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Category: General

August 10, 2016

What is Hymenoplasty?
Simply explained, hymenoplasty, also known as hymenorrhaphy, is the cosmetic repair, restoration, or construction of a woman’s hymen. Restoration of the hymen is also referred to as revirginization.

What is a Hymen?
In order to explain hymenoplasty surgery, a description, along with some information about the hymen might be beneficial.

The hymen consists of human tissue which resembles an oval rubber washer that partially or completely covers the vaginal opening. This ring-shaped membrane can be thin and flexible or thick and rigid. It begins to form while the female is still in the womb, usually beginning in about the fourth month of pregnancy.

Contrary to what many believe, except in rare cases, the hymen is NOT an impenetrable seal. If this were the case, there would be no portal for menstrual flow or healthy, normal vaginal discharge to leave the body.

Historical romance writers often describe the heroine in their bodice ripper books as having a Teflon hymen that causes her to wince or cry out painfully while in the throes of that first sexual encounter. Her lost virginity is also typically evidenced by vivid, crime scene-like blood splatter on pristine white sheets. However, in reality, that first rupture, regardless of the method, doesn’t always draw blood, and is not always painful.

Hymenoplasty photoLike the appendix, a hymen serves no real purpose. Yet, throughout history, this nondescript sheath of skin traditionally and very mistakenly has served as undeniable, positive proof of a woman’s purity and innocence. Even to this day, in many cultures, an intact hymen still indicates virginity, especially if there is the presence of blood upon first penile penetration.

Clinically speaking, however, a torn or damaged hymen is not irrefutable confirmation of virginity loss by sexual hanky panky. Depending on its rigidity, perforation of the hymen can be caused by normal everyday activities such as strenuous athletics, horseback or bicycle riding, a simple gynecological examination with speculum or gloved finger insertion or masturbation. Even placing a tampon into the vagina may rupture it.

In some cases, a hymen may not be present at all, as approximately 1 in 1,000 women are born without one.

What Are Some of the Reasons for Hymenoplasty?
Hymenoplasty is a cosmetic fix for women who may wish to repair or reconstruct their hymen. Their reasons for seeking this procedure are varied, and may be physical or psychological.

  • Reclaiming control: In the case of sexual assault, a woman is understandably left with traumatic psychological issues. She may feel that she was robbed of not only her innocence, but the opportunity to present the virginal gift of an intact hymen to the person of her choice. Hymenoplasty may not only offer the physical restoration she seeks, but may also supply some psychological comfort and healing as well.
  • Burying the past: Sexual curiosity and experimentation are a natural part of the growing process, especially during adolescence when hormonal changes and surges occur. Peer pressure may often compel a young girl to succumb to sexual activity before she’s mentally prepared for the emotional impact associated with such physical intimacy. As she matures, she may feel regretful that she indulged in that curiosity too early or too often, and may seek to bury evidence of what she might, in retrospect, view as promiscuity or bad judgment. Revirginization may psychologically allow her to turn back the clock and start over.
  • Cultural beliefs: Because the presence of an intact hymen is still important in many cultures, a woman may want to provide this indication of purity to her spouse for their upcoming nuptials.
  • A gift: Many women who have already been sexually active may wish to give their partner a virginal experience, whether it be as a surprise, for a special occasion, or on their wedding night.
  • Accidental rupture or tearing: For some women, penetration of the hymen via bicycle or horseback rides, slipping on ice, or tampon insertion is simply not acceptable and they opt for hymenoplasty to restore what was damaged unintentionally.
  • Enhancement of sexual pleasure: After childbirth, the vaginal muscles may weaken. Flaccidity also occurs over time with age. Hymenoplasty also tightens these muscles, giving the added benefit of a more sensually stimulating sexual experience.
  • Imperforate hymen: This is a condition where the entire vaginal opening is covered by the hymen. It is not usually discovered until a young girl enters into puberty and her menstrual flow is blocked. The hymenoplastic procedure to correct this is called hymenotomy, and a small hole is made in the membrane to allow blood flow.
  • Septate hymen: The hymenal tissue is split into what looks like rope-like bands. They resemble tonsils that are connected at both ends, and may impede tampon use or penile penetration. This is also corrected by hymenotomy. A septate hymen can also refer to a very thick or rigid hymen, like the almost bulletproof one of romantic lore mentioned earlier, and may require surgical penetration.
  • Microperforate hymen: This is similar to an imperforate hymen and is corrected in the same manner. A microperforate hymen has a small opening only adequate enough to permit menstrual flow. It does not usually present a problem or require enlargement unless a female wishes to use tampons.

What Happens During Hymenoplasty?
Hymenoplasty is usually a simple out-patient procedure that can be done in our clinic under local anesthesia. Any torn skin around the edges of the hymen is gently and neatly cut away, after which the remaining tissue is stitched together, leaving a small opening. This restores the hymenal ring to a normal size and shape.

If there is not enough skin to restore the hymen, or if a hymen is nonexistent, the surgeon may create one, using either some of the body’s own thin vaginal skin (vaginal mucosa) or a synthetic tissue. A small blood supply may be added, either artificial or the patient’s own taken from a piece of vaginal flap, thus simulating the traditional bleeding upon subsequent penetration.

What is the Recovery Time?
The surgery can be expected to take anywhere from one to two hours depending on the amount of repair needed. Though this is a clinical procedure with no hospital stay necessary, and women may return to work the next day, strenuous activity and heavy lifting should be avoided. During the first 48 to 72 hours, there may be some slight bleeding, but this is perfectly normal.

Full healing takes approximately six weeks. There will be no visible signs of surgery and it will be impossible to tell the difference between a natural hymen and a reconstructed one. At this time, the reconstruction process will be complete and all the sensations associated with virginal, first time sex may be experienced.

Complications
There are rarely complications. However, the doctor should be contacted if the patient experiences any of the following symptoms:

  • Dizziness
  • Pain beyond moderate discomfort after three days
  • Unusual or foul smelling discharge
  • Intense itching
  • Abnormal bleeding
  • Inflammation.

