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October 12, 2016

If your pregnancy has been defined as high risk, there is no need to panic. The truth is, all pregnancies on some level are high risk; to grow another human being inside your body is a significant event! A high risk pregnancy status is a precautionary determination to make sure that any pre-existing risk factors you have, along with any you may develop during your pregnancy, are monitored closely to ensure both your baby’s safety and yours.

Our obstetrics team has successfully delivered over 10,000 babies, many of those deemed high risk. We’re trained to detect and evaluate situations hazardous throughout gestation, and equipped with the technology to do so.

Most of all, our tenet is to treat every pregnant patient the way we would want our loved ones treated.

What Is Considered a High Risk Pregnancy?
There are many factors that can designate a pregnancy as high risk. Some medical, physical or genetic influences may predispose you to being susceptible to certain problems. These are:

    • High blood pressure
    • Being overweight or underweight
    • Diabetes
    • Cancer
    • High blood pressure
    • Heart, lung, or kidney disease
    • Epilepsy
    • Alcohol or illegal drug usage
    • Age (under 17 or over 35)
    • Multiple births
    • History of miscarriage
    • Family member or previous child with Down syndrome
    • Infections such as HIV, chicken pox, rubella, toxoplasmosis, hepatitis C, syphilis
    • Certain medications
    • Chronic health issues such a lupus, asthma, rheumatoid arthritis, heart valve abnormalities or sickle cell disease
    • History of preterm labor or preeclampsia.

What Can You Do For Me If I Have Any of These High Risk Pregnancy Markers?
The first step is to establish a trusting relationship with you, taking the time to answer all your questions and concerns.

In many cases, just a few lifestyle modifications can ensure a safe, healthy pregnancy. Some of these changes can be as simple as speaking to our diet and nutrition experts, who will counsel you on a food and supplement regimen appropriate for your specific needs. We may schedule more frequent prenatal visits so that we can carefully monitor your progress, taking immediate steps to treat whatever problems might occur.

high risk pregnancy photoYour blood pressure will be watched closely. Blood and urine tests will be taken during every prenatal visit, along with any physical examinations or scans that may be indicated.

Our high risk obstetric specialists will evaluate any medications you might be taking, making adjustments as necessary to protect you and your child. If you suffer from pre-existing chronic conditions, we will work with you to minimize any arising difficulties.

We may monitor your pregnancy more frequently with ultrasounds and fetal monitoring.

Finally, we screen for genetic abnormalities, providing information, counsel, and advice if required.

If My Pregnancy is Normal, With No Pre-Existing Conditions, Will it Stay That Way?
Usually, but not always. This is why prenatal care appointments are so important for both you and your baby. You can develop complications at any time, placing you into a high risk pregnancy category. Again, don’t become alarmed. Our specialists have combined decades of experience and training to deal with that if it happens, and the earlier we detect something, the better. Here are some of the things we look for:

  • Gestational diabetes mellitus (GDM or gestational diabetes): High blood sugar sometimes develops during pregnancy, causing headaches, depression, high blood pressure, hydramnios (increased amniotic sac fluid), and birth defects. It can also increase the danger of preeclampsia and premature labor. Babies can grow too large, resulting in a need for a caesarean, and they may suffer from jaundice and low blood sugar after birth. We screen for this between your 24th and 28th week- earlier if your history warrants it.
  • Preeclampsia: Preeclampsia causes persistent high blood pressure which can lead to organ damage and seizures, possibly requiring medication and/or early delivery. Routine urine testing at every prenatal visit can detect this, alerting us to rigidly monitor your progress.
  • Rh factor: Rh is an inherited protein found in some blood. If yours differs from your baby’s, difficulties may arise. We routinely test for this incompatibility to safeguard the well-being of the fetus.
  • Bleeding: Though not all bleeding is dangerous, if you’re deemed a high risk pregnancy, we follow up to make sure there is no jeopardy to you or your baby.
  • hCG: (human chorionic gonadotropin): This substance not only confirms pregnancy, but analyzing levels regularly can indicate if you are at high risk for ectopic pregnancy, possible miscarriage, or a Down syndrome baby.
  • Placenta previa: Sometimes the placenta covers the cervix, causing bleeding during delivery. Transvaginal ultrasound tests warn us beforehand if a caesarian is necessary.
  • Fetal problems: Our 4D ultrasound and other equipment can detect complications or abnormalities before they become a problem.
  • Premature labor: We can’t always predict if your baby will thumb its little nose at our calculated due date, but a previous history of early labor, a shortened cervix, or certain infections alert us to be vigilant of that possibility.
  • Placental abruption: When the placenta separates or peels away from the uterine wall, the situation may become detrimental to both mother and baby. We always look out for this and other potential dangers.

