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June 17, 2016

baby and storkWhen you find out that you’re pregnant, your world dissolves into a various shades of joy, curiosity, and worry. There’s a lot to learn about pregnancy and labor, especially if it’s your first child. One way many moms sort through the madness is to create a birth plan.

Birth Plans – Remember, it’s Just a Guideline

A birth plan is a short (typically 1 page or less) document that communicates your desires for labor and delivery to your medical team. It lets expectant mothers sort through their preferences and clearly articulate what type of childbirth they’d like. It’s important to remember that a birth plan is only a guideline. Delivery rarely goes as expected, and your medical team may be forced to make decisions that go against your written plan for the health of you and your baby. But if you’re trying to make sense of all the information you’re learning about labor, a birth plan is a good place to start.

What to Include in Your Birth Plan

Write your preferences clearly and concisely. It’s best to discuss your medical questions and preferences with your obstetrician and your family before writing anything down. Clearly communicate your preferences with your medical team ahead of time, before labor pains become the top priority.

  • Family: Who would you like in the delivery room with you?
  • Labor coach: What expectations do you have of the nurse who will coach you through labor?
  • IV: IV’s are typically not necessary during labor, but some women need them to receive fluids and prevent dehydration, or to quickly administer medications during labor. If you want an epidural, you will need an IV.
  • Blood tests: Though typically only necessary for high-risk pregnancies, blood tests may be needed to ensure labor goes smoothly.
  • Inducing or augmenting labor: Know how you feel about starting or speeding up the delivery process.
  • Pain relief: From breathing exercises to epidurals, there are plenty of natural and medical pain relievers for moms during labor.
  • Delivery positions: Positions vary from sitting or semi-sitting to lying on your side or squatting.
  • Episiotomy: Making a cut to widen the vaginal opening is not necessary for all women, though it may be necessary during difficult labor.
  • Cutting the umbilical cord: Waiting several minutes to cut the cord may help your baby receive more blood supply. Some fathers like to get involved by cutting the umbilical cord.
  • Skin-to-skin contact: This can help create intimacy between mother and child or father and child.
  • Cesarean section: Whether you’ve scheduled a C-section or you’re simply planning for an emergency situation, consider what types of pain relief you’d like in the event of a Cesarean birth.
  • Breastfeeding: Beginning breastfeeding is often most effective in the 30 to 60 minutes after birth. Skin-to-skin contact stimulates your infant’s impulse to breastfeed, making it more likely to be a success.

To learn more about creating a realistic birth plan, talk to your obstetrician or midwife at your next appointment.


May 26, 2016

An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 1 of a 3 Part Series

One of your areas of specialty is Cosmetic Gynecology, especially vaginal rejuvenation. Can you expand a little on the subject of vaginal rejuvenation?
Originally, as female reconstructive surgeons, we would operate on the vagina or internal and external genitalia. We took care of medical issues such as bulges or weakness that prevented the organs from working properly.

Vaginal rejuvenation is a more recent elective surgery to enhance the visual appearance of a woman’s genitalia. Over the past twenty years, the field of Cosmetic Gynecology – especially vaginal rejuvenation – has become the fastest growing niche in plastic surgery. As the popularity increased, we began to see patients who’d been encouraged to undergo plastic surgery – from surgeons who don’t specialize in women’s pelvic anatomy. We’d find ourselves called in to correct whatever mistakes had been made in those procedures – but the problems were not always ‘fixable.’ It became obvious that the best thing we could do was to offer Cosmetic Gynecology ourselves, and at least insure that the women who came under our care could avoid the irreversible damage from inexpert surgery, and receive the benefits of surgery from Pelvic Reconstruction Specialists.

Apart from esthetic merits for visual genital distortions, or internal adjustments that restore tautness and sexual pleasure, what other conditions can be corrected, with these procedures?
When it comes to external cosmesis, which is surgery performed outside the body, we mostly treat conditions like elongated genitals or labia which may interfere with clitoral stimulation. It’s mostly anatomical—things are too long, getting in the way, disrupting sexual pleasure or causing orgasmic inability.

Vaginal surgery consists mostly of correcting “bulges,” be they bladder, rectal or intestinal bulging. We increase the caliber of the vagina to allow for better sexual sensation. Since the vagina leads to the internal sexual reproductive organs, if there’s pain or bleeding or scar tissue, lots of times those things have to be corrected surgically as well.