Depending on why you might request hymenoplasty, this may be a delicate subject to discuss. Rest assured that our doctors are familiar with the many reasons patients ask for this procedure, and fully understand your discomfort and shyness in regard to this subject. It’s your body. We want to help make you as comfortable and confident with it as possible.

To learn more about hymenoplasty or to schedule an an appointment with one of our doctors, please call 770.720.7733.

What is Clitoral Hood Reduction?
Clitoral hood reduction, also known as clitoral unhooding, clitoral hoodectomy, or clitoridotomy is a cosmetic surgical procedure which reduces the excess skin (prepuce) that covers the clitoris. The technique not only
enhances the visual appearance of a woman’s pubic area, but it also serves to improve sexual pleasure by making the clitoris more accessible. As the name implies, the clitoral hood conceals the clitoris nestled inside, similar to an uncircumcised penis where the foreskin sheathes the head in its non-erect state.

What is a Clitoris?
Before launching into a description of the surgery itself, it may be of interest to understand the function, location, and description of the female clitoris.

The clitoris is a woman’s primary and most complex erogenous zone. The head (glans) of this tiny body part is estimated to have more than eight thousand sensory nerve endings twice as many as the glans of a penis. Though its sensitivity and size can differ from female to female, it normally resembles a pea or small pearl. When aroused by oral or manual stimulation, the clitoris becomes engorged much the same way the male penis does, thus enabling a woman to achieve orgasm.

In order to more easily picture the location of the clitoris, simply imagine the nude frontal view of your pubic area. What you are looking at in your lower region is called the vulva. The cushioned ridge you feel beginning halfway down from your navel is the mons veneris. As you continue to move downwards, it separates into two cheek-like mounds that are separated by a vertical opening with lip-like tissue. Those lips are called the labia majora.

By gently pulling apart the labia majora, you will expose two more inner lip-like flaps of tissue on the left and right. These are labia minora. At the base of the labia minora, leading up to the anal opening, there is a small bony ridge called a perineum. At the upper tip of the labia minora, that small tube-like protrusion is the clitoral hood. Peeking out through, or hiding inside the opening of that hood is the tip of the clitoris.

The entire clitoris itself is about 4 inches long, but, as explained earlier, the head or glans, is small, roughly the size of an eraser on the end of a pencil, and it is extremely sensitive to touch.

Clitoral Hood Reduction photoWhy Would a Woman Need a Clitoral Hood Reduction?
Because the size, shape and thickness of the clitoral hood differs from woman to woman, this procedure is not always done for medical reasons alone. It can also be done for aesthetic purposes to give the vulva a neater, trimmer look.

In some cases, the clitoral hood may be extremely large, inhibiting access to the clitoris, thereby preventing the achievement of sexual gratification. A thick or large hood may also cause friction against clothing which can lead to soreness, redness or inflammation.

Often, a woman with an enlarged hood may also have large labial lips that protrude in a manner she may find unsightly. Both the clitoral hood and the labia, if quite prominent, can sometimes create obvious bulges that can be seen outlined against close-fitting outerwear. Women may opt to cosmetically correct prominent labia through a procedure called labiaplasty at the same time as they undergo a clitoral hood reduction.

What Can be Expected During and After the Procedure?
Clitoral hood reduction surgery is normally done as an outpatient procedure under local or general anesthesia. A specialized laser and surgical instruments remove a predetermined amount of superfluous hood tissue, insuring that accessibility and stimulation to the clitoris is no longer restricted. The clitoral head is not modified in any way. Only the hood is altered. At this time, if the patient so chooses, the surgeon may perform additional procedures to the genitalia, such as vaginal tightening, hymenoplasty or vaginoplasty.

Clitoral hood reduction is microsurgery. The procedure, after complete healing, will leave no scars. Tiny, barely visible incisions will be concealed in the folds of tissue around the surgical area.

There will be some numbness experienced after surgery, but this will subside. The numbness is in no way indicative of nerve or any other damage. In fact, after the effect wears off, sensitivity to the clitoris will be heightened due to easier access to it.

The entire procedure will take approximately an hour depending on what needs to be done.

Aftercare and Recovery
The area will be tender and inflamed, but rest and application of ice will help, along with over-the-counter pain relievers. After about two or three days, the patient will be able to return to work. Complete recovery will take approximately six weeks, and the patient will be cautioned not to engage in sexual intercourse during that time in order to avoid complications. Strenuous activities such as horseback or bicycle riding, running, and heavy lifting should also be avoided during this time. Special care to keep the area clean is important in order to avoid any possibility of infection.

What Are the Complications?
Complications are rare. However, your doctor should be contacted if there are any of the following problems:

  • Intense pain or discomfort
  • Inflammation or numbness after several days
  • Any foul odor or unusual discharge
  • Excessive bleeding.

Interesting Facts Regarding the Clitoris
The size and shape of the full clitoris was not revealed until 1998. Until that time, even though physicians knew of its existence, it was either eliminated from anatomy publications that previously mentioned it briefly, or it was ignored altogether. A 3D sonography image was not available until 2009. Throughout history, the importance of the clitoris to a woman’s sexual pleasure has either been disputed or dismissed altogether. In fact, in the 1500’s, the presence of the clitoris in women was used as irrefutable proof of witchcraft, and was referred to as the ‘devil’s teat’. Perhaps the clitoris snuggled deep within the camouflage of a thick clitoral hood back then saved many a woman from imminent death.

We’re Here to Help
Our highly qualified doctors are here to frankly and openly discuss whether this procedure is right for you. Genital surgery, whether for physical, aesthetic or psychological reasons, is an intimate and important decision. We are here to guide and advise you without judgement, bias or preconception. The more confident and comfortable a woman is with her body, the more pleasurable and satisfying her intimate life will be. We are here to provide the help and advice to make that happen.

