Voted "Best OB-GYN" in Towne Lake, Woodstock and Canton Voted "Mom-Approved OBs" by Atlanta Parent magazine readers
October 9, 2018

By James Haley, MD, FACOG, FPMRS

woman with prolapsed bladderLiving with a Prolapsed Bladder

As GYNs, we address bladder issues on a daily basis, so when we discovered that our longtime patient suffered from a prolapsed bladder, we asked her to share her story of life before — and after — bladder surgery.

“I knew every bathroom in town,” recalls Gabrielle, a vibrant woman in her mid-50s, a common age for women to experience bladder problems. “I never leaked – but I had to use the bathroom ALL the time,” she explained. “My husband used to complain, ‘I hate running errands with you because you have to go to the bathroom at every stop.’

“It started in my late 40s, when I began getting this weird feeling that my bladder had ‘fallen’. It got worse and worse, and it just became this constant pressure. It affected everything. When I exercised it was never painful, but I felt this constant sensation of pressure.

“I finally talked to my GYN, and he said it was caused by a prolapsed bladder.”

What is Prolapsed Bladder?

Prolapsed bladder, also known as Fallen Bladder or Cystocele, is a condition where the bladder drops down from lack of support. Pelvic floor muscles and tissues hold the bladder and other organs in place, but they can weaken over time. This causes the bladder to descend from its fixed position and slip downwards into the vagina. In more severe cases, the bladder may dangle completely outside of the vagina.

What Causes Prolapsed Bladder?

There are four main reasons a woman may develop a prolapsed bladder:

  • Childbirth: A difficult delivery, long labor, a large baby or multiple births
  • Strain: Heavy lifting, strained bowel movements, excessive coughing
  • Menopause: Lack of estrogen, which is vital in maintaining the health of vaginal tissue
  • Obesity: Excess weight, which puts undue strain on pelvic muscles and tissues

What are the Symptoms?

  • Sensation of pressure in the bladder or vagina
  • Leakage of urine when coughing, sneezing, laughing, etc.
  • Protrusion of tissue from the vagina
  • A sensation that the bladder is not completely empty right after urinating
  • Difficulty urinating
  • Pelvic pain or discomfort
  • Painful intercourse

Life After Treatment

Gabrielle relates that she was given multiple treatment options but ultimately chose a permanent treatment solution called a surgical bladder lift. “That surgery literally changed my life. It’s been five years, and I’ve never had a problem. AND no more crazy bathroom trips!”

When Should You See Your Doctor?

If you notice that you have any of these symptoms and you suspect a prolapsed bladder, you should see your doctor immediately. This is not a condition that repairs itself. It usually worsens over time. However, it can be fixed, thanks to many modern methods available today.

Why Our FPMRS Specialists are Experts in Bladder Prolapse

Our board-certified OB-GYNs Dr. Michael Litrel, Dr. Peahen Gandhi, and Dr. James Haley have earned board certification in Female Pelvic Medicine and Reconstructive Surgery. FPMRS is a surgical sub-specialty addressing the problems women experience with the changes to their anatomy from having children and pelvic prolapse. FPMRS surgeons are also known as ‘board-certified urogynecologists.’ Cherokee Women’s Health Specialists, PC, has unique surgical expertise in the Southeast United States as an OB-GYN practice with three board-certified urogynecologists.

To schedule an appointment, call our office today at 770-720-7733.

September 5, 2018

Sherene Harati after the Teal Trot.If you go to our Canton office, there is a good chance you have met Sherene. Her bright smile and helpful attitude keeps her teammates and patients in high spirits.

What you may not know about Sherene is that she is an Ovarian Cancer Survivor. She was diagnosed in 2014 after getting a second opinion for her PCOS. She felt the doctor she was seeing at the time didn’t take her concerns about her symptoms seriously. When she saw a new doctor she mentioned her symptoms again. This time the doctor recommended an ultrasound.

During the ultrasound they identified a mass. Sherene had just graduated from college and didn’t fit the demographics of the women who usually develop Ovarian cancer, so her doctor wanted to keep an eye on the mass. It would have been easy for her to sweep it under the rug, but her doctor followed up, and Sherene kept all of her appointments.

Sherene lost one of her ovaries, but they caught the cancer early. After completing her treatment, including chemotherapy, Sherene is cancer free. It’s been almost three years and Sherene sticks to her follow-up appointments every few months to make sure she is still healthy.

Sherene’s Take Home Message

Sherene’s biggest message? Listen to your body! If you think something isn’t right, talk to your doctor. It’s okay to get a second opinion, especially if you think you aren’t being heard.