Sexual interest and gratification often diminish over time, due to a number of reasons such as lack of lubrication, the loosening of vaginal tissue and muscle, etc. Can pelvic reconstruction or vaginal rejuvenation give women a renewed sense of sexuality and confidence—and if so – how?
I think it’s a very individual thing. I’ve taken care of thousands of women and sexuality issues can vary. They can come from anatomical differences between partners, hormonal issues– even lack of awareness of proper technique. The list is endless, so I’m not going to say “have surgery and it will fix everything.” I’ve seen the full range of what causes problems, and I deal with them all on an individual basis.

As an example, I saw a patient recently who came from a neighboring state. After asking questions about the pain she was experiencing, I examined her and found there was nothing physically wrong with her. After speaking with her, I was able to pinpoint that the real problem stemmed from sexual abuse. I’m able to treat the anatomical problems, but a lot of these complaints simply must be addressed through counselling. I certainly wouldn’t recommend surgery in her case, but would guide her to other venues of help. It’s a complicated subject and doesn’t really have one answer.

Are the benefits of pelvic reconstruction and vaginal rejuvenation permanent, or does time eventually cause the original problems to recur?
I’ve seen patients I’ve operated on 10 years ago, and they’re doing great. For a lot of anatomical problems, if we fix them and they don’t suffer damage, they stay fixed. For instance, if a woman has a normal sex life and doesn’t have a baby, she probably won’t need surgery, and then, if it’s a cosmetic thing, such as labial elongation (hypertrophy), then once you fix that, it’s not going to grow back. It’s not common to have to re-operate.

For the cosmetic parts, however, sometimes you have to perform a few nips and tucks six months or a year later. But typically, that’s not necessary either. As for the tightening operations, once you do it, you’re done.

Many people might describe the procedures we’ve covered as “frivolous,” “unnecessary,” “a waste of money,” etc. Their assumption might be that you need to accept yourself “the way you are.” Can you describe the positive physical and psychological impact these procedures have had on some of your patients during your extensive career?
Fifteen or twenty years ago, I probably would have said the same thing. I remember I was very much against breast implants at one time, but over years of practicing, I noticed that women with these implants not only looked better, but felt wonderful about themselves. We all want to feel good about ourselves.

Now, in the field of Cosmetic Gynecology, with procedures such as vaginoplasty or, labiaplasty, the reason we, as female reconstructive surgeons are in this field, is because we know we’re the best at fixing it and we know that it’s not just about cosmetic surgery. It’s functional as well. Unlike a breast implant, face lift, or even a tummy tuck, none of which really have a function, internal and external genitalia are functional. Whether it’s sex, urination or defecation, there’s a biological function that’s dependent on the correct anatomical restoration of a woman’s body. So in terms of ‘frivolous,’ well, if you’re fixing a bulge here or there because a woman’s bladder is dropping or leaking, or you’re fixing the rectum bulging out, you can also do a tightening operation because the patient desires it for their sex life. I don’t think a good sex life is frivolous. I think it’s an important part of a relationship and it’s an important part of the way a woman feels about herself.

Real Self PicThe word ‘surgery’ can be frightening and intimidating. It usually sparks the fear of pain, long convalescence, operative and postoperative complications, etc. On average, what is the recovery period for most of your procedures?
Typically – because we do less invasive surgery with laparoscopes and robots – one to three weeks. Certainly some healing processes can go on for three months, but after one to two weeks, people generally feel pretty good.

At one time, the standard treatment for conditions related to pelvic prolapse was a hysterectomy. It’s now possible to treat Pelvic Floor Disorders with pelvic reconstructive surgery. How has the specialty of pelvic surgery changed since you began? What conditions are fixable that women forty years ago would just suffer with?
Nowadays, the biggest changes have been the minimally invasive laparoscopic surgeries. We can visualize things better. We can access things and also repair things less invasively. Additionally, surgery is less risky than it used to be—better antibiotics, smaller holes. Tumors and organs can be removed with much tinier incisions. We do a lot more uterine saving surgery as opposed to hysterectomies nowadays.

