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General Gynecology


Annual Exams - PAP test and Breast exam
All women from age 21 to age 65 should have a physical exam yearly. The exam is used to screen for many health problems as well as being a time to discuss any concerns you may have.

Hormone Evaluation
Fatigue, Premenstrual Syndrome, irregular bleeding, hot flashes, and night sweats can all be an indication of Hormone Imbalance. Testing may be appropriate to determine a treatment plan.  There are non prescription treatments available.  There are also many other types of hormonal treatments, including bioidentical/natural and compounding available through some of our local pharmacies.

This is a natural stage in women’s lives when they stop ovulating (releasing eggs) and ovarian function, including production of estrogen and other hormones, reduces significantly. The normal range is from age 35 through 60. It may be accompanied by unpleasant symptoms that can often be treated.

Premenstrual syndrome refers to any of the unpleasant symptoms that some women experience in the 5 to 14 days prior to their cycle each month. Examples: Irritability, bloating, cramps, emotional stresses and headaches. There are options to help.

Abnormal Bleeding
Normal menstrual cycles (periods) commonly occur every 21 to 35 days and usually lasts for 3 to 7 days. Sudden changes in your bleeding pattern can indicate problems. See your practitioner for bleeding in between cycles, bleeding more than 7 days or extremely heavy bleeding. Bleeding after Menopause as well as frequent spotting after sex should always be evaluated. If you are not sure if your bleeding is abnormal then call to discuss your concerns with our practitioners.

Bladder Problems
Leaking urine is not "normal" at any age. Accidentally leaking urine with coughing, sneezing, laughing, or lifting is called stress urinary incontinence. Many times this can be improved with exercises and other lifestyle changes. Sometimes it is appropriate to perform and outpatient surgical procedure that may make a huge difference on this urine leakage. Some women may have problems with a sudden urges to urinate or having to get up frequently from sleep in order to get to the bathroom. This is not something that just has to be “lived with” but there are many treatment options available.

Abnormal PAPs - Evaluation and Treatment
A phone call or letter from the office informing you of an abnormal PAP result is always alarming. STOP, TAKE A DEEP BREATH! This is almost never an EMERGENCY. Although it is very important to address these abnormalities, nothing is going to change rapidly in the next few weeks. Typically the first step is to schedule a more detailed exam in the office called Colposcopy to determine exactly what is happening with the cervix. Colposcopy is similar to a Pap smear but done using a type of microscope.  If biopsies are necessary they are usually very small and only minimally uncomfortable.  You will be able to drive yourself home without any impairment after the procedure.  Many low grade changes of the cervix will spontaneously regress and do not need treatment. High grade changes do need treatment but we offer the full range of treatment options so we can tailor the treatment to your specific situation.

STD Screening and Education
If you or your partner has had a different sexual partner since your last visit it may be appropriate to be tested for sexually transmitted diseases.  Many of these diseases can be spread with no obvious symptoms.  And condoms do not prevent herpes or human papilloma virus (HPV) which are 2 of the most common STDs.  So do not think that just because a condom was used that you have had “safe sex.”
 If you are concerned that your partner is not faithful, you have a vaginal discharge, or you experience blisters or bumps vaginally then please let us know. We can offer advice on how to best avoid exposure to sexually transmitted diseases as well as treat infections that are already present.

Pelvic Pain
Bad cramps with your cycles, new pains in your lower abdomen, pain with sex, or pain with urination can all be signs of problems. In addition to the physical exam we often consider scheduling an ultrasound to give us more detailed information of what may be the source of your pain. Once we have determined the potential cause we can usually offer options on how to correct the problem.

Endometriosis - Evaluation and Treatment
Endometriosis is a very common gynecologic problem. This condition can often cause pelvic pain for a week or 2 prior to the onset of the actual period. This can also lead to chronic pelvic pain as well as pain with intercourse. It may actually interfere with your ability to become pregnant as well. Endometriosis means that the lining of the uterus (the endometrium) is outside of its normal location inside the uterus. Sometimes this does require surgical diagnosis or treatment but other nonsurgical treatments are available.



