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August 30, 2016

What is Vaginal Shortening and is Vaginal Lengthening a Solution?
Vaginal shortening, or iatrogenic vaginal constriction, is a condition that occurs in women usually as a result of undergoing gynecological surgery. After removal or correction of organs within the pelvic area, post-surgical tweaks are always necessary to close any internal incisions, suture tissue together, and to restore the vagina back to its previous corridor-like shape.

Depending on the extent of the surgery, sometimes it’s necessary to stitch together a great deal of a woman’s remaining tissue, leaving the vagina shorter—the same way gathering fabric to repair a hole in the toe of a sock would alter its size. Subsequent scarring in the area over time may also contribute to narrowing and reduction. Unfortunately, though vaginal tissue is extremely elastic and stretchable, a substantial shortening may result in uncomfortable and even painful intercourse, especially during the natural penile thrusting stage of a sexual encounter.

What Conditions and Their Aftermath Cause Vaginal Shortening to Occur?
Most surgeries that involve the removal or correction of vaginal organs may contribute to this problem. Some of these include:

Vaginal mesh surgery – A transvaginal surgical mesh that may have been used to repair a woman’s urinary stress incontinence or pelvic organ prolapse (POP) can cause future problems. Mesh is sometimes used to support ligaments and organs that have slipped out of place. Its purpose is to reinforce the pelvic floor or weakened vaginal wall. Sometimes the mesh can cause infection, fuse with organs and tissue, or perforate its surrounding structures, making removal necessary. Much like cement sticking to the webbing used to adhere stucco to walls in home construction projects, tissue and organs may have stuck to the transvaginal mesh, making is difficult to remove without causing damage. When this damage is extensive, additional tissue is needed to repair the vagina, thus shortening it even more.

Bladder tack surgery/bladder suspension surgery – This procedure is used to minimize or correct stress incontinence in women by creating a hammock shaped sling made of a mesh tape. The material is different from transvaginal mesh, but with similar complications. If rejection, fusion, or infection arise, the methods used to correct these post-surgical problems may result in vaginal shortening.

Anterior repair/posterior repair (colporrhaphy) – Anterior repair surgery tightens the front wall of the vagina when the bladder has drooped or fallen out of place (cystocele or dropped bladder). Posterior repair surgery tautens a rectum that has sagged or dropped (rectocele or rectal prolapse). Though both procedures are minimally invasive, complications may occur that require surgical attention and subsequent suturing, in turn shortening the vagina.

Enterocele repair – This reparation is necessary when intestines (small bowel) bulge through the weakened tissue at the top of the vagina. As with anterior or posterior repair, risks are uncommon but may occur, needing attention that might impact vaginal proportion.

Sacrospinous ligament/vault suspension – This procedure lifts the top of the vagina and holds it in place after complete vaginal prolapse. As with several of the previous surgeries mentioned here, postoperative stitches are necessary using a woman’s available tissue. This can minimize the original size of the vagina.

Hysterectomy – In a hysterectomy, all or part of the uterus is removed. In some cases, it may also be necessary to extract the ovaries, cervix and/or fallopian tubes. The more radical the procedure, the more internal trimming and stitching may be necessary. Hysterectomy is possibly one of the biggest causes of vaginal shortening.
Cervical or uterine cancer: Due to removal of cancerous organs, and scarring that can occur as a result of follow up radiation, both vaginal capacity is usually reduced.

Can Vaginal Shortening Be Repaired?

Often, following surgery, the vagina may simply feel shorter due to swelling, inflammation, tenderness, bruising, and the presence of stitches. Vaginal tissue is very elastic, and though it may feel tight immediately after your operation, size often returns to normal after a short recovery time.

If actual shortening has occurred, repair can sometimes be complicated, depending on the extent of the surgery or cause of the diminishment.

Though it is possible to approach correction by using more drastic measures such as muscle flaps, biological animal grafts, skin grafts, or even a woman’s own bowel tissue, these methods can cause further complications and we prefer to avoid them. Instead, we opt for the least physically intrusive methods first. Several of these options are:

Pelvic floor massage – Internal and external massage can relax tenderness, muscle tightness and trigger points that cause pain, gently stretching or tightening the pelvic floor muscles and connective tissue.

Pelvic floor physiotherapy – These exercises stretch and strengthen the pelvic floor muscles.

Vaginal dilators – Plastic tubes that gradually increase in size are inserted to gently stretch the vagina over time.

If these procedures prove to be ineffective, laparoscopic surgery, which is minimally invasive and generates less blood loss, scarring, and a quicker postoperative recovery time may be beneficial.

Whatever the reason for vaginal shortening, we can recommend the safest and most effective approach to try and correct the problem. To make an appointment, call us at 770.720.7733.

What is Libido?
Libido, very simply put, is sexual desire or sex drive. Just as there are multiple shades in a color spectrum, levels of libido are unique to each woman, and these levels can rise and fall monthly throughout a woman’s lifetime depending on many biological and psychological factors.

What are the Different Levels of Sexual Desire?
Intensity can vary. Sexual desire may range from heightened – where a woman may want sex one or more times a day (hypersexuality), to several times a week, once a month, once every few months or year, (hyposexuality) or not at all (asexuality).

What is Considered ‘Normal Libido’?
There are no standards for ‘normal’ libido, especially if a couple is sexually compatible and comfortable in their mutual need for intimacy. Often, however, this is not the case. Women frequently tend to have a lower libido than men. In fact, it is estimated that 1 in 10 women suffer from low sexual desire in the United States, meaning that 16 million women have what is referred to as hypoactive sexual desire disorder (HSDD).

A female’s low libido can have a huge negative impact on a relationship. Once the brilliant shine of newly-found lustful love wears off, couples may find their physical needs are drastically different. The apathy of the less ardent woman may lead to conflict, suspicion, hurt, infidelity and even complete collapse of the relationship. The woman herself may also suffer feelings of inadequacy, self-doubt, and frustration, emotions that might send her into an emotional depression, worsening the situation.

Mass media today slants sex to appear as if anything less than constant bedroom activity is abnormal, often convincing a woman with a perfectly healthy sexual appetite that she is some kind of freak if she doesn’t engage in a passionate encounter at every opportunity. For one who suffers from a lower sex drive, the impact may be even more devastating. The inner turmoil of a dwindling self-image and shattered self-esteem can compound the problems already complicated by sexual dysfunction.

low libido photoWhat are the Causes of Low or Waning Libido?
There can many causes for low sexual desire, and they can be either physical or psychological.

