Voted "Best OB-GYN" in Towne Lake, Woodstock and Canton Voted "Mom-Approved OBs" by Atlanta Parent magazine readers


April 3, 2017

It is critical that women receive various health checks at different age ranges as recommended by your doctor. When you break down health screening by age, it can help you to stay on track and take preventative measures.

There are many key reasons to receive regular health check-ups, and by screening for medical issues or assessing your risk for future medical problems, you can maintain a healthy lifestyle at every age.

Women Ages 18-21

  • Physical Examination: At this stage of your life, you should have full physical examinations. A physical exam includes blood pressure testing and an assessment of height, weight, and BMI to help determine your need for early diabetes screenings.

    The purpose of these screenings is to evaluate risk for future health issues. You will be able to discuss lifestyle habits with your OB/GYN and keep vaccinations up-to-date.

Women Ages 21-35

  • Pelvic Examination and Pap Smear: Women should receive a pelvic examination every year and Pap smear every 3 years. A Pap test combined with a screening for HPV will help you and your doctor determine your risk of cervical cancer.

    If you are sexually active, you should ask to be screened for chlamydia and gonorrhea to help prevent the spreading to partners. You will also discuss how to take preventive measures against sexually transmitted infections and plan regular testing depending on your lifestyle.

  • Cholesterol Screening: Depending on your weight and lifestyle, starting between the ages of 20 to 40, women should receive cholesterol screenings. If you have normal levels, you only need to be tested every 5 years. By treating high/low cholesterol, you can significantly reduce your risk for heart disease.
  • Clinical Breast Examination (CBE): A breast cancer screening done by your healthcare provider trained in CBE, will strongly aid in early detection. A CBE should be done every 3 years for the average woman, and more frequently for women over the age of 40.

Women Ages 35-50

  • Mammogram: Starting at the age of 40, women should plan to receive mammograms every year to two years. This is an x-ray of the breast, and the results will help your doctor determine if further testing is needed to screen for cancer.
  • Diabetes Screening: Within this age range, women should begin getting screened for diabetes. These screenings help to prevent or treat diabetes which is a disorder of the metabolism.

    Women are evaluated with a blood glucose test to measure the amount of sugar in the blood. If you are overweight or at a greater risk for diabetes, your screenings may be more often, but typically they are done every 3 years.

Women Ages 50 and older

  • Thyroid Testing: If you are at early risk for thyroid issues, you may have already discussed screenings with your doctor. However, if not, you should receive screenings at this age since women over the age of 60 are more likely to have hypothyroidism.

    Hypothyroidism is a condition in which your thyroid does not produce the right quantity of certain critical hormones. Early and regular screenings for an under or  overactive thyroid can help to prevent serious conditions that may be caused if left undetected.

  • Colon Cancer Screening: At age 50, doctors highly recommended that women begin to receive a colonoscopy every 10 years or more often if at risk due to family history or other factors. Colonoscopies with other tests frequently done, will help you identify early signs of colon cancer so you can remove precancerous polyps.

Final Thoughts

By using these guidelines listed above for health screenings by age in combination with what your doctor recommends can help resolve and even prevent serious health issues.

If you have not received certain tests as outlined for your age group, call for an appointment to consult with your OB-GYN about setting up additional health screenings.

March 23, 2017

When used correctly and consistently, condoms can be an effective method of birth control and provide protection from STIs.

If you or your partner has a latex allergy or sensitivity to latex, rest assured that there are easily available alternatives to latex condoms. Many are equally useful in the prevention of pregnancy and sexually transmitted infections.

What is a Latex Allergy?

Latex is a natural rubber that comes from trees.Latex is natural rubber, a product made primarily from the rubber tree. Some people have a reaction to the rubber in latex, which can cause moderate, severe, or even life-threatening reactions.

Allergy to latex is an increasing health problem. In some cases, repeated contact with products containing latex can increase your sensitivity and, with continued use, develop into an allergy.

Symptoms of Latex Allergy

The following are the most common identifiers that you may be sensitive to latex. You’ll find that latex can affect both your skin as well as cause internal respiratory problems.

Below is a list of the most common skin reactions when it comes to latex allergies. These reactions most commonly occur on or near areas that come into direct contact with latex.

  • Hives
  • Burning, itchy rash
  • Contact dermatitis (inflamed or irritated skin)

You may have a latex allergy if you are experiencing any of the following respiratory issues during or after using a latex based condom.

  • Mild to moderate: sneezing, coughing, runny nose, watery eyes.
  • Severe: shortness of breath, swelling of the throat, severe wheezing, loss of blood pressure, tightening of airways.
  • Life-threatening: anaphylaxis.

If you notice one or more of these symptoms after coming in close contact with latex, contact your doctor to get tested for a latex allergy. Furthermore, if you experience severe or life-threatening symptoms, seek immediate medical attention.

Alternatives to Latex Condoms

Condoms are one of the most common types of birth control and STI protection on the market.

A condom is a thin sheath that fits over the erect penis. There are currently three types of male condoms available other than the latex variety.

Let’s take a closer look at some of your options to help you determine which will work best for you. Each has advantages and drawbacks. Ultimately, it’s up to you and your partner to make the right choice for your lifestyle.

