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Category: General

October 4, 2016

A pap smear is a simple procedure which tests for abnormal cervical cells. The test is performed on an exam table and is generally a painless and quick procedure. The doctor uses a speculum to open the vagina so that a sampling brush can be guided in to gather cells from the cervix. This sampling brush is then sent to the lab for study and results will be communicated to the patient after the lab examination is complete.

Ask your doctor if it is time for you to get a pap smear.If abnormal cervical cells are present, follow-up testing using the DYSIS colposcopy technology can reveal whether the abnormality is related to Human Papillomavirus (HPV) or cervical cancer. Pap smears are a critical component of a well-woman’s health exam. In recent years, the American Congress of Obstetricians and Gynecologists created new guidelines for the time frame between each pap test. The new guidelines were instituted following research that revealed that yearly pap smears were no more likely to catch cervical cancer than tests performed every 3 years. Previously, the pap test was generally conducted at every annual well-woman examination, but currently ACOG suggests the following:

  • Women under 21 do not require a screening
  • Women aged 21-29 should have a pap smear every 3 years
  • Women ages 30-65 years should have a pap test and an HPV test completed every 5 years, or a pap smear every 3 years
  • Women aged 65 or older do not require testing if they have had three negative pap tests in a row

These are current guidelines, but they have proven controversial, and as new data emerges, it is likely these will be changed yet again. Many doctors are concerned that these guidelines are too liberal, and that cancers will be missed. It is important to note that well-woman visits are still just as important even though the pap test guidelines have changed. Women should still have an annual visit with their gynecologist for reproductive health and for any other concerns related to women’s health.

Prevention is key in cervical cancer screening.

Having a monogamous relationship, limiting the number of sexual partners, and using condoms are paramount to a woman’s health. Doctors advise that women receive the HPV vaccine, as well as pap tests, which will help to screen for any abnormalities and catch any precancerous cells (dysplasia) before they spread.  Women who are found to have cervical dysplasia can receive treatment to prevent the cells from turning into cancer. Usually, this is removal of the abnormal cells. If cervical cancer is found to be invasive, surgery, radiation therapy, and chemotherapy may be required to treat the cancer.

Cherokee Women’s Health uses cutting edge DYSIS technology to assist in diagnosing and treating cervical issues including dysplasia and cancer. With proper screening and prevention, cervical cancer diagnoses can continue to decrease.

pregnant womanThe third trimester begins in the 28th week of pregnancy and ends when your baby officially becomes a newborn. This is a bulkier, less comfortable time, but will soon be over. At the end of this trimester, the fetus will be 17 to 23 inches long, fully formed, and weigh anywhere from 6 to 10 pounds.

What Happens Now?
Some new symptoms may appear, and familiar ones may intensify. They might include:

  • Restless Leg syndrome (RLS) and leg cramps: These can occur at any time. RLS is common in about 15% of pregnant women. Support hose, moderate exercise, less caffeine, and more fluids during the day may alleviate discomfort.
  • Nasal congestion and snoring: Estrogen increases blood flow throughout the body, including nasal membranes. Nasal strips and saline drops often help. So can elevating the head during sleep. If snoring becomes intense, your obstetrician may want to rule out sleep apnea.
  • Abdominal aches: The fetus is becoming more active. Growth is accelerating, widening the uterus so that it presses against your bladder, diaphragm and other organs. Discomfort is usually minimal.
  • Fatigue: Finding a comfortable position in bed sometimes becomes difficult. It’s recommended that you not sleep on your back now, as the growing uterus can press on the main vein (vena cava) which pumps blood from your heart to the lower part of your body. Try sleeping on your left side, using pillows as props.
  • Insomnia and/or bad dreams: Anxiety and overactive hormones may rob you of rest. Moderate exercise, a warm bath, massage, cutting caffeine and lowering the bedroom temperature helps enable sleep.
  • Heartburn: Hormones and pressure from the uterus pushing the stomach upward can trigger indigestion. Consult your obstetrician before trying any remedies.
  • Stretch marks: These may become itchy and more prominent. A good moisturizer can help.
  • Varicose veins and hemorrhoids: Extra blood pumping through your body now can make these appear. Both usually diminish or disappear after birth.
  • Clumsiness: Rapid body shape and size changes can make you misjudge distances and bump into surroundings. Try moving slower. This minimizes injury both to yourself and the fetus.
  • Pregnancy fog and distraction: Forgetfulness and distraction are attributable to brain function changes during pregnancy. Research actually shows that women pregnant with females experience pregnancy fog more than those carrying males. This haziness disappears a month or two after birth. Until then, keep to-do lists on hand to jog your memory.
  • Lack of bladder control/ frequent urination: Extra weight and pressure on the pelvic floor can result in leakage and constant bathroom visits. Do your Kegels and wear panty liners.
  • Backache: A growing stomach pulls your center of gravity forward, triggering backache. Elevating your feet, a warm bath, and gentle massage can ease pain. If it’s intolerable, however, your doctor may want to rule out injuries like sciatica.
  • Breast leakage: Your body is preparing for breastfeeding. Nursing Pads aid in preventing staining.
  • Lightening: At about week 36, you might notice your shape changing. Your stomach will drop lower and you could start waddling. Your baby is changing position to prepare for birth. Your breathing will be easier, heartburn may diminish, but urination may become more frequent.
  • Mucus plug: A clear gelatinous plug may detach from the uterus weeks or immediately before labor. This means the cervix is softening and preparing for delivery.
  • Braxton Hicks: These irregular contractions are often mistaken for the real thing by first time moms. They can occur intermittently weeks before you actually go into labor.
  • Bloody show: Pink or brown tinged mucous indicates that you are effacing and dilating. Labor is close at hand, but it can still be several days to a few hours away. Blood should not be bright red or excessive though. Call your doctor if it is.
  • Water breaking: The amniotic sac has ruptured and labor is approaching. If steady contractions have not begun within 24 hours, labor might be induced to avoid infection.
  • Contractions: These are regular and stronger than Braxton Hicks and will not diminish. Your doctor will advise you as to how long to wait before leaving for the hospital.

What Precautions Can I Take During This Time?
You can continue to do exactly what you’ve been doing all along- take care of yourself and your baby. Eat well but watch your weight. Rest when necessary, but avoid becoming inactive. Moderate exercise will make your labor and delivery easier. Avoid strenuous activity or heavy lifting. If you are uneasy about anything or notice radical symptoms that worry you, consult your doctor.

Fetal Kick Counts
Your baby’s movement may provide information that help us care for you during this pregnancy. During a convenient hour each day, after eating and emptying your bladder, please lie down (on your side is best) and concentrate on your baby’s movement. Note each movement. Smoking may interfere with the movements and should be avoided during pregnancy. Count the number of movements for thirty minutes. Your baby should move at least five times in that thirty minutes. If your baby moves less than five times during that thirty minutes call your physician or go to the hospital.

