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January 31, 2017

woman with magnifying glass photoPhysical imperfections are usually visible to the naked eye. Flaws can range from minimal irregularities such as a receding hairline or having one eye slightly larger than the other. Others can be stark abnormalities such as a distorted limb or a blatant handicap. We base these deviations on our everyday observations of what we perceive as ‘normal’. However, when it comes to the more private area of our bodies, it may be more difficult to differentiate between normal and abnormal.

Pelvic appearance and health continue to remain private subjects for most. Typically, women don’t whip off their panties or take selfies of their lady parts in order to ask someone, “Am I normal down there?” In fact, a 2015 Australian study shows that 50% of women have no idea what a normal vagina looks like. 53% have never seen a real-life vagina other than their own, and 15% have only ever seen one in science videos.

The research continued to say that many women rely on pornographic material to compare their private parts to what they think might be the norm. Based on those often misconstrued observations, a staggering 1 in 7 women request labiaplasty because what they see on TV and elsewhere appears to be different from their own.

What Am I Supposed to Look Like? What is Considered ‘Normal’ Down There?
Unlike men, whose sexual organs are mostly external, the outer visible parts of your genitalia are limited to the vulva, which can be seen when facing a mirror standing up. Even those parts may be obscured by pubic hair unless you opt for a waxed or shaven appearance. The rest of your sexual organs are internal, and investigating them for possible problems can only be done by pulling back the labia or having your gynecologist discern any possible abnormalities during your annual checkup.

There are several parts to the vulva, but most women are concerned with the appearance of the following:

Mons pubis or mons veneris: The gently sloped shaven or unshaven mound you see when facing a mirror. The mound size depends on hormone levels and weight. The mons pubis enlarges at puberty and sinks at menopause due to estrogen levels. In some cases, sharp pains in this area can occur, sometimes during later stages of pregnancy or even after, and if this discomfort is excessive, you should consult your physician.

The appearance of the mons pubis is different from woman to woman and can fluctuate in size with weight, childbirth or during the aging process. If you find yours to be unsightly, monsplasty (a pubic lift) can reduce, lift or tighten sagging in this area, thus improving its size and appearance.

Labia majora: The two outer sides of the vulva called labia majora resemble pads or cheeks that are separated by lip-like tissue (pudendal cleft). These labia extend from the mons pubis all the way down to the base of the vulva and perineum. They consist of fatty tissue that contains oil and sweat glands.

A slight musty smell is normal, and you may even emit a somewhat metallic odor around menstruation. Foul smell or discharge should be checked. Labia majora size is different from one woman to the next. Just as you can have one foot bigger than the other, labial size varies and perfect symmetry is actually more unusual than the norm.

Color varies from a normal skin tone to a deep purple, just like your facial lips. However, should you develop cysts, new moles, lumps, ulcers, experience excessive pain, itching or any discomfort that is not eased by wearing looser or cotton lined underwear, consult your physician.
A prominent labia may sometimes result in what is referred to as ‘camel toe’, where the pudendal cleft of the labia can be seen through tighter clothing. You may find this extremely embarrassing, however, labiaplasty can correct this problem.

Labia minora: These are thinner inner lips that come into view when lightly spreading the labia majora apart. In some women, the labia minora can protrude from the labia majora and this is not an abnormality. As with labia majora, color differs from one woman to the next.

Clitoris: The small, knobby, sexually sensitive sponge-like tissue located on the anterior top of the vulva is your clitoris. The visible portion of the clitoris is about the size of a pencil eraser. It can either protrude or be nestled in tissue called a clitoral hood. Both are normal—much like belly buttons that vary from person to person. Some are embedded and referred to as innies while others, known as outies, may jut out. Sometimes, the clitoral hood may be too thick or protrude too much, causing chafing and discomfort. This may interfere with sexual pleasure and gratification. A procedure called clitoral hoodectomy can correct this, either for aesthetic purposes, for physical comfort or as a medical necessity.

Urethra: Located just below the clitoris and above the vagina, the urethra is the portal for urine to pass. It is about 1-½” long. Any swelling, discomfort, pain upon urination, lumps, abdominal pressure, blood in your urine, itching, discharge, discomfort during sex, or inflammation should be discussed with your doctor.

Vaginal opening (introitus): The channel leading to the vagina and its interior. Color varies and can range from a light pink hue to a deep wine color. Size and shape also differ from woman to woman. It can be cylindrical, round or oval. As with most of your genitalia, any discomfort, pain, difficulty with sex or urination, lumps, unusual bleeding, itching, discharge, foul smell, inflammation, visible protrusions of inner organs, or growths should be reported to your gynecologist.

Perineum: This is the small section of triangularly shaped fibro muscular tissue that begins at the base of the vulva and extends to the anus. The distance between the two can vary greatly from female to female. As with all lady parts, there are no set measurements that are considered ‘normal’ or ‘abnormal’.

The perineum serves as a structural support for several internal organs. It is also referred to as an erogenous zone.

The perineum may need to be surgically incised to allow for a safe delivery of a baby (episiotomy). It is then stitched and allowed to heal. Due to the trauma the perineum may suffer as a result of childbirth, women may experience complications (prolapse) later on that may require surgical intervention (perineoplasty). Should you experience bowel problems, incontinence, pain in the perineal area or in your thighs, back, abdomen or waist, speak to your doctor.

Anus: This is the end of the digestive tract and external opening that allows for fecal elimination. Depending on your skin tones, its color can range from pink to reddish brown. The opening is puckered and closed unless either eliminating fecal matter or inserting an object such as a finger or other probe.

If you experience pain, itching, difficulty or burning during a bowel movement, have uncontrollable bowel movements (fecal incontinence), notice blood, pus, swelling, a hard mass, any discharge or mucous, discuss this with your doctor.

I’ve Been Told I’m ‘Normal’ Down There But I Still Don’t Like the Way I Look. Do I Need to be ‘Abnormal’ to Qualify for Surgery?