Polyurethane Condoms

Polyurethane is a plastic based product that contains no latex.

  • Statistically effective method of birth control when used correctly.
  • Effective in preventing STIs, including HIV, when used correctly.
  • Thinner and sometimes stronger that latex condoms.

Polyisoprene Condoms

Polyisoprene is a newer product made of a non-latex material.

  • Statistically effective method of birth control when used correctly.
  • Statistically effective in preventing STIs, including HIV.
  • Combine the strength of latex with the sensitivity of a thinner condom.

Natural Condoms

Made from the oldest material on the market—the intestinal membrane of a lamb, sometimes known as a lambskin condom.

  • Statistically effective method of birth control when used correctly.
  • NOT effective protection against STIs or HIV, due to tiny pores in the membrane. The pores are small enough to block passage of sperm but will not block transference of STIs or HIV.
  • May not be the right choice for those with animal rights convictions. Not vegan-friendly.
  • May have an odor that some find offensive.

Female condoms are not as popular of choice as traditional condoms. However, you may find that they suit your needs better.

A female condom is a thin plastic pouch that lines the vagina. It is held in place by a closed inner ring, or rim, at the cervix and an outer ring at the opening of the vagina.

  • Statistically effective method of birth control.
  • Some studies suggest that a female condom will work as well as a male condom in preventing STIs, including HIV.
  • May provide some protection of the genital area around the opening of the vagina during intercourse. May reduce the risk of getting and transmitting diseases such as genital herpes or genital warts.
  • Can be inserted up to 8 hours before intercourse.
  • Can be a good option for both partners.

Final Thoughts

There are numerous alternatives to latex condoms. All of the varieties we’ve mentioned require no prescription and can be purchased in pharmacies, stores or vending machines.

Many family planning clinics, school nurses, or university health centers will provide condoms, including non-latex condoms, free of charge.

For the best protection against unplanned pregnancy and STIs, use a condom even when using another method of birth control, such as pills or an IUD. Always use a condom when participating in vaginal, oral, or anal intercourse.

If you have a latex allergy or sensitivity to latex, make an appointment to discuss your options with your OB/GYN.

March 3, 2017

Menopause is a turning point in a woman’s life that can have a significant impact on her health and overall well-being.

Natural menopause is a gradual process that can bring about physical upheaval from hot flashes, night sweats, sleep issues and other symptoms.

Let’s take a look at the different phases of menopause and the signs and symptoms to help determine if you are entering menopause. It will be much less stressful if you are informed and know what to expect.

Perimenopause: An Overview

The transition to menopause is known as perimenopause. It can range 4-7 years prior to actual menopause. The average woman experiences perimenopause at approximately 46 years of age.

During this phase, a woman’s ovaries are beginning to produce less estrogen. Estrogen is the hormone that helps control the menstrual cycle. You will notice a difference in your periods which will vary from woman to woman.

Although periods may become unpredictable, ovulation can still occur, so it is still possible to get pregnant.

In fact, many of the signs and symptoms of perimenopause are similar to pregnancy or PMS including the following.

  • Hot flashes or night sweats
  • Decreased libido
  • Weight gain
  • Vaginal dryness
  • Mood swings

Perimenopausal women will notice these symptoms appear at any time throughout their cycle instead of only 1-2 weeks before menstruation.

Determining whether you’re experiencing perimenopause or may be pregnant can be confusing so consult with your OB-GYN right away if you think you might be pregnant.

Menopause: An Overview

Menopause is the permanent end of menstruation. It is the natural end of a woman’s potential childbearing years. At this point, the ovaries no longer function, menstrual periods have stopped, and it is not possible to become pregnant.

According to the National Institute on Aging, on average, women are 51 years of age at natural menopause. However, a woman is considered to have reached menopause after she has missed her menstrual cycle for 12 consecutive months.

There is no reliable way to predict menopause age. Women have been known to start menopause as young as 40 and as late as 60 years old. Women who smoke tend to begin menopause a few years sooner than non-smokers.

Menopause can be induced, at any age, by certain surgeries and medical treatments. Chemotherapy, pelvic radiation therapy and surgical removal of the ovaries can lead to the sudden onset of menopause.

What To Expect As Your Body Changes

Beginning in your 30s and 40s, the amount of estrogen produced by the ovaries starts to fluctuate. It’s likely you will notice a change in your menstrual cycles. You may begin to skip periods. Flow may be heavier or lighter. Cycles may be shorter or longer in duration. You may have periods less often or more frequently.

Menopause affects each woman differently. Some women reach natural menopause with little or no trouble. Others have severe symptoms that drastically affect their health and lifestyle. The length of time from perimenopause until menopause will also vary from woman to woman.

When menopause begins suddenly as a result of radiation, chemotherapy or surgical removal of the ovaries, the symptoms and adjustments can be more extreme than with naturally occurring menopause.

Signs and Symptoms of Menopause

Numerous signs and symptoms will help you, and your doctor determine if you are entering menopause. Remember, every woman is different. You may experience none, some, or all of these symptoms during perimenopause and menopause.

Hot Flashes and Night Sweats

A hot flash is a sudden feeling of heat that rushes to the face and upper body. Some women have hot flashes several times a day while others only several times a week. A hot flash can last a few seconds or several minutes or longer.

