Gynecology FAQ’s

Choosing the right birth control (contraceptive) method is a very personal decision. There are several options available and only you and your partner can decide which one is right for you. In fact, it’s not uncommon for a woman to change her birth control method several times throughout her reproductive years.

Most contraceptive methods take commitment so make sure you understand the method you have chosen before you begin.

The Pap test, or Pap smear, is a screening test for cervical cancer. The test can detect changes in the cells on the cervix (the opening to the uterus, or womb, at the top of the vagina). These changes may be cancerous, pre-cancerous, or caused by inflammation. During the pelvic exam, the doctor will insert a speculum into your vagina and gently open it so the cervix can be seen. A thin brush and a wooden or plastic spatula are used to collect a sample of cells from the cervix. These cells are sent to the lab to be viewed and read by a cytotechnologist.

Human PapillomaVirus is a very common infection that can be spread through sexual contact.  Studies suggest that three of every four people who have sex will get a genital HPV infection at some point in their lives. Sexually transmitted HPV can be spread through vaginal, anal, and oral sex. Some types of HPV can cause cancer of the cervix, vulva, vagina, and penis.Genital warts are not usually linked with cancer. To lower your risk of developing HPV, limit your number of sexual partners and use condoms. If you are between the ages of 9-26, you should have the HPV vaccine to help protect you from infection. Regular pap tests are the best way to prevent precancer and cancer of the cervix.

Cervical dysplasia is a term used to describe the appearance of abnormal cells on the surface of the cervix, the lowest part of the uterus. These changes in cervical tissue are classified as mild, moderate, or severe. While dysplasia itself does not cause health problems, it is considered to be a precancerous condition. Left untreated, dysplasia sometimes progresses to an early form of cancer known as cervical carcinoma in situ, and eventually to invasive cervical cancer. Mild dysplasia is the most common form, and up to 70% of these cases regress on their own (i.e., the cervical tissue returns to normal without treatment). Moderate and severe dysplasia are less likely to self-resolve and have a higher rate of progression to cancer. The greater the abnormality, the higher the risk for developing cervical cancer.Cervical dysplasia does not cause symptoms; therefore, regular screening and early diagnosis are important. Detecting and treating dysplasia early is essential to prevent cancer. For this reason, most physicians quickly remove suspicious cervical lesions and require frequent Pap smears to monitor for recurrences.

A colposcopy is the painless viewing of the cervix and the vagina through a high-powered microscope called a colposcope. The colposcope looks like a pair of binoculars attached to a stand. It does not enter the vagina. Direct examination through the colposcope allows the detection of abnormalities on the cervix that can not be seen with the naked eye.

You will lie on the examining table with your feet in the stirrups, just like a regular pelvic exam. The provider will use a speculum to separate the walls of the vagina, just like during a normal Pap test. The speculum will remain in the vagina throughout the procedure, causing you to feel a little pressure. A vinegar solution (called acetic acid) will be applied to the cervix to remove mucous and debris. The colposcope will be placed near the vaginal opening. The provider will be able to see your vagina and cervix under magnification. Any areas showing abnormal cells will be biopsied. In a biopsy, a tiny sample of tissue will be removed from the area with a tweezers-like instrument. An endocervical scraping from the os (the opening in the middle of the cervix) may be taken as this is often where abnormal cells begin. You may feel a pinch or cramping when the tissue samples are taken. The samples will be sent to a pathology lab to be examined.

If a biopsy was taken, you may have slight bleeding or spotting for a few days following the procedure. If a tampon is inserted, please remove it in 4-6 hours. Do not reinsert another tampon. Use only pads until the bleeding stops. Additionally, you may notice a coffee ground or mustard-like discharge. This is normal. Do not resume intercourse for one week or until bleeding stops—whichever is greater. If bleeding occurs that is heavier than a period, please call the office. If you have any cramping after the procedure, you may continue the Ibuprofen or Naproxen Sodium for relief. You may resume normal activities including showers and tub baths as desired.

