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May 3, 2018

Have you decided that it’s time to make your family of two an official family of three or more? The decision to start trying to get pregnant is exciting, but it’s easy for hopeful mamas to get discouraged after a few months without seeing those two little lines. Studies have shown the link between stress and a woman’s ability to conceive, so the first step in trying is an easy one – relax and enjoy the process.

Preconception Counseling Visit preconception appointment

Next, visit your doctor for a pre-pregnancy checkup. Also referred to as a preconception counseling visit, this appointment is your opportunity to discuss your current lifestyle, weight, medications and medical history with your doctor. Together, you discuss how all these factors affect your chances of getting pregnant. He or she can also recommend changes you can make to help you get pregnant faster.

Here are some additional steps you can take to get pregnant sooner:

  • Start taking a prenatal vitamin with folic acid. Start taking prenatal vitamins at least a month before you officially start trying to conceive. Most prenatals contain the 400 micrograms of recommended folic acid, but check the label just to make sure. Folic acid is also naturally found in leafy green veggies, citrus fruits, beans and whole grains, so doubling up is always a plus.
  • Improve your diet. Healthy babies start with healthy moms. Try to avoid junk food and load up on fresh fruits and veggies, which will aid in both helping you maintain a healthy weight and give you the energy to maintain a baby-friendly exercise plan.
  • Start limiting your caffeine intake. If you’re a 2-or-more-cup a day gal, it’s best to start cutting back, as the recommended daily intake of caffeine is 200 milligrams while pregnant.
  • Have your teeth cleaned. A rise in hormones causes gums to bleed more often than usual during pregnancy, causing what’s known as pregnancy gingivitis.
  • Get to know your cycle. Knowing when you ovulate will increase your chances of timing intercourse, which should be during the three to four days around your most fertile time of the month. There are lots of ways to track, including free apps for your phone or the good ‘ol fashioned way – with pen and paper.

Quick Conception Numbers

Overall, around 70% of couples will have conceived by 6 months, 85% by 12 months and 95% will be pregnant after 2 years of trying. Only about 8% to 10% of couples get pregnant within a one-month time frame, and the ‘per month’ rate for a normally fertile couple is around 20%.

With all these facts and figures, it’s important not to stress out to give it time and try to relax and enjoy the time you have alone with your partner. By meeting with your physician during a preconception counseling appointment before you start the process of trying to conceive, you can ensure that every possible precaution is taken to prevent future problems throughout gestation, labor, delivery and even afterwards.

Your peace of mind combined with our experience experience and expertise is our ultimate goal so that you may enjoy a safe and healthy pregnancy. For any additional questions or concerns, or to schedule your preconception counseling appointment, call us at 770-720-7733.

 

 

September 26, 2017

Can post pregnancy exercise help a woman get back to her post-pregnancy weight.If you’re like many new moms, you’re ready to shed that extra baby weight… and now! It’s a perfectly natural feeling but if you’re not careful it can lead to a never-ending cycle of harmful weight loss that doesn’t last.

There is hope, however.

A healthy combination of nutrition and exercise can get you back to pre-baby weight in a matter of mere months. Be sure not to rush it though. Remember, it took 9-months to get to where you are now. Don’t expect lasting weight loss to happen overnight.

Incorporate Exercise into Your Daily Routine

Exercise can be a wonderful tool for new moms for many reasons. Physical activity can help reduce stress and help you sleep while keeping your muscles and bones strong.

Before starting a new routine, take care to get proper guidance on what to you can expect from your post-baby body. Heading to the gym for a workout right away can be harmful to your body, especially if you’ve had a c-section.

So what can you do?

  • Start slow. Having a newborn doesn’t leave you much time for anything, much less exercise. Try incorporating 30 minutes of walking into your daily routine broken into short 10 minute breaks as you can.
  • Incorporate strength training into your routine. Strength training with medium to light weights can help increase bone density as well as building muscle.
  • Don’t go it alone. You’re more likely to stick to an exercise program if you’ve got support from friends, family, or other new moms. Try joining a gym that has classes dedicated to new mothers.
  • Avoid jumping into old routines. Instead of worrying about what you could do before your pregnancy, focus on what your body can handle now. While you’re pregnant your body releases hormones that loosen your ligaments, making giving birth easier. It can take time for them to get back to normal.

Remember, don’t start any exercise until you feel ready. Women that have had c-sections or complicated births should consult a medical professional before starting any exercise programs.

Create A Healthy Diet Plan

Although exercise plays a strong role in meeting your weight loss goals, healthy nutrition is a primary factor for lasting weight loss. No matter how much you workout, exercise does not counteract an unhealthy diet.

It’s often hard to eat right when balancing life with a newborn. But it doesn’t have to be.

Try some of the following tips to get on the right track for reclaiming your body through healthy eating.