Our hospital partner, Northside Hospital Cherokee, opens its new facility in early 2017, continuing to handle a full range of services for our patients with high risk pregnancies. Since 1993, Cherokee Women’s Health has delivered more babies at Northside Hospital Cherokee than all other OB practices combined.

Whether yours is a routine or high risk pregnancy, our highly qualified, expert providers pride themselves on giving you the best individual prenatal care necessary to ensure a safe and healthy pregnancy.

For an appointment, call us at 770.720.7733.

October 4, 2016

Vegans can have healthy pregnancy without adding animal products to their diets.A healthy pregnancy requires that mothers-to-be eat foods rich in vitamins and minerals to help support their growing baby. One of the first prenatal appointments with an obstetrician will include a discussion about what foods to eat or avoid in order to provide optimal nutrition for fetal growth. The American Congress of Obstetricians and Gynecologists suggests that pregnant women eat a well-rounded diet which should consist of fruits and vegetables, whole grains, dairy, and meat. However, for those whose diets stray from the five food groups, such as vegans, or vegetarians, they simply need to find other foods or supplements that will provide adequate nutrition for themselves and their babies.

Veganism is a dietary lifestyle which completely abstains from the consumption of animal products. A vegan’s diet eliminates: eggs, meat, dairy, honey, etc. It is not imperative for a vegan mother-to-be to include these food items in her diet because a 100% plant-based diet can include all the required nutrition a mom and baby need. A fundamental step is making sure to find alternative sources for the all-important vitamins and minerals needed to foster healthy development and less pregnancy complications.

Iodine:

No matter her dietary lifestyle, iodine is one of the essential minerals that a pregnant woman must consume. Iodine is important for proper thyroid function, and critical during pregnancy for fetal neurological development. The recommendation for pregnant women is 220 micrograms of iodine a day. Even a small deficiency can have a major impact on fetal development, which is why sources of iodine need to be included in consumption. Due to its use in the milking process, dairy can often be a main source of iodine intake for women. Instead of dairy, a vegan mother can add iodine to her diet by taking iodine supplements, eating fortified foods, or using iodized table salt.

Iron:

Iron is a mineral often found in red meat. Iron deficiency anemia is a concern for pregnant vegans, unless they can find alternative sources for the mineral. The body requires at least 30 milligrams of iron daily during pregnancy to increase blood supply and foster a healthy fetus. In addition to possibly adding in iron supplements, pregnant vegans should be eating green leafy vegetables, whole grains, and dried beans daily to ensure necessary iron levels.

Calcium:

For vegans, sufficient calcium intake will be more tedious to acquire than simply drinking milk. 1,000 mg. are needed during pregnancy to help build healthy fetal bones and teeth. Vegans can turn to kale as a large source of calcium to add to their diet. Other top vegan calcium sources include: almonds, bok choy, turnip greens, or fortified foods such as soy milk, cereal or orange juice.

Vitamin B12:

When it comes to vitamins, one vitamin vital to pregnancy is Vitamin B12. Vegans do not naturally consume as much B12, because they abstain from eating animal products which are rich sources of the vitamin. Plant products do not contain a considerable amount of B12, but foods such as cereal are often fortified with the vitamin. Pregnant women are recommended to take 2.6 mcg. of B12 a day, and even slightly more when breastfeeding. B12 deficiency is life-threatening, so pregnant and breastfeeding vegans need to ensure that their levels are appropriate for pregnancy.

Vegan mothers should bring up any questions or concerns to their doctor when it comes to meeting the crucial vitamin and mineral intake during both pregnancy and breastfeeding. It is always recommended to not begin taking any additional vitamins or supplements without consulting a physician first. If a mom-to-be is struggling to reach these nutritional values, she may be put in touch with a nutritionist, who can assist in planning a suitable diet for the duration of pregnancy and breastfeeding. Having a baby changes everything; but moms don’t have to completely adjust their dietary lifestyles to keep themselves and their baby healthy.