To make an appointment with one of our doctors, call 770.720.7733.

August 4, 2016

ThermiSmooth

Achieve Smoother, Firmer Skin with ThermiSmooth

ThermiSmooth is a simple office procedure for smoothing fine lines, wrinkles and sagging skin in all areas of the face:

  • Forehead
  • Eyes
  • Cheeks
  • Mouth
  • Neck

Patients have remarked this 30-minute procedure feels like a “warm massage” while a hand-held device delivers radiofrequency energy to the surface of the skin, heating the cells and stimulating the body’s own collagen production.

ThermiSmooth requires no anesthesia, takes little time and works beautifully. A series of 3-6 treatments is recommended for optimum results.

  • Gentle therapy
  • Non-invasive procedure
  • No downtime
  • Series of 3-6 treatments

One patient, who just started her series of ThermiSmooth treatments, says, “I’m turning 50 this year and was on the verge of scheduling a consultation with a plastic surgeon to address my wrinkles and sagging skin, but I was hesitant to go under the knife. That’s when I heard of ThermiSmooth. I did some research on RealSelf.com and was blown away by the before and after photos so I immediately scheduled an appointment. I’m so glad I did. I’ve received two treatments so far and already my skin feels better, looks younger and my makeup goes on smoother. And it really does feel like a warm massage! I can’t wait to see the results after my final treatment.”

To schedule your ThermiSmooth appointment, call 770.720.7733 or contact us here.

August 2, 2016

Dr. Crigler photo
As an OB-GYN who’s a vegan, husband and father, Dr. Crigler shares his views on diet, exercise, and bringing patients a great health experience. Working in the field of women’s health – as does his wife Lauren – he talks about how they’ve shaped each other’s practices, and how he turns off his “clinical side” at home.

12 Symptoms, One Fix: How Can Patients Experience Better Health?

Q: From your recent blogs, it’s evident that you and your family maintain a proper diet as the foundation for your health. Does going vegan have any advantages for female reproductive health, and if so, what are they?
Dr. Crigler: A plant based diet has multiple benefits for women’s health, including decreased risk of breast, ovarian and colon cancer. Meat and dairy have both been associated with increased risks of each of these cancers. Even for our pregnant patients, a vegan or plant based diet free of dairy and meat can be very healthy for both baby and mother. As we recommend taking prenatal vitamins for all women, supplementing vitamin D and B12 is more important with a vegan diet. This diet has also been associated with a decreased risk of preeclampsia. It also results in a purer breast milk with no added hormones and less risk of food allergies for the infant.

In addition to female health improvements decreasing the cancers I spoke about, I want to mention lupus, acne, high cholesterol, irritable bowel syndrome and heart disease as conditions that are likely improved with plant based diet changes.

Dr Crigler doing situps with patient photo

Dr. Crigler doing situps with his patient and baby!

Q: What percentage of the health problems you deal with regularly would you guesstimate might easily be solved through nutritional changes and exercise? Can you give some examples?
Dr. Crigler: 100%. Plant based diets will assist in losing weight, decreased systemic inflammation of the body, decrease incidence of type 2 noninsulin dependent diabetes, decrease constipation and risk of hemorrhoids (for our pregnant patients) and help decrease exposure to exogenous hormones often found in meat and dairy products. Exercise helps maintain ideal body weight, increase insulin sensitivity (reducing gestational diabetes) and also helps keep mom in shape for the laboring process. After all, they don’t call it labor for nothing! Northside Hospital Cherokee has a good online maternity resource- that’s one place to start.

Q: Now that you’ve been in private practice for several years, are there additional areas of knowledge in women’s health care you would like to explore to better help your patients?
Dr. Crigler: Many of my patients ask me about sexual health including pain with intercourse, decreased sexual desire, inability to climax and vaginal dryness. While a very sensitive topic, this is very important for the health of a relationship and the mental and physical health of the patient.
I plan to explore dietary, natural, non-invasive medical devices, pharmaceutical, and surgical ways to help patients address these important concerns.

Q: Every doctor has his or her own approach to making a patient feel comfortable. How do you personally try to put your patients at ease to encourage open, honest dialogue?
Dr. Crigler: I try to imagine how I would want my two sisters, mother or wife to be treated during a gynecologic visit. I sit down and I listen. I realize these conversations are quite personal and that I may be the only person in the position to address these issues. I attempt to destigmatize these topics; such as painful intercourse, fecal or urinary incontinence or inability to orgasm.

Q: After each patient appointment, what do you want the patient to have or to have experienced when they leave?
Dr. Crigler: I want them to feel they were given the opportunity to express their concerns, they were listened to and that I truly care about helping them. I want them to come out with a better understanding of their health condition or problem and be confident in the treatment plan that we make together.

Q: Can you share an example of a patient where one appointment made a difference in their health decisions or treatment?
Dr. Crigler: I saw an 80 year old diabetic, arthritic patient with complete pelvic prolapse who still lived on her own, cooked for herself, and really valued her independence. Two doctors at other clinics recommended different surgeries that would likely take weeks to months to recover from and put her at risk of infection. I saw her as a 3rd opinion and offered her a pessary to hold everything in place. We happened to have the exact size she needed in stock and she left that day with a cure to her prolapse, no recovery time and I am sure made it home in time to cook her own dinner.

Husband and Father:
A Wide Perspective on Women’s Health

Q: There are many similarities between your profession and your wife’s, in that you both deal with the health and maintenance of the human body by reducing pain and restoring function—you, medically and she, therapeutically. Is that a coincidence, or did one of you inspire the other to select your specialty?
Dr. Crigler: We met in our anatomy class in medical school, so we were already on a path to helping people in the medical field. Our emphasis on the role that diet and exercise play in health, pain, function and disease prevention was mutually inspired with the help of several documentaries and books for inspiration.

