woodstock ob gyn Archives

Adrian came to my office this morning for a GYN visit. She is one of hundreds of women who visit our office every year looking for relief from pelvic pain. Adrian’s story is also common. “Period pain is a normal part of being a woman,” Adrian’s mother told her when she reached adolescence and the pain first began. Adrian believed it. “I experienced intense monthly pain around her pelvic area throughout my teens. When I entered my twenties, I missed work for a day or two every month because the pain was so bad. I didn’t make a big deal about it because I truly believed my pain was “normal.” – Adrian Pelvic Pain is Not “Normal” Adrian recently visited Cherokee Women’s Health after moving to the area. Like most women, she had formed a bond with her former OB, and the switch was hard. But not every GYN focuses on treating pelvic pain, and Adrian’s OB had been no exception. Pelvic pain is a complicated condition which can arise not just from the reproductive organs, but from the urinary tract or bowel as well. A woman might have more than one condition, each with a different cause. Causes of Pelvic Pain Include: Describing Your Pain is Key To Successful Treatment Part of successful treatment is answering questions, which helps your GYN understand your health history: A history of sexual abuse can also lead to symptoms of pelvic pain, whether from actual physical damage or the emotional trauma. Tools For Diagnosing Pelvic Pain Potential Treatments for Pelvic Pain In Adrian’s case, I diagnosed a longtime history of endometriosis. She seemed genuinely surprised at the range of treatment options available for her, and chose to try birth control pills as a first step. This week Adrian returned for follow-up, happy to report that the “normal” pain she had lived with all her life was gone! Don’t Suffer with “Normal” Pelvic Pain If you’re experiencing pelvic pain, help is available. Call our office at 770.720.7733 or schedule an appointment online today.

OB Patient Stories

Miscarriage: A Father’s Grief

Diane /

A father’s grief after a miscarriage is often overlooked. Miscarriage and subsequent pregnancies often center on the emotions of the mother only: the grieving and anxiety of losing a baby, and the nerve-racking experience of becoming pregnant again with a “Rainbow Baby”. A rainbow baby is a baby born after a miscarriage, thus becoming the “rainbow after the storm.” Sharing Grief With the Husband and Learning To Live With Grief and Joy Fathers often feel they have to be “strong for the mother,” so they may put their grief on the back burner, all while silently suffering alone. But solitary grieving can take a toll on a marriage, especially during stressful times, like losing a baby. “Rainbow Mom” Mariah Foster and her husband lost their unborn daughter, Raelynn, late in Mariah’s pregnancy, from a cord accident. She shares their experience and the words of advice from their doctor, who told her to pay attention to how the experience affected not only her, but also her husband and their relationship as a married couple. “After I lost my daughter, Dr. Litrel asked to see us so he could see how we were doing. His advice was not to try to cover up our grief with antidepressants. He told us to go ahead and scream, yell, even be mad at God – but especially to learn how each other grieves.” Mom Mariah shares how she coped with the devastation of miscarriage Miscarriage is Hard on Men Too Mariah said Dr. Litrel told them that the father’s grief is often overlooked, and that he had seen couples divorce after losing a baby because neither understood how the other grieves. “He told me to pay attention to my husband during this time of being sad. He said it’s hard for the man, too – and they grieve in a different way from the woman. “That conversation opened our eyes. And honestly, the grieving process built on our communication and compromise skills.” Mariah shares that Dr. Litrel also advised them to ‘talk about our daughter and use her name’, telling us to take time to enjoy each other, so we could accept the loss better and go on with the marriage. He didn’t want us to lose what we had. He also didn’t want us to try to have another, but just to ‘let it happen’, so he did not prescribe birth control for me. Smiling at the baby beside her in the stroller, Mariah says, “Eleven months later we ended up having our wonderful Rainbow Baby, Cayson Charles. Cayson means ‘Healer’ in Gaelic,” she explains. Getting Pregnant Again is Scary Mariah comments that becoming pregnant after a miscarriage is not the purely joyful experience everyone assumes it will be. “You know, everyone’s excited when you’re pregnant with a rainbow baby, but it’s a lot harder. I was nervous. When I hit nine months and said, “I need to be induced!” I finally ended up having a C-section — and the most beautiful rainbow baby. “During the pregnancy, Dr. Litrel had us on a strict schedule of seeing doctors and also the specialist. By 29-30 weeks, we were going to the doctor every week. “Pregnancy with a Rainbow Baby is nerve-racking. You want to feel him every second of the day. When he’s not moving, you’re panicking.” “The scariest time was at one point, when I slipped and fell at work. I thought at that point I was going to lose him. Dr. Litrel and really, all the medical staff, did everything for us. “They gave me a Doppler (a hand-held monitor) so I could check on Cayson, and seeing him on the screen helped me so much with my anxiety. “Pregnancy with a rainbow baby is nerve-racking. You want to feel him every second of the day. When he’s not moving, you’re panicking. You lay on your left side, you drink ice water, you try all the tricks the doctors tell you. There were times I went to Northside Hospital and just said, ‘Hey, I just need you to do an ultrasound. I can’t find my baby on the Doppler.’ They were great and really supportive during the entire pregnancy.” The Grieving Process “Losing Raelynn was hard for my husband, and sometimes it still is. He’ll take a picture of Cayson, which is his way of grieving. He’ll say, ‘I want to be with him so much, because sometimes he fills that void.’ When Cayson was crawling at six months, my husband was excited to see him, and he’d say, ‘Wow, Raelynn, look what your little brother is doing!’ Mariah wipes away a tear. “It’s hard to explain how it feels because the grieving never stops. “We actually planted a tree for my daughter, and we watch it grow, and talk about it all the time. We got a bird feeder and all the birds come so we can feed them. It’s really sweet. Getting Support “The grievance counselors at Northside are really great and so supportive. On Facebook, there’s a group called Rainbows of Atlanta. When you’re having a hard time — when that anniversary comes up and it’s the week you lost your baby — you can get on that group and post at 4 a.m., and you know someone is going to comment. Someone will be there. It’s so rewarding to see women back each other up. They give advice, and they’re just there.” Mariah smiles and gives her rainbow baby Cayson (aka the Healer), a kiss. Her eyes glisten, but there is happiness there, too. After Miscarriage – Stories of Hope Reading stories of hope from others who have experienced what you’re going through can help you feel not so alone. Here, we share stories from patients who suffered from miscarriage and how they got through it. Sheila suffered many miscarriages so we sat down with her to get her story and learn what she had to overcome to eventually have three Rainbow Babies. Jamie shares her story of