 

A pap smear is a simple procedure which tests for abnormal cervical cells. The test is performed on an exam table and is generally a painless and quick procedure. The doctor uses a speculum to open the vagina so that a sampling brush can be guided in to gather cells from the cervix. This sampling brush is then sent to the lab for study and results will be communicated to the patient after the lab examination is complete.

Ask your doctor if it is time for you to get a pap smear.If abnormal cervical cells are present, follow-up testing using the DYSIS colposcopy technology can reveal whether the abnormality is related to Human Papillomavirus (HPV) or cervical cancer. Pap smears are a critical component of a well-woman’s health exam. In recent years, the American Congress of Obstetricians and Gynecologists created new guidelines for the time frame between each pap test. The new guidelines were instituted following research that revealed that yearly pap smears were no more likely to catch cervical cancer than tests performed every 3 years. Previously, the pap test was generally conducted at every annual well-woman examination, but currently ACOG suggests the following:

  • Women under 21 do not require a screening
  • Women aged 21-29 should have a pap smear every 3 years
  • Women ages 30-65 years should have a pap test and an HPV test completed every 5 years, or a pap smear every 3 years
  • Women aged 65 or older do not require testing if they have had three negative pap tests in a row

These are current guidelines, but they have proven controversial, and as new data emerges, it is likely these will be changed yet again. Many doctors are concerned that these guidelines are too liberal, and that cancers will be missed. It is important to note that well-woman visits are still just as important even though the pap test guidelines have changed. Women should still have an annual visit with their gynecologist for reproductive health and for any other concerns related to women’s health.

Prevention is key in cervical cancer screening.

Having a monogamous relationship, limiting the number of sexual partners, and using condoms are paramount to a woman’s health. Doctors advise that women receive the HPV vaccine, as well as pap tests, which will help to screen for any abnormalities and catch any precancerous cells (dysplasia) before they spread.  Women who are found to have cervical dysplasia can receive treatment to prevent the cells from turning into cancer. Usually, this is removal of the abnormal cells. If cervical cancer is found to be invasive, surgery, radiation therapy, and chemotherapy may be required to treat the cancer.

Cherokee Women’s Health uses cutting edge DYSIS technology to assist in diagnosing and treating cervical issues including dysplasia and cancer. With proper screening and prevention, cervical cancer diagnoses can continue to decrease.

pregnant womanThe third trimester begins in the 28th week of pregnancy and ends when your baby officially becomes a newborn. This is a bulkier, less comfortable time, but will soon be over. At the end of this trimester, the fetus will be 17 to 23 inches long, fully formed, and weigh anywhere from 6 to 10 pounds.

What Happens Now?
Some new symptoms may appear, and familiar ones may intensify. They might include:

  • Restless Leg syndrome (RLS) and leg cramps: These can occur at any time. RLS is common in about 15% of pregnant women. Support hose, moderate exercise, less caffeine, and more fluids during the day may alleviate discomfort.
  • Nasal congestion and snoring: Estrogen increases blood flow throughout the body, including nasal membranes. Nasal strips and saline drops often help. So can elevating the head during sleep. If snoring becomes intense, your obstetrician may want to rule out sleep apnea.
  • Abdominal aches: The fetus is becoming more active. Growth is accelerating, widening the uterus so that it presses against your bladder, diaphragm and other organs. Discomfort is usually minimal.
  • Fatigue: Finding a comfortable position in bed sometimes becomes difficult. It’s recommended that you not sleep on your back now, as the growing uterus can press on the main vein (vena cava) which pumps blood from your heart to the lower part of your body. Try sleeping on your left side, using pillows as props.
  • Insomnia and/or bad dreams: Anxiety and overactive hormones may rob you of rest. Moderate exercise, a warm bath, massage, cutting caffeine and lowering the bedroom temperature helps enable sleep.
  • Heartburn: Hormones and pressure from the uterus pushing the stomach upward can trigger indigestion. Consult your obstetrician before trying any remedies.
  • Stretch marks: These may become itchy and more prominent. A good moisturizer can help.
  • Varicose veins and hemorrhoids: Extra blood pumping through your body now can make these appear. Both usually diminish or disappear after birth.
  • Clumsiness: Rapid body shape and size changes can make you misjudge distances and bump into surroundings. Try moving slower. This minimizes injury both to yourself and the fetus.
  • Pregnancy fog and distraction: Forgetfulness and distraction are attributable to brain function changes during pregnancy. Research actually shows that women pregnant with females experience pregnancy fog more than those carrying males. This haziness disappears a month or two after birth. Until then, keep to-do lists on hand to jog your memory.
  • Lack of bladder control/ frequent urination: Extra weight and pressure on the pelvic floor can result in leakage and constant bathroom visits. Do your Kegels and wear panty liners.
  • Backache: A growing stomach pulls your center of gravity forward, triggering backache. Elevating your feet, a warm bath, and gentle massage can ease pain. If it’s intolerable, however, your doctor may want to rule out injuries like sciatica.
  • Breast leakage: Your body is preparing for breastfeeding. Nursing Pads aid in preventing staining.
  • Lightening: At about week 36, you might notice your shape changing. Your stomach will drop lower and you could start waddling. Your baby is changing position to prepare for birth. Your breathing will be easier, heartburn may diminish, but urination may become more frequent.
  • Mucus plug: A clear gelatinous plug may detach from the uterus weeks or immediately before labor. This means the cervix is softening and preparing for delivery.
  • Braxton Hicks: These irregular contractions are often mistaken for the real thing by first time moms. They can occur intermittently weeks before you actually go into labor.
  • Bloody show: Pink or brown tinged mucous indicates that you are effacing and dilating. Labor is close at hand, but it can still be several days to a few hours away. Blood should not be bright red or excessive though. Call your doctor if it is.
  • Water breaking: The amniotic sac has ruptured and labor is approaching. If steady contractions have not begun within 24 hours, labor might be induced to avoid infection.
  • Contractions: These are regular and stronger than Braxton Hicks and will not diminish. Your doctor will advise you as to how long to wait before leaving for the hospital.

What Precautions Can I Take During This Time?
You can continue to do exactly what you’ve been doing all along- take care of yourself and your baby. Eat well but watch your weight. Rest when necessary, but avoid becoming inactive. Moderate exercise will make your labor and delivery easier. Avoid strenuous activity or heavy lifting. If you are uneasy about anything or notice radical symptoms that worry you, consult your doctor.

Fetal Kick Counts
Your baby’s movement may provide information that help us care for you during this pregnancy. During a convenient hour each day, after eating and emptying your bladder, please lie down (on your side is best) and concentrate on your baby’s movement. Note each movement. Smoking may interfere with the movements and should be avoided during pregnancy. Count the number of movements for thirty minutes. Your baby should move at least five times in that thirty minutes. If your baby moves less than five times during that thirty minutes call your physician or go to the hospital.

Call your doctor if you experience: 

  • Decreased fetal movement
  • Rupture of membranes (water breaking)
  • Contractions every 2-5 minutes (more than five per hour)
  • Cramps in the lower abdomen with or without diarrhea
  • Low, dull backache felt below the waistline
  • Temperature over 100 degrees
  • Vaginal spotting or bleeding.

Helpful Hints: 

  • Be sure to drink at least 8-10 glasses of water every day (in addition to anything else you drink).
  • Eat small frequent meals to avoid heartburn.
  • Use Tylenol for minor aches and pains.
  • You may take warm baths or showers, place a heating pad on your back using low heat setting and rest with your feet elevated.

What Tests are Performed During the Third Trimester?
By this time, most precautionary tests have been completed, and only these regular routine tests are done during prenatal visits

  • Urine test
  • Blood pressure check
  • Fetal heartbeat check
  • Measuring of the uterus.

You could possibly require a pelvic exam to check that the cervix is changing the way it should, along with a test for group B streptococcus, a bacterium that approximately 30% of women can transfer to their babies during delivery. If results are positive, an antibiotic will be administered during labor.

Additional tests may be warranted, especially if:

  • You are having a multiple birth
  • Your baby is growing slowly
  • You have chronic problems
  • You are past your due date.

Each trimester has its own unique milestones, and our doctors have the knowledge and expertise to make sure that your pregnancy is progressing safely and well. For more information, visit Northside Hospital Cherokee. For an appointment, call our clinic at 770.720.7733.