What diseases, conditions or illnesses prevent a person from being a suitable candidate for pelvic reconstruction or gynecology cosmetics?
We have office procedures so that we can make things look better and work better without doing any surgery. If someone is sick with underlying medical problems, I don’t think they’ll be presenting with issues of vaginal laxity or problems of cosmetic appearance. They have bigger issues such as being unable to breathe, walk, etc. Typically I don’t see patients whose medical problems prevent them from having surgery. We can do more minimally invasive things for patients today.

I had a patient recently from North Carolina who was convinced I would have to perform countless surgeries. As it happened, all I had to do was a ThermiVa, a procedure which is a low frequency energy treatment we deliver in the office. It requires (3) thirty minutes treatments over a period of three months. I also have an 82 year old patient suffering from diabetes, and I’m still able to do something to help her.

Other than natural processes in the body such as aging, giving birth, etc., can your procedures repair such things as birth defects, accidental injuries, or physical trauma—and can these things be corrected even years after the damage has occurred, or is time of the essence?
Birth defects occur during birth and we certainly have to perform reconstruction because of that. This is not done in childhood, but when the person is diagnosed as an adult. If you’re referring to something like an anatomical variance, for instance, something like size and shape, or a congenital problem such as not having a uterus, vaginal septums, having two uteruses, or a hymen that doesn’t allow blood flow, typically, we do not address these issues until a woman is older. In fact, we may not become aware of them much before 15 years of age.

Defects can also happen during such occurrences as miscarriages. Typically, injury is not common. Unlike breaking an arm or something like that, the uterus and a woman’s genitals are very well protected, because they’re in the midline of the body and the center of gravity. So if injury does occur, it’s usually quite easy to repair.

To prevent such problems as infections, flaccidity, sexual discomfort, or sexual disinterest, what can women do to maintain personal gynecological health, other than general cleanliness, yearly pap smears and Kegel exercises?
I think that probably the most important thing that women can do is limit their number of sexual partners and just be sexually active with people that are faithful to them, love them and want the best for them. I think multiple partners are the number one cause of the problems that women have. If you marry someone, and have a good sexual monogamous relationship with them, it would solve most of the problems we see.

I have a 22 year old patient who is beautiful. She’s had several sexual partners. I did cosmetic surgery on her and some tightening, but she hates herself because of things her partner said to her regarding her genital appearance. Had she waited for the right, committed partner, he most likely would not have said anything and accepted her the way she is.

Many physical issues also come with a related psychological issue such as fear, shame, religious inhibition, etc. As a women’s health specialist, how do you personally deal with the psychological deterrents to put your patients at ease?
I think we’re all a little inhibited. It’s just part of being a person. Inhibitions tend to disappear when you’re in the process of having a baby come out of your body. Nothing will stop you from pushing out that baby. My specialty is OB/GYN, and my subspecialty is reconstructive surgery, so I’ve delivered thousands of babies, and women are generally comfortable with that. Many of my patients have gone through a lot, and I’ve gotten very close to them, but I think that’s only due to good communication. People want someone to help them, and if you let them know it’s okay to feel a certain way, then it’s okay to feel and express the pain, etc. They just need to be nurtured in such a way that we can open up the lines of communication.

May 24, 2016

incontinence photoOveractive Bladder Syndrome, also referred to as OAB, is an uncontrollable need to urinate, often at the worst possible times.

For most of us, when the bladder fills to about half its capacity, the urge to void is triggered. Much like a snooze button on an alarm clock that lets us sleep awhile longer, we can hold off until we’re closer to a bathroom, or the timing is more convenient.

Not so for OAB sufferers. Their urgency is more like the constant demand of a malfunctioning alarm clock without that button—intense, shrill and non-stop until it’s turned off. OAB sufferers feel more like their bladders are overflowing. They don’t have the luxury of waiting, needing relief immediately. If they’re unable to void right away, leakage may occur.

OAB is unbiased. Whether you’re at work or play, it disrupts concentration, performance and pleasure, negatively impacting your life. In time, those afflicted with OAB may become depressed, withdrawing socially.

What Causes Overactive Bladder?

No one really knows, but it’s believed that involuntary contractions of the detrusor muscle in the bladder transmits false messages to the brain.


  • A sudden, inconvenient urgency to urinate that is difficult to control: Just as your child is about to blow out those birthday candles or receive that diploma, you suddenly you have to run, not walk, to the nearest toilet.
  • Frequent urination (more than 8 times daily): Your bladder seems to control your life. You need to know where every bathroom is located when you go out. Maybe you even carry a change of clothing, “just in case”.
  • Voiding two or more times nightly, disrupting sleep (nocturia): You awaken during a delectable dream or restful sleep more than once to urinate.
  • Involuntary, uncontrolled leakage (see also urge incontinence): You can usually hold it in, but just barely, and sometimes experience embarrassing drips.