Q: How much impact and input do you have on each other’s professions? For example, does your medical knowledge help your wife Lauren understand her patients better—and does Lauren’s input of what her patients go through during therapy (ie; pain, struggle, mental issues, etc.) help you approach your own patients with more enlightenment?
Dr. Crigler: Our professions impact each other’s quite a bit. We talk about the impact of medication, food and therapeutic exercise in all kinds of conditions. Medical doctors tend to emphasize freedom from symptoms while physical therapists emphasize increased function. We both have several techniques that help meet both of those goals for a more holistic treatment plan. We enjoy learning from one another and most definitely provide better care for our patients due to all of these free consults.

Q: Other than the usual ‘how was your day?’, do you normally leave shop talk at work, or do you find it makes for interesting conversation at home?
Dr. Crigler: I might discuss interesting or challenging cases with Lauren, especially if I am looking for a different perspective or physical therapy ideas. When I am on call, I usually just report any number of babies I delivered that night. She gets excited about every one as she reminisces about her deliveries. It makes not having me home worth it when she knows that another woman was having a life changing experience.

Q: After dealing with patient health issues all day, do either of you find it difficult to turn off your clinical sides?
Dr. Crigler: That’s funny. The very first thing I hear when I get home is “daddy, daddy, daddy, huggy, huggy”. After the hugs and kisses, I get to hear about their superheros and construction sites for about 30 minutes until we wind down for bath and our bedtime routine. Having my sons so excited to see me makes it pretty easy to put on my daddy hat and leave work behind…until they go to sleep that is.

Q: You mentioned that you had the privilege of not just seeing your sons being born, but also delivering them yourself. Do you remember your first thoughts as they both came into the world, or did you remain in ‘doctor mode’ until the whole process was over?
Dr. Crigler: I was in residency while both my sons were born so while I had delivered a couple of hundred babies already, I was still nervous. I did my best to play both the supportive husband and skilled obstetrician role at the same time during the labor. As they were crowning, I did tear up in amazement that we had made this miracle, and then simultaneously, as trained, remembered “protect the perineum”, in hopes to limit any vaginal tears. After delivery, I placed them both on my wife’s chest, cut the cords, and then went into complete husband-daddy role. 

Snapshot: Medical Rescue

Q: Almost every medical TV show and movie shows the star physician out somewhere on his day off enjoying a dinner or other relaxing activity. He’s minding his own business, when suddenly some drama occurs that requires the help of a doctor. Has this ever happened to you?
Dr. Crigler: Just last weekend my family and I went up to Cave Spring, GA to take the kids to the springs and cave. On our way back, it was raining and we rode by a serious collision on the opposite side of the road that appeared to have just happened. I immediately pulled into the closest gas station and left the kids and Lauren in the car to run across the median to help out. Fortunately, only one person was injured and she was talking. She did have a large laceration on her head, complained of neck pain, was very anxious and had evidence of a concussion. With the help of a couple of other Good Samaritans, we comforted her, stabilized her neck, and controlled the bleeding until EMS arrived. I then ran back, soaked, to my family as we rode carefully home, thankful everyone was safe and healthy.

July 14, 2016

Prolapsed bladder, also known as Fallen Bladder or Cystocele, is a condition where the bladder drops down from lack of support. A concave shaped group of pelvic floor muscles and tissues hold the bladder and other organs in place. Due to a variety of reasons, these muscles and tissues can weaken over time. This causes the bladder to descend from its fixed position and slip downwards into the vagina, much like a big toe begins to rub, then protrude through an old, worn sock. In more severe cases, the bladder may dangle completely outside of the vagina.

What Causes Prolapsed Bladder?prolapsed bladder photo

  • Childbirth: A difficult delivery, long labor, a large baby or multiple births are the most common causes. A baby’s eagerness or shyness to enter the world can be difficult on a woman’s vaginal tissues and muscles.
  • Strain: Heavy lifting, straining during bowel movements, excessive or chronic coughing can weaken the pelvic floor muscles.
  • Menopause: Once Mother Nature decides we’re done with babies and periods, the body no longer produces estrogen, which is vital in maintaining the health of vaginal tissue.
  • Obesity: Excess weight also puts undue strain on pelvic muscles and tissues the same way carrying a sack of potatoes can strain the arms and back.

What are the symptoms?

  • A sensation of pressure in the bladder or vagina
  • Leakage of urine when coughing, exerting oneself, sneezing, laughing, etc.
  • Protrusion of tissue from the vagina that may bleed or be sore
  • Frequent bladder ifections
  • A sensation that thne bladder is not completely empty right after urinating
  • Difficulty urinating
  • Pelvic pain or discomfort
  • Lower back pain
  • Painful intercourse
  • Incontinence during intercourse.

In cases where the bladder prolapse is mild, women may not experience any symptoms at all, and the condition may only be discovered during a routine examination.

When Should You See Your Doctor?

If you notice that you may have any of these symptoms and suspect a prolapsed bladder, you should see your doctor immediately. This condition often means that other pelvic organs may also be prolapsed, as the same muscles and tissues hold the uterus, cervix, vagina, rectum, and intestines in place as well. This is not a condition that repairs itself. It usually worsens over time, but it can be fixed thanks to many modern methods available today.

Diagnosis and Tests

In obvious cases, an examination of the pelvis and genitalia can visually confirm prolapsed bladder. If less evident, the doctor may use something called a Voiding Cystourethrogram to confirm diagnosis. This is a sequence of x-rays taken while the patient is urinating so that the physician can see the bladder shape and what may be causing flow problems. He may also request additional x-rays of different abdominal sections to eliminate other theories, after which he may test muscles, nerves and the force of the urine stream to conclude his diagnosis and recommend treatment. Additional tests, if necessary are:

  • Cystoscopy: examines the bladder using a scope
  • Urodynamics or Video Urodynamics: measures bladder pressure and volume
  • Ultrasound: Uses sound waves that form an image
    Magnetic Resonance Imaging (MRI): Magnets and radio waves that produce images of soft internal tissues and organs.