Pregnant woman photoThe second trimester takes place from the 14th to the 27th week of a woman’s pregnancy. This is usually the most comfortable and pleasant time. Mercurial Jekyll/Hyde moods begin to balance out. You no longer sob uncontrollably over a run in your hose, or laugh maniacally when someone passes gas. Morning sickness is becoming a distant memory, and you can now start showing off that baby bump in all those maternity tops you’ve carefully selected. Even that sex drive that may have waned somewhat during the nausea, exhaustion and general malaise of your first trimester may return.

What Happens Next?
The egg (zygote) evolved from being the size of a pinhead into a recognizable little human being, first called an embryo and, after 8 weeks of gestation, a full-fledged fetus. New symptoms may occur, but generally, they are more tolerable than the previous three months. These may include:

  • Nightmares: Stress, hormonal change and anxiety can affect sleep, causing you to dream about outrageous, even horrible scenarios. Waking up in a cold sweat may happen more often.
  • Abdominal discomfort: Aches and pains caused by a stretching uterus and ligaments is normal. Excruciating pain, however, is not. Call your doctor if you experience anything other than moderate discomfort.
  • Quickening: This is the term given to feeling the fetus stir inside you. At about 16 to 20 weeks, you will feel a slight flutter. As the baby grows and takes up more room, movement is felt more distinctly.
  • Blips: An odd bubbling sensation that turns into a stronger methodical twitch as pregnancy continues is simply the fetus experiencing hiccups. Don’t worry. He or she is not having seizures. Your dinner probably just didn’t agree with it.
  • Breathlessness: The uterus can crowd the lungs as the fetus grows, disrupting smooth air flow. Unless you are gasping for air, some breathlessness is normal.
  • Body shape changes: The waist thickens, hips expand, your derriere can widen, and even your face may produce an extra temporary chin if you gain too much weight too quickly. By the end of the second trimester, you will have probably gained 16 to 22 pounds. Only two can be attributed to the baby. The rest is placenta, uterus, amniotic fluid, body fluid and blood. Your body also stores about 7 pounds of fat throughout pregnancy to prepare you for breastfeeding.
  • Stretch marks: Your tummy and thigh skin, elastic as it is, can only stretch so much at a rapid pace before the middle layer of skin (dermis) tears, exposing the deeper layers. Most of these marks diminish or disappear after birth.
  • Bleeding gums: Many women experience sensitive, bleeding gums due to hormonal changes. Use floss gently and get a softer toothbrush, but don’t skimp on your dental hygiene habits.
  • Heartburn, constipation and hemorrhoids: All are common. Smaller meals are recommended, along with more fiber and fluids. Try Sitz baths and speak to your doctor about an ointment or cream to relieve irritation.

What Precautions Can I Take During This Time?

  • Keep in shape with moderate, low impact exercise.
  • Eat healthy and keep junk food to a minimum. The more weight you gain, the harder your labor can be, and losing excess pounds afterwards may be difficult.
  • Avoid unnecessary medical procedures such as Botox injections, chemical peels etc. Even whitening your teeth or coloring your hair can be harmful.
  • Take no medications without speaking to your obstetrician.
  • Keep all your prenatal appointments. You will probably be seen once a month during this time, more often if problems are detected. It’s important to monitor your progress.

What Tests Are Performed During the Second Trimester?

  • Urine tests: These will be requested at every visit to monitor protein levels.
  • Maternal serum alpha-fetoprotein (MSAFP) and multiple marker screening (MMS): One or the other are offered for genetic screening and are optional. They are used to measure specific fetal protein output to determine if there is a possibility of Down syndrome or spina bifida. If positive, an ultrasound or amniocentesis is done for confirmation.
  • Sonogram: This non-invasive procedure can be done at any time during pregnancy, but is typically conducted at the end of the first trimester or during the second to confirm gender and due date. It can also reveal such conditions as placenta previa, cleft palate, and many other developmental or growth problems.
  • Glucose screening: This checks blood sugar levels for gestational diabetes. If readings are elevated, a glucose tolerance test may be ordered.
  • Fetal Doppler ultrasound: Sound waves determine if fetal blood flow is normal.

