Gynecology

Reno, Sparks Top Gynecology Practice

We focus exclusively on Gynecology (and Urogynecology), enabling us to stay abreast of the latest advances and technologies in the field. Because we do not offer Obstetrics, we are less likely to be pulled out of the office for emergencies or deliveries, which is an important advantage that our patients enjoy. We treat our patients with the highest respect and strive to create an environment of confidence and trust.

The following are some commonly treated problems in the field of Gynecology:

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Abnormal Pap Smears / HPV

Cervical cancer screening should begin at the age of 21 and occur annually thereafter for adolescents. Almost all abnormal Pap smears are associated with exposure to the Human Papillomavirus (HPV). Risk Factors for Human Papillomavirus include multiple sexual partners, male partner with multiple sexual partners, history of other sexually transmitted diseases, and early age of first intercourse.

PAP Classification

  • ASC – Atypical Squamous Cells

    • ASCUS – Atypical Squamous Cells of Undetermined Significance

    • ASC-H – Cannot exclude HSIL (high grade lesion)

  • LGSIL – Low-grade Squamous intraepithelial lesions

    • Human Papillomavirus, mild dysplasia, cervical intraepithelial neoplasia (CIN)I

  • HSIL – High-grade squamous intraepithelial lesions

    • Moderate and severe dysplasia, carcinoma in situ, CIN 2 and 3

  • Glandular cell

    • Atypical glandular cells (AGU)

    • Atypical glandular cells, favor neoplastic

    • Endocervical adenocarcinoma in situ (AIS)

    • Adenocarcinoma

The natural history of CIN (dysplasia) is linked to the presence of high-risk HPV. HPV is extremely common in the general population. Most women clear the virus or suppress it over time, with clearance higher in younger women. The small percentage of women who do not clear the virus are at risk for persistence or progression of cervical dysplasia. Smoking doubles the risk of progression.

The goal of PAP testing is the prevention of invasive cervical cancer. It is a screening test. If a PAP result is abnormal further evaluation and or procedures may be required.

An ASCUS pap may require further testing for the presence of high risk HPV. If testing is negative for high risk HPV, routine screening is recommended.

Colposcopy is indicated for the following Pap results:

  • ASCUS with positive high risk HPV

  • LGSIL or HGSIL

Colposcopy is an office procedure where the cervix is visualized through a microscope after application of vinegar. Biopsy (removal of a small piece of cervical tissue) may be performed to confirm the degree of dysplasia.

Treatment recommendations are made based on the findings of the colposcopy and may include 1) follow up PAP at a closer interval (4 – 6 months) or 2) treatment of the abnormal area with freezing (cryosurgery), laser or LEEP (Loop electrosurgical excision procedure), all of which may be performed as office procedures depending on your individual findings. Rarely a more extensive biopsy of the cervix is required, a conization, and is performed as an outpatient surgery under anesthesia.

Following treatment or evaluation of an abnormal PAP close follow up and repeat PAP at closer intervals (4 – 6 months) is often recommended.

More information is available at the following sites:
www.cancer.gov/cancertopics/factsheet/risk/HPV
www.nlm.nih.gov/medlineplus/hpv.html
www.ashastd.org/hpv/hpv_overview.cfm

Birth Control

Breast Health

Breast health is important for all women to be aware of. Self breast exams should be performed regularly so that a woman knows what her normal breast tissue feels like and can pick up change if it occurs. In addition, women should have a clinical breast exam each year and discuss any concerns with their physician at that time. Also, women should start having screening mammograms at the age of 40 unless she has a family history of early breast cancer or a change is noted in her own breast. Patients should report any changes in their breasts to their physician and be aware of any breast pain, nipple discharge, inflammation, lumps etc. Please see the ACOG pamphlet links for more information on breast health.

Cancer Screening 

All women should have a general health evaluation annually or as appropriate that should include evaluation for cancer and examination, as indicated, to detect signs of premalignant or malignant conditions. Here are the types of cancer we will screen for:

Breast Cancer
Mammography should be performed every 1-2 years beginning at age 40 years and yearly beginning at age 50 years. All women should have an annual clinical breast examination as part of the physical examination. Despite a lack of definitive data for or against breast self-examination, breast self-examination has the potential to detect palpable breast cancer and can be recommended.

