GYN

Annual Well Visits

  • Annual exams

The purpose of the annual ob-gyn visit is to detect and treat any new or ongoing health problems as well as to help prevent future ones from developing.

Annual assessments provide an excellent opportunity to receive counseling about preventive care. These visits provide opportunity to discuss concerns or questions with your provider. These visits include screening, evaluation and counseling, and immunizations based on age and risk factors.

  • Pap tests/Cervical Cancer Screening tests

We recommend that ALL women get yearly Well Woman Exams.  You and your provider will decide at that time how frequently a Pap Smear is needed based on individual health hsitory.

You can prevent cervical cancer with regular screening tests, like the Pap test and the HPV DNA test (HPV test).  The Pap test is a screening test that looks for early signs of cervical cancer.  It finds abnormal cells on a woman's cervix.  For this test, your doctor takes cells from your cervix so that they can be looked at with a microscope.  Cancer screening tests look for early signs of cancer so you can take steps to avoid ever getting cancer.  The Pap and HPV tests screen for early signs of cervical cancer.  It looks for abnormal cells on your cervix that could turn into cancer over time.  That way, problems can be found and treated before they ever turn into cancer.  All women should start getting regular Pap tests at age 21.

An HPV test is a test that looks for HPV on a woman's cervix.  Doctors take cells by swabbing the cervix.  This is often done at the same time as a Pap test, and may be called co-testing or HPV co-testing.  The HPV test can be used at the same time as the Pap test, called the HPV co-test, for women 30 years of age and older.  The HPV test may also be used after an inconclusive Pap test, called a reflex HPV test, for women 21 years of age and older.  For women ages 30 and older, the HPV test can be used along witht he Pap test.  This is called HPV co-testing.  Screening tests can find early problems before they become cancer.  That way, problems can be found and removed before they ever become cancer.

HPV is very common in women younger than age 30.  Since most HPV that is fund in these women will never cause them health problems, it is not useful to test young women for HPV.  Most young women will fight off HPV within a few years.

HPV is less common in women older than age 30.  HPV also is more likely to signal a health problem for these women, who may have had the virus for many years because their bodies did not fight off HPV.  Doctors may use the HPV test to tell if these women are at higher risk for cervical cancer and if they need to be screened more often.

Please refer to the Centers for Disease Control and Prevention for additional HPV information.

  • Mammograms and Breast exams

Due to the high incidence of breast cancer in the US and the potential to reduce deaths from it when caught early, it is recommend that mammography screening be offered annually to women beginning at age 40. We encourage women to have annual mammograms.
Annual clinical breast exams (CBE) are recommended for women ages 40 and older, and every one to three years for women ages 20-39.

  • Bone Mineral Density testing- BMD

Bone mineral density testing is recommended for women 65 and over no more than every two years. Post menopausal women younger than age 65 who have more than one or more risk factor should also be tested.

BMDs are used to screen for osteoporosis and bone loss. BMDs can help detect problems before a fracture occurs.

BMDs can be performed in our office.

  • Cholesterol screening

All women age 45 and older should have the cholesterol levels checked every 5 years. Women with any of the following risk factors may need to be tested and at a younger age:

-have had high cholesterol or heart disease

-have a family history of high cholesterol or heart disease

-smoke

-have diabetes

HPV Prevention and Management

Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. Most people who become infected with HPV do not even know they have it. Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years.  But, sometimes, HPV infections are not cleared and can cause:

  • Genital warts
  • Cervical cancer and other, less common but serious cancers, including cancers of the vulva, vagina, penis, anus, and oropharynx

How can people prevent HPV?

There are several ways that people can lower their chances of getting HPV:

  • Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given at 11 or 12 years of age.
    • Girls and women: Two vaccines are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Gardasil has also been shown to protect against anal, vaginal and vulvar cancers. Gardisil is recommended for girls between the age of 9 and 26.
  • For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV.
  • People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That is why the only sure way to prevent HPV is to avoid all sexual activity.
  • Not smoking also decreases your chance of getting HPV.

Is there a treatment for HPV or related diseases?

There is no treatment for the virus itself, but there are treatments for the diseases that HPV can cause:

  • Visible genital warts can be removed by the patient him or herself with prescribed medications. They can also be treated by your health care provider. Some people choose not to treat warts, but to see if they disappear on their own. No one treatment is better than another.
  • Cervical cancer is most treatable when it is diagnosed and treated early. But women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment.