Now Sherene is dedicated to spreading the message about Ovarian cancer. Every year she participates in the Teal Trot 5k in Atlanta. She raises money and awareness and has fun in the park with her friends and family. Sounds like a great day!

Learn more or help Sherene on her mission to spread awareness by visiting the Georgia Ovarian Cancer Alliance site. The next Teal Trot will be September 15, 2018; to sponsor Sherene, visit her campaign page!

Sherene kept a positive attitude during treatment.

Sherene kept a positive attitude during treatment.

Still smiling! Sherene participates in her first Teal Trot.

Still smiling! Sherene participates in her first Teal Trot.

Sherene gets the word out about Ovarian Cancer Awareness with teal hair.

Sherene gets the word out about Ovarian Cancer Awareness with teal hair.

August 23, 2018

Hysteroscopy diagramWhat is a Hysteroscopy?

A hysteroscopy is used to diagnose and treat problems of the uterus. A hysteroscopy is performed by inserting a speculum to open the walls of the vagina. The hysteroscope is gently placed into the uterus through the cervix and sterile salt water is used to dilate the uterus so the surgeon can visualize your anatomy. Small instruments are used to take biopsies when indicated.

Why is it Used?

A hysteroscopy is used to find the cause of abnormal uterine bleeding, changes in bleeding or an abnormal ultrasound finding. A hysteroscopy is performed to determine the best treatment plan.
Hysteroscopy are also used to:

  • remove scarring in the uterus
  • diagnose the cause of repeated miscarriages
  • locate an intrauterine device (IUD)
  • perform a method of permanent birth control

What Can I Expect?

Hysteroscopy is performed in our Canton office under IV sedation. You will not experience discomfort during the procedure, but you will need someone to drive you from our office.

You will go home shortly after the procedure. It is normal to have some mild cramping or a little bloody discharge for a few days. You can take Ibuprofen or Tylenol for any discomfort. If you have a fever, chills, or heavy bleeding, call your healthcare provider right away.

If you have any additional questions, please contact Cherokee Women’s Health Specialists at 770.720.7733.

hysterectomy diagramWhat is a Hysterectomy?

A hysterectomy is the surgical removal of a woman’s uterus, the womb. After hysterectomy, you will not be able to have children. Your hormones are generally not affected unless your ovaries are also removed.

Why Should I Have a Hysterectomy?

A woman may have a hysterectomy to treat common conditions, such as: pelvic pain, bleeding, prolapse, endometriosis, fibroids, painful periods, and pain with sex.

How is a Hysterectomy Performed?

A hysterectomy can be performed in different ways depending on the reason for the hysterectomy and other factors. You and your doctor can discuss the different ways of performing a hysterectomy to decide which route is safest and most appropriate for your specific situation. The three main hysterectomy procedures are laparoscopic, vaginal, and abdominal.

lap hysterectomy diagram

  • Laparoscopic Hysterectomy – A thin, lighted tube attached to a camera is inserted into the abdomen through a small incision. Additional small incisions are made to insert surgical instruments. A laparoscopic hysterectomy results in shorter hospital stays, an easier recovery and a decreased risk for infection than an abdominal hysterectomy.
  • Vaginal Hysterectomy – The uterus is removed through the vagina. The only incision is inside the vagina. However, your internal anatomy cannot be visualized by the surgeon.
  • Abdominal Hysterectomy – A larger incision is made on the abdomen to remove the uterus. An abdominal hysterectomy may be suggested if a patient has a large uterus, adhesions or other anatomical challenges. This kind of hysterectomy requires a longer hospital stay and healing time.

What are the Risks?

A hysterectomy is a commonly performed surgery. However, there are always some risks associated with having a surgical procedure. Your surgeon will discuss the risks and benefits so you can be informed to make the best decision.

What to expect after the surgery.

If you have any additional questions, please contact Cherokee Women’s Health Specialists at 770.720.7733.

March 13, 2018

Although our physicians at Cherokee Women’s Health Specialists are experienced in treating all pelvic issues unique to women, we do not concentrate solely on the physical aspects of your genitalia. We recognize that health issues can be comprised of overall physical, mental and social factors and take all that into account, offering holistic approaches to the many problems that have plagued women since the beginning of time. One of these holistic solutions is the O-Shot, also known as the Orgasm Shot.

Women have always suffered from a plethora of physical ailments unique to their gender-so much so that an entire branch of medicine, Gynecology, has been devoted to their exclusive issues. Painful intercourse, urinary incontinence, vaginal dryness, and sexual disinterest are only a few of the problems we see on a daily basis. Though medicinal and surgical intervention is always available, many women today prefer a gentler and more natural approach. The O-Shot has been known to alleviate or entirely correct many of these problems in a less invasive, natural and extremely effective way.