Not at all. Mental health and physical health go hand in hand. If you’re not happy with your body and feel cosmetic GYN surgery can make you feel better about yourself and give you more confidence, there are a range of cosmetic procedures available to you. Dr. Michael Litrel (MD, FPMRS, FACOG) participates in RealSelf.com, an online forum on cosmetic treatments and aesthetic medicine. Not only is he highly skilled in performing cosmetic surgery, his expertise includes any necessary pelvic surgery you may require. He can answer your questions frankly and honestly. He’ll even look at any ‘selfies’ you may wish to provide on RealSelf.com to help ascertain whether you may benefit from a cosmetic GYN procedure. Of course, an in-person consultation with Dr. Litrel is required prior to final decision making.REAL SELF LOGO

Just as a regular breast examination is essential to your health and well-being, it’s a good idea to take a peek down there from time to time. By looking at your body and listening to cues, you may counteract an issue before it interferes with your pelvic health.

Typically, if you feel good, have a satisfying sex life, suffer no discomfort, experience no unpleasant leaks or odors, or don’t suddenly have bits and pieces poking out that don’t seem to belong, you are perfectly ‘normal’ down there. Maintain your annual gynecological checkups and pay attention to any changes that concern you. To schedule an appointment with one of our FPMRS doctors, call 770.720.7733.

January 18, 2017

An iron rich diet is important for women's health.Whether you currently suffer from a low iron or are at risk for an iron deficiency, you may want to begin introducing more iron into your diet.

Iron is elemental in helping transport oxygen throughout your body. Without a proper amount of iron in your daily life, you may wind up feeling some of the symptoms of iron deficiency. With the help of this article, you will learn how to add more iron into your diet safely.

You may be wondering if you have low iron. Take a look at some of the following symptoms to help determine if you have an iron deficiency.

  • Fatigue
  • Shortness of breath
  • Cold hands or feet
  • Dizziness
  • Rapid heartbeat
  • Brittle nails and hair
  • Pale or ‘Sallow’ appearance
  • Pica (cravings for non-food items)

If any of these symptoms ring true for you, you might want to think about scheduling an appointment with your doctor. Many of these symptoms can mean multiple things so you should ask your doctor for a proper diagnosis. Talk to your OB-GYN about your concerns and any symptoms you may be having.

Who is at Risk for Iron Deficiency

While women are more likely to suffer from low iron than men, there are some women who are at a higher risk than others. The average woman between the ages of 14-50 should consume between 15mg and 18mg of iron on a daily basis. Use the below guide to determine if you are at a high risk for low iron levels.

Pregnant Women

Women who are pregnant need on average about twice as much iron in their bloodstream than non-pregnant women. A pregnant woman should consume 27mg of iron a day to cope with her growing fetus, and higher volume of blood levels.

Pregnant women who do not get enough iron on a daily basis are at a higher risk for a preterm birth or below-recommended weight for their little one.

Menstruating Women

Due to the loss of blood from your menstrual cycle, you may suffer from symptoms associated with low iron. Without proper iron levels throughout menstruation, you can deplete your irons stores causing month long fatigue. Introducing more iron into your diet during your period can keep iron stores built up.

Women who are menstruating should consume 18.9mg of iron and teenagers should consume 21.4mg during menstruation.

Women Before and After Surgery

Iron levels are critical to women going into surgery due to blood loss. If you plan to have surgery, your doctor may recommend adding more iron into your diet beforehand. Your doctor will likely continue to keep you on higher levels of iron than average until it is determined, your stores are built up enough.

Nutritional Tips to Safely Add Iron into Your Diet

While your doctor may recommend iron supplements, getting enough iron through your food is the safest option. Adding some of these minor dietary changes to your daily routine can have a significant impact on your life. You may begin to feel more energy almost immediately. You may also notice healthier hair, nails, and skin.

Below, you will find several tips on how to make minor dietary shifts to help improve and maintain your iron levels.

  • Don’t skip breakfast. Most of your daily iron is going to come from whole grain breakfast cereals with added iron.
  • Say hello to seafood. Clams, mussels, and oysters are filled with iron. Halibut, salmon, and tuna are also great sources of iron. When consuming fish that contains higher-mercury levels, stick to 12 ounces or less a week, especially if pregnant.
  • Introduce snacks loaded with iron into your daily diet, such as hummus or other bean dips. Add whole-grain crackers or bread for an added boost of iron.
  • Switch up your greens. When ordering a salad, choose one that has iron-rich greens such as spinach instead of iceberg or romaine.
  • Avoid drinking caffeinated beverages when consuming iron-rich foods. Caffeine can have adverse effects on how your body soaks in iron.
  • Add Vitamin C-rich foods such as oranges or tomatoes to the same meal as foods high in iron. Vitamin C can help your body absorb iron.

Final Thoughts

If you still have concerns about your iron levels, don’t hesitate to contact us. Your doctor may recommend making an appointment for further diagnosis of your symptoms.

It is important to stay hydrated, especially if you have a urinary tract infection.The risk of getting a urinary tract infection, or UTI, is high when you are a woman. Some experts say there is 50% chance to get it at least once in your life – with many women experiencing UTI’s multiple times.

Symptoms of Urinary Tract Infections

First, it is important that you recognize the symptoms associated with the infection that can be located in different parts of the urinary tract.

Low UTI’s are in the urethra or bladder. Let’s have a look at the symptoms:

  • Burning feeling while urinating
  • Frequent urge of urination with scarce amounts of urine coming out.
  • Cloudy, bloody or dark urine
  • Strong and strange-smelling urine
  • Pain or pressure in your lower abdomen or back.

Upper UTI’s are in the kidneys. These are vital to have immediately treated, due to the risk of having the bacteria moving from the kidney to the blood. This last condition is called sepsis and can cause low blood pressure, shock, and even death.

Symptoms of upper UTI’s consist of:

  • Fever or chills
  • Pain in the upper back and sides
  • Nausea
  • Vomiting

Diagnosis and Treatment for UTIs

If you think you may have a urinary tract infection, get assessed by a doctor (usually your OB-GYN for this case). You must give a urine sample, which will be used to detect the bacteria that is causing the UTI.

The treatment for lower UTI is oral antibiotics. Be sure to finish all the prescribed number of pills completely. Otherwise, you risk suffering the infection again with stronger bacteria.

Upper UTIs may involve intravenous antibiotics.

If your doctor suspects of an upper UTI, he may ask you for blood cultures and a complete blood count (CBC). This is to discard the possibility of having the infection moved to the blood.