Call your doctor if you experience: 

  • Decreased fetal movement
  • Rupture of membranes (water breaking)
  • Contractions every 2-5 minutes (more than five per hour)
  • Cramps in the lower abdomen with or without diarrhea
  • Low, dull backache felt below the waistline
  • Temperature over 100 degrees
  • Vaginal spotting or bleeding.

Helpful Hints: 

  • Be sure to drink at least 8-10 glasses of water every day (in addition to anything else you drink).
  • Eat small frequent meals to avoid heartburn.
  • Use Tylenol for minor aches and pains.
  • You may take warm baths or showers, place a heating pad on your back using low heat setting and rest with your feet elevated.

What Tests are Performed During the Third Trimester?
By this time, most precautionary tests have been completed, and only these regular routine tests are done during prenatal visits

  • Urine test
  • Blood pressure check
  • Fetal heartbeat check
  • Measuring of the uterus.

You could possibly require a pelvic exam to check that the cervix is changing the way it should, along with a test for group B streptococcus, a bacterium that approximately 30% of women can transfer to their babies during delivery. If results are positive, an antibiotic will be administered during labor.

Additional tests may be warranted, especially if:

  • You are having a multiple birth
  • Your baby is growing slowly
  • You have chronic problems
  • You are past your due date.

Each trimester has its own unique milestones, and our doctors have the knowledge and expertise to make sure that your pregnancy is progressing safely and well. For more information, visit Northside Hospital Cherokee. For an appointment, call our clinic at 770.720.7733.

September 1, 2016

Vulvodynia is persistent, inexplicable pain anywhere in the vulva. The discomfort associated with this condition can be so severe that any sexual activity may be impossible. Even sitting can become intolerable.

Vestibulodynia (Vulvar vestibulitis syndrome or vestibulitis) is another condition which is very similar to Vulvodynia except that pain is situated at the entryway just outside the vagina inside the labia (vestibule).

Though it is not known exactly what causes Vulvodynia, doctors speculate that there may be several triggers:

  • Allergies or sensitive skin that can be easily irritated
  • Hormonal changes or hormonal contraception
  • Injures to the vulvar area’s surrounding nerves
  • Sexual abuse
  • A predisposition to yeast infections
  • Pelvic floor dysfunction
  • Past history of anxiety and/or depression
  • Muscle spasms
  • Frequent antibiotic use.

Vulvodynia has also been associated with several other chronic pain-related conditions, meaning that there is a higher likelihood of Vulvodynia if a woman has any of the following:

  • Interstitial cystitis: (An inflammatory condition that causes moderate to severe pain or pressure of the bladder and surrounding pelvic area).
  • Fibromyalgia: (A chronic disorder causing widespread muscular, joint and tendon pain).
  • Irritable bowel syndrome: (Recurrent abdominal pain, diarrhea and constipation).
  • Endometriosis: (A painful disorder where tissue that is similar to the kind growing in the lining of the uterus (endometrium) grows outside of the uterus instead).
  • Chronic fatigue syndrome: (An unexplained ailment with symptoms of fatigue, fever, tenderness and depression, usually following a virus).

In most cases, however, there is no absolute known cause, and the reasons for Vulvodynia remain a mystery. Investigation of this disorder is still in its medicinal infancy because it was previously thought to be a purely psychological issue.

What are the Symptoms?

  • Itching
  • Throbbing
  • Burning
  • Stinging
  • Painful intercourse (dyspareunia)
  • Soreness
  • Rawness
  • Redness
  • Irritation.

These symptoms can be sporadic or constant. They can last for weeks, months or even years. They may also appear suddenly, and disappear just as abruptly. This discomfort can be centralized in one area such as the vaginal opening, or spread throughout the entire vulvar zone. This area may appear swollen or irritated, but often looks completely normal.

Vulvodynia can seriously impact a woman both physically and mentally. Inability to engage in sexual activity may jeopardize relationships. Chronic pain can also lead to irritability, anxiety, sleeping difficulties, social withdrawal, and low self-esteem. Vulvodynia, and the negative emotions that ripple from the condition, can disrupt quality of life and eventually activate full-blown depression.

How Is Vulvodynia Diagnosed?
There is no actual test for vulvodynia. Diagnosis is made by ruling out any other possible ailments that might mimic the symptoms of this disorder, such as:

  • Skin conditions
  • Diabetes
  • Yeast or bacterial infections
  • Cervicitis or inflammation of the cervix
  • Endometriosis.

A medical history will need to be provided, especially past infections in the pelvic region. Any current drugs you are using, specifically hormonal replacement or contraception should be mentioned.

Female pain photoYou will be asked pertinent questions in order to determine the problem. A pelvic exam will be done, both internally and externally to see if there is a possibility of a present infection. Even if the genitals show no visual signs of any infection, a cell sample may be taken to rule out bacterial vaginosis or yeast infection. Finally, to check for vulvodynia, a swab that has been moistened will be used to gently dab at and probe the vulva and surrounding area to determine the exact locations of your pain.

What Happens if I Have Vulvodynia? Can I Be Helped?
Yes. There are several treatments that can minimize pain or discomfort:

  • Antihistamines can calm itching, steroids, anticonvulsants, and antidepressants can subdue chronic pain.
  • Numbing creams or ointments containing a local anesthetic applied before initiating sex may provide temporary help, but may also cause your partner to experience numbing upon physical contact with these creams.
  • Biofeedback therapy can train you to relax, in turn decreasing suffering. You can be taught how to control your body’s responses to vulvodynia symptoms. If the human body anticipates pain, it involuntary contracts to avoid it, causing the very pain it tries to ward off. In time, this pain becomes chronic. Biofeedback can help with this vicious circle, allowing the pelvic muscles to relax and minimize this innate tightening and the subsequent discomfort.
  • Nerve blocks that are injected can help with chronic pain.
  • Pelvic floor therapy reduces muscle tension in the pelvic floor muscles. These muscles are a support for the bladder, uterus and bowel, and relaxing them can provide vulvodynia relief.
  • Surgery that removes tissue and skin affected by vulvodynia or vestibulodynia (vestibulectomy) can effectively relieve pain in many women.