How Big is My Baby Now?
The fetus is about 14.5 inches long and weighs a little less than 2 pounds. It is about the size of a cantaloupe and is able to blink, sleep and wake up. The brain is very active and developing rapidly. Its maturing taste buds can now taste what you eat. Experts even believe dreaming is possible. Hearing is becoming more acute and sensitive eyes may react to light.

Each trimester has its own unique milestones, and our doctors have the knowledge and expertise to make sure that your pregnancy is progressing safely and well. For more information, visit Northside Hospital Cherokee. For an appointment, call our clinic at 770.720.7733.

ultrasoundCongratulations, you’re pregnant! If you’re already a parent, you know what to expect, but if this is your first child, pregnancy can be a mysterious, sometimes almost frightening process.

Today’s pregnancy tests are so precise, that they can detect the presence of human chorionic gonadotropin (Hcg) levels within days following fertilization. Immediately after a fertilized eggs attaches to the woman’s uterine wall, her body produces this hormone. A pregnancy strip can confirm conception has taken place by identifying Hcg presence in only a few drops of urine.

What Happens Next?
The average pregnancy lasts 280 days or 40 weeks, calculated from the first day of the woman’s last menstrual period. The first trimester covers week 1 to 12.

As soon as the fertilized egg (zygote) latches on to the uterine wall, both the umbilical cord and placenta begin to form. Hormonal changes rapidly begin taking place in your body. Often, early symptoms of pregnancy are mistaken for PMS. These symptoms and others include:

  • Spotting or bleeding
  • Fatigue
  • Dizziness (and possibly even fainting)
  • Aversion to certain foods
  • Queasiness or nausea
  • Headache
  • Cramps
  • Bloating
  • Moodiness
  • Backache
  • Breast tenderness
  • More frequent urination (micturition).

Can Anything be Done to Counteract These Symptoms?
When the egg implants itself into the uterine wall, spotting may occur, but it’s always wise to report any bleeding to your doctor to rule out the possibility of miscarriage, ectopic pregnancy or infection.

Additional progesterone can elevate blood pressure, dilate vessels, overheat the body, and force the heart to beat faster when sending blood to the uterus. All these changes can bring about fatigue, moodiness, dizziness and possible fainting.

Progesterone can also slow some body functions down, including digestion which causes nausea, vomiting, constipation, and indigestion. The body reacts by trying to purge what is upsetting it, resulting in morning sickness. Higher Hcg in the body, especially in a multiple pregnancy, can also trigger nausea.

It’s best to avoid foods that repel you during this stage. For intolerable nausea or vomiting, inquire about supplements or devices that can ease discomfort.

If you experience dizziness, move slowly, especially when you get up from sitting or lying down. Should faintness occur, sit down with your head between your knees. Rest when possible. Moderate headaches may be relieved with acetaminophen, but never without consulting your physician. If symptoms are excessive, speak to your doctor.

Cramps, bloating and backache can also be attributed to hormonal fluctuations. Frequent urination, even in this early stage, is usually the result of uterine growth and pressure against the bladder. Fluid intake should not be limited, as this is a normal occurrence.

Breast tenderness is also hormonal. The breasts are preparing themselves for the baby’s upcoming nutritional needs. Investing in a good support bra may help.

What precautions can I take during this time?

  • Don’t smoke, and avoid exposure to second hand smoke.
  • Don’t drink alcohol or use recreational drugs. Mention any prescription drugs you use to your doctor.
  • Avoid caffeine
  • Disclose any work hazards to your obstetrician, such as exposure to harmful chemicals, radiation, dangerous metals, toxic waste, etc.
  • Do not eat or handle raw meat. Wash all fruits and vegetables thoroughly.
  • Wear gloves while handling soil. If you own a cat, have someone else change the litter, and wash hands diligently after animal contact to avoid risk of toxoplasmosis which can harm your baby.
  • Discuss your diet with your doctor and make necessary recommended changes.
  • Take any vitamins, supplements and minerals your doctor prescribes regularly.

Is it Safe to Engage in Sex During the First Trimester?
Unless you have a specific medical condition of concern, it is safe to have sex.

