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What is chronic pelvic pain?

According to the Mayo Clinic; Chronic pelvic pain refers to any pain in your pelvic region (the area below your bellybutton and between your hips) that lasts six months or longer. If you were asked to locate your pain, you'd be more likely to sweep your hand over that entire area rather than point to one spot. Chronic pelvic pain can be a symptom of another disease, or it can be designated as a condition in its own right.

What could be the cause of chronic pelvic pain?
Tension in your pelvic floor muscles
Chronic pelvic inflammatory disease
Pelvic congestion syndrome
Ovarian remnant as a result of hysterectomy that develops cysts
Irritable bowel syndrome/disorder IBS/ IBD .
Interstitial cystitis
Unknown causes
Please contact us at our office if you need additional information.

What is contraception?

The deliberate prevention of conception or impregnation by any of various drugs, techniques, or devices; birth control. Theyou choose depends on your needs. Some people only need to prevent pregnancy. Other people may also want to protect themselves or their partners from diseases that can be passed by having sex.

Oral – “The Pill"
Transdermal contraception – “The Patch”
Condoms (male barrier method)
Barrier Methods: condom, sponge, diaphram, cervical cap
Implants (inserted and removed by physician for up to five years protection)
Intrauterine systems (inserted and removed monthly by woman)
(“Morning After Pill”)
Natural methods and or abstinence
Sterilization (permanent contraception)
Please contact us at our office if you need additional information.

What is a hysterectomy?

A hysterectomy is an operation to remove a woman’s uterus. Depending on the surgical approach and the woman’s symptoms, the ovaries, fallopian tubes and/or cervix may be removed as well. You should discuss with your physician what will be removed.
Complete or Total Hysterectomy -removal of the uterus and cervix.
Supracervial Hysterectomy -removal of the uterus while leaving the cervix in place.
Bilateral SalpingOophorectomy -removal of the fallopian tubes and ovaries. This procedure can also be completed with a total or supracervical hysterectomy. Please contact us at our office if you need additional information.

What is infertility?

Infertility is the inability to conceive after a year of unprotected intercourse in women under 35, or after six months in women over 35, or the inability to carry a pregnancy to term. Couples who have known barriers to fertility, such as endometriosis, polycystic ovarian syndrome, male factor infertility, irregular cycles, etc., do not need to sit out the traditional waiting period to seek expert care for infertility.

How common is infertility?
One in every six couples of childbearing age has an infertility problem. There is a female problem in 35% of the cases, a male problem in 35% of the cases, a combined problem of the couple in 20% of cases. Therefore, it is essential that both the man and the woman be evaluated during an infertility work-up. In 10% of cases, the problem is "unexplained" meaning that all testing is normal.

When should I seek help for infertility?
Conventional medical advice is to seek treatment if you have been trying to conceive for at least one year. However, if the male partner has a known or suspected low sperm count or the female partner is over 30 years old, has a history of pelvic inflammatory disease, painful periods, recurrent miscarriage, or irregular periods then we suggest seeking treatment sooner. Please contact us at our office if you need additional information.

What is a Hysteroscopy?

The hysteroscope is a thin telescope that is inserted through the vagina, the cervix and into the uterus. A liquid or gas is introduced to expand the uterus for better visibility. The uterine cavity can then be viewed on a video monitor. This can be done as an office procedure or in an operating room. Either general or local anesthesia is used. A hysteroscopy can be done as a diagnostic procedure or additional small instruments can also be inserted through the hysteroscope to perform different procedures such a biopsy, treating a fibroid or polyp. Please contact us at our office if you need additional information.

What is a Laparoscopy?

Your doctor will make a small incision through your belly button, as well as several other smaller incisions in the abdomen. The laparoscope is a telescope that is used to see the pelvic organs on a video monitor. Surgical instruments are inserted through the smaller incisions to perform the surgery. Laparoscopic and hysteroscopic procedures are both considered minimally invasive. Please contact us at our office if you need additional information.

What is menopause?