Is There Anything I Can Do At Home in the Way of Self-Help?
There are some simple measures you can take to decrease some of the uncomfortable symptoms:

  • Sitz bath soaking, which is sitting in cool or lukewarm water for 5 to 10 minutes two or three times a day can soothe symptoms.
  • Avoid those hot tubs and long soaks in scalding water. They contribute to discomfort and itching. Chlorine pools exacerbate the problem as well.
  • Save the control top pantyhose and sexy synthetic panties for special occasions. They restrict airflow to the genitals, causing the temperature down there to rise and trap moisture that can cause irritation. Try to find cotton substitutes that promote dryness through absorption, and that encourage healthy, necessary ventilation to the delicate genital area. If you’re comfortable with it, go ‘commando’ at night and skip underwear altogether.
  • Cold compresses placed directly on the affected area can help itching and pain—especially after sex.
  • Whenever possible, try to avoid any activity that may put pressure on your vulva, such as horseback riding or biking.
  • Treat your lady parts gently. Avoid douches. Wash the area with plain water using your hand, then lightly pat it dry. Avoid soap when possible. Even residue scented laundry detergent and fabric softener in clean towels or facecloths can irritate sensitive tissue. You might even wish to put on a natural emollient without additives or preservatives after washing. Petroleum jelly creates a soothing barrier.
  • If you’re able to tolerate intercourse, a lubricant can greatly help, preferably a water soluble one.
  • Antihistamines before bed can stop itching and provide a restful sleep.
  • Unscented white toilet paper can make a difference. So can tampons and sanitary napkins that don’t smell like they’ve been dragged through a perfume factory. Contraceptive creams and spermicides can also irritate vulvodynia.
  • Harsh, irritating urine caused by certain foods and drinks like citrus beverages, beans, nuts, chocolate, berries, etc. may cause burning upon voiding. Rinsing the vulvar area after urination with cool water helps.

It is important to note that vulvodynia is NOT a sexually transmitted disease. It is not contagious, and is in no way an indication of any kind of cancer.

There is no cure for vulvodynia, but different remedies can ease the symptoms for different women. It may take time to find the combination that works best for you, but our doctors will work with you to help provide a comfortable, better quality of life. To schedule an appointment, call 770.720.7733.

August 30, 2016

What is Vaginal Shortening and is Vaginal Lengthening a Solution?
Vaginal shortening, or iatrogenic vaginal constriction, is a condition that occurs in women usually as a result of undergoing gynecological surgery. After removal or correction of organs within the pelvic area, post-surgical tweaks are always necessary to close any internal incisions, suture tissue together, and to restore the vagina back to its previous corridor-like shape.

Depending on the extent of the surgery, sometimes it’s necessary to stitch together a great deal of a woman’s remaining tissue, leaving the vagina shorter—the same way gathering fabric to repair a hole in the toe of a sock would alter its size. Subsequent scarring in the area over time may also contribute to narrowing and reduction. Unfortunately, though vaginal tissue is extremely elastic and stretchable, a substantial shortening may result in uncomfortable and even painful intercourse, especially during the natural penile thrusting stage of a sexual encounter.

What Conditions and Their Aftermath Cause Vaginal Shortening to Occur?
Most surgeries that involve the removal or correction of vaginal organs may contribute to this problem. Some of these include:

Vaginal mesh surgery – A transvaginal surgical mesh that may have been used to repair a woman’s urinary stress incontinence or pelvic organ prolapse (POP) can cause future problems. Mesh is sometimes used to support ligaments and organs that have slipped out of place. Its purpose is to reinforce the pelvic floor or weakened vaginal wall. Sometimes the mesh can cause infection, fuse with organs and tissue, or perforate its surrounding structures, making removal necessary. Much like cement sticking to the webbing used to adhere stucco to walls in home construction projects, tissue and organs may have stuck to the transvaginal mesh, making is difficult to remove without causing damage. When this damage is extensive, additional tissue is needed to repair the vagina, thus shortening it even more.

Bladder tack surgery/bladder suspension surgery – This procedure is used to minimize or correct stress incontinence in women by creating a hammock shaped sling made of a mesh tape. The material is different from transvaginal mesh, but with similar complications. If rejection, fusion, or infection arise, the methods used to correct these post-surgical problems may result in vaginal shortening.

Anterior repair/posterior repair (colporrhaphy) – Anterior repair surgery tightens the front wall of the vagina when the bladder has drooped or fallen out of place (cystocele or dropped bladder). Posterior repair surgery tautens a rectum that has sagged or dropped (rectocele or rectal prolapse). Though both procedures are minimally invasive, complications may occur that require surgical attention and subsequent suturing, in turn shortening the vagina.

Enterocele repair – This reparation is necessary when intestines (small bowel) bulge through the weakened tissue at the top of the vagina. As with anterior or posterior repair, risks are uncommon but may occur, needing attention that might impact vaginal proportion.

Sacrospinous ligament/vault suspension – This procedure lifts the top of the vagina and holds it in place after complete vaginal prolapse. As with several of the previous surgeries mentioned here, postoperative stitches are necessary using a woman’s available tissue. This can minimize the original size of the vagina.

Hysterectomy – In a hysterectomy, all or part of the uterus is removed. In some cases, it may also be necessary to extract the ovaries, cervix and/or fallopian tubes. The more radical the procedure, the more internal trimming and stitching may be necessary. Hysterectomy is possibly one of the biggest causes of vaginal shortening.
Cervical or uterine cancer: Due to removal of cancerous organs, and scarring that can occur as a result of follow up radiation, both vaginal capacity is usually reduced.

Can Vaginal Shortening Be Repaired?

Often, following surgery, the vagina may simply feel shorter due to swelling, inflammation, tenderness, bruising, and the presence of stitches. Vaginal tissue is very elastic, and though it may feel tight immediately after your operation, size often returns to normal after a short recovery time.

If actual shortening has occurred, repair can sometimes be complicated, depending on the extent of the surgery or cause of the diminishment.

Though it is possible to approach correction by using more drastic measures such as muscle flaps, biological animal grafts, skin grafts, or even a woman’s own bowel tissue, these methods can cause further complications and we prefer to avoid them. Instead, we opt for the least physically intrusive methods first. Several of these options are:

Pelvic floor massage – Internal and external massage can relax tenderness, muscle tightness and trigger points that cause pain, gently stretching or tightening the pelvic floor muscles and connective tissue.

Pelvic floor physiotherapy – These exercises stretch and strengthen the pelvic floor muscles.

Vaginal dilators – Plastic tubes that gradually increase in size are inserted to gently stretch the vagina over time.

If these procedures prove to be ineffective, laparoscopic surgery, which is minimally invasive and generates less blood loss, scarring, and a quicker postoperative recovery time may be beneficial.

Whatever the reason for vaginal shortening, we can recommend the safest and most effective approach to try and correct the problem. To make an appointment, call us at 770.720.7733.

What is Libido?
Libido, very simply put, is sexual desire or sex drive. Just as there are multiple shades in a color spectrum, levels of libido are unique to each woman, and these levels can rise and fall monthly throughout a woman’s lifetime depending on many biological and psychological factors.

What are the Different Levels of Sexual Desire?
Intensity can vary. Sexual desire may range from heightened – where a woman may want sex one or more times a day (hypersexuality), to several times a week, once a month, once every few months or year, (hyposexuality) or not at all (asexuality).

What is Considered ‘Normal Libido’?
There are no standards for ‘normal’ libido, especially if a couple is sexually compatible and comfortable in their mutual need for intimacy. Often, however, this is not the case. Women frequently tend to have a lower libido than men. In fact, it is estimated that 1 in 10 women suffer from low sexual desire in the United States, meaning that 16 million women have what is referred to as hypoactive sexual desire disorder (HSDD).