Some women have a bigger risk of being affected by a UTI. These factors contribute to a high-risk:

  • Any obstruction to the passage of urine. Can be caused by a tumor or kidney stones.
  • Pregnancy, due to the pressure the uterus may put unto the ureters and bladder, which makes it difficult for urine to go out completely.
  • A condition that involves the bladder’s nerve supply (like diabetes, multiple sclerosis, spinal cord injuries and Parkinson disease)
  • Usage of a contraceptive diaphragm or spermicide
  • Catheter placed into the bladder to drain urine.

If you have any of these conditions, it is especially important that you check with your OB-GYN right away when you experience the symptoms previously described.

Approximately 20% of women suffer a second urinary tract infection, and some undergo this continually. When this is the case, usually there is a different type of culprit or strain of bacteria. Some types can grow a community resistant to antibiotics and the body’s immune system. They travel out of the cells and re-attack.

When the UTI’s are recurrent, you should also check if there are any obstructions causing them. The tests used for this are:

  • Ultrasound
  • Intravenous pyelogram (IVP)
  • Cystoscopy

It is possible that during a cystoscopy, your doctor removes a small piece of bladder tissue to have a biopsy and rule out bladder cancer.

You should also talk to your OB/GYN about how to prevent or minimize the urinary tract infections. The recommendations may include:

  • Avoiding to hold your urine in the bladder for too long
  • Taking long-term antibiotics in a low dose
  • Taking a single dose of antibiotic after sex, which frequently triggers the infection
  • Drink more water

Final Thoughts

Don’t take too long to check with your doctor after recognizing the symptoms of a UTI. Kits designed for at-home tests can help detect a UTI but are not 100% accurate.

You can observe the results, prevent complications and ensure a full recovery when you analyze the causes behind the UTI with your OB/GYN.

January 3, 2017

Since you were a teenager, or maybe even younger, you were probably aware that gynecologists existed. You knew that, as you matured, they were there for your basic women’s health issues, annual checkups, Pap smears and other feminine physical needs. It probably wasn’t until you began experiencing problems that you learned about different specialists and subspecialists. Polysyllabic words like ‘Female Pelvic Medicine Reconstructive Surgeon’ (FPMRS), ‘Urogynecologist’ and ‘Urodynamic testing’ may have begun to litter your doctor’s vocabulary, and though they may sound daunting, they’re very simply explained.

From the time you were potty trained, the exercise of urinating was something you did automatically. Your body told you when it was time to go and, depending on the intensity of the message your bladder was sending you, you either strolled, trotted, or ran to the bathroom to take care of business.

However, as you age, you may have noticed some changes – unexpected involuntary leaks when you laugh or cough, sudden urges that leave you very little time to make it to the toilet, recurring infections, discomfort and maybe even the need to rush right back into the bathroom.

When your quality of life becomes compromised, our experts are here to step in. Our FPMRS accredited specialists are intensely educated Urogynecologists and experts in the field of women’s pelvic health issues. One of the many things we do is recommend and administer urodynamic testing to study, and subsequently, correct your urinary problems or disorders.

What is Urodynamic Testing?

Urodynamic testing is a series of tests that are run in order to evaluate exactly how well the bladder, sphincter and urethra are functioning in their job of storing and emptying the urine in your body. These tests can accurately pinpoint the reason for your particular problem.

incontinent woman photoWhy Might You Need Urodynamic Testing?

You may need one or several different urodynamic tests if a routine pelvic examination does not reveal a visible reason for your problem. Your doctor may then recommend further testing if you have experienced any of the following:

  • A pressing need to urinate without any flow
  • Difficulty in starting urine flow
  • Difficulty emptying your bladder completely
  • Recurring urinary tract infections
  • Burning or painful urination
  • Unexpected and sudden urge to urinate
  • Slow urine flow
  • A need to urinate immediately after voiding
  • Frequent urination (polyuria): You suddenly need to void more often than is normal for you, or find that you need to use the bathroom two times or more nightly (nocturia).
  • Urge incontinence or overactive bladder (OAB): This is an uncontrollable leakage resulting from the inability to reach a restroom in time.
  • Stress incontinence: You experience bladder leakage while lifting, exercising, laughing, coughing or sneezing.

How Can You Prepare For These Tests?

You will probably be asked to stop any bladder medications you are currently taking. Some tests may require that you arrive with a full bladder, while in other cases, you will be asked to arrive earlier and drinks at the testing site. Your doctor will give you this information. Complete testing should take approximately 2 to 3 hours, but again, this depends entirely on what tests are required for your particular issue.

What Will Happen During the Test?

The first part of urodynamic testing deals with emptying your full bladder, checking for any residual urine, and monitoring your urine flow.

The second part examines how your bladder behaves as it fills up. Catheters are used for this and may cause some discomfort or pinching, but the experience is not intolerable.

Leakage is common and expected, so there is absolutely no need to be embarrassed by this. It is an important part of the testing. Your input as you answer questions throughout the process is also important. You will be asked to shift positions, stand and cough. Again, your body’s reaction is important to your diagnosis and subsequent treatment.

When testing is complete, you will be required to void again while the catheters are still attached, after which they will be removed and the testing will be complete.

What Tests are Performed During Urodynamic Testing?

There are several tests. Depending on your particular case, you may need one or more of the following:

  • Video urodynamic test: While your bladder is filling and emptying, a technician will take pictures of the process, either through X-rays or via ultrasound. These are then studied, enabling your physician to make a diagnosis of your bladder function.
  • Uroflowmetry: This test measure both how quickly you empty your bladder (free uroflowmetry) and the amount of pressure exerted (pressure uroflowmetry) while doing so. The purpose is to assess why there may be a problem voiding, and to check for any possible blockages or muscle weakness.
  • Postvoid residual measurement: This measures any urine that is left in the bladder after you’ve finished urinating. Measurement can be obtained through either catheter tube drainage directly from the bladder or through an ultrasound scan. Depending on how much urine is extracted or scanned, anything over 100 milliliters may indicate inefficient bladder evacuation.
  • Multichannel Cystometry: Under local anesthesia, two pressure catheters are placed in the rectum and the bladder to gauge bladder capacity, and to determine the amount of pressure buildup as the bladder fills with warm water. You will be required to indicate when the urge to urinate begins. This procedure can also determine if there are contractions while the bladder fills, or it can pinpoint the bladder muscle (detrusor) that may not be contracting as it should.
  • Leak Point Pressure Measurement: During the cystometric test, while the bladder is filling, a sudden contraction may occur resulting in some of the water squirting out. This test, where one of the previously mentioned catheters is equipped with a pressure sensor called a manometer, measures the pressure at that leak point moment. You may also be asked to cough, or hold your nose and mouth while trying to exhale (Valsalva maneuver) at this time to check for any urine leakage that may indicate stress incontinence, and for any sphincter deficiency.
  • Electromyography: This test determines if the bladder neck and sphincters are working correctly by using special sensors to measure bladder and sphincter electrical activity. Depending on where the sensors are placed, the procedure may or may not require local anesthesia.
  • Cystoscopy: a camera is inserted through the urethra and into the bladder to check for any bulge, (diverticula) tumors, enlarged kidneys, or foreign bodies.
  • Fluoroscopic Urodynamics Study (FUDS): This is a sophisticated computerized study that measures the pressure readings of both the bladder neck and urethra while you are voiding.