Cervical Cancer
Cervical cytology should be performed annually beginning at age 21 years. Cervical cytology screening can be performed every 2-3 years after three consecutive negative test results if the patient is aged 30 years or older with no history of cervical intraepithelial neoplasia 2 or 3, immunosuppression, human immunodeficiency virus (HIV) infection, or diethylstilbestrol exposure in utero. Annual cervical cytology also is an option for women aged 30 years and older. The use of a combination of cervical cytology and HPV DNA screening is appropriate for women aged 30 years and older. If this combination is used, women who receive negative results on both tests should be rescreened no more frequently than every 3 years.

Colorectal Cancer
Beginning at age 50 years, one of five screening options should be selected:

  1. Yearly patient-collected fecal occult blood testing (FOBT) or fecal immunochemical testing (FIT)*

  2. Flexible sigmoidoscopy every 5 years.

  3. Yearly patient-collected FOBT or FIT* plus flexible sigmoidoscopy every 5 years

  4. Double-contrast barium enema even 5 years

  5. Colonoscopy every 10 years

Endometrial Cancer
Screening asymptomatic women for endometrial cancer and its precursors is not recommended at this time.

Lung Cancer
Available screening techniques are not cost-effective and have not been shown to reduce mortality from lung cancer. Accordingly, routine lung cancer screening is not recommended.

Ovarian Cancer
Currently, there are no effective techniques for the routine screening of asymptomatic, low-risk women for ovarian cancer. It appears that the best way to detect early ovarian cancer is for both the patient and her clinician to have a high index of suspicion of the diagnosis in the symptomatic woman, and both should be aware of the symptoms commonly associated with ovarian cancer. Persistent symptoms such as an increase in abdominal size, abdominal bloating, fatigue, abdominal pain, indigestion, Inability to eat normally, urinary frequency, pelvic pain, constipation, back pain, urinary incontinence of recent onset, or unexplained weight loss should be evaluated with ovarian cancer being included in the differential diagnosis.

Skin Cancer
Evaluate and counsel regarding exposure to ultraviolet rays. Examine any moles or skin lesions for change or suspicious appearance with biopsy or referral.

*Both FORT and FIT require two or three sample of stool collected by the patient at home and returned for analysis. A single stool sample FOBT or FIT obtained by digital rectal examination is not adequate for the detection of colorectal cancer.

Endometriosis / Adenomyosis

Infertility

Most experts define infertility as not being able to get pregnant after at least one year of trying. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile. Pregnancy is the result of a complex chain of events. In order to get pregnant:

  • A woman must release an egg from one of her ovaries

  • The egg must go through a fallopian tube

  • A man's sperm must join with (fertilize) the egg along the way

  • The fertilized egg must attach to the inside of the uterus (implantation).

  • Infertility can result from problems that interfere with any of these steps

If you are having a difficult time achieving pregnancy, talk to your doctor about diagnostic tests and treatment options available.

Osteoporosis

Osteopenia is defined as low bone mass. Osteoporosis is more severe loss of bone mass. The internal architecture of the bone becomes thinner and more fragile over time leading to an increased risk of fractures which may occur even in the absence of significant trauma. These fractures may occur in the wrist, spine or hip and result in significant morbidity, including pain; deformity; loss of independence; and reduced cardiovascular, respiratory, and even, digestive function. Hip fracture has been associated with a 15-20% mortality rate within a year of fracture. 37-50% of US women aged 50 years and older have osteopenia and approximately 13-18% have osteoporosis. 


The World Health Organization has defined osteopenia and osteoporosis based on the measurements of bone density of the lumbar spine or hip using dual-energy X-ray absorptiometry (DEXA). The definition is based on the T-scores, a measurement comparing you to a mean peak bone density of a normal, young adult population (about 30 years old).

Normal T Score: greater than or equal to -1
Osteopenia: -1 to -2.5
Osteoporosis: less than or equal to -2.5

Testing should be performed on the basis of an individual woman's risk profile. It should be performed on all post menopausal women aged 65 years or older and recommended to postmenopausal women younger than 65 years who have 1 or more risk factors for osteoporosis. Postmenopausal women with fractures should have testing to confirm the diagnosis of osteoporosis and determine the severity of disease.

Risk Factors for Osteoporotic Fracture in Postmenopausal Women

  • History of prior fracture

  • Family history of osteoporosis

  • Caucasian race

  • Dementia

  • Poor nutrition

  • Smoking

  • Low weight and body mass index

  • Estrogen deficiency

  • Early menopause (age younger than 45 years) or bilateral removal of ovaries

  • Prolonged premenopausal amenorrhea (no periods) > 1 year

  • Long term low calcium and Vitamin D intake

  • Excessive alcohol intake

  • Inadequate physical activity

  • Certain medications, including long term steroid or thyroid usage

Treatment may start with lifestyle changes including increased activity with resistance training/weight bearing at least 3 -4 times per week, limiting alcohol intake to no more than 1 -2 /day, avoiding excessive coffee and carbonated cola beverages and quitting smoking.