Hot flashes occurring at night are known as night sweats. They may wake you up or make sleep difficult causing you to feel tired and ill-rested the next day. A hot flash can cause temporary red blotches on the chest, back and arms. Both sweating and chills are possible.

Sleep Issues

Menopause can affect your body’s chemistry in other ways as well. Besides having problems associated with night sweats your normal sleep patterns may be disrupted.

Because of the many changes your body is experiencing, you may have trouble falling asleep and staying asleep. You may wake up long before your usual time.

Vaginal and Urinary Tract Changes

The lining of the vagina may become thinner, dry, and less elastic as estrogen levels decrease. Vaginal dryness can make intercourse uncomfortable or painful. Vaginal infections may occur more frequently.

The urethra can become dry, inflamed, or irritated causing more frequent urination and an increased risk of urinary tract infections.

Changes In Libido Function

During perimenopause and menopause, the libido may also change, for better or worse. But remember that many factors besides menopause can affect sex drive.

Stress, medications, depression, poor sleep, and relationship problems can all have an immediate impact on your libido.

Menopause Health Risks

Along with menopause comes a greater chance of heart disease (the No. 1 cause of death for U.S. women) and osteoporosis (thinning of the bones). These are areas to be aware of even after other symptoms of menopause have subsided.

Heart health and strong bones are important throughout life, but menopause is the time to get serious about it. Consult your doctor about any lifestyle changes that should be made during menopausal years to maintain a healthy heart.

How Your Doctor Can Help

Your doctor will help you monitor your transition through perimenopause into menopause and beyond. Some women experience only minor changes or discomfort. Others find the menopause years to be quite challenging both physically and mentally.

It is possible that your symptoms will require appropriate treatment to help you navigate your way through menopause more comfortably. Your doctor will work closely with you to find a treatment that will see you through this normal phase of life.

What To Tell Your Doctor About

You know your body better than anyone. If you are experiencing any of the following symptoms or have any concerns about your health, contact your doctor right away.

  • Much heavier than normal bleeding during or between menstrual cycles.
  • Periods that occur very close together.
  • Painful urination or frequent urination.
  • Vaginal pain, irritation, itching, or unusual discharge.
  • Uncomfortable or painful sexual intercourse.
  • Sleep problems that interfere with your ability to function and lead a healthy lifestyle.
  • If you think you may be pregnant.

Final Thoughts

If you are entering menopause, it is important to see your doctor on a regularly scheduled basis, according to their recommendations. Between regular appointments, if you have questions, concerns or experience severe symptoms, contact your doctor as soon as possible.

Menopause is a new beginning. Use this time to redefine yourself with positive thoughts. Dedicate yourself to a healthier lifestyle and enjoy life. You’ve earned it.

Being sexually active is a decision that comes with responsibility. As a woman who is sexually active, it is important to be informed about the risks involved as well as how to protect yourself from sexually transmitted infections (STIs) such as gonorrhea.

Since these infections can be treated effectively, it is also important to be able to recognize the signs and symptoms in order to get treated as early as possible for the best outcome.

What Is Gonorrhea?

Gonorrhea is a type of STI that is caused by a specific type of bacteria, Neisseria gonorrhoeae, which can infect the mucous membranes of the reproductive tract.

In women this includes:

  • Urethra
  • Cervix
  • Uterus
  • Fallopian tubes

For men the bacteria can infect:

  • Mouth
  • Throat
  • Eyes
  • Urethra
  • Rectum

Gonorrhea is transmitted through direct sexual contact with the penis, vagina, mouth, or anus of a person who is infected.  It can also be transmitted from a mother to baby during childbirth. In infants, gonorrhea most commonly affects the eyes.

You can be re-infected after treatment if you later come into contact with someone who is carrying the bacteria. If you’ve had gonorrhea in the past and suspect you have it again, you should schedule an appointment with your OB/GYN as soon as possible.

Who is at Risk for Gonorrhea?

Statistics show that approximately 820,000 new cases of gonococcal infections occur each year in the United States, well over half of these cases being in young people ages 15-24.

Populations most at risk for contracting gonorrhea are sexually active teenagers, young adults, and African Americans.

Signs and Symptoms of Gonorrhea

While men may or may not experience symptoms such as urethral discharge, women are almost always asymptomatic.

Initial symptoms for women can be mild but may include one or more of the following:

  • You may experience pain or discomfort upon urination. Dysuria is often described as a burning sensation.
  • Increased vaginal discharge. You may experience vaginal discharge beyond what is typical for you throughout your menstrual cycle.
  • Vaginal bleeding. You may experience bleeding outside of regular menstrual bleeding, or after vaginal intercourse.
  • Painful intercourse. Sexual intercourse may feel painful and uncomfortable.
  • Abdominal or pelvic pain. You may experience discomfort or pain in the abdomen or around the pelvic area.
  • Unusual sores or rash. You may notice unusual sores or rash around your vaginal area.
  • Rectal infection. You may experience discharge, itching, soreness and bleeding around the anus. Painful bowel movements may also be a symptom.
  • Pharyngeal infection. Although symptoms are less common, you may experience a sore throat.