How Long Does It Take to Get Results?

Uroflowmetry and Cystoscopy results can usually be given to you the same day. Several other tests may take up to a few days, but you should have all your results within two weeks.

What Can I Expect After Testing is Complete? Are There Any After Effects?

You may feel a little burning upon urination for a few hours. In order to minimize this discomfort, drinking a glass of water every half hour may help. A warm bath, or even a warm washcloth held against the sensitive site helps as well.

Avoid caffeine or any strong beverages for about 48 hours to minimize irritation upon urination. Take your time urinating to make sure your bladder is empty, and try voiding again after about a minute to make sure it is.

It is normal to see a small amount of blood in the urine after urodynamic testing. However, this should not last more than 24 hours.

Infections rarely occur, but should you experience any of the following, contact your doctor immediately:

  • Fever
  • Chills
  • Excessive bleeding
  • Pain that exceeds mild discomfort
  • Foul smelling, bloody or cloudy urine
  • Lower back pain in the area of your kidneys
  • Burning or stinging while urinating even several hours after testing
  • An urgent need to urinate
  • Frequent urge to urinate at night.

What Are My Treatment Options?

Once the results are reviewed and a diagnosis is made, your treatment plan may vary. A simple exercise regimen may be all you need. Medication, if necessary, will be prescribed. If a pessary, a mesh or even surgery is warranted, your doctor will discuss this with you and arrangements will be made. You will be informed of all your options, and any questions you have will be answered frankly, openly and honestly.

Voiding orders are very common in women, especially after giving birth or as you age. Early recognition, prevention and treatment are extremely important in order to avoid more serious problems or further pelvic health damage. We can help you.

If you are experiencing bladder problems, make an appointment today at 770.720.7733.

 

You’ve just been informed that you need a procedure called vaginal obliteration. If anything your doctor said after that became a buzzing jumble of words in your head, you’re not alone. The word ‘obliteration’ probably conjured up images of a bad war or alien invasion movie that left the earth a wasteland, and you may be picturing a similar, raw gaping devastation somewhere in the lower region of your body. This is not the case at all.

What is Vaginal Obliteration?
Simply explained, vaginal obliteration is closure of the vagina. It is all done internally and leaves no visual evidence on a woman’s outer body. It is a quick, safe and fairly simple surgery that our Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) are highly qualified to perform due to their combined decades of experience here at Cherokee Women’s Health Specialists.

FPMRS doctors photoThe female body is capable of many miracles. Not only can you reproduce human life in approximately 280 days, but you are capable of sustaining and nourishing that life from the moment of its conception, and for long after its entrance into the world.

Though they can be unusually resilient, and capable of performing this process over and over again, your reproductive organs are still only made of tissue, muscle, fiber, cartilage and bone, all of which is vulnerable to wear and tear over time. The same way the framework and internal parts of a car become dented, sluggish, loose, leaky, and damaged from years of constant use, the complicated parts of your pelvic structure may eventually become compromised. They are exposed to various traumas throughout your childbearing years, into menopause and beyond, especially if you have given birth several times or have had multiple births.

Just like that vehicle, your body may begin to need regular maintenance, and may also need repair if the damage becomes severe. In cases where the internal organs of the reproductive system begin to shift or droop drastically, and all other measures have failed or are deemed ineffective, vaginal obliteration may help you.

Who is a Candidate for Vaginal Obliteration?
This procedure is usually reserved for women who are older, who are no longer engaged in sexual activity, and who suffer from:

  • Pelvic organ prolapse (POP): This occurs when pelvic organs such as your bladder, uterus, or vagina shift from place to push against the vaginal wall.
  • Uterine prolapse: Uterine prolapse happens when the weakened support system of the uterus causes it to shift into the birth canal or vagina.
  • Vaginal vault prolapse: The upper part of the vagina has either dropped into, or protrudes out of the vaginal canal.

Because this is a brief and safe procedure, it is ideal for women who suffer from chronic conditions such as heart disease or asthma, and are unable to undergo prolonged surgery due to possible risk factors.

Your doctor may also perform a pap smear before your surgery date to insure that all is well. Afterwards, ultrasonic assessment will be done in place of a routine smear. If you have had abnormal pap smear results in the past, it is important that you discuss this with your doctor.

How is Vaginal Obliteration Performed?
You will be given either a regional, general or local anesthetic depending on the complexity of the procedure. After numbing has taken place, the surgeon will then remove the entire vaginal lining (vaginal epithelium) leaving approximately 1 to 1 ½ inches. When this is completed, the vagina will be sutured shut (total colpocleisis).

If your uterus is still intact, a small opening will be left to accommodate drainage of any fluids from the uterus (Le Fort procedure).

Sometimes, women who require vaginal obliteration surgery suffer from urinary incontinence as well, and this problem can be corrected at the same time.

Immediately after surgery, you will be on intravenous fluids and a catheter. The catheter will be removed after 24 to 48 hours and you will be able to urinate on your own from then on. This surgery does not affect your ability to pass urine, since entry to the bladder is located above the vaginal opening.

You will also be given compression stockings to avoid any risk of clots in your blood vessels that could travel to your heart or lungs. This is a precaution that is taken with most surgeries.

What About Having Sex After the Surgery?
No. Because the vagina will be closed permanently, this surgery is only usually recommended for older women who are no longer engaged in sexual activity, or for those who don’t foresee having intercourse in the future.

What is the Recovery Time?
Recovery times vary from patient to patient, but usually, vaginal obliteration requires one or two days of hospitalization. It is recommended that you avoid strenuous activity or exercise for one or two weeks after the procedure, increasing both very gradually afterwards until about 4 to 6 weeks have passed, after which you can usually resume your regular lifestyle.