Bone Health

Bones play many roles in the body. They provide structure, protect organs, anchor muscles, and store calcium. Adequate calcium consumption and weight bearing physical activity build strong bones, optimizes bone mass, and may reduce the risk of osteoporosis later in life.

While men and women of all ages and ethnicities can develop osteoporosis, some of the risk factors for osteoporosis include those who are

  • Female
  • White/Caucasian
  • Post menopausal women
  • Older adults
  • Small in body size
  • Eating a diet low in calcium
  • Physically inactive

The recommended daily dose of calcium is 1200-1500mg/day in divided doses. Vitamin D also plays an important role in healthy bone development. Vitamin D helps in the absorption of calcium. The recommended daily dose of Vitamin D is 100IU/day.

Other treatments include oral Bisphosphonate Medications. These are a class of antiresorptive medications that slow the breakdown of bone. They include Fosamax, Boniva, Actonel.

Evista is another oral osteoporosis medications called estrogen agonists/antagonists, which are also known as selective estrogen receptor modulators (SERMs).  It is approved for women only and is taken as an oral tablet daily.

Reclast is another bisphosphonates.  It is given once a year by intravenous (IV infusion over at least 15 minutes).

Another medication that can be used treat postmenopausal women at high risk of fracture or breaking a bone is Prolia. It is in a class of medications called RANK ligand (RANKL) inhibitor/human monoclonal antibody. It is given by a healthcare professional by injection every six months.

Your health care provider will determine which treatment is right for you if you are having some bone loss. All women are encouraged to take their recommended daily dose of calcium and Vitamin D.

Contraception

In the United States, almost half of all pregnancies are unintended. Yet, several safe and highly effective methods of contraception (birth control) are available to prevent unintended pregnancy.

  • Combined oral contraceptives—Also called “the pill,” combined oral contraceptives contain the hormones estrogen and progestin. It is prescribed by a doctor. A pill is taken at the same time each day. If you are older than 35 years and smoke, have a history of blood clots or breast cancer, your doctor may advise you not to take the pill. The pill is 91–99% effective at preventing pregnancy.
  • Implant—The implant is a single, thin rod that is inserted under the skin of a woman’s upper arm. The rod contains a progestin that is released into the body over 3 years. It is 99% effective at preventing pregnancy.
  • Injection or “shot”— Women get shots of the hormone progestin in the buttocks or arm every three months from their doctor. It is 94–99% effective at preventing pregnancy.
  • Patch—This skin patch is worn on the lower abdomen, buttocks, or upper body (but not on the breasts). This method is prescribed by a doctor. It releases hormones progestin and estrogen into the bloodstream. You put on a new patch once a week for three weeks. During the fourth week, you do not wear a patch, so you can have a menstrual period. The patch is 91–99% effective at preventing pregnancy, but it appears to be less effective in women who weigh more than 198 pounds.
  • Hormonal vaginal contraceptive ring— The ring releases the hormones progestin and estrogen. You place the ring inside your vagina. You wear the ring for three weeks, take it out for the week you have your period, and then put in a new ring. It is 91–99% effective at preventing pregnancy.

Intrauterine Contraception

  • Mirena or Skyla-The IUD is a small T-shaped device like the IUD. It is placed inside the uterus by a doctor. It releases a small amount of progestin each day to keep you from getting pregnant. The IUD stays in your uterus for 3-5 years. The Mirena and Skyla are more than 99% effective at preventing pregnancy.
  • Paraguard or copper IUD—An IUD is a small device that is shaped in the form of a “T.” Your doctor places it inside the uterus to prevent pregnancy. It can stay in your uterus for up to 10 years. This IUD is more than 99% effective at preventing pregnancy.

Female Sterilization—Tubal ligation or “tying tubes”

A woman can have her fallopian tubes tied (or closed) so that sperm and eggs cannot meet for fertilization. The procedure can be done in a hospital or in an outpatient surgical center. You can go home the same day of the surgery and resume your normal activities within a few days. This method is effective immediately. It is more than 99% effective in preventing pregnancy.