When you cease to have a menstrual period for 12 consecutive months you most likely have entered menopause. You will cease to be able to get pregnant and your body will undergo other changes.
Gradually declining estrogen levels begin as early as in the 30’s – this is referred to as peri-menopause. Menopause usually occurs around age 51 when the ovaries stop producing estrogen, or surgically at any age when the ovaries are removed. Please contact us at our office if you need additional information.

What is Osteoporosis?

This is a silent disease that makes your bone porous and brittle. As they become more brittle they can easily fracture. Hips, wrists and spines are the most common sites for fractures but they can occur in any bone. Women are 4 times more likely than men to get osteoporosis. If left untreated osteoporosis can seriously affect your quality of life.
      What are the risk factors?
A diet low in calcium and, a thin body frame, being menopausal, smoking, excessive alcohol and a family history of osteoporosis. Being Caucasian or Asian, a lack of exercise and certain medications or conditions. Ask your Doctor when you should tested for Osteoporosis. Please contact us at our office if you need additional information.

What is polycystic ovarian syndrome (PCOS)?

PCOS  is one of the most common hormonal diseases affecting reproductive-aged women. In actuality, PCOS includes a spectrum of disorders rather than a single, discrete disease. Women may experience a variety of signs and symptoms, and, as a result, some women may be inappropriately diagnosed with PCOS. Perhaps, more importantly, in many women the diagnosis is completely missed or even ignored.

PCOS require the presence of hyperandrogenism (excessive "male" hormones) and chronic anovulation (infrequent or absent ovulation resulting in irregular) to make the diagnosis. Others require the appearance of multiple small ovarian cysts on a vaginal ultrasound examination.

What are the symptoms of PCOS?
The symptoms of PCOS may include irregular menstrual cycles (long intervals between periods), obesity (found in only half of patients), acne, excessive coarse hair growth, and infertility. 
Some women with PCOS also have metabolic disturbances characterized by resistance to the hormone insulin. This hormone, produced in the pancreas, stimulates the cells of the body to absorb and utilize glucose, a sugar used by the body as a source of energy. In women with PCOS, the cells of the body are often resistant to insulin action and glucose is not utilized efficiently. It is therefore stored for later use in the form of fat, hence the increased obesity and abnormal glucose levels in some women with PCOS.  It is important for women with PCOS to realize that excessive fat tissue, insulin resistance and other hormonal aberrations put them at higher risk for coronary artery disease and diabetes. Furthermore, loss of ovulation and infrequent periods increase their risk for cancer of the uterus. Therefore, PCOS is a potentially serious disease and must not be ignored by women or their physicians.

How is PCOS diagnosed?
While many physicians empirically diagnose a woman with PCOS based on the clinical features mentioned above, proper diagnosis requires obtaining blood samples for a variety of hormones, including those produced by the ovaries, adrenal glands, pituitary gland and thyroid gland. A full physical examination and vaginal ultrasound are also important. Cholesterol, triglyceride, glucose and insulin screening should also be part of a complete evaluation.

What causes PCOS?
The truth is, no one really knows what causes this disease. There is certainly a miscommunication between the hypothalamus (within the brain), pituitary gland (at the base of the brain), ovary and fatty tissue. Where the miscommunication originates from is a matter of great controversy and remains unknown. There is definitely a higher incidence of PCOS within certain families but the genetic basis for the disease has not yet been fully elucidated, Please contact us at our office if you need additional information.

What is PMS and PMDD?

Pre Syndrome (PMS) symptoms are usually predictable and occur regularly during the two weeks prior to menses. The symptoms may vanish after the menstrual flow starts, but may continue even after the flow has begun.
For some women with PMS, the symptoms are so severe that they are considered disabling. This form of PMS has its own psychiatric designation: Dysphoric Disorder (PMDD)
PMS/PMDD is a collection of symptoms. More than 200 different symptoms have been identified, but the three most prominent symptoms are irritability, tension and dysphoria (unhappiness).The exact symptoms and their intensity vary from woman to woman. Most women with
Abdominal bloating and cramps.
Breast tenderness or swelling
Stress , anxiety or agression
Appetite changes and food cravings
High sexual arousal or desire
Trouble falling asleep
Joint or muscle pain
Inability to finish thoughts
Unexplained cravings
Acne and worsening of existing skin disorders, and allergies or conjunctivitis
Body temperature increase
Extreme tearfulness.  
Please contact us at our office if you need additional information.