The following are some of the physical reasons for a low libido:

  • Hormonal imbalances: The three hormones that impact a woman’s sexual function, desire and reproductive organs are estrogen, progesterone and testosterone.
  • Testosterone is the primary hormone responsible for a healthy libido in women. Yes, ladies, we all have testosterone, just as all males produce estrogen! The amounts just vary for each gender. Testosterone is what enables a woman to fantasize, piques her interest in sex, and aids in lubricating the vagina to prepare for comfortable, pleasurable intercourse. A woman’s testosterone levels begin to rise just before she ovulates, piquing a day or two before, and reaching maximum strength at ovulation. This is Mother Nature’s way of preparing the body for reproduction by plumping the uterine wall, which in turn stimulates sensitive nerve endings, encourages lubrication and heightens sexual motivation. Immediately afterwards, the amount of this hormone in her body diminishes. A low testosterone count hampers the possibility of a satisfying sexual experience by minimizing enthusiasm, sensitivity and arousal.
  • Estrogen is the main hormone responsible for the development of the female sex organs. It regulates the menstrual cycle and is crucial in thickening the uterine lining in preparation for pregnancy. As women age and enter the premenopausal stage (perimenopause), estrogen begins to significantly decrease until the levels are so low that menopause occurs. Vaginal tissue becomes thinner, less elastic, drier and more fragile. As with testosterone, natural lubrication diminishes with less estrogen, and this decrease affects sexual desire.
  • Progesterone is another female hormone that is vital in thickening both the uterine wall and endometrium to protect the egg during the process of fertilization, conception and pregnancy. Levels normally rise immediately after ovulation. If fertilization does not occur, levels drop, and the uterine walls become thin again, allowing the unfertilized monthly egg to pass as menstruation. Progesterone also regulates a woman’s menstrual cycle. As with estrogen, levels decline with age. Research is still being done, but it is believed that progesterone’s role in waning libido is just as important as those of testosterone and estrogen.
  • Menstrual cycle: Irregular or absent menstruation (secondary amenorrhea) can wreak havoc on natural hormonal processes, causing libido to become equally sporadic.
  • Age: Testosterone, progesterone and estrogen levels diminish as women age and enter menopause, causing lowered sexual interest, loss of muscle mass, compromised skeletal health, and vaginal dryness that can lead to painful intercourse. As these hormone levels decrease, so does libido.
  • Antidepressants: Sexual dysfunction, low lido and even genital numbness may be attributed to some currently prescribed antidepressants which are referred to as selective serotonin reuptake inhibitors (SSRI’S).
  • Drugs: All recreational or prescription drugs have side effects. They can inhibit hormonal functions, dull physical and mental sensations, dehydrate the body’s natural secretions and lubrications, or interfere with sexual desire. Blood pressure medications, tranquilizers and antihistamines are just a few. Always give your doctor a complete list of medications you are currently using.
  • Lack of restful sleep: Drowsiness, irritability and fatigue can dampen anyone’s mood for lovemaking.
  • Birth control: Some patches and oral contraceptives fool the body into believing it is pregnant by neutralizing the very hormones that enhance libido. If you notice a sudden disinterest in sex after beginning birth control, speak to your doctor.
  • Alcohol, smoking or drug abuse: Smoking restricts blood flow to the body. The clitoris, labia and vagina become engorged with blood during sexual arousal, just like a man’s penis, so restricting this flow also restricts sensation and response to physical stimulation. Alcohol is a depressant. It dehydrates the body, dulls sensitivity, and causes loss of vaginal lubrication.
  • Giving birth: Immediately after giving birth, a woman’s hormones are causing an uproar inside her body. Physical trauma to the vaginal area, possible postpartum syndrome, and the exhaustion and stress of caring for a newborn amplify sexual indifference. Luckily, these issues usually only last a few weeks, but if libido remains low or non-existent for longer, consult your doctor.
  • Genital abnormalities or problems: Pelvic organ prolapse(POP), muscle mass and tissue deterioration due to aging (urogenital atrophy), fecal incontinence, urinary problems, dryness, atrophy, and a small vaginal opening are only a few of the physical problems that can decrease libido.
  • Surgery: A hysterectomy with or without compete removal of the entire reproductive system (Oophorectomy) decreases or completely eliminates the hormones necessary for sexual gratification.
  • Major health conditions: Cancer, high blood pressure, neurological disorders, hypothyroidism, diabetes, arthritis, infertility, and coronary artery disease, along with the medications and procedures necessary to correct these issues are just a few disorders that can weaken female libido.
  • Anemia: Low iron levels caused by heavy periods can result in anemia. Anemia reduces red blood cells and compromises a protein called hemoglobin whose job is to push oxygen from your lungs to all your body parts, including the pelvic area. Since blood is vital to the labia, clitoris and vagina to enhance erotic sensitivity, anemia can greatly subdue bedroom pleasure and cause fatigue, weakness, and sexual apathy.

Psychological factors that can cause low libido are:

  • Low self-esteem or body image: If a woman is overweight, underweight, lacks self-confidence, or feels inferior in other ways, she may shy away from physical contact, robbing herself of the gratification of a healthy sex life.
  • History of sexual abuse: Rape, assault, and molestation can have a devastating effect on the psyche. Without counselling, the aftermath of these experiences can leave lifelong psychological scars, and it is understandable that a woman may avoid any future sexual encounters.
  • Religious and moral issues: Deep rooted personal beliefs can sometimes be detrimental to a healthy libido. Entrenched convictions about sex, religion, moral taboos and behavior can prevent a woman from truly enjoying an intimate relationship, causing her to view a physical union as repulsive or simply a ‘duty’ to get out of the way.
  • Trauma: Psychological trauma such as post-traumatic stress disorder (PTSD) can follow any highly disturbing event. Just as with sexual abuse, the repercussive emotions following the death of a loved one, a divorce, violence, being the victim of a crime, etc. may lead to sexual dysfunction and a damaged libido.
  • Relationship problems: Constant tension and conflict with a loved one can slowly chip away at even the strongest relationships. Anger, disillusionment and unresolved issues ultimately make their way into the bedroom, negatively impacting any activity that is still, or no longer, going on there.
  • Depression or anxiety: Either of these emotional conditions can affect performance or pleasure by causing disinterest, especially if medication is being used to control the issue.
  • Lifestyle: As the world becomes more and more fast paced, a busy lifestyle and the responsibilities that come with it can succeed in putting any romance on the back burner, lowering the flames of passion and eventually putting them out altogether.
  • Stress: Worries about health, finances, or other everyday problems cause physical and mental tension. If a woman is unable to relax and enjoy sex, orgasm is impossible and frustration inevitable, causing her to lose interest altogether.
  • Anxiety: Anticipation of sex is not always viewed favorably. Many women dread intercourse when they feel it’s expected or demanded of them. Some worry that they may not fulfill their partner’s expectations, or that they might be urged to perform acts that they’re not comfortable with to please their mate, especially in a new relationship.
  • Environmental stress: Distractions such as bright lights, lack of privacy and extreme noise can hinder a woman’s ability to relax and enjoy intimacy. For instance, visiting or living in a mother-in-law’s home, or listening to a neighbor’s loud, thumping music can impede full enjoyment of sex or orgasmic achievement.
  • Poor communication: Optimal sexual performance does not come naturally. It’s a learning process for both partners. Many couples avoid telling each other what pleases them in the bedroom. Whether it is because if shyness, fear of shock, or ridicule, women sometimes avoid telling their mates what they prefer and, in time, come to dread intimacy altogether.
  • Latent sexual orientation: Denial of gender preference can raise feelings of guilt and suppress the pleasure that comes with an open, honest, relationship.