Below, Dr. Litrel offers more insight on the holistic approach to treatment urinary incontinence and sexual dysfunction with the O-Shot:

What is the O-Shot?

The O-Shot is a non-surgical injectable procedure administered in-office, using your own processed growth factor cells harvested from your blood. It is then re-injected into an area of the upper vagina and near the clitoris, resulting in healing regeneration of the orgasmic zone, triggering the power of your own body’s natural healing properties.

How is This Done? 

After a vial of blood is taken from you, it is centrifuged, separating concentrated plasma and platelets from the rest of the blood. This process produces platelet-rich plasma (PRP), to which your physician applies an additive to boost the activation of your growth factors. Then, the platelet-rich serum is reintroduced into your body after swabbing the area with a numbing anesthetic.

Platelets normally swim around in your blood vessels, always on guard for any disruption or damage. When they sense one, they rush to the injury site, join together in a chain to ‘hold down the fort’, by forming a clot or plug. Then, they send out a type of S.O.S.to healing stem cells to hurry over and start repairs in the form of collagen production.

The O-Shot mimics this sequence by introducing a multitude of platelets into the body. The additive mixed in earlier sends that signal a false alarm of sorts- to lure the stem cells over. Stem cells, recognizing so many of your own platelets in one place are fooled into thinking there’s an injury and immediately respond, doing what they’re designed to do, which is to begin producing collagen and new tissue, replenishing vital elasticity, skin cells, moisture, plumpness, sensitivity, and strength to the area. 

PRP is not a not a novelty or fad. This technique has been used for many years to heal wounds, to treat sports and other injuries— has even proven effective in dentistry.

What Can the O-Shot do for Me?

The O-Shot can benefit women a great deal. By spurring the area of the body where it has been injected into healing itself, the O-Shot immediately begins to work. It starts correcting different feminine issues that have developed over time due to aging, childbirth trauma, depleted collagen, tissue damage, skin cell death, etc., physical changes which can evolve into such problems as:

  • Sexual dysfunction
  • Sexual disinterest or low libido
  • Vaginal Dryness
  • Urinary Incontinence
  • Failure to achieve orgasm
  • Desensitization
  • Painful intercourse
  • Stress incontinence
  • Urge incontinence

The O-shot, in tandem with your own biological healing factors, can then ease or altogether eliminate these troubles, resulting in:

  • Accelerated desire for sex
  • More powerful orgasms
  • Corrected or minimized urinary incontinence leakage
  • More youthful and supple vaginal lip appearance
  • Increased tautness to the vaginal opening
  • Less or no need for artificial vaginal lubricant
  • More frequent and regular orgasms
  • Less or no pain during intercourse
  • More sensitivity and arousal during clitoral stimulation
  • More ease in attaining orgasm
  • Possibility of reducing or stopping previous drug intervention
  • Possibility of less frequent or complete cessation of pelvic-related infections

How Long do the Effects of the O-Shot Last?

Individual results vary, but often noticeable change begins immediately and can last up to 18 months. Depending on how severe your issue is, we may recommend a booster procedure in about 4 to 8 weeks, and a maintenance shot in about a year so that there is no diminishment of ongoing benefit. There is also no recovery period necessary. You can resume all normal activities immediately after leaving our office. Furthermore, the whole process will cause you little or no discomfort.

Who is a Good Candidate for the O-Shot?

Almost every woman between the ages of 25 to 65 is a good candidate. There are virtually no exceptions, but we can only recommend this procedure 100% after you disclose your full medical history so we can be sure there are no foreseeable problems exempting you. Usually, however, most women prove to be excellent candidates.

Why Should I Choose Cherokee Women’s Health Specialists for my O-Shot Treatment?

At our establishment, we pride ourselves on our holistic approach to female wellness. We treat you as a whole, taking into account any metabolic or hormonal problems you may have. Even diet and lifestyle can compromise or your body’s ability to heal or regenerate tissue. We address any psychological or emotional issues as well so that we can help restore your overall health, head to toe and inside and out. We do not just focus on your pelvic area. We examine all your alternatives and only recommend the best one for your unique situation.

Drs. Litrel and Haley have spent their entire medical careers striving to learn all there is to know about a woman’s anatomy and the myriad of factors that can affect its performance and functions. They are board certified, double accredited urologists with certification in OB-GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS), the latter requiring years of study, training, hands-on experience, and meeting rigid proficiency demands specified by the American Board of Medicine (ABMS). Dr. Haley has been trained and licensed in Aesthetic Injectables for over a decade. Together and separately, these professionals are knowledgeable in every aspect of the problems exclusive to women throughout their lifetimes.