Long-Term Problems

Often these symptoms can be mistaken for other ailments such as bladder and vaginal infections. Many women are unaware they have gonorrhea until they visit their doctor for other reasons.

If left untreated, gonorrhea can put you at a high-risk for developing permanent health complications such as Pelvic Inflammatory Disease (PID), and Disseminated Gonococcal Infection (DGI). These are of particular concerns that require immediate treatment in women as they can lead to infertility, pregnancy complications, and scarring of the fallopian tubes.

Gonorrhea can also increase your risk of acquiring or transmitting the HIV virus. If you are experiencing any symptoms, it is important to have them examined by your doctor or another health care provider.

Should You be Tested?

If you experience any of the above symptoms, or if you are having sexual contact with anyone who has been recently diagnosed with an STI you should discuss testing with your health care provider.

The CDC recommends that all sexually active women under the age of 25 and women with risk factors (a new sexual partner, multiple sexual partners or a partner who has an STI) be tested on a yearly basis.

How is Gonorrhea Tested?

Your health care provider will collect and analyze a sample of cells. Samples are typically collected in one of two ways:

  • Urine test. A urine test will determine if there are any bacteria present in the urethra.
  • A swab of affected area. A swab of the throat, urethra, vagina or rectum may be taken to determine if the bacteria is present.

What is the Treatment for Gonorrhea?

The good news is that gonorrhea can be cured with the right treatment.

Treatment frequently involves dual therapy or the use of two antibiotic medications. The CDC recommends that one be taken orally, and one may be administered as a one-time intramuscular injection.

It is important to complete the full course of the medication to ensure the bacteria is eradicated adequately.

These medications can kill the infection. However, they cannot repair any permanent damage done by the disease. It is important to identify and treat symptoms as early as possible.

Remember, your partner should also be treated for gonorrhea if you have been diagnosed to prevent re-infection.

How Can You Prevent Gonorrhea?

If you are sexually active, the first line of defense against gonorrhea is practicing safe sex. Whether having oral, vaginal, or anal sex, the proper use of condoms can reduce the risk of transmission.

The only way to be sure there is no transmission risk of gonorrhea is to temporarily abstain from any type of sexual activity or be in a long-term monogamous relationship with a partner who has been tested and is not infected.

Final Thoughts

If you are a woman who is currently sexually active with one or more partners, it is important to be aware of the signs and symptoms of gonorrhea infection and be examined by your health care provider if you have any concerns.

Gonorrhea is a sexually transmitted infection that can have serious consequences if left untreated. However, when identified early and treated effectively with proper medication, it can be completely cured.

Don’t hesitate to call confidentially with any questions or concerns you may have regarding Gonorrhea or other STIs.

February 28, 2017

At Cherokee Women’s Health Specialists we strive to create a supportive environment that nurtures our patients and also brings lots of smile and laughter.

Here are some more reasons to check us out:

      1. Cumulatively our physicians have 75 years of medical experience under their belts. There’s nothing they can’t handle!
      2. Our staff is always ready with a smile and willing to help our patients.
      3. We’re the only OB-GYN practice in north Georgia with state-of-the-art advanced PAP smear screening technology
      4. Dr. Crigler does push-ups with babies on his back. Yes, really!
      5. Real help with your diet from our vegan and nutrition expert doctors, Dr. Hale and Dr. Crigler. Dr. Haley provides ALCAT testing for patients concerned about food sensitivities
      6. Our mid-wife, Susan, has delivered more than 900 babies!
      7. We offer both ThermiVa and ThermiSmooth treatments
      8. Have you seen our baby boards?
      9. Two great offices in Cherokee County: Woodstock and Canton
      10. We’ve delivered more babies at Northside Hospital Cherokee than all other OB practices combined.

BONUS REASON! (And one of the most important)
11. Our relationships with YOU – our patients – are lifelong!

Dr. Litrel delivered both McAbee sisters and still treats their mom.


February 2, 2017

Birth control is offered in many varieties with different instructions, so it can be confusing for women to know that what they are doing is correct. By using birth control correctly, you can increase its effectiveness.

Different forms of birth control including birth control pills, injections and condoms. Talk to your doctor about which is best for you.Here are the different methods of birth control and the common errors or actions you should avoid to keep yourself protected.

Hormonal Contraception

Hormonal methods of birth control have a low chance of error if used correctly. The pill is a common choice, but the first mistake is selecting the wrong pill for your body and lifestyle. Call your doctor for an appointment today to explore options and make the right decision.

Birth Control Pills

Missing a pill or forgetting to take the pill for a couple of days can negatively affect the way it works. This common error can be helped with certain steps. If you forget your pill, take one as soon as you remember, even if that means you take 2 in one day.

If you forget 2 days of pills, take 2 the day you remember and 2 the following day to get back on track. Use a backup method until your next period.

A big “no, no” when using the pill is to avoid taking rifampin, a drug used to treat tuberculosis, as it interferes with the effectiveness of the pill.

General antibiotics are fine; however, be sure to use another form of birth control if you need to take anti-seizure drugs, anti-HIV drugs, and some anti-fungal medications.

The Patch

The patch is less effective when you apply it at the wrong time of your cycle. To have high effectiveness, you must implement it on the first day of your menstrual cycle or the first Sunday following your period.