Contributing factors

  • Overweight or obesity
  • Stress
  • Drinking large amounts of caffeine, alcohol and other liquids
  • Nerve related conditions such as Parkinson’s, Dementia, Diabetes, spinal cord injuries, Multiple Sclerosis, and strokes.
  • Chronic pelvic pain
  • Limited mobility (being unable to move freely or quickly)
  • Some medications

Age may contribute to, but does not always cause Overactive Bladder Syndrome. Never assume you’re doomed to live with OAB based on the number of years you’ve roamed the earth. Speak to your gynecologist. Don’t be ashamed. They’ve heard it before—often. They can help.


You will need to provide your doctor with your medical history, including all drugs, vitamins and supplements you are taking. A physical examination will also be necessary.
Sometimes, a urine culture, ultrasound, and neurological tests may be needed to rule out any sensory or reflex problems. If necessary, you might need more extensive analysis such as:

  • Urodynamic testing (studying bladder, sphincter and urethra performance; measuring urine flow, bladder pressure, and residual urine left after voiding)
  • Cystocopy (using a scope to study the bladder and urinary tract).

You may be asked to keep a journal that includes information like fluid intake, urinary outflow, any leakage, and a time chart of bathroom visits to assess your condition more accurately.

Treatment options

  • In milder cases, your doctor may recommend the following:
  • Drink less: Fluid is vital to the body, preventing dehydration and maintaining proper kidney function, but too much can exacerbate OAB symptoms. Try to cut back on diuretic beverages such as coffee, tea and alcohol, limiting yourself to eight cups of water daily. Avoid liquids too close to bedtime so you can finish those happy dreams.
  • Use liners or pads: Annoying, we know, but they help with trickles, stains and odor.
  • Lose a little weight: It’s not easy, but it can make a difference. Extra weight increases pressure on the pelvic muscles, causing more urination.
  • Teach your bladder who’s boss: Bladder re-education is a method that trains you to urinate at certain times, eventually allowing more time between bathroom visits. Your doctor can guide you, teaching your bladder to obey you–not the other way around.
  • Kegel exercises and biofeedback: Kegels strengthen pelvic floor muscles. Recommended biofeedback devices can help you pinpoint those muscles. Kegels can be done anywhere, are painless, sweat-free, and can be beneficial for OAB.
  • Double void: Sometimes trying to urinate again shortly after the first void may coax some shyer little droplets to make an appearance.

Medications and Treatments

Other treatments may include:

  • Prescribed Medication (Antimuscarinics, anticholinergics)
  • Gentle electrical stimulation (ThermiVa)
  • Bladder Injections ( botulinum toxin A)
  • Vaginal weight training

For more resistant cases, surgery, bladder augmentation, or the use of catheters may be necessary.

Overactive bladder does not have to isolate you. Help is available. Speaking to your doctor is always the first step to overcoming the problems associated with this syndrome, restoring your confidence, happiness, and quality of life.

May 18, 2016

By James Haley, MD, FACOG, FPMRS

Vaginal rejuvenation can help improve a woman's pelvic health.It’s never too late for vaginal rejuvenation. Women should not have to feel insecure about the appearance and feel of their vagina. Yet, many women suffer in silence with embarrassing symptoms such as vaginal looseness because they accept it as part of the natural aging process. In addition to vaginal laxity, decreased sexual sensation with sexual intercourse can put undue strain on a woman’s self-confidence with intimacy. The causes of these uncomfortable symptoms result from damage sustained during childbirth, alongside the effects of aging. Through vaginal rejuvenation surgery, women can regain a positive self-image and a better sense of intimacy.

What is Vaginal Rejuvenation?
Cherokee Women’s Health serves the Atlanta Metro and offers two types of Vaginal Rejuvenation surgeries. Vaginoplasty and labiaplasty are two genital rejuvenation procedures that can improve vulvar tone, vaginal laxity, and vaginal looseness. Both Vaginoplasty and Labiaplasty can be performed in an hour and have full recovery times between 6-8 weeks. Women may choose to have both procedures performed together, or choose the surgery that will offer them the benefits they are seeking.