Cervical cryosurgery or cryotherapy is a gynecological treatment that freezes a section of the cervix. Cryosurgery of the cervix is most often done to destroy abnormal cervical cells that show changes that may lead to cancer. These changes are called precancerous cells. Your gynecologist will probably use the term cervical dysplasia. Cryosurgery is done only after a colposcopy confirms the presence of abnormal cervical cells. Cyrotherapy is also used for the treatment of cervicitis or inflammation of the cervix. Cryosurgery is not a treatment for cervical cancer. Cryosurgery is performed in your doctor’s office while you are awake. It is similar to a pelvic exam. You will lie on an exam table with your feet in stirrups, a speculum is inserted into your vagina to hold the vaginal canal open so that your cervix can be seen. Cryotherapy uses special instruments called cryo probes. During cryosurgery the cryo probes are inserted into your vagina until they firmly cover the abnormal areas of cervical tissue. Next, liquid nitrogen begins to flow through the cryo probes at a temperature of approximately -50 degrees Celsius. This causes the metal cryo probes to freeze and destroy superficial abnormal cervical tissue. The most effective treatment result is obtained by freezing for three minutes, letting the cervix thaw, and repeating the treatment for three more minutes. You may feel some slight cramping and may experience either a sensation of cold or of heat. You can return to most normal activities the day after cryosurgery; however, there are a few things you should take note of for the first two to three weeks following treatment. It is normal to experience a watery discharge for the first few weeks. This is caused by the sloughing of dead cervical tissue. Do not insert anything into the vagina for at least two to three weeks. This means no tampons, no douches, and no sexual intercourse.

If you’ve had a Pap test or cervical biopsies come back showing dysplasia, a LEEP may be recommended as treatment for these cells. Dysplasia is not cancer, but can lead to cervical cancer if not treated. During a LEEP, your doctor can remove the affected tissue, including the transformation zone (where many problems begin). It is sent to the pathologist to be sure that there is no cancer, and that the margins are clear – which means all the affected tissue was excised. The procedure begins like a Pap test in that you will put your feet in stirrups and a speculum will be inserted into your vagina and opened. Your cervix will be numbed with a local anesthetic and a mild vinegar solution (called acetic acid) will be applied. This solution turns the affected cells white. The doctor will use a colposcope (it looks like binoculars on a stand) placed outside your vagina to look at your cervix microscopically. This will help them decide the size and shape of the loop used to excise the abnormal tissue. A fine wire loop with a high frequency current (hence the name – loop electrosurgical excision procedure) is used to remove the abnormal tissue from your cervix. The loop will seal blood vessels as it cuts, decreasing bleeding. To further decrease bleeding, a medicated paste or solution may be applied to your cervix. This solution often causes a dark coffee-ground like vaginal discharge for a few days after the procedure. The tissue removed will be sent to a pathologist for diagnosis. Following the procedure, you may feel a few mild cramps for a few days and you will have a vaginal discharge sometimes for up to 4 weeks. You should not put anything in your vagina (including tampons or sexual intercourse) for three to four weeks after your procedure. You should also avoid heavy lifting and vigorous exercise for three to four weeks. Your doctor will want to monitor your Pap test for at least two years following your LEEP.

You must call your doctor if you:

• Suffer from heavy bleeding or bleeding with clots (a “coffee ground” discharge is normal)
• Experience severe abdominal pain
• Develop a fever
• Have a severe foul-smelling discharge

Gardasil is a vaccine that helps protect against diseases caused by HPV such as cervical cancer, abnormal and precancerous cervical, vaginal, and vulvar lesions, and genital warts. It is given in 3 doses over a period of six months.It is currently available for girls ages 9-26 years old.

Every year more than 200,000 women in the United States are diagnosed with breast cancer. Nearly 90% of breast lumps are found by the woman herself. Only by doing this task every month will you become familiar with your breasts and make it more likely to notice any changes. And, changes are what you are looking for. If you find any lump, hard knot or thickening you should contact your doctor or midwife immediately. If you are still having periods, you should do the exam seven days after your period begins. Your breasts are least likely to be tender and swollen at this time. If you no longer have periods, choose a day each month for the exam, such as the first of the month.

Premenstrual syndrome (PMS) is a term used to describe the abnormal symptoms many women experience one to two weeks before the beginning of their period. Physical symptoms, accompanied by mood swings and depression, are the classic signs. PMS symptoms can occur any time after ovulation, approximately two weeks after the beginning of your period. Ways to decrease incidence of PMS symptoms include: decrease caffeine, avoid salt, avoid sugar, stop smoking, decrease alcohol intake, increase calcium, increase exercise, increase magnesium.  All PMS symptoms should disappear rapidly once menstruation begins.

Pelvic Inflammatory Disease (PID) is not a single illness but a broad term covering a variety of infections of the internal reproductive organs.  The most common symptom of PID is a dull abdominal ache. Other signs include fever, vaginal discharge, abnormal uterine bleeding, fever and chills and sometimes nausea and vomiting. The symptoms vary among women and some women do not have symptoms at all. Sexual activity and movement often makes them worse. There are several bacteria that can cause PID. Gonorrhea and Chlamydia are the most common.