You should try to drink plenty of water and eat a diet high in fiber to avoid constipation.

Are There Any Risks With Vaginal Obliteration?
As you’ve probably heard, there are risks involved with any surgery, but vaginal obliteration is a quick, safe and effective procedure and complications are uncommon, with a high 90 to 95 % success rate.

You may notice a white or creamy discharge for up to six weeks after surgery. This is nothing to worry about. This occurs because there are stitches in the vagina. As these stitches dissolve, the discharge will become more minimal until it disappears altogether.

Discharge stained with some brownish blood may also appear immediately, or even a week after the procedure. There is no need for concern as this is the body’s natural way of breaking down any blood trapped under the skin. However, you should contact your doctor if you experience any of the following:

  • Foul smelling discharge
  • Fever
  • Pelvic pain
  • Abdominal pain
  • Unusual bleeding
  • Abnormally frequent urination
  • Blood in the urine
  • Pain or burning upon urination (urinary tract, bladder, pelvic or vaginal infections sometimes occur in a very small percentage of women after vaginal obliteration, but are easily treatable).

There is no need for postmenopausal or older women to suffer with the pain and discomfort associated with the various symptoms that vaginal obliteration can easily repair. If you have questions or would like to make an appointment with one of our specialists, call 770.720.7733.

January 2, 2017

cosmetic vs reconstructive surgery photoAt Cherokee Women’s Health Specialists, we offer women the most modern, up-to-date solutions to gynecological problems that were formerly considered almost impossible to treat. Our OB-GYNs, urogynecologists, and Female Pelvic Medicine and Reproductive Surgeons are trained and credentialed to perform the many highly specialized cosmetic and reconstructive procedures that can dramatically change women’s lives and boost their psychological outlook.

Since the beginning of time, women have strived for ultimate beauty, perfect body symmetry and feminine wellness. Similarly, the world of medicine has dedicated itself to studying and repairing human anatomy, and to provide and maintain optimum overall health. It was inevitable that this combination would ultimately lead to a branch of medicine focused solely on women’s unique medical and cosmetic pelvic health issues.

From the time of the misguided, but well-intentioned Hippocrates, who believed in using a pomegranate as a pessary to cure prolapse, doctors have dissected, analyzed, and tried to understand the all-important female reproductive system, not just to insure the future of mankind, but to alleviate and correct those gender-specific disorders.

Eventually, as medical knowledge evolved, specialties such as gynecology, obstetrics, and urogynecology emerged. However, it wasn’t until 2014 that cosmetic and reconstructive surgery combined into a recognized and accredited field called Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This subspecialty satisfied women’s dual concerns of both repair and cosmetically improved genital appearance without the need to see several different doctors for each individual requirement.

Today, complete hysterectomies and other radical surgeries are no longer the all-in-one solution to many of the pelvic health problems women encounter throughout their lifetimes. The days of dangerous, invasive surgeries that resulted in disfiguring scars and months of recuperation and rehabilitation are slowly being left behind in the last century where they belong.

Yet many women, especially older ones, are unaware of the many options available to them today. They suffer needlessly, assuming their disorders are simply something they must learn to live with. They shyly excuse themselves to leave a room to change an adult diaper, or to push back something that might be peeking out from their private areas, not realizing that a simple surgery with minimal scarring and recovery time is available and can easily correct the problem. Others are hesitant to indulge in sexual intimacy because they’re concerned their partner may find a particular irregularity distasteful.

What is the Difference Between Pelvic Cosmetic and Pelvic Reconstructive Surgery?
Cosmetic surgery is usually an elective procedure to correct physical flaws, irregularities or deformities, and is not typically done out of necessity, but more to improve appearance and elevate self-confidence. It can also reverse many physical age-related effects, providing a more youthful rejuvenation to the area.

Reconstructive surgery is done for medical, and sometimes life threatening issues. It corrects damage to the pelvic area, and usually restores function, stability, sensation, and position, reverting the reproductive system to its pre-trauma state.

Can Pelvic Reconstructive Surgery Also be Cosmetically Beneficial?
It certainly can! While repairing damage that requires necessary tightening or trimming, reconstructive surgery can also automatically provide a more visually appealing and youthful look. Also, in many cases, as reconstructive surgery is being performed, an elective cosmetic procedure can be done simultaneously as well.

What are the Different Cosmetic Surgeries and Reconstructive Procedures you Offer?
There are a number of different procedures available to you for both physical wellness and aesthetic benefits.

Reconstructive Surgeries include:

  • Midurethral slings: This procedure quickly, easily and effectively corrects the problem of stress urinary incontinence, which is involuntary urine leakage when you cough, sneeze or laugh. Urinary incontinence may also occur during different activities. This is an outpatient procedure that can be completed in approximately 30 minutes.
  • Colposuspension: Used to treat stress urinary incontinence as well, colposuspension is a surgical procedure that requires restoring the shifted or fallen vagina to its original location. This can either be done by laparoscopic technique or via abdominal incision.
  • Posterior/anterior colporrhaphy: This vaginal wall defect repair corrects any protrusion of the bladder into the vagina (cystocele) or the rectum into the anus (rectocele). Both these problems are known as pelvic organ prolapse (POP), meaning organs are drooping from their regular place in the pelvic vault. POP can cause pelvic pain and pressure, vaginal bleeding, painful intercourse, back pain, bowel movement problems and incontinence.

Cosmetic Surgeries include:

  • Vaginal rejuvenation (Vaginoplasty): Vaginoplasty is a blanket term that encompasses several different procedures, both reconstructive and cosmetic. Cosmetically speaking, however, one of the procedures of vaginoplasty is vaginal rejuvenation which tightens, modifies, and/or reforms the shape of the vaginal tissue to achieve a younger appearance and ‘feel’. It can be described as a face lift of sorts for a woman’s genitals.
  • Labiaplasty: Labiaplasty reduces the size of the labia—usually the labia minora. If you have large or saggy labia, or are uncomfortable with any bulging that may show through tighter clothing, labiaplasty can give that area a trimmer appearance.