Vaginoplasty – This procedure is a tightening and rejuvenation of the vagina. The purpose is to reduce the opening of the vagina and tighten the vaginal canal that may have widened after childbirth. Benefits of the procedure can lead to a more satisying sex life. A 60 minute surgery, vaginoplasty can be performed with general or local anesthetic in a hospital setting, or in the office.

Labiaplasty – This genital rejuvenation procedure reduces the size of, or reshapes the labia minora, or labia majora. This process can help decrease the pain and discomfort of enlarged labia, or correct an irregularity of the labia. It improves the aesthetics and appearance of the external tissues and produces optimal vulvar tone. Labiaplasty also takes approximately 60 minutes to perform. Sedative options include general or local anesthesia.

Dr. Haley photo

Vaginal Rejuvenation Surgeons in Atlanta
Because vaginoplasty and labiaplasty require precise skill in the highly specialized field of vaginal surgery, it is important to seek out a surgeon with experience in this area. At Cherokee Women’s Health, board certified doctors who specialize in Female Pelvic Medicine and Reconstructive Surgery understand a woman’s needs when it comes to entrusting a doctor with her vaginal health and appearance. They offer expertise in the field of pelvic medicine because they have years of practice in the understanding vaginal anatomy and routinely perform these surgeries. More than a cosmetic procedure, our doctors consider all facets of pelvic medicine when performing surgery, leading to optimal results and satisfied patients.

With offices located in Canton and Woodstock, Cherokee Women’s Health is ready to answer all your questions about vaginal rejuvenation. Take the next step and call to make an appointment to discuss surgical options. Restore feeling, function, appearance, and find yourself more confident about your body with vaginal rejuvenation.

May 17, 2016

woman with incontinence photoOne in five women endures the symptoms of Urinary Incontinence. Yet often, a suffering woman does not acknowledge it as an issue. She may be self-conscious about mentioning the condition to her doctor, or she may assume it’s a normal part of being a woman. Two of the most commonly accepted situations are incontinence after pregnancy and incontinence during exercise.

The truth is, although urinary incontinence is common, it is not considered normal. Needing to urinate frequently, as well as urinary urgency, are signs that one may be dealing with Urinary Incontinence. Fortunately, for a woman experiencing these symptoms, she can find both surgical and non-surgical options in treatment to minimize or even eliminate these symptoms permanently.

What is Urinary Incontinence?
Weakening of the pelvic floor can affect bladder control and urethra function, causing issues with urination. Women suffering from Urinary Incontinence find themselves running to the bathroom frequently. Strong urges to use the restroom, even after urinating, is another sign that a woman may be dealing with Urinary Incontinence. It is important to not brush off the occasional leak experienced while exercising or shifting position, because there are treatments available for women dealing with Urinary Incontinence.

One important step in the diagnosis process is identifying the type of Urinary Incontinence, in order to find the best treatment option.

  • Stress Incontinence
    This type of incontinence occurs when urine leaks out of the bladder during certain strenuous activities. Jogging or other exercising can cause urine leakage. Coughing and laughing can also bring on an unexpected leak. More severe symptoms of Stress Incontinence may include urine leakage during low stress activities such as changing position or walking. Many pregnant women can experience Stress Incontinence as the growing uterus puts pressure on their relaxed pelvic floor and the organs shift to make room for baby. Sometimes the symptoms are dismissed as an annoying pregnancy symptom, but if they do not subside after delivery, they may need medical assistance to prevent symptoms from worsening.
  • Urge Incontinence
    Commonly referred to as Overactive Bladder, or OAB, Urge Incontinence is a continued sensation of needing to urinate. This sensation is often an overwhelming, powerful urge which sends women dodging for the nearest restroom. Urge Incontinence is different from Stress Incontinence in that it occurs suddenly, without pressure on the bladder from strenuous activity. In addition to strong urges to urinate, women with Urge Incontinence may find themselves waking up at night to use the restroom, interfering with a full night’s rest. Sometimes, there may be an underlying condition that is causing the undeniable urges to urinate. An honest discussion about symptoms with a doctor can help them determine any underlying conditions so they can better treat you.