Administration of the O-Shot requires focused expertise, strict adherence to FDA guidelines, and astute knowledge of anatomy for optimum results. Our accomplished practitioners offer this skill on a daily basis. For more information on the O-Shot procedure, we invite you to email Oshot@cherokeewomenshealth.com or call our office at 770-720-7733.

January 24, 2018

Polycystic ovarian syndrome, commonly known as PCOS, affects nearly 1-in-10 women of childbearing age. PCOS is a hormonal imbalance where the ovaries or adrenal glands produce an excess of the male hormone, androgen. Fluid-filled can cysts grow on the ovaries due to the imbalance.

PCOS Symptoms

Women with polycystic ovarian syndrome may experience one or more of the following symptoms:

  • Irregular Menstrual Periods
  • Pelvic Pain
  • Cysts on One or Both Ovaries
  • Infertility
  • Weight Gain
  • Acne
  • Excess Facial or Body Hair
  • Patches of Thick Skin

Many of the above symptoms can be signs of something bigger. It’s important to schedule regular check-ups to maintain a overall healthy well-being. Talk to your doctor about any concerns you may be having in regards to your health.

If you experience severe pelvic discomfort or pain, seek medical attention immediately.

Causes of PCOS

While the exact cause of PCOS is still unknown, there are several key factors that are linked to the hormonal disorder.

  • Obesity – Polycystic ovarian syndrome is more common in women who are overweight or obese. Weight loss can have a positive impact on reducing symptoms.
  • Genetics – Women who have a close relative that has PCOS is more likely to be afflicted with the condition. Also some ethnic groups have higher risks of PCOS, including South Asians and Hispanics.
  • Lifestyle Factors – Sedentary Lifestyle, consumption of hypoglycemic index foods

Polycystic ovarian syndrome can be diagnosed through several methods. If you or your doctor thinks you may have PCOS, they will first perform a physical and pelvic exam. The next step would then be a pelvic ultrasound or laboratory tests.

Treatment for PCOS

Once it’s confirmed that PCOS is present, there are several treatment options available. Unfortunately, PCOS is not curable but with medical intervention, symptoms can easily be managed.

Depending on the severity of your symptoms and plans for children, you may be prescribed one or more of the following medications and lifestyle changes:

Exercise can help with PCOS symptoms

  • Exercise and low glycemic diet – Diet, exercise, and lifestyle changes can help control the symptoms associated with PCOS. If you are obese, weight loss is the preferred method of treatment. Talk to your doctor about what treatment options might be right for you.
  • Hormonal Based Birth Control. Birth control that contains both estrogen and progesterone are ideal for treating the majority of PCOS symptoms. Women who are not considering children in the near future can benefit from hormonal based birth control.
  • Anti-Androgen Medication. Although these medicines are not FDA-approved for all PCOS symptoms, they can be prescribed to reduce unwanted hair growth and acne.
  • Metformin. Over time, metformin can help lower insulin and androgen production. After several months, the medicine may help restart ovulation. Metformin has no effect on excess hair growth or acne symptoms.

Complications Associated with PCOS

Women who suffer from polycystic ovarian syndrome are often at a higher risk for other health problems and potential pregnancy complications. Among others, type-2 diabetes, heart disease, high blood pressure, and certain cancers are all potential problems down the line. If you have PCOS, it is important to maintain regular doctors visits for preventative and diagnostic care.

Questions or concerns about your health? Schedule an appointment with one of our skilled healthcare providers today at our Woodstock and Canton locations.



January 15, 2018

If your period pain has ever made you lie to your boss, you’re not alone. Recently, an Australian study found that 77% of women surveyed admitted menstrual difficulties affected their work. Only over a third honestly admitted the reason to their bosses, while 43% fibbed, using some other excuse. Almost a quarter of those surveyed stoically worked through the discomfort which ranged anywhere from mild to excruciating.

Almost every woman has suffered from menstrual cramps or heavy bleeding at least once since her first period. For many, a simple over the counter pain reliever, heat applications, or a soothing hot bath can alleviate the discomfort, but for others this can be a debilitating experience month after month, often interfering with enjoyment of daily living.

Our professionals at Cherokee Women’s Health Specialists encounter this problem on such a frequent, regular basis that our skills are honed to immediately recognize the symptoms and provide help. We know the physical limitations and psychological impact chronic pelvic pain and heavy bleeding have on your life. Our physicians take menstrual pain very seriously and are very aware of the limitations it may put on you if you suffer from its distressing effects.