Also, be cautious of the day you change your patch, and do not apply it to skin that is moisturized, has make-up, or is ultra-dry.

Vaginal Rings

The vaginal ring releases hormones into the body the same way the pill does. A typical mistake is not inserting it within 5 days of the beginning of your period.

You will also be at risk of getting pregnant while using the ring if you forget to remove it after 3 weeks and don’t replace it within 7 days.

Condoms and Barrier Methods

When using a female condom, common mistakes include not applying enough lubrication and not entering the penis directly into the condom. Make sure to remove the female condom carefully after sex to avoid leakage.

With male condoms, effectiveness is decreased if you do not leave enough space at the tip or do not remove the air before intercourse. Never reuse condoms, and make sure to hold the base when withdrawing. Be sure to check the expiration date before use along with the size and fit.

If a diaphragm is not the right size for you, then it will not be as effective. Be sure to consult your doctor with questions at any point when using contraception. A common mistake to avoid is leaving your diaphragm in for more than 30 hours. Plan to remove the diaphragm or sponge 6 hours after sex and no sooner.

Intrauterine Devices (IUDs)

With IUDs being almost mistake-proof, they are one of the most effective forms of birth control. However, as with the pill, the ring and the diaphragm, the IUD only protects users from pregnancy, not sexually transmitted infections.

Error or lack of effectiveness can arise from not checking the placement of your IUD after insertion. Be sure to check for the string inside your vagina as directed by your physician.

Do not use a copper IUD if you are allergic to copper. If you are not in a committed relationship and have multiple partners, the IUD may not be the right choice for you. Similarly, with other forms of birth control, do not use an IUD if you are pregnant. When taking contraception post-pregnancy, check with your OB for the best course of action.

Final Thoughts

If you are considering birth control or are currently unhappy with your contraception, call your doctor with questions or for an appointment to explore options.

Birth control is primarily designed to protect you from an unwanted pregnancy. It does not provide STD protection, so always use condoms if you are not in a committed relationship or may be at risk for STD exposure. To increase the effectiveness of your birth control, make sure to educate yourself about the risks and follow the appropriate instructions.

pelvic inflammatory disease photoMore than one million women in the United States alone suffer from pelvic inflammatory disease each year. Females under twenty years old are affected more often than women in a higher age bracket. Left untreated, it can cause infertility, ectopic pregnancy, subsequent scar tissue (adhesions), chronic pelvic pain, complications to an unborn baby if you are pregnant, cancer and many other serious, even life threatening problems. If ignored, more than 25% of women affected suffer some or all of these long-term effects, some of which may lead to the need for a complete hysterectomy. However, it is also one of the most preventable diseases if diagnosed and treated in time.

What is Pelvic Inflammatory Disease and What Causes it?
Pelvic inflammatory disease, or PID, is a serious complication that usually arises from exposure to a sexually transmitted disease or infection (STD, STI). Your cervix, located just above your vagina, usually protects bacteria from attacking your reproductive organs, which include the fallopian tubes, uterus, and ovaries. However, if you’ve contracted a sexually transmitted infection such as gonorrhea, syphilis or chlamydia, and it was allowed to go untreated, complications could arise. Infection could travel past the cervix and wreak havoc on your reproductive system, often causing irreversible damage.

Although the cervix is usually shut tightly, and thus serves as a kind of protective barrier to the reproductive organs, it opens during childbirth or when menstruating to allow blood flow. Though regular sex does not penetrate the cervix, semen carrying an STD can linger outside of it. Then, much like a plunger forces blockage in a toilet or sink to push through pipes, any means by which the cervix is opened or penetrated can allow that STD or other bacteria to ascend to the reproductive system. Therefore, though the highest percentage of pelvic inflammatory disease incidents are caused by sexually transmitted diseases during unprotected vaginal, anal and oral sex, you may also get PID by:

• Having an abortion
• Engaging in sex with multiple partners
• Having sex under the age of 25
• Undergoing a pelvic examination
• Having an intrauterine device (IUD) inserted
• Undergoing other surgical procedures such as a D & C or endometrial biopsy
• Using douches
• Using tampons
• Inserting foreign objects into the vagina
• Undergoing surgical procedures to the uterus
• The migration of normal human bacteria that has travelled to and past the cervix
• Having a previous history of pelvic inflammatory disease.

What are the Symptoms of Pelvic Inflammatory Disease?
Often, there aren’t any symptoms until it has spread, particularly if the infection is caused by chlamydia. This makes PID hard to diagnose, especially in its early stages. You should consult your doctor if you experience any of the following:

• Lower abdominal pain
• Fever of 101° F or more
• Chills
• Uncomfortable or painful intercourse
• Upper abdominal pain
• Fatigue
• Irregular bleeding or spotting
• Discharge accompanied by foul smell
• Nausea and vomiting
• Chronic pelvic pain
• Fainting
• Difficulty or pain when urinating
• Pain when walking (PID shuffle)
• Symptoms of dehydration
• Sharp abdominal pain worsening over a period of several days that mimics appendicitis.

If symptoms are unbearably severe, this may indicate that infection may have spread into the blood stream. You should seek immediate medical attention, as the situation may become life threatening.