Preventing Urinary Incontinence:
Many situations can result in Urinary Incontinence. There are some factors that do make a woman more prone to the condition, including pregnancy and childbirth. Women who want to lessen the chance of experiencing Urinary Incontinence can follow the advice below:

  • Quit smoking- those who smoke are at a greater risk of developing Urinary Incontinence.
  • Maintain a normal weight-carrying excess weight can cause more problematic symptoms because of the pressure on the pelvic floor.
  • Exercise- regular exercise improves body function. Exercising the pelvic floor as well can keep symptoms at bay.
  • Regular Bowel Movements- pressure from waste can put unnecessary pressure on the organs of the pelvic floor. Women can lessen symptoms by maintaining regular bowel movements.

Leaky Bladder Remedies:
Don’t be ashamed or embarrassed to mention your symptoms to your doctor. Treatment options will be chosen based on the severity of the symptoms but can include:

  • Changes to diet and fitness lifestyle
  • Physical Therapy
  • Medications
  • Minimally-invasive surgical procedures

Don’t accept the meddlesome symptoms of Urinary Incontinence as part of your life. Seek out the advice of one of our specialists in Urogynecology, and discuss treatments options today.

The birth of a child is a time of joy and excitement, but for many new moms, it can also be a time of anxiety, stress, and inexplicable sadness. Postpartum mood disorders affect 10-15% of all new mothers. Postpartum depression can develop in the weeks after birth, and some begin women showing signs as late as 6 months post-labor. If you’re experiencing symptoms of postpartum depression, it’s important to realize that your feelings are valid. Reach out to get the help you need for the sake of you and your baby.

depressed woman pic

Signs You May Be Suffering Postpartum Depression

The postpartum blues, or “baby blues,” are feelings of stress, depression, anxiety, and frustration that many mothers experience in the days after childbirth. The baby blues rarely last longer than 1-2 weeks, and don’t require medical treatment. Postpartum depression, however, is a more serious condition that usually requires medical care. Signs of postpartum depression include:

  • Difficulty bonding with your newborn
  • Feeling overwhelmed by the responsibilities of motherhood
  • Withdrawing from your spouse, family members, and friends
  • Guilt about your shortcomings as a mother or feelings of shame and worthlessness
  • Loss of appetite or increased eating habits
  • Difficulty sleeping or sleeping too much
  • Fatigue and loss of energy
  • Feeling numb or disconnected from the world around you
  • Inability to enjoy activities you used to love
  • Cloudy thoughts and an inability to concentrate
  • Anxiety and/or panic attacks
  • Mood swings
  • Feelings of depression or suicidal thoughts
  • Thoughts of harming yourself or your baby
  • Fear that if you reach out, your baby will be taken away

Every mother experiences postnatal depression differently. Some women may have each of these symptoms at one point or another, while other mothers may experience only a few. If your symptoms last longer than two weeks or become a barrier to living life normally, don’t hesitate to contact your doctor. If you have thoughts of suicide or of harming yourself or your baby, seek immediate assistance.

If you think you may be experiencing postpartum depression, there is hope. Postnatal depression and anxiety are both temporary and treatable. Call Cherokee Women’s Health to schedule an appointment today.

Postpartum Depression

May 10, 2016
Zika Virus pregnant woman photo

The recent Zika virus outbreak is frightening, especially for expectant mothers. Though the virus itself has mild symptoms, the transmission of the virus from mother to fetus is linked to birth defects in infants. Carried by Aedes mosquitoes, it can also be transmitted by sexual contact.

Protect Yourself from Zika
No vaccine exists for Zika, but by taking precautions, you can minimize your risk of contracting the virus. The Centers for Disease Control and Prevention is urging pregnant women and their partners to take strong precautions against mosquito bites.

What Bug Repellent Is Safe to Use When You’re Pregnant?
No repellent is right every time, and no repellent is 100% effective. The Environmental Working Group (EWG), which specializes in research on toxic chemicals, has published a complete guide to Bug Repellents in the Age of Zika.

Check out EWG’s Guide to the safest BUG Repellents

Avoid Travel to Certain Areas
The Zika virus has not spread to most of the US; however, all known cases of Zika in the United States are due to travel. The CDC recommends that pregnant women avoid travel, especially to areas with known outbreaks of the Zika virus. If you’re trying to get pregnant, both you and your partner should avoid travel.