How Big is My Baby in the First Trimester?
Between week four and twelve, your baby grows from the size of a tiny fig seed to roughly the length of that credit card you’re probably beginning to max out in happy anticipation. He or she is almost 3 inches long, weighing approximately one ounce and is about the size of a golf ball. Yet, by now, those tiny fingers have fingerprints. Organs are formed, functioning, and are visible through almost transparent skin. A heartbeat can be detected. The body is beginning to catch up with the head that still accounts for one third of body size. Reflexes are becoming sharper. The fetus can make sucking motions and respond to stimuli such as prodding. Eyes are close together on the face instead on either side of the head. Ears are forming and almost in position. The skeleton is made of cartilage that will gradually become bone. Gender is discernable.

What Tests Are Performed During the First Trimester?

  • Your blood will be will screened for type, count, RH factor, anemia, German measles (rubella), hepatitis B, HIV and other sexually transmitted diseases, along with exposure to diseases such as toxoplasmosis and varicella.
  • Other test will look for genetic problems such as sickle cell anemia, Tay- Sachs disease, cystic fibrosis, etc. A combination blood/ultrasound nuchal translucency for Down syndrome and other chromosomal abnormalities may be offered during the latter part of this trimester.
  • Glucose levels will be analyzed for signs of diabetes and urine checked for albumin which may indicate preeclampsia
    An ultrasound, usually near the end of the first trimester, will determine a due date, gender, and normal fetal progress.

Although your baby develops throughout your entire pregnancy, extra precaution during the first trimester when fetus growth is so accelerated is vital. Our doctors can guide you in all the ways possible to ensure both your health and that of your child. For more information, visit Northside Hospital Cherokee. For an appointment, call our clinic at 770.720.7733.

September 1, 2016

Vulvodynia is persistent, inexplicable pain anywhere in the vulva. The discomfort associated with this condition can be so severe that any sexual activity may be impossible. Even sitting can become intolerable.

Vestibulodynia (Vulvar vestibulitis syndrome or vestibulitis) is another condition which is very similar to Vulvodynia except that pain is situated at the entryway just outside the vagina inside the labia (vestibule).

Though it is not known exactly what causes Vulvodynia, doctors speculate that there may be several triggers:

  • Allergies or sensitive skin that can be easily irritated
  • Hormonal changes or hormonal contraception
  • Injures to the vulvar area’s surrounding nerves
  • Sexual abuse
  • A predisposition to yeast infections
  • Pelvic floor dysfunction
  • Past history of anxiety and/or depression
  • Muscle spasms
  • Frequent antibiotic use.

Vulvodynia has also been associated with several other chronic pain-related conditions, meaning that there is a higher likelihood of Vulvodynia if a woman has any of the following:

  • Interstitial cystitis: (An inflammatory condition that causes moderate to severe pain or pressure of the bladder and surrounding pelvic area).
  • Fibromyalgia: (A chronic disorder causing widespread muscular, joint and tendon pain).
  • Irritable bowel syndrome: (Recurrent abdominal pain, diarrhea and constipation).
  • Endometriosis: (A painful disorder where tissue that is similar to the kind growing in the lining of the uterus (endometrium) grows outside of the uterus instead).
  • Chronic fatigue syndrome: (An unexplained ailment with symptoms of fatigue, fever, tenderness and depression, usually following a virus).

In most cases, however, there is no absolute known cause, and the reasons for Vulvodynia remain a mystery. Investigation of this disorder is still in its medicinal infancy because it was previously thought to be a purely psychological issue.

What are the Symptoms?

  • Itching
  • Throbbing
  • Burning
  • Stinging
  • Painful intercourse (dyspareunia)
  • Soreness
  • Rawness
  • Redness
  • Irritation.

These symptoms can be sporadic or constant. They can last for weeks, months or even years. They may also appear suddenly, and disappear just as abruptly. This discomfort can be centralized in one area such as the vaginal opening, or spread throughout the entire vulvar zone. This area may appear swollen or irritated, but often looks completely normal.

Vulvodynia can seriously impact a woman both physically and mentally. Inability to engage in sexual activity may jeopardize relationships. Chronic pain can also lead to irritability, anxiety, sleeping difficulties, social withdrawal, and low self-esteem. Vulvodynia, and the negative emotions that ripple from the condition, can disrupt quality of life and eventually activate full-blown depression.