Cosmetic and Reconstructive Surgeries
ThermiVa: ThermiVa is a completely non-invasive, nonsurgical, drug and hormone- free vaginal rejuvenation treatment that restores vaginal health in many beneficial ways. Though it cannot actually be classified as ‘reconstructive’ in a surgical sense, temperature controlled heat administered via radio frequency energy rejuvenates interior and exterior vaginal tissue by stimulating new collagen growth. This process revitalizes the vagina to much of its former condition by reducing discomfort, providing lubrication, and eliminating laxity. ThermiVa can also correct incontinence and deliver support to the bladder, correcting many disorders caused by natural aging and childbirth, with added aesthetic advantages.

  • Perineoplasty: Though usually considered a reconstructive procedure, perineoplasty can also be cosmetic in the case of a deformed perineum. Perineoplasty corrects damage and defect in the perineum, the triangular section located between the anus and vagina, and serves an important role as a structural support for several reproductive organs. Typically, it can become impaired through childbirth, episiotomy, obesity or excess weight loss. Perineoplasty can correct issues such as scarring, excess skin, reduction in sexual pleasure, and can restore support to internal organs.
  • Hymenoplasty: Though this usually involves cosmetic restoration or creation of the ‘virginal’ tissue that may have been non-existent from birth, lost through trauma, sexual intercourse or other forms of rupture, hymenoplasty can also correct conditions such as imperforate, septate or microperforate hymen that can make intercourse, menstruation or tampon insertion difficult or impossible without surgical intervention.
  • Monsplasty (pubic lift): Reduces, tightens or lifts the pubic mound located just under your abdomen for a more feminine look.
  • Clitoral hood reduction: A thick or prominent clitoral hood may inhibit sensation and diminish sexual pleasure. A clitoral hood reduction can alleviate extreme discomfort, redness or irritation that can possibly lead to infection from constant chafing against clothing. Often, this procedure is accompanied by labiaplasty to shorten the vagina.
  • G-shot: G-shot is a treatment to enhance sexual pleasure, thus making it beneficial physically. G-shot can be administered by our pelvic health care providers.

Surgery Methods

  • Robotic surgery: This is a minimally invasive surgery that implements the use of a robotic arm to perform corrective surgery for such problems as pelvic cancerous tumors, fibroids, obstructions and masses. It is also used to ease pelvic pain and bleeding, and to rectify pelvic, rectal, vaginal vault and uterine prolapse. Today’s robotic surgery, under the practiced guidance of a specialist, can perform hysterectomies and endometrial excisions and resections. Due to its precision, robotic surgery offers wonderful benefits such as almost insignificant scarring, minimal discomfort or pain, rapid recovery, and less danger of infection.
  • Laparoscopic and single incision laparoscopic surgery: Apart from being a wonderful diagnostic tool, laparoscopy can correct many pelvic problems. A thin tube that is equipped with a light can be inserted into the body to probe for the cause of various problems within the reproductive system. It can also remove cysts, tumors, scarring (adhesions) and fibroids, as well as perform hysterectomies and tubal ligations. Laparoscopic surgery and can correct disorders such as incontinence and pelvic organ prolapse, leaves insignificant scarring, and allows for a much shorter recovery time with less risk of infection.

What is the Recovery Time for Most of These Surgeries You’ve Described?
Because of the less invasive methods we use today, like robotic and laser surgery, the recovery time is far shorter than most women may imagine. Some procedures only require one to three weeks of recuperation, others a little longer. Generally the longest recovery time is about three months. Your doctor will always provide you with aftercare instructions and any special precautions you may need to take.

The days of heavy handed scalpel wielding are becoming a thing of the past, giving way to treatments that were beyond our scope of imagination even 20 years ago. By today’s standards, yesterday’s methods seem almost barbaric in comparison. Yet many woman are still convinced that they are destined to endure the discomfort and changes Mother Nature sends their way, convinced that it is their destiny, or just a result of passing years.

In this day and age of open, frank, and honest dialogue, the word “vagina’ does not have to be whispered. Sex is no longer a marital ‘duty’ explained on the night prior to your wedding, but is a pleasurable experience you have every right to participate in and enjoy without discomfort or embarrassment. Nor is it a taboo subject to consider a lift, tuck, tightening or trim to an intimate zone if that change can allow you more self-confidence, less inhibition and additional ‘feel-good’ sensation.

We offer the physical, psychological, aesthetic and therapeutic means for you to achieve and maintain optimum pelvic health and confidence. At Cherokee Women’s Health Specialists, we not only listen and guide you in confidential privacy, but also communicate vital information regarding genital heath in public forums like Real Self, so that you can always be informed and make knowledgeable choices regarding your body.

The procedures covered in this article are only a partial and generalized list of the many various services we offer. The pelvic structure is a complicated myriad of bone, tissue, fiber, blood, organs, and cartilage, and the possible problems that can affect your wellness are equally complex. That is why we treat each person who comes to us with the individual attention their personal issues deserve.

If you have additional questions on cosmetic or reconstructive surgery, or to book an appointment, call 770.720.7733.

December 7, 2016

Uterine fibroids are a benign growth that appears on your uterus, uterine wall, or on the surface. These growths can be so small your doctor won’t notice them during an exam or significant enough to change the shape of your uterus, giving you severe discomfort.

Uterine fibroids can cause discomfort and impact a woman's fertility.Statistics show that a whopping 25 percent of women suffer from uterine fibroids. As many as one-third of those women will experience pain or abnormal bleeding due to their fibroids.

While uterine fibroids don’t cause pain in every woman, they have been known to create complications for some. Depending on the location of your fibroids, you may experience symptoms that can affect your daily life.

You should consult your doctor about any symptoms you may be experiencing, especially if you have been trying to conceive.

Symptoms Caused by Fibroids

Uterine fibroids affect each woman differently. Women who suffer from uterine fibroids can have varying degrees of pain, especially during menstruation.

Women who are at high-risk for uterine fibroids are between the ages of 25-45. African-American women also are more likely to suffer from them. Research is still unclear why this may be. Women who are considerably overweight are 2-3 times more likely to get uterine fibroids.

If you suffer from one or more of the following symptoms, you may have uterine fibroids.