Is Help Available?
YES!!!! There is no reason to go through life with lowered libido. Women can enjoy a satisfying sex life at any age, and with today’s resources and modern technology, we are usually able to effectively treat the problem.

Diagnosis and Treatment
In order to pinpoint the root of this dysfunction, frank honest discussion is necessary, as well as a list of any medications you are currently taking. Your doctor will ask pertinent questions to find out whether the problem is physical or emotional.

After an examination of the genital area, blood tests may be required to determine hormonal levels.

Once a diagnosis is made, your doctor will move forward to correct the problem. It may be as simple as a change or alteration in medication or a new prescription. If surgery is indicated, most physical corrections are minimally invasive, can be done in our clinic, and the recovery time is usually short.

If the problem is psychological, resources to help are available. For an appointment, call us at 770.720.7733.

August 16, 2016

dr litrel interview part 3 graphic
An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 3 of a 3 Part Series

Guiding Principles
My philosophy as a doctor is the mother principle—in that you treat all your patients the same, and always keep in mind how you would want your mother, wife or other loved one to be treated. If your mother is on that operating table, you’d want the surgeon operating on her to bring his A game. For me, an A game is not just about being in one place and doing well, it’s about availability, continuous improvement, compassion, learning the latest technology and methods, follow- up, etc. so I’m giving my patients the best possible care and aftercare.

The Doctor/Patient Relationship
Apart from the mother principle, the patient’s attitude tends to guide me. My principle is that I do my very best and I’m as honest as I can be. I try to do it in a way where people can be receptive. Sometimes it works very well and other times, well, not so much. Physician-patient compatibility is very important.

For example, I recently had a patient with life-threatening blood pressure issues, and she really didn’t want to hear anything I had to say. She was being completely non-compliant by not taking her prescribed medication to combat dangerously high blood pressure readings. She became impatient, even angry with me, changing the subject to something else each time I tried to discuss the severity of her situation and the importance of following my recommendations.

On the other hand, another patient reached out to me in desperation. She described how her son was heavily into drugs and how her father was seriously ill. The situation was causing devastation to her, both mentally and physically. Apart from understandable emotional turmoil, she was compensating for the difficulty in her life by overeating and was rapidly gaining weight.

Dr. Litrel with patient photoI listened to her because I truly sympathize and care about the struggles she’s going through. I gave her the best advice I possibly could. It was clear that she was receptive to everything I was telling her and would follow my advice.

The non-compliant patient made me realize that our doctor/patient relationship was a mismatch and was going nowhere. I knew I would probably decide not to see her again, and I’m okay with that. My heart is telling me that she would be-or should be-better off with another doctor, and I’m okay with that too.

However, the troubled mother was appreciative of the help I was trying to give her. I knew that, unlike my other patients, or those that I see over the years for just an annual exam, she would remain in the forefront of my thoughts. I would remember her son’s name, follow up with her regularly, stay in touch, and even pray for her because I’m genuinely concerned. I don’t doubt she truly wants my help. I can only help those people who want to accept my advice and, in turn, help themselves.

Talking with Inhibited Patients
With shyer patients who are more reluctant to discuss their problems, I simply confront the issue. I basically just tell my patients, “Look, I completely understand that it’s very embarrassing sometimes to talk about sexual or genital issues. It’s humiliating if you ‘poop’ or ‘pee’ on yourself, don’t know what an orgasm is, or if you’re ashamed of the way you look. Whatever it is, I know some of these things can be difficult to talk about. That said, I’ve heard and seen it all, so now I’m going to get the information I need from you. Sooner or later, I’m going to find everything out anyway, and we’re eventually going to have a trusting relationship so the more you tell me now, the more comfortable you’re going to be, and the more I can help you.”

If I just acknowledge the fact that it’s an awkward or socially embarrassing subject, people tend to relax a little and speak more freely. Then, once I do an exam, my knowledge and experience guides me to ask more direct, delicate questions based on my visual findings—questions like, “Do you need to touch your vagina to defecate? Do you leak stool? Are you sexually active? Do you urinate when you cough, sneeze or jump? Do you have a sensation like your bottom is coming out? Does your back hurt a lot?”

Because I’ve been practicing for so long, I can duplicate the anatomical findings with the physical symptoms. This makes them think, ‘Oh, he knows that, so maybe this is a normal thing!’ When that connection is made, we can discuss and build a trusting relationship.

Surgery
My philosophy is that, unless surgery is absolutely necessary, I discourage it. If you must have surgery, do it for the right reasons. I feel that patients seeking operations to improve their sexuality or the appearance of their genitals can be extremely vulnerable, impressionable and overly trusting of people who might want to take advantage of that vulnerability for their own profit.

Since the internet has come into our lives, we’re often led to believe that there’s only one solution to all our problems. A place that sells widgets will try to convince you that widgets will solve everything that’s wrong with your life. Desperation causes people to believe that so they buy that widget only to find out it’s not a cure-all. It’s the same thing with surgery. It’s not always the answer to everything simply because it’s radical and is made to sound like the perfect answer to everything.

Dr. Litrel Surgery Pic I don’t subscribe to that way of thinking. Again, I rely on the ‘mother principle’, going on the premise that if this was my mother, wife, sister or daughter seeking help, I would recommend surgery only when surgery is indicated. I wouldn’t want my mother or my wife going somewhere and being talked into surgery simply because that’s how the provider makes money. There’s a higher degree of ethics that’s required, and that’s to do your very best and treat people with as much love as possible. If you honor that, your patients will thrive and you’ll have a very happy career.

Cosmetic Gynecology
I feel that a lot of plastic surgeries promise unrealistic results, but because I deal solely with women’s problems, I understand that quite often, these desired results will not happen. In my opinion, altering genital appearance for visual enhancement only is much like the case of Michael Jackson, who pursued surgery after surgery, turning his original attractiveness into an almost garish version of his former self. Plastic surgery did not solve his underlying problems of low self-esteem. Unnecessary cosmetic gynecology is no different.

For me, cosmetic gynecology is all about making women more comfortable with their bodies. A lot of women come to me devastated because they don’t feel like they’re good enough. Some have given an important part of themselves to a husband or father of their children for years and have been made to feel substandard. And suddenly they’re faced with separation or divorce. These women seek cosmetic help so they’ll feel attractive, desirable and confident enough again to have a good sex life with someone else in future. I see these things all the time.