A female’s low libido can have a huge negative impact on a relationship. Once the brilliant shine of newly-found lustful love wears off, couples may find their physical needs are drastically different. The apathy of the less ardent woman may lead to conflict, suspicion, hurt, infidelity and even complete collapse of the relationship. The woman herself may also suffer feelings of inadequacy, self-doubt, and frustration, emotions that might send her into an emotional depression, worsening the situation.

Mass media today slants sex to appear as if anything less than constant bedroom activity is abnormal, often convincing a woman with a perfectly healthy sexual appetite that she is some kind of freak if she doesn’t engage in a passionate encounter at every opportunity. For one who suffers from a lower sex drive, the impact may be even more devastating. The inner turmoil of a dwindling self-image and shattered self-esteem can compound the problems already complicated by sexual dysfunction.

low libido photoWhat are the Causes of Low or Waning Libido?
There can many causes for low sexual desire, and they can be either physical or psychological.

The following are some of the physical reasons for a low libido:

  • Hormonal imbalances: The three hormones that impact a woman’s sexual function, desire and reproductive organs are estrogen, progesterone and testosterone.
  • Testosterone is the primary hormone responsible for a healthy libido in women. Yes, ladies, we all have testosterone, just as all males produce estrogen! The amounts just vary for each gender. Testosterone is what enables a woman to fantasize, piques her interest in sex, and aids in lubricating the vagina to prepare for comfortable, pleasurable intercourse. A woman’s testosterone levels begin to rise just before she ovulates, piquing a day or two before, and reaching maximum strength at ovulation. This is Mother Nature’s way of preparing the body for reproduction by plumping the uterine wall, which in turn stimulates sensitive nerve endings, encourages lubrication and heightens sexual motivation. Immediately afterwards, the amount of this hormone in her body diminishes. A low testosterone count hampers the possibility of a satisfying sexual experience by minimizing enthusiasm, sensitivity and arousal.
  • Estrogen is the main hormone responsible for the development of the female sex organs. It regulates the menstrual cycle and is crucial in thickening the uterine lining in preparation for pregnancy. As women age and enter the premenopausal stage (perimenopause), estrogen begins to significantly decrease until the levels are so low that menopause occurs. Vaginal tissue becomes thinner, less elastic, drier and more fragile. As with testosterone, natural lubrication diminishes with less estrogen, and this decrease affects sexual desire.
  • Progesterone is another female hormone that is vital in thickening both the uterine wall and endometrium to protect the egg during the process of fertilization, conception and pregnancy. Levels normally rise immediately after ovulation. If fertilization does not occur, levels drop, and the uterine walls become thin again, allowing the unfertilized monthly egg to pass as menstruation. Progesterone also regulates a woman’s menstrual cycle. As with estrogen, levels decline with age. Research is still being done, but it is believed that progesterone’s role in waning libido is just as important as those of testosterone and estrogen.
  • Menstrual cycle: Irregular or absent menstruation (secondary amenorrhea) can wreak havoc on natural hormonal processes, causing libido to become equally sporadic.
  • Age: Testosterone, progesterone and estrogen levels diminish as women age and enter menopause, causing lowered sexual interest, loss of muscle mass, compromised skeletal health, and vaginal dryness that can lead to painful intercourse. As these hormone levels decrease, so does libido.
  • Antidepressants: Sexual dysfunction, low lido and even genital numbness may be attributed to some currently prescribed antidepressants which are referred to as selective serotonin reuptake inhibitors (SSRI’S).
  • Drugs: All recreational or prescription drugs have side effects. They can inhibit hormonal functions, dull physical and mental sensations, dehydrate the body’s natural secretions and lubrications, or interfere with sexual desire. Blood pressure medications, tranquilizers and antihistamines are just a few. Always give your doctor a complete list of medications you are currently using.
  • Lack of restful sleep: Drowsiness, irritability and fatigue can dampen anyone’s mood for lovemaking.
  • Birth control: Some patches and oral contraceptives fool the body into believing it is pregnant by neutralizing the very hormones that enhance libido. If you notice a sudden disinterest in sex after beginning birth control, speak to your doctor.
  • Alcohol, smoking or drug abuse: Smoking restricts blood flow to the body. The clitoris, labia and vagina become engorged with blood during sexual arousal, just like a man’s penis, so restricting this flow also restricts sensation and response to physical stimulation. Alcohol is a depressant. It dehydrates the body, dulls sensitivity, and causes loss of vaginal lubrication.
  • Giving birth: Immediately after giving birth, a woman’s hormones are causing an uproar inside her body. Physical trauma to the vaginal area, possible postpartum syndrome, and the exhaustion and stress of caring for a newborn amplify sexual indifference. Luckily, these issues usually only last a few weeks, but if libido remains low or non-existent for longer, consult your doctor.
  • Genital abnormalities or problems: Pelvic organ prolapse(POP), muscle mass and tissue deterioration due to aging (urogenital atrophy), fecal incontinence, urinary problems, dryness, atrophy, and a small vaginal opening are only a few of the physical problems that can decrease libido.
  • Surgery: A hysterectomy with or without compete removal of the entire reproductive system (Oophorectomy) decreases or completely eliminates the hormones necessary for sexual gratification.
  • Major health conditions: Cancer, high blood pressure, neurological disorders, hypothyroidism, diabetes, arthritis, infertility, and coronary artery disease, along with the medications and procedures necessary to correct these issues are just a few disorders that can weaken female libido.
  • Anemia: Low iron levels caused by heavy periods can result in anemia. Anemia reduces red blood cells and compromises a protein called hemoglobin whose job is to push oxygen from your lungs to all your body parts, including the pelvic area. Since blood is vital to the labia, clitoris and vagina to enhance erotic sensitivity, anemia can greatly subdue bedroom pleasure and cause fatigue, weakness, and sexual apathy.

Psychological factors that can cause low libido are:

  • Low self-esteem or body image: If a woman is overweight, underweight, lacks self-confidence, or feels inferior in other ways, she may shy away from physical contact, robbing herself of the gratification of a healthy sex life.
  • History of sexual abuse: Rape, assault, and molestation can have a devastating effect on the psyche. Without counselling, the aftermath of these experiences can leave lifelong psychological scars, and it is understandable that a woman may avoid any future sexual encounters.
  • Religious and moral issues: Deep rooted personal beliefs can sometimes be detrimental to a healthy libido. Entrenched convictions about sex, religion, moral taboos and behavior can prevent a woman from truly enjoying an intimate relationship, causing her to view a physical union as repulsive or simply a ‘duty’ to get out of the way.
  • Trauma: Psychological trauma such as post-traumatic stress disorder (PTSD) can follow any highly disturbing event. Just as with sexual abuse, the repercussive emotions following the death of a loved one, a divorce, violence, being the victim of a crime, etc. may lead to sexual dysfunction and a damaged libido.
  • Relationship problems: Constant tension and conflict with a loved one can slowly chip away at even the strongest relationships. Anger, disillusionment and unresolved issues ultimately make their way into the bedroom, negatively impacting any activity that is still, or no longer, going on there.
  • Depression or anxiety: Either of these emotional conditions can affect performance or pleasure by causing disinterest, especially if medication is being used to control the issue.
  • Lifestyle: As the world becomes more and more fast paced, a busy lifestyle and the responsibilities that come with it can succeed in putting any romance on the back burner, lowering the flames of passion and eventually putting them out altogether.
  • Stress: Worries about health, finances, or other everyday problems cause physical and mental tension. If a woman is unable to relax and enjoy sex, orgasm is impossible and frustration inevitable, causing her to lose interest altogether.
  • Anxiety: Anticipation of sex is not always viewed favorably. Many women dread intercourse when they feel it’s expected or demanded of them. Some worry that they may not fulfill their partner’s expectations, or that they might be urged to perform acts that they’re not comfortable with to please their mate, especially in a new relationship.
  • Environmental stress: Distractions such as bright lights, lack of privacy and extreme noise can hinder a woman’s ability to relax and enjoy intimacy. For instance, visiting or living in a mother-in-law’s home, or listening to a neighbor’s loud, thumping music can impede full enjoyment of sex or orgasmic achievement.
  • Poor communication: Optimal sexual performance does not come naturally. It’s a learning process for both partners. Many couples avoid telling each other what pleases them in the bedroom. Whether it is because if shyness, fear of shock, or ridicule, women sometimes avoid telling their mates what they prefer and, in time, come to dread intimacy altogether.
  • Latent sexual orientation: Denial of gender preference can raise feelings of guilt and suppress the pleasure that comes with an open, honest, relationship.

Is Help Available?
YES!!!! There is no reason to go through life with lowered libido. Women can enjoy a satisfying sex life at any age, and with today’s resources and modern technology, we are usually able to effectively treat the problem.

Diagnosis and Treatment
In order to pinpoint the root of this dysfunction, frank honest discussion is necessary, as well as a list of any medications you are currently taking. Your doctor will ask pertinent questions to find out whether the problem is physical or emotional.

After an examination of the genital area, blood tests may be required to determine hormonal levels.

Once a diagnosis is made, your doctor will move forward to correct the problem. It may be as simple as a change or alteration in medication or a new prescription. If surgery is indicated, most physical corrections are minimally invasive, can be done in our clinic, and the recovery time is usually short.

If the problem is psychological, resources to help are available. For an appointment, call us at 770.720.7733.

August 16, 2016

dr litrel interview part 3 graphic
An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 3 of a 3 Part Series

Guiding Principles
My philosophy as a doctor is the mother principle—in that you treat all your patients the same, and always keep in mind how you would want your mother, wife or other loved one to be treated. If your mother is on that operating table, you’d want the surgeon operating on her to bring his A game. For me, an A game is not just about being in one place and doing well, it’s about availability, continuous improvement, compassion, learning the latest technology and methods, follow- up, etc. so I’m giving my patients the best possible care and aftercare.

The Doctor/Patient Relationship
Apart from the mother principle, the patient’s attitude tends to guide me. My principle is that I do my very best and I’m as honest as I can be. I try to do it in a way where people can be receptive. Sometimes it works very well and other times, well, not so much. Physician-patient compatibility is very important.

For example, I recently had a patient with life-threatening blood pressure issues, and she really didn’t want to hear anything I had to say. She was being completely non-compliant by not taking her prescribed medication to combat dangerously high blood pressure readings. She became impatient, even angry with me, changing the subject to something else each time I tried to discuss the severity of her situation and the importance of following my recommendations.

On the other hand, another patient reached out to me in desperation. She described how her son was heavily into drugs and how her father was seriously ill. The situation was causing devastation to her, both mentally and physically. Apart from understandable emotional turmoil, she was compensating for the difficulty in her life by overeating and was rapidly gaining weight.

Dr. Litrel with patient photoI listened to her because I truly sympathize and care about the struggles she’s going through. I gave her the best advice I possibly could. It was clear that she was receptive to everything I was telling her and would follow my advice.

The non-compliant patient made me realize that our doctor/patient relationship was a mismatch and was going nowhere. I knew I would probably decide not to see her again, and I’m okay with that. My heart is telling me that she would be-or should be-better off with another doctor, and I’m okay with that too.

However, the troubled mother was appreciative of the help I was trying to give her. I knew that, unlike my other patients, or those that I see over the years for just an annual exam, she would remain in the forefront of my thoughts. I would remember her son’s name, follow up with her regularly, stay in touch, and even pray for her because I’m genuinely concerned. I don’t doubt she truly wants my help. I can only help those people who want to accept my advice and, in turn, help themselves.

Talking with Inhibited Patients
With shyer patients who are more reluctant to discuss their problems, I simply confront the issue. I basically just tell my patients, “Look, I completely understand that it’s very embarrassing sometimes to talk about sexual or genital issues. It’s humiliating if you ‘poop’ or ‘pee’ on yourself, don’t know what an orgasm is, or if you’re ashamed of the way you look. Whatever it is, I know some of these things can be difficult to talk about. That said, I’ve heard and seen it all, so now I’m going to get the information I need from you. Sooner or later, I’m going to find everything out anyway, and we’re eventually going to have a trusting relationship so the more you tell me now, the more comfortable you’re going to be, and the more I can help you.”

If I just acknowledge the fact that it’s an awkward or socially embarrassing subject, people tend to relax a little and speak more freely. Then, once I do an exam, my knowledge and experience guides me to ask more direct, delicate questions based on my visual findings—questions like, “Do you need to touch your vagina to defecate? Do you leak stool? Are you sexually active? Do you urinate when you cough, sneeze or jump? Do you have a sensation like your bottom is coming out? Does your back hurt a lot?”

Because I’ve been practicing for so long, I can duplicate the anatomical findings with the physical symptoms. This makes them think, ‘Oh, he knows that, so maybe this is a normal thing!’ When that connection is made, we can discuss and build a trusting relationship.

Surgery
My philosophy is that, unless surgery is absolutely necessary, I discourage it. If you must have surgery, do it for the right reasons. I feel that patients seeking operations to improve their sexuality or the appearance of their genitals can be extremely vulnerable, impressionable and overly trusting of people who might want to take advantage of that vulnerability for their own profit.

Since the internet has come into our lives, we’re often led to believe that there’s only one solution to all our problems. A place that sells widgets will try to convince you that widgets will solve everything that’s wrong with your life. Desperation causes people to believe that so they buy that widget only to find out it’s not a cure-all. It’s the same thing with surgery. It’s not always the answer to everything simply because it’s radical and is made to sound like the perfect answer to everything.