Adequate calcium and vitamin D intake are important in bone metabolism.

Recommended Calcium requirements

  • Premenopausal women: 1,000 mg

  • Postmenopausal women

  • Postmenopausal women not using estrogen: 1,500 mg

  • All women older than 65 years: 1,500 mg

Calcium is better absorbed when taken after meals and in divided doses. 

Recent evidence suggests that many women are vitamin D deficient and the recommended daily amounts in the past (400 iu/day) have been too low. Supplementation with 1,000 -2,000 iu/day is probably needed to maintain normal vitamin D levels. Measurement of Vitamin D levels may be appropriate. Vitamin D deficient women may require larger (prescription) doses.

Medications are in general indicated in women with osteoporosis (T score less than -2.5), whether to treat women with a higher bone density (osteopenia) depends on additional risk factors. Options include:

  • Estrogen

  • Bisophosphonates (alendronate, risedronate, ibandronate)

  • Selective estrogen receptor modulators (SERMs) (raloxifene)

  • Parathyroid Hormone

  • Prolia (new)



More information is available at the following sites:
www.nof.org
www.nlm.nih.gov/medlineplus/osteoporosis.html
www.sciam.com/article.cfm?id=cell-defenses-and-the-sunshine-vitamin

Ovarian Cysts

Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. The ovaries are two organs each about the size and shape, located on each side of your uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during your childbearing years.

Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months.

Certain cysts may cause symptoms or be a type of cyst that needs to be watched closely or removed. Simple cysts are common and are usually normal/functional, often going away on their own. Complex cysts may be normal and go away but, in general, are more worrisome.

Symptoms

It's important to be watchful of any symptoms or changes in your body and to know which symptoms are serious. If you have an ovarian cyst, you may experience the following signs and symptoms:

  • Menstrual irregularities

  • Pelvic pain of a constant or intermittent dull ache that may radiate to your lower back and thighs

  • Pelvic pain shortly before your period begins or just before it ends

  • Pelvic pain during intercourse (dyspareunia)

  • Pain during bowel movements or pressure on your bowels

  • Nausea, vomiting or breast tenderness similar to that experienced during pregnancy

  • Fullness or heaviness in your abdomen

  • Pressure on you rectum or bladder or difficulty emptying your bladder completely

  • The signs and symptoms that signal the need for immediate medical attention include:

    • Sudden, severe abdominal or pelvic pain

    • Pain accompanied by fever or vomiting

Causes

Your ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg when you ovulate. Sometimes a normal monthly follicle just keeps growing. When that happens, it becomes known as a functional cyst. This means it started during the normal function of your menstrual cycle. There are two types of functional cysts:

Follicular cyst: Around the midpoint of your menstrual cycle, your brain's pituitary gland releases a surge of luteinizing hormone (LH), which signals the follicle holding your egg to release it. When everything goes according to plan, your egg bursts out of its follicle and begins its journey down the fallopian tube in search of fertilization.

A follicular cyst begins when the LH surge doesn't occur. The result is a follicle that doesn't rupture or release its egg. Instead it grows and turns into a cyst. Follicular cysts are usually harmless, rarely cause pain and often disappear on their own within two or three menstrual cycles.

Corpus luteum cyst. When LH does surge and your egg is released, the ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. This changed follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst. Although this cyst usually disappears on its own in a few weeks, it can grow to almost 4 inches in diameter and has the potential to bleed into itself or twist the ovary, causing pelvic or abdominal pain. If it fills with blood, the cyst may rupture, causing internal bleeding and sudden, sharp pain.

If you think that you have an ovarian cyst, ask you doctor about diagnostic tests and treatment options available.

Painful Intercourse (Dyspareunia)

When a woman feels pain while having sexual intercourse, it is called dyspareunia. Painful sex is fairly common. Nearly 2 out of 3 women have it at some time during their lives. The pain can range from very mild to severe. To understand the causes of painful sex, it helps to know about the female body. The vagina is a passage that leads from the uterus to the outside of the body. The cervix is the lower, narrow end of the uterus. It protrudes into the vagina. The outside of the female genital area is called the vulva. At the opening of the vagina are the inner and outer labia (or lips). The clitoris is at top of the inner lips. For most women, the clitoris is a center of sexual pleasure. The perineum is the area between the anus and vagina.