Essure Sterilization

A thin tube is used to thread a tiny device into each fallopian tube. It irritates the fallopian tubes and causes scar tissue to grow and permanently plug the tubes. It can take about three months for the scar tissue to grow, so use another form of birth control during this time. Return to your doctor for a test to see if scar tissue has fully blocked your fallopian tubes. It is more than 99% effective in preventing pregnancy. See in office procedures for more information.

Hormone Replacement & Menopause Management

Hormone therapy use should be limited to the treatment of menopausal symptoms at the lowest effective dosage over the shortest duration possible, and continued use should be reevaluated on a periodic basis.

Risks factors include increased incident of breast cancer, stroke, and blood clots. Benefits associated with estrogen and progesterone use in the WHI trial included a 37% reduction in colorectal carcinoma rates and reduced incidence of hip and vertebral fractures.

Compounded hormones are plant-derived hormones that are prepared, mixed, assembled, packaged, or labeled as a drug by a pharmacist and can be custom made for a patient according to a physician's specifications.

Risk versus benefits have to be considered when starting hormones and can be discussed on an individual bases depending on symptoms and medical history.

MonaLisa Touch®

The MonaLisa Touch®is designed for postmenopausal women who are suffering from changes in their gynecologic health.  Women experiencing side effects as a result of a hysterectomy or breast cancer treatments may benefit from gynecologic laser therapy. The MonaLisa Touch®delivers gentle fractional CO2 laser to the vaginal wall tissue.  It restores gynecologic health by generating new collagen, elastin and vascularization.

o    3 treatments <5 minutes

o    In office procedure

o    Requires no anesthesia

o    Minimal side effects

o    Symptom relief after just one treatment

o    No downtime

o    Thousands of women successfully treated since 2012

If you are a breast cancer survivor or are peri or postmenopausal and are suffering from these changes, we can help you.  Ask us today more about it.

 

Menstrual problems

A number of medical conditions can cause irregular or missed menses. Usually anovulation or not ovuating regularly is the cause however irregular menses may also be associated with many conditions, including pregnancy, endocrine disorders, and acquired medical conditions. Menstrual irregularities can be caused by significant weight loss, strenuous exercise, substantial changes in sleeping or eating habits, and severe stressors. Menstrual disturbances also occur with chronic diseases, such as poorly controlled diabetes mellitus. The diagnosis of pregnancy always should be excluded.

Menstrual flow requiring changes of menstrual products every 1–2 hours is considered excessive, particularly when associated with flow that lasts more than 7 days at a time.

Menstrual Conditions That May Require Evaluation

Menstrual periods that:

  • Have not started by 15 years of age
  • Are regular, occurring monthly, and then become markedly irregular
  • Occur more frequently than every 21 days or less frequently than every 45 days
  • Occur 90 days apart even for one cycle
  • Last more than 7 days
  • Require frequent pad or tampon changes (soaking more than one every 1–2 hours)

Sexually Transmitted Diseases 

Sexually Transmitted Diseases (STDs) are a significant health challenge facing the United States. CDC estimates that nearly 20 million new sexually transmitted infections occur every year in this country, half among young people ages 15–24. Each of these infections is a potential threat to an individual’s immediate and long-term health and well-being. In addition to increasing a person’s risk for HIV infection, STDs can lead to severe reproductive health complications, such as infertility.

Routine STD testing is not included in your yearly wellness exam.  We offer testing for Bacterial Vaginosis (BV), Chlamydia, Gonorrhea, Hepatitis, Genital Herpes, HIV/AIDS, Human Papillomavirus (HPV), Pelvic Inflammatory Disease (PID), Syphilis, and Trichomoniasis in our clinic. Please ask your provider if you are interested in any STD testing.

 Chlamydia

Most people who have chlamydia don’t know it since the disease often has no symptoms.

  • Chlamydia is the most commonly reported STD in the United States.
  • Sexually active females 25 years old and younger need testing every year.
  • Easy to cure, chlamydia can impact a woman’s ability to have children if left untreated.

 Gonorrhea

Anyone who is sexually active can get gonorrhea.

  • If they occur, symptoms in men and women vary depending on what part of the body is infected: Gonorrhea can affect the anus, eyes, mouth, genitals, or throat.
  • This disease can impact a woman’s ability to have children if left untreated.
  • Gonorrhea is cured with antibiotics

 Genital Herpes

Genital herpes is a common STD, and most people with genital herpes infection do not know they have it.