Treatment

If tests confirm prolapsed bladder, your doctor will categorize its degree as mild, moderate, severe or complete. If it is mild, it usually requires no immediate treatment other than to refrain from heavy lifting or exertion.
For more serious cases, depending on health, age and other factors, some non-surgical treatments include:

  • Pessary: A device placed into the vagina to hold the bladder in the correct position. He may also prescribe an estrogen cream to prevent vaginal wall degradation and infection. Just like dentures, pessaries need regular, thorough cleaning.
  • Estrogen replacement therapy: Estrogen strengthens, maintains and preserves vaginal muscles.
  • Electrical stimulation: Probes send small electrical currents to contract the muscles and strengthen them. Electrical stimulation can also be magnetically delivered from outside the body targeting the pudendal nerve to help with incontinence.
  • Biofeedback: A sensor is used to check muscular contractions during exercise to make sure they are being done correctly and are being beneficial.

Surgery

Should you need surgery, one of the following may be recommended:

  • Tension Free Vaginal Tape Surgery (TVT): A mesh tape placed under the urethra like a sling to keep it stable and in place.
  • Retropubic Suspension Surgery: Abdominal surgery to lift sagging urethra and bladder neck.
  • Electrical Stimulation: A series of sessions using a vaginal or anal electrode to aid stress and urge incontinence.
  • Urethral Bulking: Injection of bulking agents (collagen, autologous substances) around the urethra to treat incontinence.
  • Burch Colposuspension: Attachment of the vaginal wall to a ligament near the pubic bone.
  • Urethral sling surgery: A sling that lifts the urethra to its correct position and to aid urine retention.
  • Posterior Tibial Nerve Stimulation (PTNS): A small electrode introduced into the lower leg. The procedure decreases the need for frequent urination and requires several sessions.
  • Sacral Nerve Stimulation (SNS): An electrical stimulator placed under the skin of the buttocks that sends pulses to the lower back nerve (sacrum) to aid with bladder control.
  • Transobturator Tape Surgery (TOT): Similar to TVT with some small variations.

Types of Reconstructive Surgery

  • Anterior and Posterior Colporrhaphy: Resuspension of rectum and bladder.
  • Sacrohysteropexy: Repairs uterine prolapse by attaching the cervix to the sacrum with mesh.
  • Sacrocolpopexy: Repairs vaginal vault prolapse by attaching the vaginal vault to the sacrum with mesh.

What Can You Do?

  • Maintain a healthy weight.
  • Eat fiber to prevent constipation.
  • Don’t smoke. Chronic coughing contributes to bladder prolapse.
  • Train your bladder by trying to maintain a regular schedule of set times for urination.
  • Wear clothing you can remove easily if you suffer from frequent urination or overactive bladder.
  • Do Kegels and strengthen your pelvic floor muscles.
  • Cut back on tea, coffee and sodas that contain caffeine. Caffeine can have a diuretic effect.

Prolapsed bladder and its effects can be uncomfortable, restrictive and inhibit a normal lifestyle. Our highly trained GYN specialists can address these issues so you can get back to living the life you deserve.

Call and make an appointment today at 770.720.7733.

A mother’s body is more than just a home as her baby grows: it is protection, sustenance, and strength. When a mother eats well, exercises, and takes care of her body, she is also helping her baby grow healthy and strong. Vaccines can help both mother and baby stay healthy during pregnancy and the early postpartum months. But not all immunizations are safe for pregnant women. If you’re trying to expand your family, here’s everything you need to know about vaccines during pregnancy.

Pre-Pregnancy Vaccines

If you’re trying to become pregnant, you likely have a list of things to eat, avoid, measure, and track. Moms-to-(Hopefully)-Be can add “vaccinations” to the list. Vaccines that contain traces of live viruses aren’t safe for pregnant women. Get these immunizations at least one month before trying to become pregnant. To prevent illness and infection during pregnancy (for both yourself and your baby), make sure you’re up-to-date on these vaccines.

  • MMR (Measles, Mumps, and Rubella vaccine)
  • Chickenpox vaccine

Safe Vaccines During Pregnancy

mom holding baby's handAccording to the CDC, some vaccines are safe for pregnant or breastfeeding mothers. The flu shot is recommended for pregnant women during flu season (November-March). The flu shot, which is made of dead strains of the virus, is safe for both mother and child. Vaccines that contain live viruses, such as some flu nasal sprays, are not safe during pregnancy. The TDAP vaccine, which protects against whooping cough, is made with toxoids (bacterial proteins which have been chemically altered), and is also safe for pregnant women. Other low-risk vaccines, such as the Pneumococcal vaccine and Hepatitis B vaccine, may be recommended by your physician based on your individual risk of contracting the disease.

Post-Pregnancy Vaccines

If you weren’t able to get up-to-date before welcoming your bundle of joy aboard, the postnatal period is the time to get caught up on your adult vaccinations. Parents should get immunized to protect their infants while they’re still too young for some vaccinations. Breastfeeding mothers can follow a normal adult vaccination schedule.

For more information about which vaccines are safe during pregnancy, call Cherokee Women’s Health.

Mother and Child

What Is Fecal Incontinence?

Fecal incontinence is a condition where one lacks the ability to control bowel movements. In some cases, even the sensation associated with the need to move one’s bowels is not felt. In these cases, stool or mucus may be impossible to hold back and can oftentimes result in mortifying accidents.

fecal incontinence photoNormally, strong healthy muscles and nerves in the anus and rectum cooperate with each other, working together to keep stool in the rectum where it belongs until it’s time to have a bowel movement.

This works much the same way as a garden hose with a fitting attached to a spray nozzle. When the tap is turned on, the water remains contained in the hose until the trigger of the nozzle is squeezed, releasing water spray. If the nozzle or fitting is faulty, depending on the extent of the damage, water will either dribble out slowly or gush uncontrollably. Fecal incontinence is similar. There is either some uncontrolled leakage or full incontinence.