Painful sex can have both physical and emotional causes. To understand why the pain occurs, you should know what happens to your body during sex. A woman's body follows a regular pattern when she has sex. There are four stages:

  • Desire- the feeling that you want to have sex.

  • Arousal- physical changes take place. Your vagina and vulva get moist and the muscles of the opening of the vagina relax. The clitoris swells and enlarges. The uterus lifts up, and the vagina gets deeper and wider.

  • Orgasm- the peak of the response. The muscles of the vagina and uterus contract and create a strong feeling of pleasure. The clitoris can feel orgasm, too.

  • Resolution- the vagina, clitoris, and uterus return to their normal state.

The arousal stage is important because this is when your vagina prepares itself for your partner to enter you. If any part of this natural pattern does not happen, you may feel discomfort or pain with sex.

During sex a woman may feel pain in the vulva, at the opening of the vagina, within the vagina, or deep inside. Vulvar pain is pain felt on the surface (outside) of the vagina. Vaginal pain is felt within the vagina. Deep pain can occur in the lower back, pelvic region, uterus, and bladder. Different types of pain have different causes. It's important to find the cause because you may have problems that need medication, surgery, or counseling.

Vulvar Pain
Pain can occur when some part of the vulva is touched. The vulva may be tender or irritated from using soaps or over-the-counter vaginal sprays or douches. Other causes include scars, cysts, or infections.

Vaginal Pain
Vaginal dryness. The most common cause of pain inside the vagina is lack of moisture. This can occur with certain medications, with certain medical conditions, or because you are not aroused. It can occur at certain times of your life such as during or just after pregnancy, while breast feeling, or near or after menopause.

Around menopause, estrogen levels become lower. As a result, vaginal tissue may get thinner and drier. This may cause discomfort during sex. Some menopausal women take estrogen therapy to relieve the dryness. You can also buy water-soluble lubricants that help moisten the vagina.

Vaginal dryness can be normal and occur when you are not aroused enough during sex. You should discuss with your partner what makes you feel aroused. Often it is helpful for a couple to use a cream, jelly, or vaginal suppository to provide vaginal lubrication needed for sex. However, never use any kind of oil- such as petroleum jelly or baby or mineral oil- with latex condoms. These substances can dissolve the latex and cause the condom to break. Water-based cream or jelly is safe for use with condoms.

Another cause of vaginal pain is vaginitis - an inflammation of the vagina. The most common symptoms of vaginitis are discharge, itching, and burning of the vagina and vulva. Vaginitis has many possible causes, such as yeast or bacterial infection. Vaginitis can be treated with medication that you take by mouth or place in the vagina.

Vaginismus is a spasm of the muscles at the opening of the vagina. It causes pain when your partner tries to enter the vagina. In some cases, vaginismus is present the first time a woman has- or tries to have- sex. The pain also may occur during a pelvic exam.

Pain that starts deep inside may be a warning sign of an internal problem. Pain that happens when the penis touches the cervix can have many causes:

  • Pelvic inflammatory disease (PID)

  • Problems with the uterus

  • Endometriosis

  • A pelvic mass

  • Bowel or bladder disease

  • Scar tissue (adhesions)

  • Ovarian cysts

A pelvic exam often gives clues about the causes of deep pain. Your doctor may suggest laparoscopy to look into your abdomen and at the reproductive organs. Laparoscopy also can be used to treat some of these problems.

Pain during sex sometimes can be linked to a state of mind. Emotional factors, like memories or fears, can keep you from relaxing. Some women may feel guilty having sex. Or, some women may be afraid of getting pregnant or getting a sexually transmitted disease (STD). Sometimes, a past bad sexual experience, such as rape or sexual abuse, may be the cause. All these factors may make it hard to relax during sex. This prevents arousal and lubrication.

Some women may feel pain during sex if they are having problems with their partner. It's a good idea to talk about your concerns with your partner and your doctor. Your doctor may suggest that you see a counselor to help you cope with your problems.

Finally...
Pain during sex is a sign there may be a problem. Talk to your doctor about the pain so that the cause can be found and treated as soon as possible. Proper treatment can help you enjoy your sex life.

Pelvic Pain

What Is Pelvic Pain?

Pelvic pain is concentrated in the lower pelvic area, and it tends to be chronic (lasting six months or longer). This type of pain may be sporadic, but it can also be constant in some rare cases. Pelvic pain is often at its height during menstruation. It may also happen while urinating, during intercourse, or at other times. Pelvic pain can range from mild to severe. For some people, the pain can be so severe that it can significantly inhibit their ability to live their life normally.

 

Why Does Pelvic Pain Happen?