  • You can get genital herpes even if your partner shows no signs of the infection.
  • If you have any symptoms (like a sore on your genitals, especially one that periodically recurs) laboratory tests can help determine if you have genital herpes.
  • There is no cure for herpes, but treatment is available to reduce symptoms and decrease the risk of transmission to a partner.

Trichomoniasis

Trichomoniasis is a common sexually transmitted disease (STD) that is easy to cure.

  • The infection often has no symptoms although women are more likely than men to get symptoms. You may notice an unusual genital discharge.
  • Without treatment, trichomoniasis can increase a person’s risk of acquiring HIV.

Prevention of STD’s

  • Abstinence: The most reliable way to avoid infection is to not have sex (i.e., anal, vaginal or oral). 
  • Vaccination:  Vaccines are safe, effective, and recommended ways to prevent hepatitis B and HPV. HPV vaccines for males and females can protect against some of the most common types of HPV. It is best to get all three doses (shots) before becoming sexually active. However, HPV vaccines are recommended for all teen girls and women through age 26 and all teen boys and men through age 21, who did not get all three doses of the vaccine when they were younger. You should also get vaccinated for hepatitis B if you were not vaccinated when you were younger. 
  • Mutual monogamy:  Mutual monogamy means that you agree to be sexually active with only one person, who has agreed to be sexually active only with you. Being in a long-term mutually monogamous relationship with an uninfected partner is one of the most reliable ways to avoid STDs. But you must both be certain you are not infected with STDs. It is important to have an open and honest conversation with your partner. 
  • Reduced number of sex partners:  Reducing your number of sex partners can decrease your risk for STDs. It is still important that you and your partner get tested, and that you share your test results with one another. 
  • Condoms:  Correct and consistent use of the male latex condom is highly effective in reducing STD transmission. Use a condom every time you have anal, vaginal, or oral sex. 

  Put Yourself to the Test

  • Knowing your STD status is a critical step to stopping STD transmission. If you know you are infected you can take steps to protect yourself and your partners.
  • Be sure to ask your healthcare provider to test you for STDs — asking is the only way to know whether you are receiving the right tests. And don’t forget to tell your partner to ask a healthcare provider about STD testing as well.
  • Many STDs can be easily diagnosed and treated. If either you or your partner is infected, both of you need to receive treatment at the same time to avoid getting re-infected.  

Incontinence

Stress incontinence is losing urine without meaning to during physical activity, such as coughing, sneezing, laughing, or exercise.

Urge incontinence is the strong, sudden need to urinate due to bladder spasms or contractions.

Mixed incontinence is having symptoms of both stress and urge incontinence.

Treatment depends on how severe your symptoms are and how much they affect your everyday life.

Your health care provider may ask you to stop smoking (if you smoke) and avoid caffeinated beverages (such as soda) and alcohol. You may be asked to keep a urinary diary, recording how many times you urinate during the day and night, and how often you leak urine.

There are four types of treatment for stress incontinence:

BEHAVIOR CHANGES

Examples of behavior changes include:

  • Drinking less fluid (if you drink more than normal amounts of fluid)
  • Urinating more often to reduce the amount of urine that leaks
  • Avoiding jumping or running, which can cause more urine to leak
  • Making your bowel movements more regular by taking dietary fiber or laxatives to avoid constipation (which can make incontinence worse)
  • Quitting smoking to reduce coughing and bladder irritation (and your risk of bladder cancer)
  • Avoiding alcohol and caffeine, which can stimulate the bladder
  • Losing weight if you are overweight
  • Avoiding food and drinks that irritate the bladder, such as spicy foods, carbonated drinks, and citrus fruits
  • Keeping blood sugar under control if you have diabetes

PELVIC FLOOR MUSCLE TRAINING

Pelvic muscle training exercises (called Kegel exercises) may help control urine leakage. These exercises keep the urethral sphincter strong and working properly.

MEDICATIONS

Medicines tend to work better in patients with mild to moderate stress incontinence. There are several types of medications that may be used alone or in combination. They include:
Anticholinergic drugs control overactive bladder (oxybutynin, tolterodine, Enablex, Sanctura, Vesicare, Oxytrol)

SURGERIES

Surgery is only recommended after the exact cause of urinary incontinence has been found. Most of the time, your health care provider will try bladder retraining or Kegel exercises before considering surgery.