If you have recently traveled, schedule a visit with your OB-GYN. Your healthcare provider can test for the virus, even if you’re not symptomatic. The Zika virus stays in the blood for about a week, and in semen for slightly longer.  Based on current information, Zika causes no risk to future pregnancies once it has run its course.

Zika Safety
The CDC recommends special precautions for the following groups:

  • Women who are pregnant: Check the CDC recommendations for travel to specific areas such as: Cape Verde, Mexico, The Caribbean, Central America, The Pacific Islands and South America.
  • Women who are trying to become pregnant: Before you or your male partner travel, talk to your doctor about your plans to become pregnant and the risk of Zika virus infection.
  • You and your male partner should strictly follow steps to prevent mosquito bites during your trip.
  • If you have a male partner who lives in or has traveled to certain areas, either use condoms or do not have sex (vaginal, anal, or oral) during your pregnancy.
  • See CDC guidance for how long you should wait to get pregnant after traveling to specific areas.
  • Men who have traveled to an area with Zika and have a pregnant partner should use condoms or not have sex (vaginal, anal, or oral) during the pregnancy.

Symptoms of Zika Virus
The symptoms of the virus are fairly mild in adults, typically only lasting a few days, but can cause developmental defects in infants. Symptoms include:

  • Fever
  • Rash
  • Joint Pain
  • Red eyes
  • Muscle pain
  • Headache

Contact your doctor immediately if you may have come in contact with the Zika virus.

At Cherokee Women’s Health, we’re dedicated to keeping you and your baby healthy throughout your pregnancy. Please contact our offices if you think you may have been exposed to the Zika virus.

May 5, 2016

Because preeclampsia only affects women during pregnancy and the postpartum period, many first time mothers are unaware of the effects and symptoms of preeclampsia. Proper prenatal care with a certified obstetrician or CNM is typically enough to catch the early signs of preeclampsia; however, new mothers should be aware of the symptoms and notify their doctor about any changes in their health. 

What Is Preeclampsia?

Preeclampsia is pregnancy induced hypertension that affects mothers and infants during late pregnancy. Symptoms typically develop after week 20, and can show up as late as 6 weeks postpartum. Researchers have yet to isolate the cause of preeclampsia, but the disorder affects 5-8% of all pregnancies. Preeclampsia is most common in first time mothers. It is one of the leading causes of illness and death in mothers and infants, but identifying the problem in its early stages allows for the best possible outcome.

Recognizing the Problemfotolia_104899014

Although some women show few symptoms of pregnancy induced hypertension, preeclampsia is typically characterized by high blood pressure and protein in the urine. Your obstetrician will monitor your pregnancy for signs of preeclampsia, but it’s important to tell your physician if you’re experiencing any symptoms.

Symptoms of preeclampsia may include:

  • Swelling
  • Sudden weight gain
  • Stomach or shoulder pain
  • Lower back pain
  • Headaches
  • Changes in vision
  • Anxiety
  • Shortness of breath
  • Nausea or Vomiting

Preeclampsia develops rapidly, so it’s important to notify your doctor as soon as you experience symptoms. But with early detection and proper care, your physician can provide the best possible outcome for you and your baby.

To learn more about preeclampsia or to schedule a prenatal appointment with a certified OB or CNM, contact Cherokee Women’s Health in Canton.

Blood Pressure Test

labiaplasty-womanLabiaplasty is not a plastic surgery fad; it can be a medically necessary procedure with functional benefits. Labiaplasty is a surgical procedure that can correct enlarged or asymmetrical labia. By changing the shape or size of the labia, a woman can eliminate the aggravating symptoms she experiences due to her large labia and restore her confidence in her body. Many women dealing with large labia have difficulty with comfortable or satisfying sexual intercourse because of an increase in friction. In addition, exercising can induce painful chafing because of increased labia size. Even wearing certain clothing such as a swimsuit, or other skin-hugging apparel can be an embarrassing or painful experience for women with sagging labia. Whether the need is reconstructive or cosmetic, Labiaplasty can help women decrease these unpleasant symptoms and restore comfortable function.

Understanding Labiaplasty
Labiaplasty has two reasons for being performed. Each outpatient procedure takes about 60-90 minutes and can be performed under general or local anesthesia. Whether you are considering reconstructive or cosmetic Labiaplasty, it is important to choose a vaginal surgeon who specializes in Gynecology. Though a plastic surgeon may offer labiaplasty as part of the scope of their services, they may be unfamiliar with the entirety of the vagina and its structures. It is important to find a vaginal surgeon who is highly skilled and certified to perform labiaplasty or any other reconstructive surgery.