The reason for pelvic pain varies from one patient to the next. Pelvic pain is most often related to the reproductive organs, but it can also be the result of urinary tract or bowel issues. Sometimes, the pelvic pain has multiple causes. For example, a patient can have both endometriosis and irritable bowel syndrome with severe pelvic pain resulting from both conditions.

 

How Does the Doctor Diagnose Pelvic Pain?

A thorough medical history will be the first thing needed to diagnose pelvic pain. The OBGYN will perform a pelvic exam, and other tests like an ultrasound, colonoscopy, laparoscopy, or MRI may also be needed.

 

How Is Pelvic Pain Treated?

Pelvic pain is treated in a variety of ways today. Medications can provide short-term relief, and they may be especially helpful for people who have only sporadic pelvic pain. However, long-term relief may require surgical treatment. Pelvic pain can be resolved by surgically removing the source of the pain in many cases. For example, a patient with endometriosis can get pain relief when the uterine lining is destroyed during a procedure like endometrial ablation. There are also procedures that can cut or destroy specific nerves, which blocks the signals of pain from making it to the tissue and organs.

Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is a hormone imbalance that is usually diagnosed clinically. However, there are some tests that can be done to help support the diagnosis. Unfortunately, there is no cure for PCOS but treatment is aimed at control of symptoms.

Signs and symptoms of PCOS include:

  • Irregular menstrual periods or no periods

  • Infertility

  • Increased hair growth in a male pattern

  • Oily skin and/or acne

  • Weight gain (especially around the middle)

  • Darkened skin along the neck, armpits, groin and/or inner thighs

  • Hair loss in a male pattern

Diagnosis of PCOS is largely based on clinical findings determined in a detailed history and physical exam. Other tests that may be ordered include blood test (hormone levels, insulin/blood sugar levels), and a pelvic ultrasound.

Treatment depends on symptoms and the desire for pregnancy. Many times a multi-factorial approach is necessary.

This may include:

  • Lifestyle changes: diet, exercise, weight loss

  • Medications:

    • Menstrual cycle regulation: birth control pills, progesterone, metformin

    • Infertility: Metformin, ovulation induction meds, ie. clomid

    • Hair growth, acne, oily skin: OCPs, metformin, spironolactone, vaniqua

    • Weight gain: metformin

Patients with PCOS have a high chance of developing diabetes and endometrial cancer so steps should be taken to help decrease secondary morbidities such as heart disease, hypertension and diabetes. If you think you may have PCOS, make an appointment with your doctor to further discuss this topic and how it relates to your health.

More information is available at the following sites:
www.4woman.gov/faq/polycystic-ovary-syndrome.cfm
women.webmd.com/tc/polycystic-ovary-syndrome-pcos-topic-overview
www.medicinenet.com/polycystic_ovary/article.htm
www.nichd.nih.gov/health/topics/Polycystic_Ovary_Syndrome.cfm

Vulvodynia

Vulvodynia is a chronic vulvar discomfort or pain, characterized by burning, stinging, irritation or rawness of the female genitalia in cases in which there is no infection or skin disease. The causes of vulvodynia are largely unknown. Some theories regarding the cause of vulvodynia include:

  • An injury or irritation to the nerves of the vulva

  • An abnormal response to trauma or injury to the vulva

  • Genetic factors

  • Hypersensitivity to yeast/allergies

  • Spasm of the pelvic floor muscles

  • Changing estrogen levels

There is no definitive test to diagnose vulvodynia, instead ruling out other causes of vulvar pain is very important. Also, a careful medical history and physical exam which may include vaginal cultures, biopsy, Q-tip test, and/or colposcopy of the vulva is critical. Most women with vulvodynia have normal appearing vulvas/vaginas. However, pressure to the area may cause more pain than is normal.

There is no cure for vulvodynia so treatments are meant to relieve symptoms. It usually takes time to find a treatment or combination of treatments that will decrease of alleviate the pain. Current treatment options include:

  • Local anesthetic ointment (xylocaine jelly)

  • Tricyclic antidepressants (amitryptyline, nortriptyline, desipramine)

  • Anticonvulsants (tegretol, neurontin)

  • Antihistamines (hydroxyzine)

  • Topical estrogen cream (premarin or estrace cream)

  • Nerve blockades

  • Diet modification (low oxalate diet, calcium citrate)

  • Pelvic floor therapy/Physical therapy

  • Acupuncture

  • Surgery (localized removal of painful area)

If you think you may have vulvodynia, consult your doctor for further information, workup, and treatment.