  • Changes in Menstruation. A typical menstrual cycle will last seven days. It should be heavier in the first several days and become lighter. Women who have fibroids can experience longer, more frequent or heavier periods. Bleeding or spotting at times other than your period are more likely to occur as well.
  • Difficulty or Frequent Urinating. You may feel the need to use the restroom more often if you have uterine fibroids. Urinary leakage can be another side effect of having fibroids.
  • Abdominal or Lower Back Pain. Generally, this pain will be a dull, heavy ache. However, you may experience a sharp pain as well.
  • Pain or Pressure during Sex. Sex can be uncomfortable when you have fibroids, depending on the size and location of them.
  • Infertility. Although there are many reasons you may be unable to conceive, your doctor will want to check to see if you have uterine fibroids.

If you believe that you have uterine fibroids, you might want to consider speaking with your doctor about diagnosing them. Once diagnosed there are many treatment options available.

 

Relieving Uterine Fibroid Symptoms

There are several non-surgical options your doctor will suggest to help relieve the symptoms you may be feeling. If you are near menopause, your OB-GYN may recommend waiting out the fibroid symptoms if you can. Fibroids are linked to high estrogen levels, so they are likely to disappear with menopause.

Use some of the following techniques to alleviate they symptoms of your uterine fibroids.

  • Over-the-Counter Pain Medicine. If you suffer from painful, long lasting periods, drugs such as ibuprofen may help alleviate some of your pain.
  • Birth Control. These pills can be prescribed to help control heavy bleeding during your period.
  • Relax. Some research has determined a link between high-stress levels and your fibroids. Try relaxation techniques such as yoga, medication, and exercise to manage stress.
  • Manage Your Blood Pressure. High blood pressure has been linked to fibroids. Talk to your doctor about lowering your blood pressure through diet, exercise or medication.
  • Steer Clear of Smoking. Cigarette smoking can reduce the amount of oxygen that can reach your pelvic area and can worsen your menstrual pain.

Be sure to contact your OB-GYN before taking any supplements or medicines that could affect your estrogen levels.

 

Final Thoughts

If you are still having discomfort from your uterine fibroids, you may want to consider making an appointment with your doctor. Ask them about the various non-surgical treatment options for uterine fibroids.

Don’t hesitate to call with any further questions or concerns you may have regarding your uterine fibroids.

December 6, 2016

Perineoplasty, also referred to as perineorrhaphy, is plastic surgery that focuses on the deformities, imperfections, damages and defects of a woman’s anus and vagina. The surgery specifically removes scar tissue, unsightly bulges and unwanted skin, and then tightening or loosening the perineal muscles and vagina. An added benefit of perineoplasty is that, by making these adjustments, the surgery also serves to restore a woman’s confidence, and physically increase her levels of sexual pleasure.

What is the Perineum?
The perineum is the area located between the anus and the vagina. Small as it is, the perineum has the important job of being a structural support for several surrounding organs, and it encapsulates muscles that play a large part in vaginal tightening and loosening.

What Can Cause Damage to the Perineum?
Childbirth: Giving birth vaginally, especially during a difficult delivery, is the most common cause of perineal damage. Even an uncomplicated delivery can cause physical trauma to the vaginal and perineal muscles. Sometimes, an incision is made (episiotomy) in the perineum to ease baby out more easily. Sloppy stitching by a less experienced physician to mend either the natural tearing or planned cut may result in improper healing of the tissue, muscles and perineum. This may leave heavy scarring, pain and discomfort. Multiple births, of course, may worsen these problems. Perineoplasty can rectify them by opening the stitched area again and re-suturing it correctly, enabling proper healing.

Obesity: Excess weight can put strain on the entire body, including the perineum and the structures that it supports. It can also stretch the muscles, causing them to lose elasticity, much the way a mattress becomes concave in places as it conforms to the weight of your body sleeping on it night after night, providing less support as time goes on.

Extreme weight loss: We’ve all seen the ravages of sagging, flaccid, excess skin on someone who has thinned rapidly due to illness or binge dieting. Just as these unsightly effects are visible outside of the body, they can also happen internally, causing the perineal and other muscles to droop permanently even though the pressure of weight is gone. Think of that mattress again. It may regain its shape again during the day for a while, but eventually, after several years, the indentations and depressions become permanent.

What Other Conditions Does Perineoplasty Treat?

  • Vaginal itching
  • Vaginal laxity: (looseness of the vaginal opening that can cause decreased sexual sensation)
  • Vaginismus: (involuntary contractions of the vagina during attempted intercourse)
  • Vulvar vestibulitis: (severe pain during attempted penile or tampon entry)
  • Genital wart removal
  • Incontinence: (involuntary loss of urine)
  • Intraoital vaginal stenosis: (narrowing of the vagina, often caused by cancer treatment)
  • Dyspareunia: (painful intercourse due to a small vaginal opening)
  • Cystocele: (protrusion of the bladder into the vagina)
  • Rectocele: (protrusion of the rectum into the bowel)
  • Aesthetic enhancement: (tightening of loose or flaccid tissue or bulges to give the area a more attractive visual appearance).

What to Expect
Perineoplasty is an out-patient procedure that usually takes about an hour under general or local anesthetic. Rarely is hospitalization required.

A ‘V’ shaped incision is made to the posterior vaginal wall. Scar tissue, bulges and other damages are removed. Depending on the reason for the surgery, the muscles are then either tightened or loosened to correct the problem, then stitched carefully. After a brief recovery time, the patient is permitted to go home.

Recovery
Patients are cautioned to refrain from having sex for six weeks. It is recommended that any strenuous activity such a bicycling, horseback riding, heavy lifting, or stretching be avoided during this time as well. Tampons should not be used. Most patients should be able to return to work after several days.

Pain and discomfort is usually minimal to moderate and can be treated with over the counter pain medication, or a prescription supplied by the doctor. Minor bleeding and some discharge can occur, and this is normal.

There may be some dizziness or nausea for a day or two as a result of the anesthesia, but this should disappear after forty-eight hours.
The incision must be kept clean and dry. Stitches will dissolve by themselves in about two weeks. It is important to drink lots of water and increase fiber intake during this time to avoid constipation.

Complications
Generally, there are few risks associated with perineoplasty. However, the doctor should be contacted if any of the following occur:

  • Excessive bleeding
  • Signs of infection
  • Constipation not relieved through fiber intake
  • Vaginal discharge accompanied by a foul odor.

Childbirth can cause a great deal of trauma and physical change to the body, and women have accepted this as part of the reproductive process since the beginning of time. Today, however, there are procedures that can virtually restore your body to its pre-pregnancy state.