How is Pelvic Inflammatory Disease Diagnosed?
A series of tests may be necessary to isolate a positive diagnosis of pelvic inflammatory disease. Your doctor will want to perform some or all of the following:

• A complete and thorough examination of genital organs and abdomen which may include taking cervical cultures.
• Manual probing of the vagina to feel for inflammation or ovarian tenderness.
• Blood tests and cultures to check blood counts and to determine if you might be pregnant.
• A urine test to look for traces of blood, cancer or other diseases.
• Tests to check for the existence of any sexually transmitted diseases such as syphilis, hepatitis, HIV, chlamydia, gonorrhea, herpes, genital warts, etc.
If your doctor concludes that you do, in fact, have pelvic inflammatory disease, he may suggest the following additional tests:
• An ultrasound, especially if the ovaries are too painfully sensitive for a manual probe. Sound waves can create an image of your reproductive organs for assessment.
• An endometrial biopsy to examine a sample of the lining of the uterus.
• A laparoscopy to pinpoint a more accurate, positive diagnosis.

What is the Treatment?
If you are positively diagnosed with pelvic inflammatory disease, the treatment is usually an antibiotic shot or course of antibiotics. Sometimes both are required. In the event the actual bacteria causing the infection cannot be determined, additional medication may be recommended. Your doctor will discuss all options with you.

Depending on the severity of your case, you may be required to be hospitalized on an inpatient basis, especially if there are more advanced complications such as ovarian abscesses. Sometimes, even surgery may be necessary.

If your doctor has ascertained that your pelvic inflammatory disease is caused by an STI, your partner will also need to be treated in order to stop any continuing transmission. Of course, all sexual activity will need to be discontinued until you are confirmed infection-free.

What Can I Do to Avoid Getting Pelvic Inflammatory Disease?
There are many precautions you can take to avoid getting this disease. Most are simply safe practices such as:

• Having your partner use a condom unless you are in a trusting, monogamous relationship.
• Regular STD screening if you have had, or presently have, multiple sex partners.
• Reporting to your gynecologist if you suffer from any unusual pain, discomfort, bleeding or discharge after a medical procedure that involved manipulation of your pelvic area.
• Avoiding douching.
• Always wiping from front to back after using the toilet.
• Making sure your hands are clean when inserting a new sterile tampon.
• Avoiding any trauma to the pelvic area.
• Making sure you regularly clean and sterilize any intimate sexual enhancers.
• Using spermicides after intercourse.
• Requesting that your partner be tested, especially if you are considering intimacy with someone new.
• Avoiding excessive drinking or drug use that may compromise your ability to think clearly and rationally.

Opting for birth control pills instead of internal devices to avoid pregnancy. Though birth control pills do not prevent PID, they may help deter bacteria from reaching the reproductive organs by creating a denser cervical mucus.

Finally, statistics show that teenagers are having sex more often and at an earlier age than ever. Because the incidence of pelvic inflammatory disease is highest in girls under 20, it’s important to educate our youth, both male and female, in the practices of safe sex. Though discussion regarding intimacy is still a delicate one for many parents, an open and frank dialogue can help future prevent issues.

At Cherokee Women’ Health Specialists, our physicians have decades of combined experience that enable us to diagnose, treat, correct, and answer any questions regarding not just pelvic inflammatory disease, but also the many other different disorders that can affect a woman’s genital health and reproductive system. Our staff includes Female Pelvic Medicine Reconstructive Surgeons (FPMRS). These specialists are among the first board certified highly qualified urogynecologists in the nation to ever receive this accreditation, and are here to help you with all your women’s health issues.

For an appointment to discuss pelvic health, contact us at 770.720.7733.


Almost every woman knows annual gynecological checkups and regular pap smears are important to maintaining good pelvic health. Sometimes, though, things go wrong down below and we begin to hear about tests and procedures that not only sound intimidating, but are hard to pronounce. One of those procedures may be urethrocystoscopy, a multisyllabic word that sounds as complicated as it is to spell. Based on symptoms you’ve mentioned having to your doctor, he or she may have recommended urethrocystoscopy to further investigate and diagnose your problem.

What is Urethrocystoscopy?
Simply put, urethrocystoscopy or cystoscopy is an examination of the bladder and urinary tract. An instrument is inserted into the urethra, the tube or duct that empties urine from your bladder and out of your body. This instrument is called a cystoscope and assesses any damage, disorder, disease or irregularity.

What is a Cystoscope and How Does it Work?
A cystoscope is a long tube with a light and camera on one end. The other end is equipped with lenses just like a microscope or telescope. As the doctor slowly probes the area to be examined, the camera will project pictures onto a screen to study. Some cystoscopes also have flexible glass called optic fibers that can generate an image from the probe end to the examiner’s viewing lens.

Depending on your particular case, your doctor may opt to use a cystoscope that is either hard and rigid or soft and flexible. He may also use one equipped with an extra tube in order to perform surgical procedures or immediately correct other problematic urinary issues.

For biopsy purposes, or for surgical procedures, the rigid cystoscope is used, but if your doctor is simply investigating the area to look for whatever might be ailing you, the flexible tool is used.