Bleeding Education, Menopause and Hormone Therapy

PMS Explained

Diane /

PMS (premenstrual syndrome) affects most women at one time or another. In fact, it’s estimated that three out of four women suffer from PMS regularly. What is PMS? Premenstrual syndrome refers to a cluster of physical and emotional changes a woman undergoes during the two weeks before bleeding actually occurs. This time frame is referred to as the ‘luteal cycle’. At the onset of her period, symptoms usually disappear. What Are the Symptoms of PMS? Symptoms of PMS are numerous and may include any or all of the following: What Causes PMS? The exact cause has not been pinpointed, but lowering levels of the sex hormones, estrogen and progesterone are believed to be key factors. Serotonin, a neurotransmitter responsible for feelings of well-being and happiness, also drops. Though this is a natural process, and necessary to prepare the body for reproduction, the monthly depletion can cause a hormonal imbalance, wreaking havoc on women physically and emotionally. If you are experiencing extreme discomfort and PMS is negatively affecting you physically and psychologically, do not hesitate to see your doctor. What is Dysphoric Menstrual Syndrome? Most women have mild to moderate cases of PMS which can be annoying, or at most, uncomfortable. These symptoms cause little or no disruption in their daily routines, and usually does not warrant medical help. However, about 5% of women with PMS suffer from what is categorised as dysphoric menstrual syndrome (PMDD), which is a far more severe and negatively impacts their lives. These women require more aggressive psychological or medicinal intervention. The criteria to meet the diagnosis of PMDD is that the patient has at least five of the emotional symptoms mentioned above during their luteal cycle. The presence of these symptoms is usually more exaggerated. These are a few that we look for: Approximately another 20% meet the definition of ‘subthreshold’ PMDD, meaning that they may be monitored diligently to avoid full-blown PMDD. This particular disorder is classified as ‘menstrually related mood disorder’ (MRMD) and may also need some medicinal or psychological treatment. Like PMS, hormone dissipation during the menstrual cycle may be the underlying cause. Are There Any Tests That Accurately Diagnose PMS? There are no specific lab tests to diagnose premenstrual syndrome. Instead, we’ll need to study your medical history to establish if you are suffering from it. It is very important to be completely truthful so that we can help you. We know that some of these symptoms may be frightening to you, and perhaps, at times, embarrassing to discuss, but getting the full picture allows us to give you the best and most effective advice and care. Keeping a diary of your symptoms for a few months helps. Three of the main things we look for are: Even jotting down specific odd thoughts and ideas, levels of fatigue, etc., can be helpful. This allows us to properly determine which hormonal imbalance is affecting you more and enable us to deal with the more troublesome symptoms accordingly. Remember to list the dates as these symptoms occurred, and exactly when menstruation itself began and ended. Can PMS be Treated? Mild to moderate PMS can be fairly easily managed with a few lifestyle changes and over-the-counter pain relievers. Heating pads or warm baths may help with pain, and ice packs with headaches. Topical rubs and ointments can reduce inflammation and joint pain. You may be advised to limit or completely eliminate salt, alcohol, caffeine, sugar and any artificial sweeteners as they contribute to many sleep and anxiety issues. Other recommendations to help alleviate PMS symptoms are: Some herbs and supplements may counteract PMS symptoms, although some have not been studied fully so it’s always best to get these from a healthy diet instead. Before taking them, it is recommended that you speak to your physician. Though they may help, the medications you already take may interact with them and cause adverse, sometimes dangerous interactions. Here is a list of the vitamins, herbs and supplements and the symptoms they may alleviate: For more severe PMS, your doctor may prescribe one or more of the following: How Can Cherokee Women’s Health Specialists Help Me? Because we deal with women’s health issues daily, we are aware of the debilitating effects of PMS. We would never minimize the detrimental influence it can have on you and yours. We are here to offer counsel, diagnosis, empathy, and treatment, using all our expertise and knowledge of the most up-to-date information medical science has to offer. Our staff includes three doubly accredited urogynecologists with the outstanding certification in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This qualifies us to diagnose and treat all your female-related problems. Additionally, our staff includes specialists in other fields related to a women’s unique needs. To book an appointment to further discuss your PMS symptoms, call 770.720.7733.