Reconstructive Labiaplasty – This type of Labiaplasty improves the functionality of labia. By resizing or reshaping the labia, patients will experience an ease in painful friction caused by large labia.
Cosmetic Labiaplasty – This procedure changes the aesthetics by correcting an irregularity of the labia and improving appearance.

Labiaplasty Surgeons
Cherokee Women’s Health specializes in labiaplasty. Our doctors are board certified, highly skilled surgeons who understand the intricacies of vaginal anatomy. Because they specialize in Female Pelvic Medicine and Reconstructive Surgery, they have the highest credentials to perform the delicate procedure. Serving the Atlanta Metro area, Cherokee Women’s Health can help you determine if labiaplasty is the right procedure for you.

Labiaplasty can help you restore comfortable function and gain confidence in your appearance. Call our offices to schedule a consultation with one of our surgeons and discover how labiaplasty can transform your life.

May 3, 2016


By Britton Crigler, MD, FACOG

ThermiVa is a ground-breaking office treatment that helps women address common problems with their sexual health. As an OB-GYN, I’ve seen symptoms such as incontinence, difficulty or pain with sex, and vaginal dryness interfere with my patients’ lives.  The natural aging process, childbirth, and menopause affect vaginal function. ThermiVa is a new technology that has become the standard for in-office, non-surgical vaginal rejuvenation – with no downtime.

Harnessing the power of thermal energy, ThermiVa helps to reduce or eliminate a wide range of the unpleasant symptoms of aging. I’ve witnessed my post-menopausal patients, as well as those who miss their pre-baby body, regain confidence when treated with this innovative system.

I’ll say this directly: ThermiVa means you do not have to accept the effects of aging. It helps you reclaim a more youthful vulvovaginal structure – while lessening any unpleasant symptoms you may be experiencing.


ThermiVa is a temperature-controlled radio frequency system, designed to tighten the internal and external tissues of the vagina. The procedure, which is non-invasive and non-surgical, uses a slim “S” shaped wand to deliver gentle heat to areas of the vagina. This heat restores and tightens vaginal tissue both internally and externally.

A unique feature of the treatment is that you control the level of heat for a comfortable and virtually painless experience. ThermiVa treatments stimulate your own body’s production of collagen, even helping to heal tissue or nerve damage sustained during childbirth.

A typical treatment takes place in the office. It requires no anesthesia, so you can go about your day afterward. There is no stinging or burning: the effects of the procedure are mostly painless.  A bonus feature is its affordability; it’s suited for many lifestyles.


ThermiVa treats the external and internal tissues of the vagina. The result is tighter, smoother skin and a restoration of the vagina’s functionality. ThermiVa is not just an aesthetic procedure: it combats losses and damage from aging or childbirth. I’ve seen symptoms ranging from vaginal laxity to stress incontinence to vaginal dryness, be reduced or eliminated with ThermiVa treatments.

These benefits greatly enhance your basic quality of life – no longer do you have to deal with the negative effects of menopause. Some of the powerful benefits of ThermiVa include:

Vaginal Tightening: Patients suffering from vaginal looseness find that ThermiVa improves vaginal tightness as it shrinks the tissues of the vagina, lending itself to a better sex life.

Vaginal Lubrication: Women who have lost interest in sex due to pain and dryness will find that ThermiVa increases their natural lubrication – making daily life and intercourse more comfortable without any added hormone treatments.

Urinary Leakage: ThermiVa treatments, coupled with Kegel exercises, can help strengthen the vaginal walls. Tighter vaginal walls can help to stop inconvenient or embarrassing urinary incontinence, along with a reduction in urgency and frequency.Dr. Crigler photo

Labia Majora Rejuvenation: ThermiVa treatments result in smaller, smoother, less “saggy” skin. Patients often experience more comfort with sex and less embarrassment with their appearance.

With ThermiVa, you can reclaim your body and enjoy your life to the fullest. At Cherokee Women’s Health, my colleagues and I specialize in delivering ThermiVa to obtain the most benefits from the procedure for our patients. Call or make an appointment to discuss questions and concerns about thermal energy treatments.

You can restore your confidence and youth with ThermiVa!

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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