Sometimes, a ureteroscope, which is similar to a cystoscope, but of a thinner caliber, is better suited for the procedure if it’s necessary to remove stones or other blockages high in the urinary tract. This apparatus allows the physician to push a wire equipped with a basket through the ureteroscope’s extra tube to remove the stone. It also enables him to insert a laser fiber to break up larger ones that will later pass harmlessly during normal urination.

That Sounds Terribly Painful. Is it?
No. At worst, urethrocystoscopy can be uncomfortable and you may experience a burning sensation, along with the urge to urinate while the tube is being inserted. For a flexible cystoscopy, a local, often topical anesthetic is given before the procedure with plenty of time to take effect. If a rigid cystoscope is used, local anesthetic can be equally effective, but a general one can be used as well.

Why Would I Need a Urethrocystoscopy?
This procedure may be warranted if you’re experiencing or complaining of the following:

• Repeated urinary tract infections
• Kidney stones in the kidney ducts (ureters)
• Blood in your urine (hematuria)
• Pain or discomfort when urinating
• Suspicious cells found in your urine sample
• Suspicious polyps, tumors, growths or cancer in the ureter
• A necessity for a bladder catheter
• Urinary tract stones
• Overactive bladder
• Chronic pelvic pain
• Incontinence
• Interstitial cystitis
• Any blockage that might be impeding your urinary flow, or causing a narrowing in your ureters.

What Preparations are Necessary for a Urethrocystoscopy?
Your doctor will discuss any preparations necessary. In some cases, with a weakened immune system, you may be prescribed an antibiotic prior to the examination. A urine sample may also be required. Make certain your physician is aware of any and all medications you may be taking. This includes vitamins and supplements. You may be asked to discontinue some of them to prevent excessive bleeding during the procedure. Unless you’ll be given a general anesthesia, you can probably eat and drink normally that day, but again, check with your doctor in case you may need to fast.

What Can I Expect During the Urethrocystoscopy?
First, you will be asked to change into a gown and empty your bladder. When you are finished, you will be led to a table, asked to lie down on your back, and possibly put your feet into stirrups. Depending on your case, you may be given an antibiotic to avoid getting a bladder infection.

At this time, the area will be cleaned and sterilized and you will be given anesthesia. If it is general anesthesia, you won’t remember much after this point until you wake up.

If your doctor has opted for a regional or local anesthetic, a sedative may be provided to calm you as you will feel some sensation during the examination.

The area of the urethra will be treated with a numbing agent and checked to make sure that you are properly desensitized.

The lubricated probe will now be gently inserted into your urethra. You may experience a burning sensation, coupled with a need to urinate.

As the scope moves through your bladder, your doctor will be watching through the lens. He will then flood your bladder with a sterile solution, enabling him to assess the situation. Again, you may feel the need to urinate.

The entire urethrocystoscopy with local anesthetic will take about 5 minutes, and perhaps 15 to 30 if using general anesthesia. Complete results may be immediate or they may take a few days.

What Happens After?
Urethrocystoscopy doesn’t usually have too many side effects, but you should take note of the following:

• If general anesthesia was required, you may be somewhat groggy and should avoid driving or operating machinery. It would be wise to have someone stay with you for a few hours or even the rest of the day if possible.
• You may need to urinate more often for a few days. Void as often as you need to and do not hold it in. Urinating whenever your body urges you to can prevent clots from forming in the bladder and creating possible blockages.
• It’s normal to see a little blood in your urine, especially if you had a biopsy.
• Drink lots of fluids to minimize bleeding and burning.
• If you have swelling or pain, holding a damp warm washcloth against your urethra. Taking a warm bath may also help.
• Avoid alcohol for a few days.
• Refrain from sexual activity for the time period your doctor has recommended.
• Biopsies require healing time. Don’t do any heavy lifting or strenuous exercise.
• If you are given antibiotics, take them for the entire duration of time prescribed.

Is There Anything Else I Should Worry About?

Some mild discomfort could be expected, but contact your doctor immediately if you experience any of the following symptoms:

• Severe stomach pain
• Inability to urinate for more than eight hours
• Fever over 100.4 ° F
• Foul smelling urine or discharge
• Lower back pain
• Nausea
• Vomiting
• Serious bleeding
• Bright red blood or clots when you urinate.

All urethrocystoscopy procedures are performed at Northside Hospital Cherokee, where we have generous use of their state-of-the-art cystoscopy equipment.

At Cherokee Women’s Health Specialists, our Female Pelvic Medicine Reconstructive Surgeons (FPMRS) are highly trained urogynecologists who are skilled in performing all diagnostic testing and women’s health surgeries.

If you are experiencing bladder issues, call us today at 770.720.7733.

February 1, 2017

According to the American Cancer Society, one out of every eight women will have breast cancer. However, early detection can lead to a good prognosis, and the screenings are simple. There are several types of breast cancer screenings, so you want to discuss the best option with your doctor.

The Types of Breast Cancer Screenings
Breast exams are an important part of a woman's health and wellness.You have multiple options for screenings, and it is important to select the one that is right for your situation. Cherokee Women’s Health recommends that you have an annual exam to check for breast cancer.