Menstrual pain is different from premenstrual syndrome (PMS) in that PMS usually occurs within 7 to 14 days before actual menses. Symptoms associated with PMS are bloating, irritability, weight gain, and fatigue, whereas menstrual pain occurs during your period.

Symptoms include cramping and a throbbing dull ache or pressure low in your abdomen. It can radiate to your lower back, hips and inner thighs. Other more extreme symptoms may be nausea, vomiting, or diarrhea. It can be annoying, but tolerable for -or so severe that it limits functionality.

Different Types of Menstrual Pain 

Menstrual pain is called dysmenorrhea, and there are two types –primary and secondary.

Most women suffer from primary dysmenorrhea, which is usually linked directly to menstruation itself without any other underlying conditions. Contractions of the uterus push against neighboring blood vessels, briefly cutting off blood supply to the uterine tissue, thus resulting in menstrual pain. It generally lasts 2 to 4 days.

Secondary dysmenorrhea is caused by a medical disorder of your reproductive system which may require testing to identify the source. It is typically treated with either medication or surgery. Some causes may include conditions such as pelvic inflammatory disease (PID), fibroids, adenomyosis, cervical stenosis, or endometriosis. There can also be diarrhea, nausea, fatigue or vomiting. Accompanying pain lasts longer and begins earlier than primary dysmenorrhea.

Another menstrual disorder that can lessen the quality of life, interfere with regular activities, and is often cause to call into work to take the day off, is heavy bleeding or menorrhagia. It affects a whopping 10 million American women and is one of the complaints gynecologists hear most often. This excessive bleeding can last longer than a full week. Sanitary napkins or tampons need changing every hour or two and, often, throughout the night. There can be leakage, even with precautionary double padding. Some women with severe menorrhagia can pass large, quarter-sized clots. This condition can cause serious anemia if left untreated for too long.

Causes of menorrhagia can include:

  • Hormonal disturbances or imbalances
  • Dysfunction of the ovaries
  • Fibroids
  • Polyps
  • Pelvic inflammatory disease (PID)
  • Bleeding diseases-hereditary or other
  • IUDs
  • Thyroid disorders
  • Ectopic pregnancy
  • Stress
  • Ovarian cancer
  • Endometriosis
  • Cervical stenosis
  • Kidney disease
  • Medications
  • Miscarriage
  • Cancer of the ovaries
  • Adenomyosis
  • Liver disease
  • Cervical cancer
  • Menopause
  • Perimenopause

If you suffer from menstrual pain that is not relieved by over the counter medicine, rest, heat application, or soothing hot baths- or if experience heavier than normal bleeding, you should seek the advice of an accredited practitioner familiar with women’s reproductive wellness, especially if your discomfort interferes drastically with day to day life.

At Cherokee Women’s Health Specialists we are familiar with every aspect regarding a woman’s exclusive health issues. Doubly accredited Drs. Haley, Gandhi and Litrel, our urogynecologists, hold certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) and OB-GYN. They were among the first to receive this special recognition by the American Board of Medical Specialties (ABMS) in recognition of their ability, proficiency, and training. This qualifies them to diagnose and treat any and all disorders pertaining to your feminine health. Furthermore, they are three of only a limited number of doubly accredited physicians in private practice in Atlanta.

When you choose our facility for your care, your first consultation will probably consist of in-depth questions in order to determine what your possible complications might be. A pelvic examination may reveal the problem immediately. If not, our state-of-the-art facility and our close affiliation with Northside Hospital Cherokee, with access to all its amenities, enables us to perform all additional testing necessary such as:

Laparoscopy: A tiny fibro-optic telescope can be inserted through a minuscule incision to examine internal reproductive organs, and take a small sample of tissue for biopsy.

Hysteroscopy: A fibro optic telescope is introduced into the womb via the vagina to look for any abnormalities.

Urine and blood tests: These pinpoint and accurately identify any medical disorders or diseases

Pelvic ultrasound study: This detects physical irregularities painlessly via high-frequency sound waves.

Pap smear: A quick swab rules out any cancer, infection, dysplasia or inflammation.

Sonohysterogram: After the uterus is infused with fluid, ultrasound is used to find any anomalies.

Dilation and curettage: Though this is usually a treatment, it can also be used to pinpoint any physical abnormalities.

Normally, invasive intervention is unnecessary. We do our best to avoid any treatment that makes you more uncomfortable. We analyze results carefully, taking in all factors such as your age, general health, weight, etc., and use our combined expertise and decades of accumulated knowledge to decide on the most effective management for your dysmenorrhea or menorrhagia.