Prayer, Spirituality and Health
It’s already been documented that I pray with my patients when they ask or need me to, usually before a surgery when they’re frightened and more vulnerable. I’m happy to do it. I pray all the time. It’s part of my life, much like breathing to me.

As a doctor I can alleviate a lot of the physical suffering, especially in my areas of expertise, but much of the pain we have is not of the body, it’s of the soul.

Prayer is very basic and healthy. If you’re not praying, then you’re not really listening. I’m not saying prayer as in asking for something. I’m saying prayer as in listening to what God wants from you and if you listen, I think things will go pretty well. You need to have good relationships with people around you, have loving relationships with family and God, and for me, prayer is a very important part of that – to be faithful and to strive to listen to what God wants me to do. I think that’s a really important factor in maintaining good health.

An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 2 of a 3 Part Series

Of all the specialties you could have chosen, why did you choose obstetrics and gynecology?
I was quite surprised myself that I chose OB/GYN. I really hadn’t thought of it as a specialty before I attended medical school because I was more inclined towards surgery. However, when I delivered my first baby, it was such a miraculous moment in my life. It was 3:00 in the morning, and I remember it distinctly. I was in awe that this child actually came from a woman’s body. Ten seconds later, as I was placing that baby into that little infant warmer, I realized that I wanted to participate in this miracle; that I was going to be an obstetrician. It was a profound moment for me, and I can’t begin to express how much great personal satisfaction and enjoyment I’ve received over the years by taking care of women and women’s issues.

Your wife Ann also works at Cherokee Women’s. Do you find it difficult to separate work-related issues from home life, or do you find it can strengthen a relationship?
Ann works on public relations for the clinic and I have my medical practice so yes, we work under the same roof and our paths do cross but we each tend to our own professions. I’m a doctor, something I’ve wanted to be since the age of seven and Ann is, first and foremost, an artist.Dr. Litrel and Ann photo

In answer to the second part of your question regarding separating work-related issues from home life, I think it’s very important to be married to your best friend and someone you trust implicitly. Ann is both of those to me.

We have a strong, healthy relationship and have been married for 28 years. Like any normal couple, we have our ups and downs, but we know how to apologize and go on from there. We’ve grown together and share similar interests. We agree on many things, including our relationship with God, and about becoming better people. As we advance through life, we continue to support, encourage and help each other. We’ve known each other half our lives so I wouldn’t say being a doctor and discussing work-related issues makes either my job or my marriage harder, any more than Ann being an artist and sharing her passion for it impacts either of those things.

You have an identical twin brother named Chris. When growing up, did you find that you and he shared that proverbial ‘brain’.
As identical twins, he and I understood each other so well that we didn’t learn to speak early or verbalize our thoughts to other people.

Dr. Litrel, Chris and Mary photoHowever, we’re very different. My brother is a lawyer by trade, and a lawyer’s thought process is entirely different from a doctor’s. Physicians focus more on immediate problems, whereas attorneys think three years ahead of time. Still, we’re very close and I rely on his counsel a great deal.

If you decided to retire tomorrow, what would you do?
Do you mean if I stopped practicing medicine? Well, I love what I do so as long as I’m healthy enough to keep doing it, I don’t really want to retire unless I absolutely have to. If anything, as I get older, I’ve become a better surgeon so I’d like to continue for as long as possible.

My other passion would be writing and speaking about the relationship between health and spirituality, something that’s very important to me. That’s one of the reasons I was drawn to the care of women and their health—because what life event could possibly be more spiritual and meaningful than the birth of a child?

I chose to specialize in surgical gynecology because human beings grow inside of a woman’s body, and sometimes you need a surgeon that can bring them safely into the world. I enjoy it, not only for the concrete aspects of surgery, but also for the deep spiritual meaning of this process known as the creation of a life.

We can clinically describe how a single cell turns into a newborn baby over 280 days, but the process itself is miraculous. It’s a testimony to the fact that our lives have deep purpose and deep meaning, and that God grants us life.

If you were to write another book, what topic would you choose?
As it happens, I’m currently working on a book on pelvic reconstructive surgery, but I’m also tying it in with the correlation between health and spirituality. Women not only endure suffering and damage to their bodies, but also to their souls. We all do. So the book I’m writing expands on that subject.

Women have unique human problems because of the nature of creating new life inside their bodies, and there’s suffering that comes from that process. So from that perspective, I’m writing about the nature of surgery in terms of when to have it and when not to have it. I’m also writing about the nature of health since health is not only about the physical but about the sexual and spiritual aspects as well.

I’d like to educate patients on the fact that we’re not human beings having spiritual problems, but that we’re spiritual beings having human problems. These human problems we all sometimes have call for the attention of a surgeon.

Do you like to travel? If so, where was your favorite place?
One of the things I like about practicing medicine is that I don’t have to travel anywhere. People from all over the world come to see me. I guess I’m more of a homebody than I am a traveler. I like keeping my life pretty simple. I have traveled and visited many different countries, but it’s not my favorite thing to do. I’ll go, but I prefer to stay home.

As a busy OB/GYN surgeon, I’m sure the demands can be overwhelming. How do you deal with those demands – both at work and at home?
I try to manage my schedule in such a way that I can always be in top form whenever I have patient duties. When I see my patients, I remain completely focused and concentrate on them. I also make sure I leave openings in my schedule to allow for free personal time. That way, I know that I can continue to do what I do indefinitely to prevent burn out.

Instead of allowing myself to get overwhelmed, I try to set up my calendar in a manner that guarantees I can be in peak mental condition all the time, thus insuring that I give the best care I possibly can. I’m 50 years old so I know myself well enough to know what works for me.

To unwind after work hour, Ann and I will often go for a walk around the neighborhood for about 40 minutes. We may go to the gym for some exercise, or out to have something to eat. Our favorite date is going out for a glass of wine, an appetizer, some dessert, and maybe catch a movie. That’s probably been our favorite type of date for the last thirty years.Dr. Litrel and Ann photo

I think we all need to give ourselves personal time to build up a relaxed, spiritual reservoir so that we can make good choices. To me, good choices are eating right, exercising, taking my wife out, having friends over, laughing and enjoying life—that’s MY relaxation.

Coming from an Asian-Italian background, how did you combine the two worlds when it came to traditional customs, beliefs and holidays?
Since I have a mixed ethnicity, I always had a few problems in the sense of fitting in. I was born in 1965 and there weren’t that many Chinese-Italian people out there back then. Although we’ve come a long way as a society in the sense that people are much more tolerant of interracial marriages today than they used to be, it was a bit difficult for me at times when I was growing up.

I probably chose my profession, because as a kid, I didn’t fit in too well with the world around me. I think that’s one of the reasons I was so drawn to medicine. In medicine, it’s not about skin color, ethnicity, wealth, or socioeconomics. It’s about helping and healing people.