• Mammograms. They are the most common type of breast cancer screening, and require the use of X-rays. Mammograms can show both the early and late stages of tumors through X-ray imaging. It is recommended that women over the age of 40 have an annual mammogram.

• Clinical breast exams (CBE). This type of screening checks for abnormalities and lumps in the breasts without invasive tools. The National Comprehensive Cancer Network (NCCN) shares that the breasts and underarms are usually part of the examination.

• Magnetic resonance imaging (MRI). An MRI relies on magnetic fields to generate images. This is considered to be a more invasive procedure and is usually reserved for high-risk patients such as those with BRCA1 or BRCA2 genes, family histories of cancer or dense breast tissue.

• BRCA testing. Our practice also offers BRCA testing to help determine your genetic risk for breast cancer. This type of screening looks for the BRCA1 or BRCA2 gene mutations that increase the risk of having breast cancer.

• Thermography. Cherokee Women’s Health also offers thermography. This procedure uses a camera with heat sensing technology to create a map of your breasts. Changes in temperature in the tissue can be a sign of tumors.

Why You Need Breast Cancer Screenings
The goal of breast cancer screenings is to catch problems at an early stage, so treatment is more effective. It is crucial to use screening tests and exams to catch this type of cancer because symptoms may not appear right away. Regular screenings can detect cancer before it spreads to other parts of your body, so they can increase your chances of survival.

When You Should Start Breast Cancer Screenings
The American Cancer Society recommends that you begin to discuss breast cancer screenings with your doctor at the age of 40. Women who are at a low to moderate risk of breast cancer should have an annual exam such as a mammogram from the age of 45 to 54. If you are 55 or older and in the low-risk category, then you can choose to have an exam every two years. However, women who are considered high-risk should get an annual mammogram and an MRI.

Breast cancer kills 40,000 women every year, but screenings can help with early diagnosis and increase the rate of survival. You can discuss the best exams and tests with your doctor, so you will feel confident in your screening choices. Early detection is the key to fighting cancer. According to the American Society of Clinical Oncology (ASCO), if breast cancer is caught in the beginning stages and before it spreads beyond the breast, the 5-year survival rate for women is 99%.

Don’t delay your annual exam. Call today for a breast cancer screening appointment.

New Year Resolutions can improve health and wellness.Many women set unrealistic goals for themselves over the holidays. Setting the bar too high can cause you to become overwhelmed, making you less likely to fulfill your promise to yourself. The more times you fail to achieve a goal, the harder it becomes to accomplish in your mind.

Instead, focus on healthy resolutions for the New Year can easily be achieved. You will be surprised at how well you feel both physically and mentally when you make healthy choices.

Ideal Resolutions for a Healthy Lifestyle

Let’s take a look at how you can substitute unhealthy resolutions for healthier choices. You can incorporate these your daily life without the worry of them leaving you feeling stressed.

Eat Healthy

Instead of focusing on goals such as weight loss, try giving yourself a more realistic goal such as eating healthier. A resolution that promotes a healthy lifestyle will improve your body’s overall well-being.

Follow some of these tips to incorporating nutrition into your daily life.

• Find a healthier option to curb your cravings whether it’s salty or sweet.
• Avoid overeating by stopping when you are 80% full.
• Take your time. Your body can process food better with smaller bites spread over more time.
• Stock yourself with healthy snacks throughout the day at home, work and on-the-go.

Move Differently

Many women resolve to incorporate exercise into healthy living. Skip committing to hours at the gym which can be difficult on your schedule, budget, and energy levels. Even with the best intentions, there are numerous reasons these types of resolutions can disappoint.

There are many ways that you can be more physically active while going about your daily routine. Try some of these easy methods to get yourself physically fit over the course of the next year.

• Instead of fighting for the best parking spot available, try parking further away. You will get more exercise and likely find yourself inside quicker than circling multiple times.
• Focus on things you love to do, like swimming or dancing for a whole body workout you will enjoy.
• Use the buddy system. Exercising with a group or friend will give you more accountability. You may feel more inclined to follow through with your goals.

Take Care of Your Body

For each woman, this resolution can mean something different. Whether you plan to reduce your blood pressure, commit to visiting your doctor for regular check-ups, or quit smoking, taking care of yourself should be the number one goal.

Choose a resolution big or small that will make you feel better about yourself, and go for it. Accomplishing even small goals towards a healthy lifestyle can make you feel physically as well as emotionally balanced.

Tips on How to Follow Through with Your Resolutions

Try some of the following tips to help keep you on track so that you can accomplish your resolutions.

• Be honest with yourself. Set attainable goals that you know you can fulfill.
• Reward yourself. Choose milestones and congratulate yourself once you obtain them.
• Keep a progress journal. Seeing the minor changes you make on a daily basis will keep you on track.
• Acknowledge that your goal won’t happen overnight. You will be more likely to commit to long-term resolutions.

Final Thoughts

A healthy lifestyle doesn’t have to be difficult to achieve. You can make healthy resolutions for the new year without setting unrealistic goals for yourself. Improve your overall well-being by making healthy choices and sticking to them.

Remember to schedule an appointment with your doctor before making any major health related decisions. Your OB/GYN will be happy to consult you with any questions or concerns you may have about healthy resolutions for the New Year.

Request a Consultation

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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