Treatment Options for Severe Period Pain and Heavy Bleeding

The first option we look into is oral hormonal or non-hormonal therapy such as contraception, non-steroidal anti-inflammatories (NSAIDs), or other medications that can reduce bleeding and pain. If you suffer from anemia as a result of your condition, folic acid or iron supplements might be prescribed. In some cases, a hormonal intrauterine device (IUD), patch, vaginal ring or injections can be helpful.

Should you require a surgical alternative to alleviate your pain or bleeding, our FPMRS, OB-GYN specialists have the most current medical knowledge to do everything possible to treat your individual problem.

Severe period pain and heavy bleeding do not have to keep you from living the life you want. With the proper help, you can get better and no longer have a reason to lie to your boss.

If period pain or prolonged, heavy bleeding is interfering with your life, call today to schedule an appointment at 770.720.7733.

October 4, 2017

romantic couple photoLoss of sexual desire after fifty does not have to be the norm. If you find yourself uttering “not tonight” excuses more and more lately, Cherokee Women’s Health Specialists can provide treatment options so you can say goodbye to your low libido and get back to feeling “alive” again.

Many women after fifty weren’t raised talking about sexual health so it may be an uncomfortable topic to bring up to your GYN. However, after over forty years of combined specialized experience in women’s health, our providers can assure you that, although you are a unique individual, your struggle with a lowered libido is not unique at all. Nor is it something you should be embarrassed about.

Declining sex drive is often something older women keep to themselves. They may feel isolated and abnormal in a world of uninhibited sexual openness. Additionally, new libido medications for men increase the pressure for women to perform when desire is nonexistent. They avoid bedtime until their partner is fast asleep. Some fear their unresponsiveness may cause their significant other to seek gratification elsewhere. Others, wanting to please the person they love, dutifully ‘fake it’, which results in eventual resentment and even feelings of being violated.

Without intervention, waning desire can lead to a sense of inadequacy, self-loathing, insecurity and depression. It can cause misunderstandings and hurt feelings, sometimes ultimately leading to shattered relationships. None of this has to happen. For menopausal and post- menopausal women looking to recapture lost desire, help for the following problems is available:

• Dryness and pain: Dryness after menopause is common. The vaginal walls grow thinner, the opening can get smaller, and the canal shorter. Causes include a drop in the hormone, estrogen, which previously kept your lady parts firm, plump and moist. These changes can make intercourse unpleasant enough to embrace celibacy. We can recommend different hormonal therapies, topical creams and water based lubricants that have come a long way from the petroleum products and creams recommended by your grandmother.

• Sagging and loss of sensitivity:  Just as your body shows signs of aging, time can impact your genitals. Vaginal childbirth delivery can stretch and displace internal organs and tissue. Estrogen loss can leave your vulva and labia loose and flaccid. This can affect sexual pleasure attained through friction. Orgasms become harder to achieve.

Today, there are more options than ever to correct these problems. ThermiVa, a non-invasive, gentle warming laser treatment, can restore the youthful appearance and function of your vulva and vagina by tightening and treating their external and internal tissues.

Vaginal rejuvenation, which includes labiaplasty and vaginoplasty, reshapes, trims and alters the appearance of the vagina and labia. It not only offers aesthetic enhancement but can renew your self-confidence exponentially.Various reconstructive surgeries can secure genital organs back into their original position with a relatively short recovery period. We even have the technology now to transform your genitalia to a virginal state if you so choose.

• Incontinence: Fecal and bladder incontinence are usually a result of internal organ trauma from childbirth. If you’ve been avoiding sex because you’re worried about accidents or being seen in adult diapers, we offer solutions ranging from simple exercises to surgical repair.

• Post hysterectomy issues: Removal of reproductive parts does not mean the end of intimacy. In fact, a high percentage of women report that they enjoy sex even more after a hysterectomy so whether you’ve undergone a partial, total or radical procedure, sex doesn’t have to become a memory.

Your hormones may be out of whack for several weeks and depression, whether psychological or triggered by abrupt hormonal changes, may occur. The extent of your surgery will determine how your estrogen and testosterone levels will be affected. You may possibly enter menopause and experience hot flashes, insomnia, and other symptoms. These temporary after-effects should abate with time. If not, and you are still disinterested in sex, talk to us. Once we determine if hormonal levels, medication, scarring, or other problems are causing your low libido, our FPMRS urogynecologists can help determine treatment options.

If loss of sexual desire is a concern for you, call us to book an appointment at 770.720.7733.

September 29, 2017

What is Tubal Ligation?