  • Eat at least 1,800 calories a day, especially if breastfeeding. Avoid crash diets. Pushing yourself to the max can leave you stressed which actually promotes weight gain.
  • Stock up on healthy snacks. Noshing on foods like sliced fruits, veggies or wheat crackers throughout the day is a healthy way to keep cravings at bay.
  • Choose a well-balanced variety of foods. Stick to foods high in the nutrients you need while low in calories and fats. Try a variety of lean meat, chicken, and fish as your primary source of protein to keep your energy levels up.
  • Drink lots of water. Not only does water keep you feeling full but some studies have shown that water can also aid in speeding up your metabolism.

When you were pregnant you likely changed your eating habits to support your baby’s growth and development. Making the change back to your old routine can seem daunting. Seek support from friends, family, or other new moms when necessary.

Final Thoughts

Don’t be afraid to ask for help with your post-baby weight loss. Every woman and every situation are unique. Here at Cherokee Women’s Health, we have a medically supervised weight loss program designed especially for women.

We can help nursing moms like you find a sustainable diet plan. Feel free to give us a call to learn more about our weight loss programs tailored just for you.

October 12, 2016

If your pregnancy has been defined as high risk, there is no need to panic. The truth is, all pregnancies on some level are high risk; to grow another human being inside your body is a significant event! A high risk pregnancy status is a precautionary determination to make sure that any pre-existing risk factors you have, along with any you may develop during your pregnancy, are monitored closely to ensure both your baby’s safety and yours.

Our obstetrics team has successfully delivered over 10,000 babies, many of those deemed high risk. We’re trained to detect and evaluate situations hazardous throughout gestation, and equipped with the technology to do so.

Most of all, our tenet is to treat every pregnant patient the way we would want our loved ones treated.

What Is Considered a High Risk Pregnancy?
There are many factors that can designate a pregnancy as high risk. Some medical, physical or genetic influences may predispose you to being susceptible to certain problems. These are:

    • High blood pressure
    • Being overweight or underweight
    • Diabetes
    • Cancer
    • High blood pressure
    • Heart, lung, or kidney disease
    • Epilepsy
    • Alcohol or illegal drug usage
    • Age (under 17 or over 35)
    • Multiple births
    • History of miscarriage
    • Family member or previous child with Down syndrome
    • Infections such as HIV, chicken pox, rubella, toxoplasmosis, hepatitis C, syphilis
    • Certain medications
    • Chronic health issues such a lupus, asthma, rheumatoid arthritis, heart valve abnormalities or sickle cell disease
    • History of preterm labor or preeclampsia.

What Can You Do For Me If I Have Any of These High Risk Pregnancy Markers?
The first step is to establish a trusting relationship with you, taking the time to answer all your questions and concerns.

In many cases, just a few lifestyle modifications can ensure a safe, healthy pregnancy. Some of these changes can be as simple as speaking to our diet and nutrition experts, who will counsel you on a food and supplement regimen appropriate for your specific needs. We may schedule more frequent prenatal visits so that we can carefully monitor your progress, taking immediate steps to treat whatever problems might occur.

high risk pregnancy photoYour blood pressure will be watched closely. Blood and urine tests will be taken during every prenatal visit, along with any physical examinations or scans that may be indicated.

Our high risk obstetric specialists will evaluate any medications you might be taking, making adjustments as necessary to protect you and your child. If you suffer from pre-existing chronic conditions, we will work with you to minimize any arising difficulties.

We may monitor your pregnancy more frequently with ultrasounds and fetal monitoring.

Finally, we screen for genetic abnormalities, providing information, counsel, and advice if required.

If My Pregnancy is Normal, With No Pre-Existing Conditions, Will it Stay That Way?
Usually, but not always. This is why prenatal care appointments are so important for both you and your baby. You can develop complications at any time, placing you into a high risk pregnancy category. Again, don’t become alarmed. Our specialists have combined decades of experience and training to deal with that if it happens, and the earlier we detect something, the better. Here are some of the things we look for:

  • Gestational diabetes mellitus (GDM or gestational diabetes): High blood sugar sometimes develops during pregnancy, causing headaches, depression, high blood pressure, hydramnios (increased amniotic sac fluid), and birth defects. It can also increase the danger of preeclampsia and premature labor. Babies can grow too large, resulting in a need for a caesarean, and they may suffer from jaundice and low blood sugar after birth. We screen for this between your 24th and 28th week- earlier if your history warrants it.
  • Preeclampsia: Preeclampsia causes persistent high blood pressure which can lead to organ damage and seizures, possibly requiring medication and/or early delivery. Routine urine testing at every prenatal visit can detect this, alerting us to rigidly monitor your progress.
  • Rh factor: Rh is an inherited protein found in some blood. If yours differs from your baby’s, difficulties may arise. We routinely test for this incompatibility to safeguard the well-being of the fetus.
  • Bleeding: Though not all bleeding is dangerous, if you’re deemed a high risk pregnancy, we follow up to make sure there is no jeopardy to you or your baby.
  • hCG: (human chorionic gonadotropin): This substance not only confirms pregnancy, but analyzing levels regularly can indicate if you are at high risk for ectopic pregnancy, possible miscarriage, or a Down syndrome baby.
  • Placenta previa: Sometimes the placenta covers the cervix, causing bleeding during delivery. Transvaginal ultrasound tests warn us beforehand if a caesarian is necessary.
  • Fetal problems: Our 4D ultrasound and other equipment can detect complications or abnormalities before they become a problem.
  • Premature labor: We can’t always predict if your baby will thumb its little nose at our calculated due date, but a previous history of early labor, a shortened cervix, or certain infections alert us to be vigilant of that possibility.
  • Placental abruption: When the placenta separates or peels away from the uterine wall, the situation may become detrimental to both mother and baby. We always look out for this and other potential dangers.

Our hospital partner, Northside Hospital Cherokee, opens its new facility in early 2017, continuing to handle a full range of services for our patients with high risk pregnancies. Since 1993, Cherokee Women’s Health has delivered more babies at Northside Hospital Cherokee than all other OB practices combined.

Whether yours is a routine or high risk pregnancy, our highly qualified, expert providers pride themselves on giving you the best individual prenatal care necessary to ensure a safe and healthy pregnancy.

For an appointment, call us at 770.720.7733.

August 16, 2016

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

August 5, 2016

Nutrition is an important part of pregnancy. It gives moms the opportunity to increase their intake of vitamins, minerals, and essential nutrients. This boosts their energy, helps their babies’ development, and can even improve some of the symptoms of pregnancy. But as important as what to eat when pregnant is a topic that’s decidedly less fun: what not to eat during pregnancy.

Foods to Avoid During Pregnancy

  • Raw meats. Raw or undercooked meat can carry all kinds of bacteria. Stay away from rare beef and poultry, sushi, uncooked hot dogs, and items that contain raw eggs, which may include salad dressings and sauces (be careful about Caesar salad dressing and aioli!), raw cookie dough, and desserts like tiramisu.
  • Other meats. Just because it’s cooked doesn’t mean that it’s safe. Expectant mothers should avoid eating deli meat, smoked seafood, fish containing mercury, refrigerated pate or meat spreads, and fresh meat that may have been exposed to pollutants.
  • Soft cheese. Some imported soft cheeses–including brie, feta, Camembert, and many Mexican quesos–are not made with pasteurized milk, which increases the risk of listeria. Love soft cheese? Read the label! If it was made with pasteurized milk, you’re free to satisfy your cravings.
  • Unpasteurized anything. Milk is the biggie, but moms-to-be should also avoid unpasteurized juices, especially ones bought from local farms.
  • Unwashed veggies. Vegetables provide essential nutrients for pregnant women and the babies they carry. Just make sure to wash them before digging in.
  • pregnant woman eating yogurtCaffeine. New studies show that small amounts of caffeine are okay later in pregnancy, but expectant mothers should keep a close eye on their caffeine intake. Try to avoid caffeine entirely during the first trimester. Consume no more than 200 mg per day later in your pregnancy, or you may increase your risk of miscarriage, premature birth, or low birth weight. (*Tips for pregnant women who consume caffeine: drink plenty of water, remember that decaf coffee contains caffeine, and look for hidden caffeine in protein bars, yogurt, and candy).
  • Alcohol. Most moms know not to drink alcohol during pregnancy, because it can lead to Fetal Alcohol Syndrome. But in today’s climate of “sure, that’s fine!” advice, it bears repeating: no matter what you see in the news, alcohol is a big no-no for moms-to-be.

Cherokee Women’s Health helps expectant mothers in Canton through the unique experience of pregnancy. For a personalized diet plan, advice on healthy eating and fitness during pregnancy, and other prenatal care, schedule an appointment with one of our certified physicians or midwives.

regnant Woman Eating Yogurt

August 2, 2016

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

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

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

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

Dr Crigler doing situps with patient photo

Dr. Crigler doing situps with his patient and baby!

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

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

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

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

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

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

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

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

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

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

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

Snapshot: Medical Rescue

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

July 14, 2016

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

What Causes Prolapsed Bladder?prolapsed bladder photo

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

What are the symptoms?

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

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

When Should You See Your Doctor?

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

Diagnosis and Tests

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

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

Treatment

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

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

Surgery

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

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

Types of Reconstructive Surgery

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

What Can You Do?

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

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

Call and make an appointment today at 770.720.7733.

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

Pre-Pregnancy Vaccines

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

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

Safe Vaccines During Pregnancy

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

Post-Pregnancy Vaccines

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

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

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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

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