uses 
  • Cervical cerclage (Shirodkar, abdominal cerclage) 
  • Sling surgeries 
  • Cervicopexy 
  • Sacrocolpopexy 
  • Prolapse surgery in young women 
Disadvantages 
  • Difficult handling 
  • Risk of erosion if exposed near skin or vaginal mucosa 
Rating: 7/10 

Essential in modern gynecologic surgery despite handling challenges. 

What’s Coming in Part 2? 

So, In the next session we will cover: 

  • Staplers 
  • Prolene 
  • Ethilon 
  • Catgut 
  • Linen 
  • Monocryl 
  • Barbed sutures (Stratafix) 
Final Takeaway 

Understanding sutures is not about memorizing brands—it’s about knowing why, where, and how to use them. Once you learn how to read a suture packet and apply the three-point description rule, both exams and OT work become far easier. 

Stay tuned for Part 2 of this comprehensive suturing series. 

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Dr Aditya Nimbkar

Must Watch Topic for NEET SS: Predictors and Future of Preeclampsia – Explained Simply By Dr. Aditya Nimbkar

by with No Comment OBS-GYN
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Estimated reading time: 4 minutes

Preeclampsia is something every OBG resident sees almost every day. Honestly, it’s so common that we sometimes forget how serious it actually is. In India, the numbers are worrying. Roughly one in every 10 to 20 pregnant women develops preeclampsia. That means almost every clinic or ward has multiple such patients.

What’s frustrating is this — even after so many years of research, and despite India being a high-risk population, we still struggle with predicting and preventing preeclampsia effectively. This session by Dr. Aditya Nimbkar focuses exactly on that: what we can predict today, what we can actually do, and where the future might be headed.

What Exactly Is Preeclampsia?

By definition, preeclampsia means:

  • Blood pressure more than 140/90 mmHg
  • Recorded on two occasions, at least 4 hours apart
  • After 20 weeks of pregnancy

That part is basic, and everyone knows it. But the real issue is not diagnosis.
The real issue is prediction.

Why Does Preeclampsia Happen?

The core problem starts very early in pregnancy.

Normally, trophoblasts invade the spiral arterioles. This invasion destroys the tunica layers and converts high-resistance vessels into low-resistance ones. This change is necessary because pregnancy needs more blood flow to the placenta and fetus.

When this trophoblastic invasion is faulty:

  • Blood flow to the placenta reduces
  • Placental hypoxia develops
  • The whole disease process begins
Angiogenic vs Anti-Angiogenic Factors

Placental hypoxia leads to increased anti-angiogenic factors, mainly:

  • sFlt-1
  • Soluble endoglin

At the same time, pro-angiogenic factors reduce:

  • Placental Growth Factor (PLGF)
  • VEGF

Simply put:

  • Less PLGF
  • More sFlt-1
     = higher risk of preeclampsia
PLGF Levels – Why They Matter

PLGF is one of the most useful markers we have today.

  • PLGF > 100 → risk of preeclampsia is very low
  • PLGF < 33 → very high chance of developing preeclampsia later

The lower the PLGF, the worse the placental function.

sFlt-1 / PLGF Ratio – Short-Term Prediction

This ratio helps predict what may happen in the next 1–2 weeks.

  • Before 34 weeks
    • Ratio > 85
    • High risk of severe preeclampsia, eclampsia, or abruption
  • Between 34–37 weeks
    • Ratio > 110
    • Again, there is a high risk of serious events soon

The cut-offs differ because PLGF and sFlt-1 levels behave differently as pregnancy advances.

Is This Test Really Useful?

Practically speaking, not for everyone.

The test is expensive, and even if it predicts risk, it doesn’t help us stop the disease. What it helps with is planning.

It tells us:

  • Whether delivery may be needed soon
  • Whether steroids should be given
  • Whether magnesium sulfate is required
  • Whether the patient needs admission and close monitoring

It reduces complications, but does not prevent preeclampsia.

Where Can We Actually Help the Patient?
Uterine Artery Doppler – Very Important

This is where real prevention starts.

Done along with the NT-NB scan, it tells us about placental blood flow.

  • Low resistance → good trophoblastic invasion
  • High resistance → higher risk

Key values:

  • 11–14 weeks: Mean PI > 2.4
  • 20–24 weeks: Mean PI > 1.4

Higher values mean increased risk of:

  • Preeclampsia
  • Fetal growth restriction
Aspirin – But Timing Is Everything

If the uterine artery PI is high:

  • Start low-dose aspirin
  • Ideally 150 mg
  • Before 16 weeks

After 16 weeks, trophoblastic invasion is already complete, so starting late doesn’t provide much benefit.

Aspirin doesn’t completely prevent preeclampsia, but it can delay the onset and reduce the severity.

Other Early Predictors

Better prediction comes from combining:

  • Uterine artery PI
  • PLGF
  • Mean arterial pressure (MAP)

If MAP > 90 in early pregnancy, future risk increases.

High-Risk Patients Need Extra Attention

Some women need close monitoring right from the first trimester:

  • Previous preeclampsia or eclampsia
  • History of abruption or unexplained stillbirth
  • Chronic kidney disease
  • Diabetes
  • Autoimmune disorders like SLE

These patients benefit the most from early aspirin and strict surveillance.

What About the Future?

Many new markers are being studied:

  • Placental protein 13
  • ADAM-12
  • Soluble endoglin
  • Micro-RNAs

There are also drugs under research:

  • Sildenafil
  • Statins
  • Metformin

At present, aspirin is all we have. But in the future, safer drugs may help us actually prevent, not just predict, preeclampsia.

Final Thoughts

Right now, our focus should be:

  • Early screening
  • Identifying high-risk women
  • Starting aspirin on time
  • Close maternal and fetal monitoring

Prediction helps, but prevention is the real goal. We’re not there yet — but we’re getting closer.

Subscribe to the Conceptual OBG YouTube channel for more insightful sessions.

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