Fecal incontinence can be occasional or chronic. Most of us suffer from gastric issues from time to time and can experience some loss of bowel control. But sometimes, what we presume will be simple flatulence may result in an unwelcome surprise of anal leakage.
Urge bowel incontinence is the need to defecate without warning. Those who have it know they need to get to a toilet, but usually cannot get there in time. Passive incontinence is being completely unaware of the need to defecate. The sensation is simply not there, and stool is passed with no warning.

Because of humiliating factors such as sound, odor and visible staining associated with this condition, it can often draw unwanted attention. In time, psychological issues like humiliation, depression, shame and even self-disgust may arise, causing those afflicted to withdraw and isolate themselves from society.

Who is Affected?

Fecal incontinence affects one in 12 adults in the United States alone. There is no age limit, however it affects older adults more often, and slightly more women than men. To put this ratio into perspective, at least one person at every family reunion or five people at any moderate church gathering may be suffering from fecal incontinence. It’s not uncommon.

What Causes Fecal Incontinence?

• Inactivity: Bed or wheelchair bound individuals, the elderly who lead a less vigorous lifestyle and those who spend most of their day in a sitting or prone position are more susceptible. A sedate lifestyle is more likely to cause stool retention in the rectum. Softer or more liquid fecal matter can leak past the harder stool causing fecal incontinence.

• Constipation: Hard, thick stool can develop with constipation, stretching the rectum and relaxing sphincter muscles. More watery fecal matter forms behind this stool and may leak out. Subsequent straining to relieve constipation may weaken pelvic floor muscles.

• Diarrhea: We’ve all had it at one time or another and know how hard it is to get to a bathroom in time. Accidents often result because watery fecal matter is harder to hold in than firmer stool and fills the rectum faster.

• Loss of rectal elasticity: The rectum stretches to allow room for fecal waste, however scarring, sores and irritation caused by such things as radiation, inflammatory bowel disease and rectal surgery may cause the rectum to stiffen and no longer expand.

• Childbirth via vaginal delivery: Giving birth vaginally, especially if forceps are used, can cause damage to nerves and muscles in the pelvic floor. So can surgically cutting (episiotomy) in an effort to minimize vaginal tearing during birth. Fecal incontinence may occur years later or immediately after giving birth.

• Hemorrhoids: Hemorrhoids that develop around the anus may prevent sphincter muscles from closing completely. Since this muscle keeps feces in the rectum, any small portal can allow leakage to escape.
• Rectal prolapse: Sometimes the rectum can descend through the anus, causing the sphincter to not do its job properly.

• Rectocele: The rectum and vagina are separated by a thin layer of muscle. If that layer weakens, the rectum may jut down into the vagina forming bulges. In more severe cases, it can visibly hang outside the vagina, resulting in possible retention of stool in the rectum. It is speculated, though not certain, that this may cause fecal incontinence.

• Diet: Certain drinks such as dairy products or caffeine beverages may have a laxative effect, aggravating fecal incontinence symptoms, as can spicy, greasy foods.

• Overuse of laxatives: Sometimes mother nature may need a little medicinal nudge, but chronic use of laxatives poses a higher risk for developing fecal incontinence.

• Muscle weakness or damage: Circular muscles called sphincters located in the rectum contract tightly to prevent feces from passing through the anus (similar to the concept of aperture on a camera). These muscles can be damaged or weaken with age, losing strength and tautness.

• Nerve damage: Impairment of the nerves in the sphincter muscles, and those that sense the need to pass stool can also result in leakage.

Damage to both the sphincters and nerves can be caused by childbirth, cancer or hemorrhoid surgery. Additionally, nerves may be damaged due to stroke, constant forcing of stool, head trauma, injury to the spinal cord and diseases that affect nerve function such as multiple sclerosis and diabetes.

How is Fecal Incontinence Diagnosed?

After questions are asked, symptoms charted and a physical examination is completed, your doctor may order a series of tests to correctly diagnose fecal incontinence. These tests may include:

• Anal Ultrasound: This test specifically pinpoints the anus and rectum. Sound waves form an image of the sphincter muscles.

• Anal Manometry: An inflated balloon and pressure sensors check rectal sensitivity and function, along with sphincter muscle tightness.

• Magnetic Resonance Imaging (MRI): Magnets and radio waves produce images of soft internal issues and organs.

• Anal Electromyography (Anal EMG): This checks the health and electrical activity of the pelvic floor nerves and muscles, translating those into images and sounds.

• Defecography: An x-ray of the area surrounding the anus and rectum indicates the patient’s ability to hold and void stool. It also shows any structural damage in the rectum, pelvic floor and anus.

• Flexible Sigmoidoscopy or Colonoscopy: Similar to a regular colonoscopy, this test concentrates only on the lower colon and rectum to check for fecal incontinence. In some cases, if necessary, a small piece of tissue is harvested for a biopsy.

Treatment

• Diet: About 20 to 25 grams of fiber, along with plenty of water should slowly be introduced into the diet to counteract diarrhea and constipation. It’s always best to get fiber from natural sources, but there are plenty of flavored and unflavored fiber supplements on the market. We’ve come a long way from the phlegmy, thick, pasty drinks. Keeping a diary of foods that can aggravate incontinence is always a good idea too.

• Bowel Training: It can take a few weeks to several months, but training your body to obey you by having bowel movements at certain times of the day can help minimize fecal incontinence.

• Medication: If chronic diarrhea is a problem, bulk laxatives can help for more controllable and solid bowel movements. Antidiarrheal medications may also be prescribed.

• Pelvic floor exercise and biofeedback: Exercises targeted to strengthen the muscles on the pelvic floor by squeezing and relaxing can help with bowel function and control. Biofeedback, using sensors can make sure the correct muscles are pinpointed.

Surgery

Surgery is usually reserved as a final option, but when all other forms of treatment prove ineffective, it may be necessary. If so, you’ll receive a detailed description of all you need to know about the procedure and any possible risks associated with it.