In-Office Procedures


Endometrial Ablation
If you are certain that you do not wish to become pregnant again and if your periods are particularly heavy and are effecting your every day life then you may want to consider an outpatient surgical option. Uterine (Endometrial) Ablation is a minor procedure designed to destroy the majority of the lining tissue inside of the Uterus. Typically the procedure itself takes about fifteen minutes to perform and gives approximately a 90% probability of reducing your bleeding significantly. You are quickly back to normal activity with no long recovery time.  Some lucky patients never have menstrual bleeding again! We offer both in-office as well as outpatient surgical choices. Call today if your periods are controlling your life.  Most insurances require that other hormonal treatments be tried first. The method that we use is called ThermaChoice.  Further information may be found at http://www.pelvichealthsolutions.com/thermachoice 

This is a revolutionary and minimally invasive means of permanent surgical sterilization.  This is done in the office under local anesthesia by means of a hysteroscope.  A hysteroscope is a very thin camera device used to look into the uterus and with the Essure procedure it is used to view the openings of the tubes.  An inert coil is placed under direct visualization into the opening of each tube.  It is very important that you plan on continuing some other form of reversible birth control for at least three months.  Three months after the procedure is complete it is very important to have an X ray test called a hysterosalpingogram (HSG) to confirm that both tubes are now completely blocked before relying on the procedure alone for birth control.    www.essure.com

Colposcopy / LEEP
The PAP smear is a screening tool used to detect potentially abnormal cells on the cervix. If there is evidence of abnormalities then we can utilize a microscope (Colposcope) to evaluate the cervix in more detail. If we determine that there are significant pre-Cancerous cells on the Cervix then one option for treatment is a LEEP procedure. LEEP stand for Loop Electrocautery Excision Procedure. After numbing the Cervix with a local anesthetic we shave off the area of abnormal cells using a wire loop.  Using over the counter Ibuprofen or Naproxen may help minimize any cramping.  You will be able to drive yourself home from the office.



Minimally Invasive Surgery


Laparoscopic Hysterectomy
 Certain gynecologic problems may ultimately require hysterectomy (or removal of the uterus). This can be accomplished several different ways. The old fashion abdominal incision is sometimes necessary. A hysterectomy can also be performed vaginally. There are many instances when removal of the uterus may be accomplished through the laparoscope and the patient may be able to go home the same day. If the hysterectomy is performed laparoscopically the patient can also often returned to normal activities within 2 weeks. Laparoscopic hysterectomy would require 3 small incisions in the abdomen each approximately 1/2 inch long.

Urethral Slings
Stress urinary incontinence or accidental leakage of urine with coughing, laughing, or lifting is a very common problem. Sometimes lifestyle changes such as pelvic floor exercises can make a big difference. If surgery is necessary the TVT Abbrevo suburethral sling is a very effective means of surgically correcting this incontinence problem. This involves a very small piece of nonabsorbable material placed through a vaginal incision less than 1 inch long. Typically the patient is able to go home same day and return to normal activities within just a few weeks. This has a very high success rate and patient's experience very little discomfort with the procedure.

For those patients who have completed their family in desire in the desire permanent birth control, there are a few options. Laparoscopic tubal ligation is a very safe affective option that is been around for a long time. Patients typically go home just a few hours after the procedure and may return to normal activities within one to 2 days.
The Essure procedure is a very effective means of permanent birth control that can be done in the office with no incisions or any down time. This is done under local anesthesia in the office through an instrument called a hysteroscope.  Continuing your current form of birth control for 3-6 months till an X-Ray test confirms the tubes are blocked is extremely important to prevent an unanticipated pregnancy.

Uterine Ablation
Uterine or endometrial ablation is an outpatient procedure that treats the lining of the uterus in such a way that the periods are much lighter or, for some patients, actually stop altogether. It is important that the patient is certain that she has completed her family before proceeding with this.  This procedure is not intended as a sterilization procedure so it would be important that she have a sterilization procedure of some type.  The sterilization may be done at the same time as the ablation.  The endometrial ablation can be done in the office under certain circumstances but can also be done under anesthesia in the operating room. Either way, this is an outpatient procedure and the patient is able to return to normal activities very quickly.


Urogynecology & Pelvic Support


Uterine Prolapse
This is the dropping of the Uterus into the vaginal canal. Quite commonly this problem can occur after childbirth and can cause pressure, pain, or bulging from the Vagina. Although surgery is typically needed to correct this problem the newer options can be performed on an outpatient basis with a quick return to most activities.

Bladder/Vaginal Prolapse
Similar to Uterine prolapse, the Bladder and the Vagina itself can drop after childbirth or injury. The symptoms are similar. Sometimes these prolapse problems do not cause any significant symptoms and may not need to be treated.  There is a nonsurgical option called a pessary. This is a device that can be placed, removed, and replaced into to vagina to basically prop things back where they belong.  There are also surgical options available.

Cystocele and Rectocele Repair
Cystocele refers to the specific bulge below the bladder that may occur after childbirth. It is often associated with Stress Urinary Incontinence but can cause other problems as well. Rectocele refers to a bulging into the Vagina from the rectal wall. Constipation, pressure, and splinting (the need to apply pressure in the vagina to allow for bowel movements) are common symptoms. Kaegel exercises (pelvic floor muscle exercises), physical therapy, pessaries, and outpatient surgeries are common corrective measures discussed for the problems.