Dr. Litrel Surgery Pic I don’t subscribe to that way of thinking. Again, I rely on the ‘mother principle’, going on the premise that if this was my mother, wife, sister or daughter seeking help, I would recommend surgery only when surgery is indicated. I wouldn’t want my mother or my wife going somewhere and being talked into surgery simply because that’s how the provider makes money. There’s a higher degree of ethics that’s required, and that’s to do your very best and treat people with as much love as possible. If you honor that, your patients will thrive and you’ll have a very happy career.

Cosmetic Gynecology
I feel that a lot of plastic surgeries promise unrealistic results, but because I deal solely with women’s problems, I understand that quite often, these desired results will not happen. In my opinion, altering genital appearance for visual enhancement only is much like the case of Michael Jackson, who pursued surgery after surgery, turning his original attractiveness into an almost garish version of his former self. Plastic surgery did not solve his underlying problems of low self-esteem. Unnecessary cosmetic gynecology is no different.

For me, cosmetic gynecology is all about making women more comfortable with their bodies. A lot of women come to me devastated because they don’t feel like they’re good enough. Some have given an important part of themselves to a husband or father of their children for years and have been made to feel substandard. And suddenly they’re faced with separation or divorce. These women seek cosmetic help so they’ll feel attractive, desirable and confident enough again to have a good sex life with someone else in future. I see these things all the time.

Prayer, Spirituality and Health
It’s already been documented that I pray with my patients when they ask or need me to, usually before a surgery when they’re frightened and more vulnerable. I’m happy to do it. I pray all the time. It’s part of my life, much like breathing to me.

As a doctor I can alleviate a lot of the physical suffering, especially in my areas of expertise, but much of the pain we have is not of the body, it’s of the soul.

Prayer is very basic and healthy. If you’re not praying, then you’re not really listening. I’m not saying prayer as in asking for something. I’m saying prayer as in listening to what God wants from you and if you listen, I think things will go pretty well. You need to have good relationships with people around you, have loving relationships with family and God, and for me, prayer is a very important part of that – to be faithful and to strive to listen to what God wants me to do. I think that’s a really important factor in maintaining good health.

An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 2 of a 3 Part Series

Of all the specialties you could have chosen, why did you choose obstetrics and gynecology?
I was quite surprised myself that I chose OB/GYN. I really hadn’t thought of it as a specialty before I attended medical school because I was more inclined towards surgery. However, when I delivered my first baby, it was such a miraculous moment in my life. It was 3:00 in the morning, and I remember it distinctly. I was in awe that this child actually came from a woman’s body. Ten seconds later, as I was placing that baby into that little infant warmer, I realized that I wanted to participate in this miracle; that I was going to be an obstetrician. It was a profound moment for me, and I can’t begin to express how much great personal satisfaction and enjoyment I’ve received over the years by taking care of women and women’s issues.

Your wife Ann also works at Cherokee Women’s. Do you find it difficult to separate work-related issues from home life, or do you find it can strengthen a relationship?
Ann works on public relations for the clinic and I have my medical practice so yes, we work under the same roof and our paths do cross but we each tend to our own professions. I’m a doctor, something I’ve wanted to be since the age of seven and Ann is, first and foremost, an artist.Dr. Litrel and Ann photo

In answer to the second part of your question regarding separating work-related issues from home life, I think it’s very important to be married to your best friend and someone you trust implicitly. Ann is both of those to me.

We have a strong, healthy relationship and have been married for 28 years. Like any normal couple, we have our ups and downs, but we know how to apologize and go on from there. We’ve grown together and share similar interests. We agree on many things, including our relationship with God, and about becoming better people. As we advance through life, we continue to support, encourage and help each other. We’ve known each other half our lives so I wouldn’t say being a doctor and discussing work-related issues makes either my job or my marriage harder, any more than Ann being an artist and sharing her passion for it impacts either of those things.

You have an identical twin brother named Chris. When growing up, did you find that you and he shared that proverbial ‘brain’.
As identical twins, he and I understood each other so well that we didn’t learn to speak early or verbalize our thoughts to other people.

Dr. Litrel, Chris and Mary photoHowever, we’re very different. My brother is a lawyer by trade, and a lawyer’s thought process is entirely different from a doctor’s. Physicians focus more on immediate problems, whereas attorneys think three years ahead of time. Still, we’re very close and I rely on his counsel a great deal.

If you decided to retire tomorrow, what would you do?
Do you mean if I stopped practicing medicine? Well, I love what I do so as long as I’m healthy enough to keep doing it, I don’t really want to retire unless I absolutely have to. If anything, as I get older, I’ve become a better surgeon so I’d like to continue for as long as possible.

My other passion would be writing and speaking about the relationship between health and spirituality, something that’s very important to me. That’s one of the reasons I was drawn to the care of women and their health—because what life event could possibly be more spiritual and meaningful than the birth of a child?

I chose to specialize in surgical gynecology because human beings grow inside of a woman’s body, and sometimes you need a surgeon that can bring them safely into the world. I enjoy it, not only for the concrete aspects of surgery, but also for the deep spiritual meaning of this process known as the creation of a life.

We can clinically describe how a single cell turns into a newborn baby over 280 days, but the process itself is miraculous. It’s a testimony to the fact that our lives have deep purpose and deep meaning, and that God grants us life.

If you were to write another book, what topic would you choose?
As it happens, I’m currently working on a book on pelvic reconstructive surgery, but I’m also tying it in with the correlation between health and spirituality. Women not only endure suffering and damage to their bodies, but also to their souls. We all do. So the book I’m writing expands on that subject.

Women have unique human problems because of the nature of creating new life inside their bodies, and there’s suffering that comes from that process. So from that perspective, I’m writing about the nature of surgery in terms of when to have it and when not to have it. I’m also writing about the nature of health since health is not only about the physical but about the sexual and spiritual aspects as well.

I’d like to educate patients on the fact that we’re not human beings having spiritual problems, but that we’re spiritual beings having human problems. These human problems we all sometimes have call for the attention of a surgeon.

Do you like to travel? If so, where was your favorite place?
One of the things I like about practicing medicine is that I don’t have to travel anywhere. People from all over the world come to see me. I guess I’m more of a homebody than I am a traveler. I like keeping my life pretty simple. I have traveled and visited many different countries, but it’s not my favorite thing to do. I’ll go, but I prefer to stay home.

As a busy OB/GYN surgeon, I’m sure the demands can be overwhelming. How do you deal with those demands – both at work and at home?
I try to manage my schedule in such a way that I can always be in top form whenever I have patient duties. When I see my patients, I remain completely focused and concentrate on them. I also make sure I leave openings in my schedule to allow for free personal time. That way, I know that I can continue to do what I do indefinitely to prevent burn out.

Instead of allowing myself to get overwhelmed, I try to set up my calendar in a manner that guarantees I can be in peak mental condition all the time, thus insuring that I give the best care I possibly can. I’m 50 years old so I know myself well enough to know what works for me.