More information is available at the following sites:
National Vulvodynia Association
Vulvar Pain Society
Vulvar Pain Foundation

Uterine Fibroids

Birth control, also called contraception, is a way to prevent or dramatically reduce the chance of getting pregnant. The type of birth control you choose depends on your needs. Different methods of birth control have varying characteristics. Condoms, for example, are the only methods that provide significant protection from sexually transmitted diseases.

 

Types of contraception available:

  • Barrier methods - condoms, diaphragm, spermicides

  • Birth control pills - contain estrogen and progesterone and block ovulation or may contain progesterone only and make it hard for fertilization  occur.

  • Vaginal ring - called Nuvaring is placed in the vagina for 3 - 4 weeks and secretes estrogen and progesterone absorbed through the vagina into the body to block ovulation like the pill.

  • Injections - Depo-Provera is a progesterone shot given every 3 month

  • Implant - Implanon is a progesterone only imp

  • Birth control, also called contraception, is a way to prevent or dramatically reduce the chance of getting pregnant. The type of birth control you choose depends on your needs. Different methods of birth control have varying characteristics. Condoms, for example, are the only methods that provide significant protection from sexually transmitted diseases.

  •  

  • Types of contraception available:

  • Barrier methods - condoms, diaphragm, spermicides

  • Birth control pills - contain estrogen and progesterone and block ovulation or may contain progesterone only and make it hard for fertilization  occur.

  • Vaginal ring - called Nuvaring is placed in the vagina for 3 - 4 weeks and secretes estrogen and progesterone absorbed through the vagina into the body to block ovulation like the pill.

  • Injections - Depo-Provera is a progesterone shot given every 3 month

  • Implant - Implanon is a progesterone only implant that is placed under the skin and lasts for 3 years.

  • Intrauterine device (IUD) - an apparatus placed inside the uterus in the office that blocks fertilization. There are 2 types: Mirena which secrets progesterone and lasts for up to 5 years and Paragard which is non-hormonal and lasts up to 10 years. Both IUDs can be easily removed in the office when desired.

  • Permanent sterilization - Bilateral tubal ligation is a procedure done in the operating room and involves destroying a portion of each fallopian tube to prevent pregnancy. Adiana and Essure are procedures that can be done in the office that rely on small implants placed in the fallopian tube hysteroscopically to cause tissue to grow into and block the tube. Read more about permanent sterilization here.

  •  

  • Misconceptions about pregnancy prevention:

  • Modern misconceptions and urban legends have given rise to a great deal of false claims:

  • The suggestion that douching with any substance immediately following intercourse works as a contraceptive is untrue. While it may seem like a sensible idea to try and wash the ejaculate out of the vagina, it is not likely to be effective. Due to the nature of fluids and the structure of the female reproductive tract, douching most likely actually spreads semen further towards the uterus. Some slight spermicidal effect may occur if the douche solution is particularly acidic, but overall it is not scientifically observed to be reliably effective method.

  • It is untrue that a female cannot become pregnant as a result of the first time she engages in sexual intercourse.

  • While women are usually less fertile for the first few days of menstruation, it is a myth that a woman absolutely cannot get pregnant if she has sex during her period.

  • Having sex in a hot tub does not prevent pregnancy, but may contribute to vaginal infections.

  • Although some sex positions may encourage pregnancy, no sexual positions prevent pregnancy. Having sex while standing up or with a woman on top will not keep the sperm from entering the uterus. The force of ejaculation, the contractions of the uterus caused by prostaglandins in the semen, as well as ability of sperm to swim, overrides gravity.

  • Urinating after sex does not prevent pregnancy and is not a form of birth control, although it is often advised anyway to help prevent urinary tract infections.

  • Toothpaste cannot be used as an effective contraceptive

  •  

  • Effectiveness

  • Effectiveness is measured by how many women become pregnant using a particular birth control method in the first year of use. Thus, if 100 women use a method that has a 12 percent first-year failure rate, then sometime during the first year of use, 12 of the women should become pregnant.

    The most effective methods in typical use are those that do not depend upon regular user action. Surgical sterilization, Depo-Provera, implants, and intrauterine devices (IUDs) all have first-year failure rates of less than one percent for perfect use. Sterilization, implants, and IUDs also have typical failure rates under one percent. The typical failure rate of Depo-Provera is disagreed upon, with figures ranging from less than one percent up to three percent.

