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


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.

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.

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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