There is no need to suffer quietly and resign yourself into assuming that nothing can be done to ease the pain or embarrassment associated with any of the conditions mentioned above, or to dread intimacy because of possible discomfort or lack of sensation. We can help you. To make an appointment with one of our specialists, please call 770.720.7733.

gspot-happy-woman-photoFor many women, the genital area and its many complicated parts still remain a mystery, often depriving them of the many delightful sensations they are capable of enjoying.

Our specialists at Cherokee Women’s Health are aware of the possible inhibitions you may have when it comes to asking what you might consider embarrassing questions. Simply admitting to exploring your own body may seem like a taboo subject, but to us, it’s a very natural and healthy practice, so we welcome any questions you may have regarding erogenous areas of your body such as the G-spot.

What is the G-spot and Where is It?
The G-spot, or Gräfenberg spot, is an internal area located inside the entrance of a woman’s vagina. Named for a German gynecologist, Ernst Gräfenberg, who also invented the intrauterine device (IUD), the G-spot is believed to be an extremely sensitive nerve bundle that, when aroused, can result in a profound, thrilling orgasm, sometimes culminating in female ejaculation.

Although the G-spot varies slightly in location from one woman to the next, it is usually situated 2 to 3 inches upwards on the front wall inside the vagina. Some theorize that it is part of the prostate, while others believe it to be an extension of the clitoris, which extends up to four inches into the vagina.

Does Every Woman Have a G-spot?
There is some controversy on the subject. Some sexologists and doctors say no, while others say with absolute certainly that, yes, it is present in all woman. If you’ve ever achieved G-spot orgasm, you know it exists. It is likely that the reason for any doubt may be because of the G-spot’s location in your body, which varies a little from woman to woman, making it tricky to pinpoint sometimes. As well, it cannot always be accessed and stimulated with normal penile penetration in the traditional missionary position. Rear entry vaginal penetration, or the woman on top, (‘cowgirl’) position are two examples you may wish to try. Sometimes, it just requires a little imagination, practice, and/or the introduction of oral, manual or artificial methods to achieve G-spot gratification.

You Mentioned Female Ejaculation. Isn’t That Something Only Men Do?

No, some women are capable of ejaculating fluid during a G-spot climax, and there is nothing harmful or unusual about it. It’s not known for certain if this happens because the G-spot is an extension of the clitoris, which becomes engorged during sexual activity, or if the fluid is expelled by the woman’s prostatic-like glands that are situated in the urethral sponge, a part of the inner clitoral structure.

Am I Abnormal if I’ve Never Experienced This?
Absolutely not! It is still difficult for many women to achieve orgasm, whether it be through clitoral, vaginal or G-spot stimulation. There are many factors that can prevent a woman from enjoying full and satisfying intimacy, and these can be both psychological and/or physical. It’s our job to determine which might be preventing you from doing so, and to help you in any way we can. If a pelvic examination shows no abnormalities, then some of the following reasons may be preventing you from enjoying the full, stirring benefits of G-spot orgasm
Inhibitions such as nervousness or sexual taboo beliefs:

  • Insufficient lubrication
  • Improper positioning
  • Minimal or no foreplay
  • Rough manipulation
  • Lack of pressure during stimulation
  • Lack of candid verbal or manual guidance between partners.

Is There Anything Else You Can Do to Help Me Experience G-spot Pleasure Regularly?
Yes, we can. If we find there are no physical or psychological reasons preventing you from achieving G-spot satisfaction, a procedure called G-spot amplification (also known as G-Shot or GSA) enhances sexual arousal and gratification.

Our experts are fully qualified to administer this quick, safe, and painless procedure which injects a harmless filler that allows the G-spot to extend lower into the vagina, making it more accessible and easier to stimulate. The effects have proven to be highly successful, and can last anywhere from three to five months, allowing women to enjoy the delightful benefits and gratification of G-spot orgasms.

Sexual pleasure is a personal experience with individual preferences. What impassions one woman may not necessarily excite another, and that includes attaining climax through G-spot stimulation. We are always here to help you and to discuss your concerns regarding intimacy and other feminine health issues that you may be dealing with.

If you have any questions about your sexual health, call us today for an appointment at 770.720.773.

There is a clear relationship between cosmetic surgery and health. For the majority of us, there are things about our appearance that we find displeasing. Perhaps it’s the shape of our body, or we think we’re too fat, our waist is too big, or a woman might think her breasts are too small, or too big.

Whatever it may be, there are common surgical techniques in our modern era that allow us to transform the shape and appearance of a person’s body. If this leads to a person liking the way they look more, then perhaps cosmetic surgery can improve a person’s happiness and sense of well-being. This in turn, can lead to improved social relationships since someone who is more content with themselves often enjoys more success and happiness.

The Shadowy Side of Cosmetic Surgery
But there is a shadowy side to cosmetic surgery that anyone who is considering such operations should be aware of.  There are many patients who have gotten operation after operation only to find that they’re still not as happy as they’d hoped. The issue at the core is that our health and happiness in life cannot be exclusively about the way your body looks in the mirror. Anyone who lives their life with this thinking will inevitably suffer, especially during the inevitable aging process.

It’s an interesting phenomenon, unique to human beings, that we judge the way we look.  A dog or cat or squirrel does not spend time looking in the mirror and judging itself. The difference between human beings and other life forms on earth, as we understand it, has to do with our self-awareness.

woman-looking-in-mirror-photoFrom a metaphorical sense, this is what is meant in the Bible in terms of eating from the tree of knowledge. The garden of Eden is a metaphorical representation of the time in our existence when we were not aware of our appearance or how others might judge our appearances.

Judgment Call
We have all experienced this lack of awareness in our own lives and it usually occurs during our childhood. This was a more blissful time, before the awakening of sexual desire. But then all of this changes with puberty, because we become acutely aware of our own self and the physical attraction we feel toward the opposite gender. It’s then when we most become aware that not only are we judging ourselves, but others are judging us as well.

This can be a painful time, when we conclude through rejection from others that we are not worthy of love. We learn to dislike ourselves and sometimes even hate who we are. This, of course, is not a healthy way to live.

Perhaps a skillful cosmetic surgeon can change the appearance of the face or body we see in the mirror. Perhaps these changes can help us feel better. But if we simply do not like ourselves because of childhood pain, no amount of cosmetic surgery will lead us to health, no matter how skillfully performed.

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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