    Other methods may be highly effective if used consistently and correctly, but can have typical use first-year failure rates that are considerably higher due to incorrect or ineffective usage by the user. Hormonal contraceptive pills, patches or rings, fertility awareness methods, and the lactational amenorrhea method (LAM), if used strictly, have first-year (or for LAM, first-6-month) failure rates of hormonal contraceptive pills (and by extrapolation, patches or rings) were as high as five percent per year. Fertility awareness methods as a while have typical use first-year failure rates as high as 25 percent per year; however, as stated above, perfect use of these methods reduces the first-year failure rate to less than 1%.

    Condoms and cervical barriers such as the diaphragm have similar typical use first-year failure rates (14 and 20 percent, respectively), but perfect usage of the condom is more effective (three percent first-year failure vs. six percent) and condoms have the additional feature of helping to prevent the spread of sexually transmitted diseases such as the HIV virus. The withdrawal method, if used consistently and correctly, has a first-year failure rate of four percent. Due to the difficulty of consistently using withdrawal correctly, it has a typical use first-year failure rate of 19 percent, and is not recommended by some medical professionals.

    Talk to your doctor about your individual situation to determine the best contraceptive option(s) for you and your partner.

  • lant that is placed under the skin and lasts for 3 years.

  • Intrauterine device (IUD) - an apparatus placed inside the uterus in the office that blocks fertilization. There are 2 types: Mirena which secrets progesterone and lasts for up to 5 years and Paragard which is non-hormonal and lasts up to 10 years. Both IUDs can be easily removed in the office when desired.

  • Permanent sterilization - Bilateral tubal ligation is a procedure done in the operating room and involves destroying a portion of each fallopian tube to prevent pregnancy. Adiana and Essure are procedures that can be done in the office that rely on small implants placed in the fallopian tube hysteroscopically to cause tissue to grow into and block the tube. Read more about permanent sterilization here.

 

Misconceptions about pregnancy prevention:

Modern misconceptions and urban legends have given rise to a great deal of false claims:

  • The suggestion that douching with any substance immediately following intercourse works as a contraceptive is untrue. While it may seem like a sensible idea to try and wash the ejaculate out of the vagina, it is not likely to be effective. Due to the nature of fluids and the structure of the female reproductive tract, douching most likely actually spreads semen further towards the uterus. Some slight spermicidal effect may occur if the douche solution is particularly acidic, but overall it is not scientifically observed to be reliably effective method.

  • It is untrue that a female cannot become pregnant as a result of the first time she engages in sexual intercourse.

  • While women are usually less fertile for the first few days of menstruation, it is a myth that a woman absolutely cannot get pregnant if she has sex during her period.

  • Having sex in a hot tub does not prevent pregnancy, but may contribute to vaginal infections.

  • Although some sex positions may encourage pregnancy, no sexual positions prevent pregnancy. Having sex while standing up or with a woman on top will not keep the sperm from entering the uterus. The force of ejaculation, the contractions of the uterus caused by prostaglandins in the semen, as well as ability of sperm to swim, overrides gravity.

  • Urinating after sex does not prevent pregnancy and is not a form of birth control, although it is often advised anyway to help prevent urinary tract infections.

  • Toothpaste cannot be used as an effective contraceptive

 

Effectiveness

Effectiveness is measured by how many women become pregnant using a particular birth control method in the first year of use. Thus, if 100 women use a method that has a 12 percent first-year failure rate, then sometime during the first year of use, 12 of the women should become pregnant.

The most effective methods in typical use are those that do not depend upon regular user action. Surgical sterilization, Depo-Provera, implants, and intrauterine devices (IUDs) all have first-year failure rates of less than one percent for perfect use. Sterilization, implants, and IUDs also have typical failure rates under one percent. The typical failure rate of Depo-Provera is disagreed upon, with figures ranging from less than one percent up to three percent.

Other methods may be highly effective if used consistently and correctly, but can have typical use first-year failure rates that are considerably higher due to incorrect or ineffective usage by the user. Hormonal contraceptive pills, patches or rings, fertility awareness methods, and the lactational amenorrhea method (LAM), if used strictly, have first-year (or for LAM, first-6-month) failure rates of hormonal contraceptive pills (and by extrapolation, patches or rings) were as high as five percent per year. Fertility awareness methods as a while have typical use first-year failure rates as high as 25 percent per year; however, as stated above, perfect use of these methods reduces the first-year failure rate to less than 1%.

Condoms and cervical barriers such as the diaphragm have similar typical use first-year failure rates (14 and 20 percent, respectively), but perfect usage of the condom is more effective (three percent first-year failure vs. six percent) and condoms have the additional feature of helping to prevent the spread of sexually transmitted diseases such as the HIV virus. The withdrawal method, if used consistently and correctly, has a first-year failure rate of four percent. Due to the difficulty of consistently using withdrawal correctly, it has a typical use first-year failure rate of 19 percent, and is not recommended by some medical professionals.