As for holidays and customs, my mom’s father and stepmother lived in New York City. They were vegetarian Buddhists. For Chinese New Year, my step-grandmother would make a traditional Chinese meal, after which we would go into the city and celebrate. When fireworks were still legal, we would light them and throw them at the dragon. I remember how much fun that was.

As for the other side of my family, my dad had a lot of Italian friends—in fact his business was Italian food manufacturing. He worked with a lot of Italians, so we spent most of our time in their environment. New York is very rich in Italian flavor and community, so we got a lot that particular ethnic exposure too.

I still have Italian friends in New York. My grandparents have since passed away, so I’m not as in touch with my Chinese roots these days as I am with my Italian ones.

What is your very first childhood memory?
I remember when I was 3 years old we were moving to the house that would become my childhood home. I remember driving down that block and coming to the house that I would grow up in.

Ok, I just have to ask: When you watch medical movies or TV shows, do you find yourself mentally correcting the inconsistencies?
When I was younger, I used to think about all the things they were doing wrong. Now I simply sit back and enjoy what I see on the screen. I’ve come to understand that they’re just trying to create drama, and I recognize that movies and TV are all about the story.

When I was training to be a resident I used to watch ER—and that was actually a very good show. Michael Crichton was asked to be a consultant on that show because he was a Harvard trained doctor. It was a good series but sometimes it was just too much. To draw viewers, they would try to condense all these improbable situations into a one-hour episode of heightened drama and sensationalism. A lot of it was very real but it was just too intense. I DID enjoy it though. I also used to like M*A*S*H*. I still watch medical shows today because it made people aware of what it’s like to be a doctor, or a doctor in training.

What inspires you to continuously educate yourself and want to learn more? Did you have a mentor?
I think I became a doctor because I wanted to matter to other people. I also think that perhaps childhood pain is the root of my deep desire for my life and my actions to matter.

For me, life is about evolving, learning and constantly getting better and better. I don’t think my motivation to learn can be attributed to any one person. I’ve had excellent teachers and mentors throughout my life, and I feel blessed to have had them, but I don’t think that I can ascribe sole mentorship to any one person.

I think the best way to live is to always improve one’s self. I’m hoping my children have learned that from Ann and me. I pray they will always strive for self-improvement in their lives. I think that the people who don’t try, who don’t aspire to progress, who choose to remain stagnant in their viewpoints—these people become trapped in the belief that they are always right, when in fact, they can be tragically wrong.

Symptoms to bring to your doctor photoOftentimes women accept minor gynecological or urinary symptoms as a normal part of being a woman. The truth is those minor symptoms may be indicative of a more serious condition.

It is important to take charge of one’s health, stay up to date on annual visits, and make sure to speak with a doctor about any concerns, no matter how minor they may be. By recognizing and disclosing these symptoms early, doctors may be able to diagnose and treat underlying pelvic or urinary conditions.

If a woman is unsure whether to call her doctor, here are some symptoms that may go unnoticed but can be cause for concern:

  • Urinary Incontinence – Leaking urine is commonly seen in women who have had multiple pregnancies, or who are advancing in the aging process. However, urinary incontinence is not something a woman should take lightly. Leaking any amount of urine while laughing, sneezing, coughing, or exercising can be a sign of several urinary conditions, including bladder prolapse. Don’t wait until an annual exam to bring this to a doctor’s attention. There are treatments and lifestyle changes one can make to minimize the symptoms of incontinence.
  • Unexplained Bleeding Bleeding that is not associated with a monthly cycle should be brought to a doctor’s attention immediately. While one shouldn’t stress about the worst case scenario, possible conditions that could cause the bleeding range from fibroids and cysts, to ectopic pregnancies, anemia, or even cancer.
  • Pelvic Pain – Any pelvic pain whether it is during sex, or any other time should be mentioned to a doctor. There could be underlying causes that may need to be examined further and/or treated such as a sexually transmitted disease, endometriosis, or uterine fibroids.
  • Changes Anything seem out of the range of normal, lately? A change in discharge, itching, visible bumps or bulges, or burning while peeing are definite reasons to call your gynecologist immediately. These unpleasant symptoms may be signs of vaginal infections, sexually transmitted diseases, urinary tract infections, or other vaginal conditions that require a doctor’s diagnosis and treatment.

At Cherokee Women’s Health, we are here for any concerns you may have about your gynecological health. Make an appointment at one of our two locations where our highly specialized doctors can diagnose and treat any worrisome symptoms.

Pelvic Organ Prolapse (POP) refers to the sagging or drooping of any pelvic organs due to damage, trauma, childbirth or injury.

The pelvic floor consists of a group of cradle-shaped muscles that hold pelvic organs in place. The pelvic organs include the uterus, bladder, cervix, vagina, rectum and intestines. Like any other part of the body, these muscles, with their surrounding tissues (fascia), can develop problems.

If you fill a small plastic bag with grocery items, say for instance, a box of cereal, a few cans of vegetables, some jars and a package of rice —the bag should hold the items with no problem. But if you hang that full bag on a wall hook and leave it suspended, you’ll start to notice the items in it begin to bulge against the membrane of the bag as it takes on the shape of its contents.

After a while, depending on how heavy the items are, the corner of the cereal box or rim of a can may start to bulge and even poke through as the bag stretches, weakens and eventually tears from the weight of the items in it. The groceries may even begin to protrude and dangle outside of the bag as the tears get larger.

Pelvic pain photoPelvic prolapse happens much the same way. As the muscles and tissues holding the pelvic organs weaken, degrade or tear, the pelvic organs slip or drop through, sometimes forming a small hanging internal bulge. At other times, depending on the damage, they may actually dangle externally from the vagina or anus, causing problems and inhibiting their function. This is called prolapse.

Who is at Risk for Pelvic Organ Prolapse?

One in three women suffer from POP. Any activity that puts undue pressure on the abdomen can cause pelvic floor disorders. Typically, labor and childbirth are the leading causes of prolapse, especially when a woman has had several children, a long, difficult labor, or has given birth to a larger child.
Pelvic organ prolapse becomes more common with age, usually around menopause when tissues damaged during a woman’s childbearing years begin to lose strength. Other causes are:

  • Obesity: Excess weight places increased pressure on the abdomen.
  • Pelvic organ cancers: Tumors can also put additional pressure on the abdomen.
  • Constipation: The bowel puts increased pressure on the vaginal wall when constipation is a chronic problem.
  • Uterus removal (hysterectomy): During surgery, there is always a possibility of inflicting damage on pelvic organ support, resulting in dislocation of any organ within the pelvis.
  • Smoking and respiratory problems: Excessive coughing, especially if chronic, can put extra strain on the abdomen.
  • Genetics: Pelvic connective tissue weakness may be hereditary. Often, if immediate female family members have suffered from prolapse, there is a greater possibility that you will too.
  • Heavy lifting: Excess abdominal pressure from heavy lifting may cause POP.
  • Diseases of the nervous system: There is a greater risk of developing pelvic organ prolapse for women who suffer from multiple sclerosis, spinal cord injury or muscular dystrophy.