How Is Vulvodynia Diagnosed?
There is no actual test for vulvodynia. Diagnosis is made by ruling out any other possible ailments that might mimic the symptoms of this disorder, such as:

  • Skin conditions
  • Diabetes
  • Yeast or bacterial infections
  • Cervicitis or inflammation of the cervix
  • Endometriosis.

A medical history will need to be provided, especially past infections in the pelvic region. Any current drugs you are using, specifically hormonal replacement or contraception should be mentioned.

Female pain photoYou will be asked pertinent questions in order to determine the problem. A pelvic exam will be done, both internally and externally to see if there is a possibility of a present infection. Even if the genitals show no visual signs of any infection, a cell sample may be taken to rule out bacterial vaginosis or yeast infection. Finally, to check for vulvodynia, a swab that has been moistened will be used to gently dab at and probe the vulva and surrounding area to determine the exact locations of your pain.

What Happens if I Have Vulvodynia? Can I Be Helped?
Yes. There are several treatments that can minimize pain or discomfort:

  • Antihistamines can calm itching, steroids, anticonvulsants, and antidepressants can subdue chronic pain.
  • Numbing creams or ointments containing a local anesthetic applied before initiating sex may provide temporary help, but may also cause your partner to experience numbing upon physical contact with these creams.
  • Biofeedback therapy can train you to relax, in turn decreasing suffering. You can be taught how to control your body’s responses to vulvodynia symptoms. If the human body anticipates pain, it involuntary contracts to avoid it, causing the very pain it tries to ward off. In time, this pain becomes chronic. Biofeedback can help with this vicious circle, allowing the pelvic muscles to relax and minimize this innate tightening and the subsequent discomfort.
  • Nerve blocks that are injected can help with chronic pain.
  • Pelvic floor therapy reduces muscle tension in the pelvic floor muscles. These muscles are a support for the bladder, uterus and bowel, and relaxing them can provide vulvodynia relief.
  • Surgery that removes tissue and skin affected by vulvodynia or vestibulodynia (vestibulectomy) can effectively relieve pain in many women.

Is There Anything I Can Do At Home in the Way of Self-Help?
There are some simple measures you can take to decrease some of the uncomfortable symptoms:

  • Sitz bath soaking, which is sitting in cool or lukewarm water for 5 to 10 minutes two or three times a day can soothe symptoms.
  • Avoid those hot tubs and long soaks in scalding water. They contribute to discomfort and itching. Chlorine pools exacerbate the problem as well.
  • Save the control top pantyhose and sexy synthetic panties for special occasions. They restrict airflow to the genitals, causing the temperature down there to rise and trap moisture that can cause irritation. Try to find cotton substitutes that promote dryness through absorption, and that encourage healthy, necessary ventilation to the delicate genital area. If you’re comfortable with it, go ‘commando’ at night and skip underwear altogether.
  • Cold compresses placed directly on the affected area can help itching and pain—especially after sex.
  • Whenever possible, try to avoid any activity that may put pressure on your vulva, such as horseback riding or biking.
  • Treat your lady parts gently. Avoid douches. Wash the area with plain water using your hand, then lightly pat it dry. Avoid soap when possible. Even residue scented laundry detergent and fabric softener in clean towels or facecloths can irritate sensitive tissue. You might even wish to put on a natural emollient without additives or preservatives after washing. Petroleum jelly creates a soothing barrier.
  • If you’re able to tolerate intercourse, a lubricant can greatly help, preferably a water soluble one.
  • Antihistamines before bed can stop itching and provide a restful sleep.
  • Unscented white toilet paper can make a difference. So can tampons and sanitary napkins that don’t smell like they’ve been dragged through a perfume factory. Contraceptive creams and spermicides can also irritate vulvodynia.
  • Harsh, irritating urine caused by certain foods and drinks like citrus beverages, beans, nuts, chocolate, berries, etc. may cause burning upon voiding. Rinsing the vulvar area after urination with cool water helps.

It is important to note that vulvodynia is NOT a sexually transmitted disease. It is not contagious, and is in no way an indication of any kind of cancer.

There is no cure for vulvodynia, but different remedies can ease the symptoms for different women. It may take time to find the combination that works best for you, but our doctors will work with you to help provide a comfortable, better quality of life. To schedule an appointment, call 770.720.7733.

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.

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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