To unwind after work hour, Ann and I will often go for a walk around the neighborhood for about 40 minutes. We may go to the gym for some exercise, or out to have something to eat. Our favorite date is going out for a glass of wine, an appetizer, some dessert, and maybe catch a movie. That’s probably been our favorite type of date for the last thirty years.Dr. Litrel and Ann photo

I think we all need to give ourselves personal time to build up a relaxed, spiritual reservoir so that we can make good choices. To me, good choices are eating right, exercising, taking my wife out, having friends over, laughing and enjoying life—that’s MY relaxation.

Coming from an Asian-Italian background, how did you combine the two worlds when it came to traditional customs, beliefs and holidays?
Since I have a mixed ethnicity, I always had a few problems in the sense of fitting in. I was born in 1965 and there weren’t that many Chinese-Italian people out there back then. Although we’ve come a long way as a society in the sense that people are much more tolerant of interracial marriages today than they used to be, it was a bit difficult for me at times when I was growing up.

I probably chose my profession, because as a kid, I didn’t fit in too well with the world around me. I think that’s one of the reasons I was so drawn to medicine. In medicine, it’s not about skin color, ethnicity, wealth, or socioeconomics. It’s about helping and healing people.

As for holidays and customs, my mom’s father and stepmother lived in New York City. They were vegetarian Buddhists. For Chinese New Year, my step-grandmother would make a traditional Chinese meal, after which we would go into the city and celebrate. When fireworks were still legal, we would light them and throw them at the dragon. I remember how much fun that was.

As for the other side of my family, my dad had a lot of Italian friends—in fact his business was Italian food manufacturing. He worked with a lot of Italians, so we spent most of our time in their environment. New York is very rich in Italian flavor and community, so we got a lot that particular ethnic exposure too.

I still have Italian friends in New York. My grandparents have since passed away, so I’m not as in touch with my Chinese roots these days as I am with my Italian ones.

What is your very first childhood memory?
I remember when I was 3 years old we were moving to the house that would become my childhood home. I remember driving down that block and coming to the house that I would grow up in.

Ok, I just have to ask: When you watch medical movies or TV shows, do you find yourself mentally correcting the inconsistencies?
When I was younger, I used to think about all the things they were doing wrong. Now I simply sit back and enjoy what I see on the screen. I’ve come to understand that they’re just trying to create drama, and I recognize that movies and TV are all about the story.

When I was training to be a resident I used to watch ER—and that was actually a very good show. Michael Crichton was asked to be a consultant on that show because he was a Harvard trained doctor. It was a good series but sometimes it was just too much. To draw viewers, they would try to condense all these improbable situations into a one-hour episode of heightened drama and sensationalism. A lot of it was very real but it was just too intense. I DID enjoy it though. I also used to like M*A*S*H*. I still watch medical shows today because it made people aware of what it’s like to be a doctor, or a doctor in training.

What inspires you to continuously educate yourself and want to learn more? Did you have a mentor?
I think I became a doctor because I wanted to matter to other people. I also think that perhaps childhood pain is the root of my deep desire for my life and my actions to matter.

For me, life is about evolving, learning and constantly getting better and better. I don’t think my motivation to learn can be attributed to any one person. I’ve had excellent teachers and mentors throughout my life, and I feel blessed to have had them, but I don’t think that I can ascribe sole mentorship to any one person.

I think the best way to live is to always improve one’s self. I’m hoping my children have learned that from Ann and me. I pray they will always strive for self-improvement in their lives. I think that the people who don’t try, who don’t aspire to progress, who choose to remain stagnant in their viewpoints—these people become trapped in the belief that they are always right, when in fact, they can be tragically wrong.

Symptoms to bring to your doctor photoOftentimes women accept minor gynecological or urinary symptoms as a normal part of being a woman. The truth is those minor symptoms may be indicative of a more serious condition.

It is important to take charge of one’s health, stay up to date on annual visits, and make sure to speak with a doctor about any concerns, no matter how minor they may be. By recognizing and disclosing these symptoms early, doctors may be able to diagnose and treat underlying pelvic or urinary conditions.

If a woman is unsure whether to call her doctor, here are some symptoms that may go unnoticed but can be cause for concern:

  • Urinary Incontinence – Leaking urine is commonly seen in women who have had multiple pregnancies, or who are advancing in the aging process. However, urinary incontinence is not something a woman should take lightly. Leaking any amount of urine while laughing, sneezing, coughing, or exercising can be a sign of several urinary conditions, including bladder prolapse. Don’t wait until an annual exam to bring this to a doctor’s attention. There are treatments and lifestyle changes one can make to minimize the symptoms of incontinence.
  • Unexplained Bleeding Bleeding that is not associated with a monthly cycle should be brought to a doctor’s attention immediately. While one shouldn’t stress about the worst case scenario, possible conditions that could cause the bleeding range from fibroids and cysts, to ectopic pregnancies, anemia, or even cancer.
  • Pelvic Pain – Any pelvic pain whether it is during sex, or any other time should be mentioned to a doctor. There could be underlying causes that may need to be examined further and/or treated such as a sexually transmitted disease, endometriosis, or uterine fibroids.
  • Changes Anything seem out of the range of normal, lately? A change in discharge, itching, visible bumps or bulges, or burning while peeing are definite reasons to call your gynecologist immediately. These unpleasant symptoms may be signs of vaginal infections, sexually transmitted diseases, urinary tract infections, or other vaginal conditions that require a doctor’s diagnosis and treatment.

At Cherokee Women’s Health, we are here for any concerns you may have about your gynecological health. Make an appointment at one of our two locations where our highly specialized doctors can diagnose and treat any worrisome symptoms.

Pelvic Organ Prolapse (POP) refers to the sagging or drooping of any pelvic organs due to damage, trauma, childbirth or injury.

The pelvic floor consists of a group of cradle-shaped muscles that hold pelvic organs in place. The pelvic organs include the uterus, bladder, cervix, vagina, rectum and intestines. Like any other part of the body, these muscles, with their surrounding tissues (fascia), can develop problems.

If you fill a small plastic bag with grocery items, say for instance, a box of cereal, a few cans of vegetables, some jars and a package of rice —the bag should hold the items with no problem. But if you hang that full bag on a wall hook and leave it suspended, you’ll start to notice the items in it begin to bulge against the membrane of the bag as it takes on the shape of its contents.

After a while, depending on how heavy the items are, the corner of the cereal box or rim of a can may start to bulge and even poke through as the bag stretches, weakens and eventually tears from the weight of the items in it. The groceries may even begin to protrude and dangle outside of the bag as the tears get larger.

Pelvic pain photoPelvic prolapse happens much the same way. As the muscles and tissues holding the pelvic organs weaken, degrade or tear, the pelvic organs slip or drop through, sometimes forming a small hanging internal bulge. At other times, depending on the damage, they may actually dangle externally from the vagina or anus, causing problems and inhibiting their function. This is called prolapse.

Who is at Risk for Pelvic Organ Prolapse?