  • Anterior vaginal repair or paravaginal repair procedures are often done in women when the bladder is bulging into the vagina (called a cystocele). Anterior repair is done through a surgical cut in the vagina. A paravaginal repair is done through a surgical cut in the vagina or abdomen.
  • Retropubic suspensions are a group of surgical procedures done to lift the bladder and urethra. They are done through a surgical cut in the abdomen.
  • Tension-free vaginal tape
  • Vaginal sling procedures are often the first choice for treating stress incontinence in women (they are rarely done in men). A sling is placed that supports the urethra.

Most health care providers recommend that their patients try other treatments before having surgery.

Prolapse

Pelvic organ prolapse is a medical condition that occurs when the normal support of the vagina is lost, resulting in “sagging” or dropping of the bladder, urethra, cervix and rectum.

Symptoms include:

  • Feeling like you are sitting on a small ball
  • Difficult or painful sexual intercourse
  • Frequent urination or a sudden urge to empty the bladder
  • Low backache
  • Uterus and cervix that stick out through the vaginal opening
  • Repeated bladder infections
  • Feeling of heaviness or pulling in the pelvis
  • Vaginal bleeding
  • Increased vaginal discharge

Many of the symptoms are worse when standing or sitting for long periods of time.

Treatment is not necessary unless the symptoms bother you. Many women seek treatment by the time the uterus drops to the opening of the vagina.

LIFESTYLE CHANGES

Weight loss is recommended in obese women with uterine prolapse. Heavy lifting or straining should be avoided, because they can worsen symptoms. Coughing can also make symptoms worse. If you a chronic cough, ask your doctor how to prevent or treat it. If you smoke, try to quit. Smoking can cause a chronic cough.

VAGINAL PESSARY

Your doctor may recommend placing a rubber or plastic donut-shaped device, called a pessary, into the vagina. This device holds the uterus in place. It may be temporary or permanent. Vaginal pessaries are fitted for each individual woman. Some are similar to a diaphragm used for birth control.

SURGERY

Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The specific type of surgery depends on:

  • Degree of prolapse
  • Desire for future pregnancies
  • Other medical conditions
  • The women's desire to retain vaginal function
  • The woman's age and general health

Hereditary Cancer Testing & Genetic Testing - Testing performed in our office

BRCA

This is not a test for cancer: it is a test that can tell you if a higher risk for breast and ovarian cancer runs in your family.
Knowing your risk can help you and your doctor make better, more informed decisions about your health, before cancer has a chance to develop. You should consider testing for Hereditary Breast and Ovarian Cancer (HBOC) syndrome if you have/had:

  • Breast cancer at age 50 or younger
  • Ovarian cancer at any age
  • Male breast cancer at any age
  • Ashkenazi Jewish ancestry and a personal or family history of an HBOC-associated cancer*
  • Two breast cancers in the same person or on the same side of the family
  • Triple negative breast cancer at any age
  • Pancreatic cancer and an HBOC-associated* cancer in the same person or on the same side of the family
  • There are three family members with breast cancer in the same side of the family
  • A previously identified BRCA1 or BRCA2 mutation in your family

Colaris

Is COLARIS Right for Me?

Not everyone with a family history of colorectal cancer has Lynch syndrome. Look carefully into your personal and family health history for certain factors that are red flags, or warning signs, for hereditary cancer. If red flags are found in your history, you may benefit from COLARIS testing. Before a decision to test is made, a doctor, genetic counselor, or other healthcare professional should carefully evaluate your history.

Do you have a family or personal history of any of the following?

  • Colorectal cancer before age 50
  • Endometrial (uterine) cancer before age 50
  • Two or more Lynch syndrome-related cancers
  • A previously identified Lynch syndrome mutation 

Weight Management

We provide medically supervised weight management for our patients who qualify. To be eligible, a person has to be an established gynecologic patient and meet the Basal Metabolic Index (BMI) requirements as instituted by the Surgeon General. An initial consult is required including a detailed medical history. Once the criteria is met and the patient’s medical history allows, follow up visits are once monthly to assess progress and monitor blood pressure. Insurance reimbursement for these visits is on an individual policy basis.