Talk to your doctor about your individual situation to determine the best contraceptive option(s) for you and your partner.

Endometriosis is a common gynecological condition. It was described in medical literature more than 300 years ago and has since been recognized as a chronic, painful, and often progressive disease in women. However, the causes of endometriosis are unknown, it is widely variable in symptoms and severity, and it is difficult to diagnose. In fact, some experts believe that endometriosis may turn out to be several disorders, not just one.

In spite of the high prevalence of endometriosis in women all over the world, researchers have been unable to determine its cause. A combination of genetic, biologic, and environmental factors appear to work together to trigger the initial process, to produce implantation, and to trigger subsequent reseeding and spreading of the implants.

Pain at the time of menstruation (dysmenorrhea) is the primary symptom and occurs in nearly all girls and women with endometriosis. Studies suggest that endometriosis is the cause of about 15% of cases of pain in the pelvic region in women. (This is the area in the lower trunk of the body). In addition to during menstruation, endometrial pain can occur at other times of the month. A survey published by the Endometriosis Association reported the following findings on the timing of endometrial pain:

  • 71% of women reported pain within two days after their periods started.

  • 47% reported pain in the middle of a cycle. (A sharp pain during ovulation may be due to an endometrial cyst located in the fallopian tube that ruptures as the egg passes through)

  • 40% reported pain at other times of the month.

  • 20% reported continual pain.

  • 7% said there was no pattern.

  • Many women with endometriosis experience pain during intercourse.

  • Adolescents are more likely to experience pain that occurs both during their periods and at other times in the cycle, while in older women endometrial pain is more likely to occur during menstruation.

Nearly all women with endometrial pain experience it in the pelvic area (the lower part of the trunk of the body). The pain is often a severe cramping that occurs on both sides of the pelvis, radiating to the lower back and rectal area and even down the legs. Occasionally, however, pain may also occur in other regions if endometriosis affects other part of the pelvic area, such as the bladder or intestine. The severity of the pain also varies widely and does not appear to be related to the extent of the endometriosis itself. In other words, a woman can have very small or few implants and have severe pain, while those with extensive endometriosis may have very few signs of the disorder except for infertility. Large cysts can rupture and cause very severe pain at any time.

Patients may experience additional symptoms, which include the following:

  • Joint and muscle aches

  • Fatigue

  • Bloating

  • Nausea

  • Dizziness

  • Heavy menstrual bleeding

  • Headaches

  • Depression and malaise (feeling generally low)

  • Sleep problems

If you think you have endometriosis, talk to your doctor about diagnosis and treatment options.

Uterine fibroids are benign tumors that grow in the uterus. The medical term for fibroids is leiomyomas, sometimes shortened to myomas. These benign tumors occur in approximately 1 in 3 women, usually during the reproductive years. Most of the time, they do not cause any problems. However, depending on the size, number and location of the fibroids, they may cause symptoms such as heavy or irregular bleeding, pain, infertility, pressure and/or urinary or bowel complaints.

Fibroids may be diagnosed on pelvic exam and/or pelvic ultrasound. Sometimes a MRI is used to further delineate the size, location and number of fibroids. Fibroids causing symptoms or problems can be treated. The treatment depends on the size, location, and number of fibroids, symptoms, and patient's desire for future fertility. Treatment options may include medications, which do not get rid of the fibroids, but may control the symptoms, versus procedures that destroy of shrink the fibroids (uterine artery embolization or focused ultrasound ablation), versus surgical management to remove the fibroid(s) (myomectomy or hysterectomy). 

Surgery options to remove uterine fibroids include hysterectomy, which removes the entire uterus, and myomectomy, which removes the fibroids but leaves the uterus. Usually, if patients have completed their childbearing, a hysterectomy is recommended as this decreases the chance of reoccurrence. This can be done minimally invasive (through small incisions) in most cases. Most patients are amazed at how quickly they recover and thrilled with the results.

Myomectomy is usually done in patients that want to maintain the option for future fertility. With the aid of the da Vinci surgical system, this is also a minimally invasive surgery.

If you have fibroids that are causing problems, talk to your doctor about treatment options. More information can be found at:
 

More information is available at the following sites:
www.emedicinehealth.com/uterine_fibroids/article_em.htm
WomensHealth.gov - Uterine Fibroids
www.fibroids.net/aboutfibroids.html