What are the Symptoms of Pelvic Organ Prolapse?

It is entirely possible not to have any symptoms at all. Sometimes pelvic organ prolapse is only discovered during a routine gynecological examination. Minor symptoms are a feeling of annoying pressure of the uterus or other pelvic organs against the vaginal wall, minimal malfunction of those organs, and mild discomfort. Other symptoms are:

    • Painful intercourse
    • Vaginal bleeding or spotting
    • A sensation of pelvic pressure
    • Feeling as if something is falling out of the vaginal opening.
    • Bowel movement problems such as constipation.
    • Urinary problems such as needing to void frequently, especially if this interrupts sleep (overactive bladder) or involuntary urine release (incontinence).
    • Stretching or pulling sensations in the groin or pain in the lower back.

Symptoms may be aggravated by jumping, lifting or standing. Relief is usually found after lying down for a while.

When Should You See Your Doctor?

If you have increased sensations of pelvic pressure or pulling which is exacerbated by lifting or straining, but relieved when you lie down.

  • If sexual intercourse has become painful or difficult.
  • If lower back pain or pelvic pain interferes with daily living.
  • If you can feel a bulge inside your vagina or see one protruding.
  • If you have irregular spotting or bleeding.
  • If urinary problems have developed, such as leakage, an urgent need to void, or more frequent urination, including two or more times a night.
  • If you suddenly develop bowel movement problems.

Diagnosis

At times, pelvic organ prolapse may be hard to diagnose, especially if a patient does not complain of any symptoms. Patients might be aware there’s a problem but cannot actually pinpoint its location.After asking questions regarding symptoms, medical history, past pregnancies, and other health problems, your doctor will perform a physical examination. Then, if organ prolapse is suspected or discovered, the following additional tests may be ordered:

    • Urodynamics test: Results will indicate how your body stores and releases urine.
    • Intravenous Pyelogram (IPV): An x-ray that reveals position, size and shape of the bladder, kidneys, ureters and urethra.
    • Cystoscopy: This lets your doctor see the interior lining of your bladder and urethra.
    • Computed Tomography Scan (CT scan): X-rays showing details of interior pelvic area structures.

The doctor will then use a classification system to decide the organ prolapse level so he can best decide treatment options. Often, only simple non-invasive treatments and lifestyle changes are recommended for minor prolapse. If surgery is warranted, the following may be suggested:

  • Cystocele repair: Repair of the bladder
  • Urethrocele repair: Repair of the urethra
  • Hysterectomy: Removal of the uterus
  • Rectocele repair: Repair of the rectum
  • Enterocele repair: Repair of the small bowel
  • Vaginal vault suspension: Repair of the vaginal wall
  • Vaginal obliteration: Closure of the vagina.

What Can You Do?

  • Eat fiber: Try to get at least 20mg daily to prevent constipation. Regular elimination is essential to good pelvic health.
  • Kegel exercises: These strengthen and tighten pelvic floor muscles and can be done anywhere, any time—on the sly.
  • Maintain a healthy weight: Your abdominal muscles will thank you.
  • Avoid heavy lifting: If you have to grunt to lift, it’s too heavy.
  • Gentle exercise: Walking is great. Put on those sneakers and try to gradually work up to 20 minutes a day.
  • Drink plenty of water: Not gallons, but about 8 cups a day. This also helps with constipation.
  • Bowel training: Try to schedule bowel movements at the same time every day. It may take time, but eventually your body will cooperate.
  • Don’t smoke.

Pelvic prolapse often sounds worse than it is. For many women, there are hardly any symptoms. For those who DO suffer, there is help available, whether it is a simple lifestyle change, surgical repair, cosmetic enhancement or reconstruction.

If you have questions about your gynecological health or would like to consult with one of our pelvic reconstructive surgeons, please call 770.720.7733 or contact us here.

August 10, 2016

First Gynecology Appointment PhotoFirst Gynecology Appointment
At Cherokee Women’s Health, we understand the nerves a woman may experience when making a gynecology appointment, even for a routine annual examination. Our goal is to make patients feel as comfortable and assured as we can, beginning with their first appointment. To help prepare for an appointment, here are some expectations and answers to commonly asked questions about our practice and a routine gynecology examination.

Health History
Honesty is important when disclosing one’s health history. Doctors need to be aware of the past, so they can accurately care for a patient. Usual topics covered in a health history will include any medications currently being taken; sexual history; past pregnancies, surgeries, or treatments; and a familial history of cancer and other diseases.

Come with Questions
Don’t hesitate to bring up any concerns, no matter how trivial they may seem. It is best to be straightforward about symptoms, in the event that additional procedures need to be scheduled. Don’t leave our office with any questions unanswered! There is no need to be self-conscious about asking questions or discussing symptoms because our doctors have years of experience in their field. They discuss these topics daily with their patients.

What to Expect

  • A routine appointment lasts about an hour. Several exams take place during the appointment including a pelvic exam and a breast exam. Patients should also be prepared to provide a urine sample to test for pregnancy, and to catch any abnormalities in the sample that may indicate disorders or infections.
  • A pelvic examination is performed to ensure that both external and internal areas of the vagina are normal, including a pap smear which is used to test for cervical cancer. At a patient’s request, a culture can be ordered to screen for any sexually transmitted diseases. The pelvic exam can make patients uncomfortable, but it is important to relax during the process. Reproductive health is important!
  • A breast exam is completed to check for any lumps or irregularities in breast tissue. Based on family history of breast cancer, and your age, you may be referred for a mammogram which will screen for breast cancer.
  • An opportunity to ask questions is part of the appointment. Be proactive and mention anything that is concerning. Honesty is essential to providing the best personalized care to our patients.

What is Hymenoplasty?
Simply explained, hymenoplasty, also known as hymenorrhaphy, is the cosmetic repair, restoration, or construction of a woman’s hymen. Restoration of the hymen is also referred to as revirginization.

What is a Hymen?
In order to explain hymenoplasty surgery, a description, along with some information about the hymen might be beneficial.

The hymen consists of human tissue which resembles an oval rubber washer that partially or completely covers the vaginal opening. This ring-shaped membrane can be thin and flexible or thick and rigid. It begins to form while the female is still in the womb, usually beginning in about the fourth month of pregnancy.

Contrary to what many believe, except in rare cases, the hymen is NOT an impenetrable seal. If this were the case, there would be no portal for menstrual flow or healthy, normal vaginal discharge to leave the body.

Historical romance writers often describe the heroine in their bodice ripper books as having a Teflon hymen that causes her to wince or cry out painfully while in the throes of that first sexual encounter. Her lost virginity is also typically evidenced by vivid, crime scene-like blood splatter on pristine white sheets. However, in reality, that first rupture, regardless of the method, doesn’t always draw blood, and is not always painful.