What is Urinary Incontinence ?

UI is defined as the involuntary loss of urine which is objectively demonstrable and a social or hygienic problem. Urinary incontinence has been reported to:
Affect 10-25% of women under age 65 and 15-30% of women over age 60.
13 million Americans are incontinent; 11 million are women
Urinary Incontinence has been shown to affect a person’s social, clinical, and psychological well-being. It is estimated that less than half of incontinent women seek medical care. Often, incontinent women rely on absorbent pads or changes in their life style to cope with this condition. Incontinent individuals have been reported to be more likely to be depressed; they may be fearful and embarrassed about their appearance or the color of urine. Sexual relationships are often affected.
Quite simply, there are 2 basic types of incontinence.
Stress Incontinence: is the involuntary loss of urine during physical activity. One of the causes of Stress Incontinence is the loss of anatomic support of the bladder and its surrounding tissue. This damage may be the result of pregnancy and vaginal delivery or due to tissue atrophy that result from advancing age.
Urge Incontinence: is the involuntary loss of urine associated with an abrupt and strong desire to void (urgency).
There are other less common forms, including:
Mixed incontinence is a combination of both stress and urge incontinence, as is most common in older women.
Overflow Incontinence, in which the bladder becomes too full because it cannot be emptied, is rarer and is the result of bladder obstruction or injury.
We can perform the top technology testing called Cystometrics in our office rather than being sent to the Urologists. Cystometrics allows us to evaluate the cause of your incontinence using very simple and painless techniques. A treatment plan is created using a Gynecologic point of reference including life style changes rather than promoting surgery as an immediate remedy to your problem.  Please contact us at our office if you need additional information.

What is Loop Electrosurgical Excision Procedure (LEEP)?

A LEEP is performed as an out patient procedure to treat abnormal cell changes (dysplasia) on the cervix. The purpose is to stop the abnormal changes on the cervix from turning into cancer. A LEEP can offer a cure of abnormal changes, as well as help prevent cancer of the cervix.
A LEEP can be easily done in the office. You will be in the same position as you would for your Pap test and Colposcopy. Numbing medicine is injected into your cervix a few minutes before the LEEP is done. A fine wire loop with a special high frequency current is used to remove the abnormal tissue from the cervix. After the tissue is removed, any bleeding is stopped with a special paste called Monsel’s solution. This medicine will come out of the vagina over the next few days and be black and clumpy. The tissue that is taken from your cervix is sent to the lab to be examined to see how abnormal the changes on the cervix are, if all the areas were removed, and if further treatments need to be done. LEEP is about 85-93% effective.
The risks include but are not limited to heavy bleeding, infection, cramping, incomplete removal of all abnormal tissue, and scarring of the cervix. Rare but possible complications include weakening of the cervix that could cause problems during pregnancy.
With reference to pregnancy “incompetent cervix” is an uncommon complication that can cause a late miscarriage in the 2nd trimester of your pregnancy. You should make your obstetrician aware at the time of your early pregnancy that you have had a LEEP in the past.
Before your LEEP:
Take 600 mg Motrin ( equal to 3 tab. 200 mg each) Or OTC analgesics as Advil, Excedrin or Tylenol ES.
After your LEEP you may have the following:
A slight increase bleeding with your periods
A thick brownish black discharge.
Light vaginal bleeding.
To ensure complete healing – DO NOT:
Have sex till you will be seen back in office
Do strenuous exercise.
Please call the office right away if you have any of the following occurs
Heavy Vaginal Bleeding with Clots
Severe abdominal pain.
Foul smelling vaginal discharge.
You will need to return to the office in TWO WEEKS  for a check up after your LEEP.
Your doctor will tell you when you can return to your normal life style.
You will also need to have more frequent Pap smears over the next two years. Please contact us at our office if you need additional information.