You don’t have to suffer with fecal incontinence. It can almost always be corrected with non-invasive methods. Sometimes, a more aggressive approach may be needed, but in almost all cases, the problem CAN be fixed.
Our doctors are here to help. Call today to schedule an appointment so you can get your life back on track.

vaginal discharge photoWhat is vaginal discharge and what causes it?

The vagina is similar to a corridor that leads from outside of woman’s body to her inner reproductive organs. The vagina and cervix contain tiny internal glands that create and secrete fluids. The purpose of these fluids is to wash away bacteria and dead cells. This natural cleansing process protects the vagina, and prevents infection– much the same way a kitchen sieve holds strawberries while a good rinsing flushes away harmful dirt, grit and anything else those berries might have been lying in as they grew.
While vaginal discharge can be annoying, often staining and occasionally ruining those favorite, overpriced panties, it is a perfectly natural bodily function and should not be tampered with unless problems arise. If something interferes with the delicate balance of vaginal secretions, uncomfortable, painful and even serious infection may occur.

What is normal healthy vaginal discharge?

Color:
The color of healthy vaginal discharge can range from clear to milky white, the latter usually occurring during ovulation. It may also be clear with white stringy flecks. When dry, white discharge may turn yellow on underclothing.
A bloody discharge is also perfectly normal during a woman’s period and is no cause for alarm. At times, droplets of blood can be mingled in with discharge between menstrual periods and this is known as spotting. Unless excessive, or accompanied by discomfort, this is also normal.

Amount:
The amount can vary anywhere from 20 mg to 60mg a day (yes, it feels like much more!) This can increase to about 600mg during ovulation. Increase in discharge can also occur during exercise, breastfeeding, contraceptive use, sexual arousal and even emotional stress. Vaginal discharge decreases at menopause due to lower estrogen levels.

Consistency:
The texture of normal discharge also fluctuates. During ovulation, it can be thin and watery. This texture is Nature’s way of enabling sperm to pass into the uterus allowing a better chance of fertilization. At other times, it is thicker, more acidic, and less hospitable towards sperm. This is temporary, just like a mild marital spat.

Discharge texture varies depending on the body’s levels of the hormones estrogen and progesterone, both found in birth control pills. This is why women who take oral contraceptives produce thicker discharge, thus preventing unwanted pregnancy.

During pregnancy, a thick mucus plug (operculum) forms inside the cervical canal. Containing antibacterial properties, its function is similar to that of a cork or safety seal for the uterus, protecting it from uterine fluid leakage or pathogen invasion. When dilation begins to occur before childbirth, the plug loosens and drops out, resembling discharge tinged with blood.

Odor:
Discharge odor can vary depending on medication, menstrual cycle, diet, activity, personal hygiene, pregnancy, lubricants, and hygienic cleansing products, but usually a slight musky, though not unpleasant odor is normal. Receiving oral sex can sometimes produce a different odor.

When should you see your doctor?

Although vaginal discharge is vital in maintaining optimal health of the reproductive organs, the delicate Ph balance can sometimes be compromised leading to infection. Infections may occur at any time, but are more likely to happen when the Ph balance is less acidic, right before or during menstruation.

If you experience any of the following symptoms, see your doctor. These can possibly be indications of infections or sexually transmitted diseases such as Bacterial Vaginosis, Yeast Infection(Candida), Pelvic Inflammatory Disease, Human Papillomavirus, Trichomoniasis, Gonorrhea, or Chlamydia –to name a few:

• Pain or inflammation accompanying discharge
• Redness in vulvar or vaginal areas
• Strong unpleasant smelling discharge immediately after intercourse
• Burning or itching
• Rash
• Burning while urinating
• A cottage cheese like texture.
• Thick, lumpy, or pasty discharge
• Foul smelling green, yellow, grey, or cloudy discharge
• Excessive or recurring brown or bloody discharge, especially when not on your menstrual cycle
• Strong, foul, fishy odor
• Watery discharge
• Any unusual discharge accompanied by abdominal pain, uncommon fatigue, fever, sudden weight loss, and increased urination.
• Blisters or sores in the vaginal or vulvar area.
• Painful intercourse

Treatment

After a brief medical examination which is usually enough to identify the problem, your doctor may request additional tests to analyze skin, cervical or discharge samples.
When the problem is identified, most vaginal discharge abnormalities can be treated with prescription medications such as antibiotics, creams, antifungals, or suppositories. These should always be taken for the full amount of time prescribed by your doctor, no matter how much better you feel.
In some cases, it may be necessary to treat both the patient and her sexual partner, and both may be asked to refrain from sexual intercourse until treatment is successfully completed.
If symptoms persist after medication is completed, a follow up visit may be necessary.
Over the counter medications are available for common yeast infections, but should be avoided if pregnant unless approved by a physician.
Abnormal discharge may be indicative of some cancers, but this is rare.

How you can help prevent problems

• Use condoms, especially with new sexual partners.
• Have an annual pap smear to screen for possible cancer. It’s only uncomfortable for a minute
• Keep the genital area dry and clean with regular bathing, showering and gentle wiping from front to back after urination or defecation.
• Avoid harsh soaps, feminine sprays, powders, chemicals or douches around the vaginal area. They can may upset the Ph balance and kill important bacteria. Being field flower fresh can sometimes do more harm than good
• Avoid deodorized pads and tampons, especially those discount store brands that can be smelled before you enter a room.
• Wear absorbent cotton underwear, and save the sexy, synthetic ones for special occasions unless they have a cotton crotch piece.
• Be vigilant when you wear tampons. Anyone can forget, especially near the end of a period when there is little or no blood. It happens more often that women think.
• Use products designed specifically for vaginal lubrication. Avoid petroleum jelly or other household lubricants your grandmother suggested.
• Eat a healthy, well balanced diet and drink plenty of fluids. Yogurt containing live cultures helps to prevent yeast infections.
• If treating an infection, use sanitary napkins instead of tampons and avoid intercourse if advised by your doctor.