Polycystic Ovarian Syndrome (PCOS) is one of the leading causes of female infertility and is associated with long-term health risks of heart disease and diabetes. Three features of PCOS are 1) enlarged ovaries containing multiple, small cysts; 2) excess androgens (male hormone); and 3) chronic amenorrhea (missed periods).Symptoms include: hirsuitism, irregular/lack of ovulation, obesity, acne/oily skin, infertility, ovarian cysts, insulin resistance, and hair loss.The diagnosis is made through a careful history of symptoms along with physical findings, blood work and ultrasound testing. There is no cure for PCOS. The treatment of PCOS is generally symptomatic and centers on life-style modifications and medication.

Insulin resistance (IR) is a condition in which the cells of the body become resistant to the effects of insulin. As a result, higher levels of insulin are needed. Reproductive abnormalities include difficulty with ovulation and conception (infertility), irregular menses, or a cessation of menses. Once insulin resistance is diagnosed, it is controlled by medication and lifestyle changes.

Normally, during the menstrual cycle tissue builds up and breaks down within the uterus. In endometriosis, endometrial tissue (tissue from the lining of the uterus) is found outside the uterus. During the menstrual cycle this tissue builds up and breaks down in the same way but there is no way for it to leave the body. Women with endometriosis have symptoms ranging from mild to severe, although some women have no symptoms at all. Symptoms can include menstrual cramps, pain during sex, low back pain, constipation, pain with bowel movements, and infertility. Some women have chronic pelvic pain. Symptoms are usually at their peak just prior to and with the menstrual period.When your medical history and exam suggest endometriosis as a possibility, a laparoscopy may be offered to diagnose endometriosis.  Endometriosis is usually treated with medications first and if that is unsuccessful possible surgery.

Fibroids are benign growths that develop from the cells that make up the muscle of the uterus. The size and location of fibroids can vary greatly. They may appear inside the uterus, on its outer surface, or within its wall.The two most common symptoms are abnormal uterine bleeding and pelvic pressure. Menstrual periods with fibroids may be very long and very heavy. There may be pressure in the pelvic region from the enlarged uterine size caused by the fibroids. However, many women with fibroids never have any symptoms at all.If you have uterine fibroids you should be checked by your doctor on a regular basis. Getting regular checkups and being alert to warning signs will help you be aware of changes that may require treatment.

Menopause technically means the “end of menstruation”. Beginning in the early 30’s, the levels of estrogen and progesterone produced by a woman’s ovaries starts to decline. This decline escalates when they enter peri-menopause – usually three to five years up to menopause. When the supply of eggs is finally exhausted, ovulation stops. The levels of estrogen and progesterone eventually drop so low that menstruation stops. A woman knows she has passed menopause when she has no periods for 12 months. Until this point you will need to use birth control. Despite having menopausal symptoms, you can still get pregnant until you have been without a menstrual period for one year.The diminishing amount of estrogen produced by the ovaries produces changes in the body. Some women notice very little change while other women find it difficult to deal with the symptoms caused by these changes. They may include: hot flashes, insomnia, vaginal dryness, bone thinning which can lead to osteoporosis, and emotional changes. These symptoms may be treated with hormone replacement therapy.  For further information please visit http://pause.acog.org/.

Hormone Replacement Therapy is the use of two hormones – estrogen and progesterone – to help relieve the symptoms of menopause. Because there are both risks and benefits to HRT choosing whether or not to take hormone replacement therapy (HRT) can be a difficult decision to make. Your decision should be based on a number of factors including the severity of your menopausal symptoms/how they affect your life, and your individual risk for blood clots, heart disease, bone loss, breast and reproductive tract cancer. If you have had your uterus surgically removed, then you will only need to take estrogen. Progesterone is added for those with a uterus to cut the risk of uterine cancer that exists with unopposed estrogen (estrogen without progesterone).

Bioidentical hormone replacement therapy is a marketing term not recognized by the FDA. These products are compounded in pharmacies to meet an individual’s special medical needs. But some pharmacies that compound these products are making unsupported claims that these are more effective and safer than FDA-approved HRT drug products. No bioidentical hormone product has met federal standards for approval. They are not safer just because they are “natural”.You might not see a lot of reports of bad side effects with bioidentical hormones. Unlike commercial drug manufacturers, pharmacies aren’t required to report adverse events associated with compounded drugs.Some compounding pharmacies will claim that they can make bioidentical hormones “just for you” based on a saliva sample.  While this is appealing, it is unrealistic. There is no scientific basis for using saliva testing to adjust hormone levels. Hormone levels in saliva do not accurately reflect the amount of hormones present in a woman’s body for the purpose of adjusting those levels.