Commonly referred to as “getting your tubes tied,” tubal ligation is a permanent surgical procedure that is performed to prevent pregnancy. More formally, it’s also known as female sterilization. In recent years, the term “tubal sterilization” is most accurate, since the technical definition of the word “ligation” refers to a specific surgical technique that is no longer used in most sterilization surgeries.

Whatever the term you prefer, the procedure involves closing off a woman’s fallopian tubes to prevent eggs from traveling down to the uterus, and prevents pregnancy.

When Can Tubal Ligation be Performed?

Tubal ligation can be done in conjunction with childbirth, since the advantage is that it can be performed at the same time as a C-section or within 48 hours of a vaginal delivery. Many surgeons prefer to do the surgery after birth because you’re already in the hospital, and your abdominal muscles are still relaxed from having just given birth.

If you decide later on that a tubal sterilization is the procedure for you, it can also be done as an outpatient procedure separate from childbirth via interval tubal ligation. This process uses a laparoscope, a thin tube with a camera lens and light on the end. The procedure involves general anesthesia to prevent any pain or discomfort.

What to Expect During the Procedure

If you have an interval tubal ligation as an outpatient procedure, either a needle is inserted or an incision is made through your navel so your abdomen can be inflated with gas (carbon dioxide or nitrous oxide). Then the laparoscope is inserted into your abdomen.

In most cases, your doctor will make a second small incision to insert special instruments. Using these instruments passed through the abdominal wall, your doctor seals the fallopian tubes by destroying segments of the tubes or blocking them with plastic rings or clips.

If you have a tubal ligation after vaginal childbirth, your doctor will likely make a small incision under your navel, providing easy access to your still-enlarged uterus and fallopian tubes. If you have a tubal ligation during a C-section, your healthcare provider will use the same incision that was made to deliver the baby.

What to Expect After the Procedure

If your abdomen was inflated with gas during the interval tubal procedure, the gas will be withdrawn. You may be allowed to go home several hours after the procedure. If you have the procedure in combination with childbirth, the tubal ligation isn’t likely to add to your hospital stay.

You may have some discomfort at the incision site afterwards. Other symptoms you may experience include:

  • Abdominal pain or cramping
  • Fatigue
  • Dizziness
  • Gassiness or bloating
  • Shoulder pain

You may take acetaminophen (e.g. Tylenol) or ibuprofen (Advil, Motrin IB, others) for pain relief, but avoid using aspirin, since it may increase bleeding. Your doctor will most likely permit you showering or bathing 48 hours after the procedure, but will advise against straining or rubbing the incision for a week.

You should also avoid strenuous lifting and sex for one to two weeks, but can resume your day-to-day activities gradually as you begin to feel better. Your stitches will dissolve and won’t require removal.

If you have any concerns that you aren’t healing properly, it’s important to call your doctor to see if you need a follow-up appointment. Additionally, contact your health care provider immediately if you experience:

  • A temperature of 100.4 F (38 C) or greater
  • Fainting spells
  • Severe abdominal pain that’s persistent or gets worse after 12 hours
  • Bleeding from your incision that’s persistent or gets worse after 12 hours, despite use of pressure and bandages
  • Discharge from your incision that’s persistent or gets worse

Who is the Ideal Candidate for the Procedure

Tubal sterilization is considered a permanent surgery, so it’s a good option only if you’re completely sure you don’t want any more children.

If you’re not entirely sure if you’re done having children, you might consider other less permanent forms of birth control. While you may have heard of women who successfully get their tubal sterilizations reversed, it isn’t guaranteed to be effective, and involves a second invasive surgery.

Additionally, because tubal sterilization is a surgery, your doctor may advise against the surgery if you’re obese, have chronic health conditions such as heart disease, or if you’ve had complicated abdominal surgeries in the past.

Complications from Tubal Ligation Procedures

If you think you may be pregnant after your tubal ligation procedure, you should contact your health care provider immediately. While tubal ligation is highly effective in preventing most pregnancies, it isn’t an absolute in preventing pregnancy. An estimated 1 out of every 200 women will become pregnant after tubal ligation.

Complications related to tubal ligation include an increased risk of an ectopic pregnancy, which happens when a fertilized egg implants in the fallopian tubes instead of traveling to the uterus. An ectopic pregnancy can be dangerous, and can cause a rupture in the fallopian tube, resulting in internal bleeding.

Considering Tubal Ligation? Start a Conversation

In 95% of cases, tubal ligation is an effective permanent form of birth control. Before deciding if this procedure is the best fit for you, it’s important to consider all the possibilities and know your options. If you think tubal ligation might be the right permanent birth control option for you, we invite you to contact your doctor to start a conversation.