Normal vaginal discharge is essential good pelvic health, but any unusual symptoms should be addressed immediately. Speak to your doctor honestly and frankly to alleviate the problem as soon as possible. There’s no need for embarrassment. Open dialogue is vital to an accurate diagnosis and effective treatment.

June 29, 2016

Every expectant mother has heard jokes about pregnant women running to the bathroom all the time. Overactive bladder is one of the most common symptoms of pregnancy in the first trimester, and it only gets worse as your pregnancy develops. But for some, overactive bladder causes an even more embarrassing symptom: pregnancy incontinence.

What to Know about Pregnancy Incontinence

pregnant woman laughingPregnancy incontinence, or bladder leakage, gets less press than overactive bladder syndrome (possibly because fewer dads-to-be find it a funny road trip joke), but many pregnant women suffer it. Bladder leakage most frequently occurs when coughing, laughing, sneezing, or straining, but it can happen almost anytime. The good news is that pregnancy incontinence is usually temporary. When your hormone levels go back to normal and your body heals, your bladder should return to normal too.

How to Treat Pregnancy Incontinence

Before trying home remedies, make sure you’re leaking urine. If the liquid is clear and odorless, it may be amniotic fluid. It’s rare, but if you are leaking amniotic fluid, contact your obstetrician immediately.

Okay, you sure it’s urine? Here’s what you can do to treat pregnancy incontinence.

  • Do Kegels to strengthen your pelvic muscles.
  • Train your bladder to behave by slowly extending the amount of time between trips to void your bladder.
  • Monitor your weight. Unnecessary weight gain during pregnancy puts undue pressure on your bladder.
  • Try to avoid constipation, which also puts pressure on your bladder.
  • Keep drinking water! Limiting your water intake doesn’t minimize pregnancy incontinence, it only dehydrates your body and increases your risk of UTI (another cause of bladder leakage).
  • Avoid foods that irritate the bladder such as citrus, tomatoes, coffee, and alcohol (which you shouldn’t be having anyway!).
  • Use pads in case of accidental leaks.
  • Brace your pelvic muscles before laughing or sneezing by crossing your legs or doing Kegels.
  • Pay attention to any patterns. If you notice a specific behavior causes bladder leakage, stop that behavior.
  • Talk to your practitioner. Your OB or CNM does this for a living, so you can be sure they have some good tricks for minimizing bladder leakage.

Pregnancy incontinence may be frustrating, but it’s a normal part of pregnancy. If your incontinence lasts up to six weeks postpartum, speak to your physician about treating incontinence before it becomes a long-term issue. For more information on pregnancy incontinence, call Cherokee Women’s Health.

Laughing Mom-to-Be

June 24, 2016

breastfeeding mother

Breastfeeding is probably the first most intimate bond a mother will ever create with her child, but sometimes it can take a little while to get it right—both for mother and baby. Much like picking up rice with chopsticks for the very first time, breastfeeding requires patience, practice, time and effort. Although babies are born with a natural instinct to suckle, and mothers usually produce the colostrum and milk they need immediately, sometimes getting the two natural occurrences to cooperate with each other can be difficult.

Apart from the time and discomfort needed to recover from childbirth, baby’s constant demands for food, cuddling, changing– not to mention possible colic- the first few days can be overwhelming on a new parent. Lack of sleep can also cause impatience, which in turn is something a baby can easily sense. No matter how many decibels you attempt to lower your voice after drowsily walking into walls during that three o’clock feeding, your baby will still pick up on your irritability and react accordingly with fussing, flailing or crying.

Compounding all this with a difficulty to breastfeed could easily leave the mother experiencing feelings of failure, shame and anxiety. Rapid hormonal changes on her part add to the melting pot of emotional stew.

Latching Problems
Breastfeeding can be a painful, uncomfortable experience during the first few postpartum weeks. Although hungry newborns may not have teeth, their gums can certainly clamp on well enough to make a new mother wince, even yelp at times. Until tender, engorged nipples become accustomed to the sensation, it can be highly unpleasant for the first little while.

If pain persists after this adjustment period, however, it may possibly be caused by a bad latch. A bad latch may occur for a number of reasons, such as cradling the baby’s head at an improper angle, positioning your breast incorrectly, flat or inverted nipples, or an infant who hasn’t quite yet grasped the intricacies of sucking and getting tasty results.

Learning to latch may take time. If you look down and see that your areole or nipple are visible, your baby may not be latching correctly. Both serve a purpose similar to a bull’s eye on a target. Baby needs to zone in and clamp on the center to achieve proper suction. The sensation of the nipple, and in some cases the tiny bumps surrounding it on the areole serve as a type of braille to baby’s sensitive mouth. Nursing pillows may facilitate finding the correct angle, thus gently coaxing your child to a better position.

If you can’t resolve the latching problems on your own, there is no need to get frustrated or to feel badly about it. At your next appointment, ask your obstetrician or certified nurse-midwife for information on overcoming breastfeeding problems. They are familiar with the problem and will gladly help to make breastfeeding a more enjoyable nurturing time for you and your infant.

Inverted or Flat Nipples
1 to 3% of all women have flat or inverted nipples which can create a challenge when breastfeeding. Speak to your obstetrician about breastfeeding with inverted nipples. Some methods he or she may recommend would be to pump before breastfeeding to stimulate milk flow, or using a silicone shield to help your baby latch.

Some women with flat or inverted nipples may require the help of their spouses to get a good latch going. In a way, this can also be a pleasant bonding time for their partners.

Breast milk provides babies with vital nutrients to help them grow and develop into healthy, strong little people. It is recommended that mothers try as much as possible to introduce their infants to not only this beneficial form of nourishment, but the resulting closeness and warmth both mother and baby can derive from it.

For more information on lactation, Northside Hospital-Cherokee has a center dedicated to lactation and their website offers lots of great tips.

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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.”
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