Hymenoplasty photoLike the appendix, a hymen serves no real purpose. Yet, throughout history, this nondescript sheath of skin traditionally and very mistakenly has served as undeniable, positive proof of a woman’s purity and innocence. Even to this day, in many cultures, an intact hymen still indicates virginity, especially if there is the presence of blood upon first penile penetration.

Clinically speaking, however, a torn or damaged hymen is not irrefutable confirmation of virginity loss by sexual hanky panky. Depending on its rigidity, perforation of the hymen can be caused by normal everyday activities such as strenuous athletics, horseback or bicycle riding, a simple gynecological examination with speculum or gloved finger insertion or masturbation. Even placing a tampon into the vagina may rupture it.

In some cases, a hymen may not be present at all, as approximately 1 in 1,000 women are born without one.

What Are Some of the Reasons for Hymenoplasty?
Hymenoplasty is a cosmetic fix for women who may wish to repair or reconstruct their hymen. Their reasons for seeking this procedure are varied, and may be physical or psychological.

  • Reclaiming control: In the case of sexual assault, a woman is understandably left with traumatic psychological issues. She may feel that she was robbed of not only her innocence, but the opportunity to present the virginal gift of an intact hymen to the person of her choice. Hymenoplasty may not only offer the physical restoration she seeks, but may also supply some psychological comfort and healing as well.
  • Burying the past: Sexual curiosity and experimentation are a natural part of the growing process, especially during adolescence when hormonal changes and surges occur. Peer pressure may often compel a young girl to succumb to sexual activity before she’s mentally prepared for the emotional impact associated with such physical intimacy. As she matures, she may feel regretful that she indulged in that curiosity too early or too often, and may seek to bury evidence of what she might, in retrospect, view as promiscuity or bad judgment. Revirginization may psychologically allow her to turn back the clock and start over.
  • Cultural beliefs: Because the presence of an intact hymen is still important in many cultures, a woman may want to provide this indication of purity to her spouse for their upcoming nuptials.
  • A gift: Many women who have already been sexually active may wish to give their partner a virginal experience, whether it be as a surprise, for a special occasion, or on their wedding night.
  • Accidental rupture or tearing: For some women, penetration of the hymen via bicycle or horseback rides, slipping on ice, or tampon insertion is simply not acceptable and they opt for hymenoplasty to restore what was damaged unintentionally.
  • Enhancement of sexual pleasure: After childbirth, the vaginal muscles may weaken. Flaccidity also occurs over time with age. Hymenoplasty also tightens these muscles, giving the added benefit of a more sensually stimulating sexual experience.
  • Imperforate hymen: This is a condition where the entire vaginal opening is covered by the hymen. It is not usually discovered until a young girl enters into puberty and her menstrual flow is blocked. The hymenoplastic procedure to correct this is called hymenotomy, and a small hole is made in the membrane to allow blood flow.
  • Septate hymen: The hymenal tissue is split into what looks like rope-like bands. They resemble tonsils that are connected at both ends, and may impede tampon use or penile penetration. This is also corrected by hymenotomy. A septate hymen can also refer to a very thick or rigid hymen, like the almost bulletproof one of romantic lore mentioned earlier, and may require surgical penetration.
  • Microperforate hymen: This is similar to an imperforate hymen and is corrected in the same manner. A microperforate hymen has a small opening only adequate enough to permit menstrual flow. It does not usually present a problem or require enlargement unless a female wishes to use tampons.

What Happens During Hymenoplasty?
Hymenoplasty is usually a simple out-patient procedure that can be done in our clinic under local anesthesia. Any torn skin around the edges of the hymen is gently and neatly cut away, after which the remaining tissue is stitched together, leaving a small opening. This restores the hymenal ring to a normal size and shape.

If there is not enough skin to restore the hymen, or if a hymen is nonexistent, the surgeon may create one, using either some of the body’s own thin vaginal skin (vaginal mucosa) or a synthetic tissue. A small blood supply may be added, either artificial or the patient’s own taken from a piece of vaginal flap, thus simulating the traditional bleeding upon subsequent penetration.

What is the Recovery Time?
The surgery can be expected to take anywhere from one to two hours depending on the amount of repair needed. Though this is a clinical procedure with no hospital stay necessary, and women may return to work the next day, strenuous activity and heavy lifting should be avoided. During the first 48 to 72 hours, there may be some slight bleeding, but this is perfectly normal.

Full healing takes approximately six weeks. There will be no visible signs of surgery and it will be impossible to tell the difference between a natural hymen and a reconstructed one. At this time, the reconstruction process will be complete and all the sensations associated with virginal, first time sex may be experienced.

Complications
There are rarely complications. However, the doctor should be contacted if the patient experiences any of the following symptoms:

  • Dizziness
  • Pain beyond moderate discomfort after three days
  • Unusual or foul smelling discharge
  • Intense itching
  • Abnormal bleeding
  • Inflammation.

Depending on why you might request hymenoplasty, this may be a delicate subject to discuss. Rest assured that our doctors are familiar with the many reasons patients ask for this procedure, and fully understand your discomfort and shyness in regard to this subject. It’s your body. We want to help make you as comfortable and confident with it as possible.

To learn more about hymenoplasty or to schedule an an appointment with one of our doctors, please call 770.720.7733.

What is Clitoral Hood Reduction?
Clitoral hood reduction, also known as clitoral unhooding, clitoral hoodectomy, or clitoridotomy is a cosmetic surgical procedure which reduces the excess skin (prepuce) that covers the clitoris. The technique not only
enhances the visual appearance of a woman’s pubic area, but it also serves to improve sexual pleasure by making the clitoris more accessible. As the name implies, the clitoral hood conceals the clitoris nestled inside, similar to an uncircumcised penis where the foreskin sheathes the head in its non-erect state.

What is a Clitoris?
Before launching into a description of the surgery itself, it may be of interest to understand the function, location, and description of the female clitoris.

The clitoris is a woman’s primary and most complex erogenous zone. The head (glans) of this tiny body part is estimated to have more than eight thousand sensory nerve endings twice as many as the glans of a penis. Though its sensitivity and size can differ from female to female, it normally resembles a pea or small pearl. When aroused by oral or manual stimulation, the clitoris becomes engorged much the same way the male penis does, thus enabling a woman to achieve orgasm.

In order to more easily picture the location of the clitoris, simply imagine the nude frontal view of your pubic area. What you are looking at in your lower region is called the vulva. The cushioned ridge you feel beginning halfway down from your navel is the mons veneris. As you continue to move downwards, it separates into two cheek-like mounds that are separated by a vertical opening with lip-like tissue. Those lips are called the labia majora.