September 27, 2017

You think you may have an ovarian cyst. Or, could it be a uterine fibroid?

Ovarian cysts and fibroids have many of the same symptoms and can be difficult to self-diagnose. You may experience pelvic pain during certain activities, dull or sharp pain in your abdomen, or no symptoms at all.

Unless you’re a trained professional, you probably don’t know the differences between the two. In fact, many women often don’t know they’ve got either until their OB-GYN does a routine pelvic exam.

Ovarian cysts are very common and typically go away on their own. While uterine fibroids are not an issue for some women, others experience problems such as changes in their menstrual cycle and even infertility.

In this article, we’ll discuss the most obvious ways to tell which of the two you have. We’ll also cover several treatment options to consider for both.

Overview: Ovarian Cysts

An ovarian cyst is a sac or pouch filled with fluid or other tissue and is caused by your menstrual cycle. As you’ve probably guessed it forms directly on your ovary.

Each month your body grow normal follicles (a cyst-like structure). These follicles produce hormones such as estrogen and regulate the timing of releasing an egg during ovulation. Cysts occur when a normal follicle continues to grow.

Because of this, ovarian cysts are most common for women who are at the childbearing age or going through menopause. You are also at a higher risk of getting ovarian cysts if:

  • You’re taking fertility drugs
  • During pregnancy
  • You’ve had a severe pelvic infection
  • You’ve had ovarian cysts in the past

Most ovarian cysts go away on their own within 1-2 menstrual cycles.

You may experience little to no symptoms when you have an ovarian cyst. However, they can also cause dull or sharp pain in your abdomen during certain activities.

Treating an Ovarian Cyst

When your doctor diagnoses you with an ovarian cyst they will typically suggest treatment if your cyst becomes large, is causing problems such as pain, or if cancer is suspected.

There are two types of treatments for ovarian cysts.

  • Watchful Waiting. This is a process of monitoring your cyst for changes in size or appearance through scheduled ultrasounds.
  • Minimal Invasive Surgery. Typically, your OB-GYN won’t suggest surgery unless the cyst continues to grow or doesn’t go away on its own.

Uterine fibroids can cause discomfort and impact a woman's fertility.Overview: Uterine Fibroids

A uterine fibroid is a growth from muscle tissue. Fibroids can appear as single growths or clusters. They vary in size, shape, and location. Some grow rapidly, while others take years to form.

Unlike ovarian cysts, fibroids can form anywhere throughout the uterus. Fibroids can be found within the uterine walls, on the outer surface, or even attached to the stem-like structure.

Doctors still aren’t exactly sure what the cause of uterine fibroids is. However, research has led to several factors being involved such as genetic changes and hormonal changes.

Women of childbearing age are most affected by uterine fibroids. Often, fibroids will decrease in size after menopause due to reduced hormone production.

Although most women have had at least one uterine fibroid throughout their life, many aren’t aware because often symptoms don’t occur. Other women aren’t as lucky. Fibroids can have numerous adverse health effects including:

  • Abdominal pain or cramps
  • Difficult or frequent urination
  • Bleeding between periods
  • Pelvic Pain
  • Infertility

You may experience one, all, or none of the above symptoms if you have a uterine fibroid. It’s important to have regular visits to your doctor including routine pelvic exams.

Treatment for Uterine Fibroids

Your healthcare provider will suggest seeking treatment for your fibroid if you’re noticing symptoms. Rarely are uterine fibroids found to be cancerous.

There are a few treatment options available to you. Talk to your doctor about which of the following is the best approach.

  • Drug Therapy. Often your doctor will suggest birth control pills or other hormone altering drugs.
  • Myomectomy. This is the surgical removal of the fibroid. During this procedure, your uterus is left in place.

More abrasive approaches include:

  • Hysteroscopy. This is an outpatient procedure that destroys fibroids within the uterine walls through electricity or a laser.
  • Endometrial Ablation. This procedure is intended to destroy the lining of the uterus and in turn, the fibroids.
  • Hysterectomy. This is the surgical removal of the uterus. Sometimes doctors will leave ovaries in place for hormonal reasons. Speak to your doctor about this possibility.

Final Thoughts

Women experiencing pain or other symptoms from either ovarian cysts or uterine fibroids should seek medical advice. Once you get an official diagnosis, your healthcare provider can help you decide on a plan for treatment.

Still have questions? Don’t hesitate to contact us with questions regarding your symptoms or to schedule an appointment. A member of our trained staff will be happy to help you in any way possible.

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