One in three women suffer from POP. Any activity that puts undue pressure on the abdomen can cause pelvic floor disorders. Typically, labor and childbirth are the leading causes of prolapse, especially when a woman has had several children, a long, difficult labor, or has given birth to a larger child.
Pelvic organ prolapse becomes more common with age, usually around menopause when tissues damaged during a woman’s childbearing years begin to lose strength. Other causes are:

  • Obesity: Excess weight places increased pressure on the abdomen.
  • Pelvic organ cancers: Tumors can also put additional pressure on the abdomen.
  • Constipation: The bowel puts increased pressure on the vaginal wall when constipation is a chronic problem.
  • Uterus removal (hysterectomy): During surgery, there is always a possibility of inflicting damage on pelvic organ support, resulting in dislocation of any organ within the pelvis.
  • Smoking and respiratory problems: Excessive coughing, especially if chronic, can put extra strain on the abdomen.
  • Genetics: Pelvic connective tissue weakness may be hereditary. Often, if immediate female family members have suffered from prolapse, there is a greater possibility that you will too.
  • Heavy lifting: Excess abdominal pressure from heavy lifting may cause POP.
  • Diseases of the nervous system: There is a greater risk of developing pelvic organ prolapse for women who suffer from multiple sclerosis, spinal cord injury or muscular dystrophy.

What are the Symptoms of Pelvic Organ Prolapse?

It is entirely possible not to have any symptoms at all. Sometimes pelvic organ prolapse is only discovered during a routine gynecological examination. Minor symptoms are a feeling of annoying pressure of the uterus or other pelvic organs against the vaginal wall, minimal malfunction of those organs, and mild discomfort. Other symptoms are:

    • Painful intercourse
    • Vaginal bleeding or spotting
    • A sensation of pelvic pressure
    • Feeling as if something is falling out of the vaginal opening.
    • Bowel movement problems such as constipation.
    • Urinary problems such as needing to void frequently, especially if this interrupts sleep (overactive bladder) or involuntary urine release (incontinence).
    • Stretching or pulling sensations in the groin or pain in the lower back.

Symptoms may be aggravated by jumping, lifting or standing. Relief is usually found after lying down for a while.

When Should You See Your Doctor?

If you have increased sensations of pelvic pressure or pulling which is exacerbated by lifting or straining, but relieved when you lie down.

  • If sexual intercourse has become painful or difficult.
  • If lower back pain or pelvic pain interferes with daily living.
  • If you can feel a bulge inside your vagina or see one protruding.
  • If you have irregular spotting or bleeding.
  • If urinary problems have developed, such as leakage, an urgent need to void, or more frequent urination, including two or more times a night.
  • If you suddenly develop bowel movement problems.

Diagnosis

At times, pelvic organ prolapse may be hard to diagnose, especially if a patient does not complain of any symptoms. Patients might be aware there’s a problem but cannot actually pinpoint its location.After asking questions regarding symptoms, medical history, past pregnancies, and other health problems, your doctor will perform a physical examination. Then, if organ prolapse is suspected or discovered, the following additional tests may be ordered:

    • Urodynamics test: Results will indicate how your body stores and releases urine.
    • Intravenous Pyelogram (IPV): An x-ray that reveals position, size and shape of the bladder, kidneys, ureters and urethra.
    • Cystoscopy: This lets your doctor see the interior lining of your bladder and urethra.
    • Computed Tomography Scan (CT scan): X-rays showing details of interior pelvic area structures.

The doctor will then use a classification system to decide the organ prolapse level so he can best decide treatment options. Often, only simple non-invasive treatments and lifestyle changes are recommended for minor prolapse. If surgery is warranted, the following may be suggested:

  • Cystocele repair: Repair of the bladder
  • Urethrocele repair: Repair of the urethra
  • Hysterectomy: Removal of the uterus
  • Rectocele repair: Repair of the rectum
  • Enterocele repair: Repair of the small bowel
  • Vaginal vault suspension: Repair of the vaginal wall
  • Vaginal obliteration: Closure of the vagina.

What Can You Do?

  • Eat fiber: Try to get at least 20mg daily to prevent constipation. Regular elimination is essential to good pelvic health.
  • Kegel exercises: These strengthen and tighten pelvic floor muscles and can be done anywhere, any time—on the sly.
  • Maintain a healthy weight: Your abdominal muscles will thank you.
  • Avoid heavy lifting: If you have to grunt to lift, it’s too heavy.
  • Gentle exercise: Walking is great. Put on those sneakers and try to gradually work up to 20 minutes a day.
  • Drink plenty of water: Not gallons, but about 8 cups a day. This also helps with constipation.
  • Bowel training: Try to schedule bowel movements at the same time every day. It may take time, but eventually your body will cooperate.
  • Don’t smoke.

Pelvic prolapse often sounds worse than it is. For many women, there are hardly any symptoms. For those who DO suffer, there is help available, whether it is a simple lifestyle change, surgical repair, cosmetic enhancement or reconstruction.

If you have questions about your gynecological health or would like to consult with one of our pelvic reconstructive surgeons, please call 770.720.7733 or contact us here.

August 10, 2016

First Gynecology Appointment PhotoFirst Gynecology Appointment
At Cherokee Women’s Health, we understand the nerves a woman may experience when making a gynecology appointment, even for a routine annual examination. Our goal is to make patients feel as comfortable and assured as we can, beginning with their first appointment. To help prepare for an appointment, here are some expectations and answers to commonly asked questions about our practice and a routine gynecology examination.

Health History
Honesty is important when disclosing one’s health history. Doctors need to be aware of the past, so they can accurately care for a patient. Usual topics covered in a health history will include any medications currently being taken; sexual history; past pregnancies, surgeries, or treatments; and a familial history of cancer and other diseases.

Come with Questions
Don’t hesitate to bring up any concerns, no matter how trivial they may seem. It is best to be straightforward about symptoms, in the event that additional procedures need to be scheduled. Don’t leave our office with any questions unanswered! There is no need to be self-conscious about asking questions or discussing symptoms because our doctors have years of experience in their field. They discuss these topics daily with their patients.

What to Expect

  • A routine appointment lasts about an hour. Several exams take place during the appointment including a pelvic exam and a breast exam. Patients should also be prepared to provide a urine sample to test for pregnancy, and to catch any abnormalities in the sample that may indicate disorders or infections.
  • A pelvic examination is performed to ensure that both external and internal areas of the vagina are normal, including a pap smear which is used to test for cervical cancer. At a patient’s request, a culture can be ordered to screen for any sexually transmitted diseases. The pelvic exam can make patients uncomfortable, but it is important to relax during the process. Reproductive health is important!
  • A breast exam is completed to check for any lumps or irregularities in breast tissue. Based on family history of breast cancer, and your age, you may be referred for a mammogram which will screen for breast cancer.
  • An opportunity to ask questions is part of the appointment. Be proactive and mention anything that is concerning. Honesty is essential to providing the best personalized care to our patients.
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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