By gently pulling apart the labia majora, you will expose two more inner lip-like flaps of tissue on the left and right. These are labia minora. At the base of the labia minora, leading up to the anal opening, there is a small bony ridge called a perineum. At the upper tip of the labia minora, that small tube-like protrusion is the clitoral hood. Peeking out through, or hiding inside the opening of that hood is the tip of the clitoris.

The entire clitoris itself is about 4 inches long, but, as explained earlier, the head or glans, is small, roughly the size of an eraser on the end of a pencil, and it is extremely sensitive to touch.

Clitoral Hood Reduction photoWhy Would a Woman Need a Clitoral Hood Reduction?
Because the size, shape and thickness of the clitoral hood differs from woman to woman, this procedure is not always done for medical reasons alone. It can also be done for aesthetic purposes to give the vulva a neater, trimmer look.

In some cases, the clitoral hood may be extremely large, inhibiting access to the clitoris, thereby preventing the achievement of sexual gratification. A thick or large hood may also cause friction against clothing which can lead to soreness, redness or inflammation.

Often, a woman with an enlarged hood may also have large labial lips that protrude in a manner she may find unsightly. Both the clitoral hood and the labia, if quite prominent, can sometimes create obvious bulges that can be seen outlined against close-fitting outerwear. Women may opt to cosmetically correct prominent labia through a procedure called labiaplasty at the same time as they undergo a clitoral hood reduction.

What Can be Expected During and After the Procedure?
Clitoral hood reduction surgery is normally done as an outpatient procedure under local or general anesthesia. A specialized laser and surgical instruments remove a predetermined amount of superfluous hood tissue, insuring that accessibility and stimulation to the clitoris is no longer restricted. The clitoral head is not modified in any way. Only the hood is altered. At this time, if the patient so chooses, the surgeon may perform additional procedures to the genitalia, such as vaginal tightening, hymenoplasty or vaginoplasty.

Clitoral hood reduction is microsurgery. The procedure, after complete healing, will leave no scars. Tiny, barely visible incisions will be concealed in the folds of tissue around the surgical area.

There will be some numbness experienced after surgery, but this will subside. The numbness is in no way indicative of nerve or any other damage. In fact, after the effect wears off, sensitivity to the clitoris will be heightened due to easier access to it.

The entire procedure will take approximately an hour depending on what needs to be done.

Aftercare and Recovery
The area will be tender and inflamed, but rest and application of ice will help, along with over-the-counter pain relievers. After about two or three days, the patient will be able to return to work. Complete recovery will take approximately six weeks, and the patient will be cautioned not to engage in sexual intercourse during that time in order to avoid complications. Strenuous activities such as horseback or bicycle riding, running, and heavy lifting should also be avoided during this time. Special care to keep the area clean is important in order to avoid any possibility of infection.

What Are the Complications?
Complications are rare. However, your doctor should be contacted if there are any of the following problems:

  • Intense pain or discomfort
  • Inflammation or numbness after several days
  • Any foul odor or unusual discharge
  • Excessive bleeding.

Interesting Facts Regarding the Clitoris
The size and shape of the full clitoris was not revealed until 1998. Until that time, even though physicians knew of its existence, it was either eliminated from anatomy publications that previously mentioned it briefly, or it was ignored altogether. A 3D sonography image was not available until 2009. Throughout history, the importance of the clitoris to a woman’s sexual pleasure has either been disputed or dismissed altogether. In fact, in the 1500’s, the presence of the clitoris in women was used as irrefutable proof of witchcraft, and was referred to as the ‘devil’s teat’. Perhaps the clitoris snuggled deep within the camouflage of a thick clitoral hood back then saved many a woman from imminent death.

We’re Here to Help
Our highly qualified doctors are here to frankly and openly discuss whether this procedure is right for you. Genital surgery, whether for physical, aesthetic or psychological reasons, is an intimate and important decision. We are here to guide and advise you without judgement, bias or preconception. The more confident and comfortable a woman is with her body, the more pleasurable and satisfying her intimate life will be. We are here to provide the help and advice to make that happen.

To make an appointment with one of our doctors, call 770.720.7733.

August 5, 2016

Nutrition is an important part of pregnancy. It gives moms the opportunity to increase their intake of vitamins, minerals, and essential nutrients. This boosts their energy, helps their babies’ development, and can even improve some of the symptoms of pregnancy. But as important as what to eat when pregnant is a topic that’s decidedly less fun: what not to eat during pregnancy.

Foods to Avoid During Pregnancy

  • Raw meats. Raw or undercooked meat can carry all kinds of bacteria. Stay away from rare beef and poultry, sushi, uncooked hot dogs, and items that contain raw eggs, which may include salad dressings and sauces (be careful about Caesar salad dressing and aioli!), raw cookie dough, and desserts like tiramisu.
  • Other meats. Just because it’s cooked doesn’t mean that it’s safe. Expectant mothers should avoid eating deli meat, smoked seafood, fish containing mercury, refrigerated pate or meat spreads, and fresh meat that may have been exposed to pollutants.
  • Soft cheese. Some imported soft cheeses–including brie, feta, Camembert, and many Mexican quesos–are not made with pasteurized milk, which increases the risk of listeria. Love soft cheese? Read the label! If it was made with pasteurized milk, you’re free to satisfy your cravings.
  • Unpasteurized anything. Milk is the biggie, but moms-to-be should also avoid unpasteurized juices, especially ones bought from local farms.
  • Unwashed veggies. Vegetables provide essential nutrients for pregnant women and the babies they carry. Just make sure to wash them before digging in.
  • pregnant woman eating yogurtCaffeine. New studies show that small amounts of caffeine are okay later in pregnancy, but expectant mothers should keep a close eye on their caffeine intake. Try to avoid caffeine entirely during the first trimester. Consume no more than 200 mg per day later in your pregnancy, or you may increase your risk of miscarriage, premature birth, or low birth weight. (*Tips for pregnant women who consume caffeine: drink plenty of water, remember that decaf coffee contains caffeine, and look for hidden caffeine in protein bars, yogurt, and candy).
  • Alcohol. Most moms know not to drink alcohol during pregnancy, because it can lead to Fetal Alcohol Syndrome. But in today’s climate of “sure, that’s fine!” advice, it bears repeating: no matter what you see in the news, alcohol is a big no-no for moms-to-be.

Cherokee Women’s Health helps expectant mothers in Canton through the unique experience of pregnancy. For a personalized diet plan, advice on healthy eating and fitness during pregnancy, and other prenatal care, schedule an appointment with one of our certified physicians or midwives.

regnant Woman Eating Yogurt

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“Dr. Litrel was a fantastic doctor. I had my first exam with him, although at first I was skeptical about a male doctor for my GYN. But after I met him I’m glad I kept an open mind, and I couldn’t have dreamed up a better doctor. He cares about you as a person and not just a patient. The front desk ladies and nurses were very friendly and it’s a great office, very clean and not intimidating. I highly recommend Cherokee Women’s Health.”
– Vicki