Well Woman

Lesser Known Menopause Symptoms

Diane /

You always knew menopause would happen. You may have even looked forward to getting rid of those bulky pads, contraceptive devices, and tampons you’ve been using. You expected some hot flashes and maybe a few cranky days, but assumed those probably wouldn’t be much worse than getting through a long summer heat wave and then it would be all over. What you possibly didn’t know is that there are countless other symptoms that science is constantly learning about regarding the menopausal process. If you’re between the ages of 40 and 65 — and in some cases even a bit younger — you may be suffering with those very symptoms right now. Your body begins to change several years before menopause actually takes place, during the period known as perimenopause. This is the time when periods start to become irregular, along with some other unwelcome physical and emotional developments that you never anticipated. Lesser Known Menopause Symptoms Menopause comes with many minor and major changes. Some women manage to get through the process with only a little discomfort. Others may be slammed with multiple symptoms, many of which occur gradually over time so that they may not even notice that they’re happening, or that one may be linked to the other. Most menopausal changes are caused by the decline of three hormones; estrogen, progesterone, and testosterone. Progesterone and estrogen, produced by the ovaries, not only prepare a woman for reproduction during her childbearing years, but they impact the rest of her body’s health, both physically and emotionally. During menopause, the adrenal glands continue to produce testosterone, but those levels also decrease with age. Some of the most common symptoms of menopause are: The following menopausal symptoms are not as common, but are also usually caused by the same hormonal shifts: Serious conditions due to hormonal changes during menopause include: How Cherokee Women’s Health Specialists Help? Many menopausal symptoms are of little concern and often correct themselves given time. Others can be easily remedied through diet, exercise, hormone therapy and/or other medications. However, all unusual symptoms that arise should always be assessed by a physician to rule out other causes. Our broad-based practice consists of three board-certified, doubly-accredited urogynecologists who hold certification in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Our staff also includes obstetricians, gynecologists and experts in holistic medicine and diet, and other specialists who, combined, have decades of accumulated expertise in the unique field of women’s health care. Call 770.720.7733 or schedule an appointment online today. Help is available.

Nutrition and Weight Loss

Is Snacking Feeding Your Insulin Levels and Leaving You With the Weight?

Diane /

by James Haley, MD FACOG, FPMRS As a physician and fitness enthusiast, I’ve read a plethora of articles, books, and journals on weight loss. My patients continually tell me their struggles with dieting, lamenting that the weight always returns, usually along with a few extra pounds. Personally, I can relate. It’s not a dilemma exclusive to women. Men struggle, too. As you age, you just can’t eat like you used to—ven if you exercise regularly. After reading numerous books and trying different diets myself, I finally discovered an author who not only pinpoints the problem of obesity, but also the answer to those last ten pounds. In his book, ‘The Obesity Code’, Dr. Jason Fung, a nephrologist, states that the real culprit of weight gain isn’t overeating. It’s excessive insulin. He is emphatic that many of his patients would need less medical intervention if they lost weight. Since most of his patients are Type 2 Diabetics, a disease associated with too much insulin, he has been able to determine the common link – SNACKING. In the past few decades, the number of times we eat daily has increased. People have gone from eating three meals a day to about six, counting snacks. Go on, admit it. It’s what you do—what I’ve done. it’s a cycle, and it makes sense once you understand the reason why. Every time you eat, you stimulate insulin, keeping it at a constant high level. This fools the body into thinking it’s always hungry. Your body is constantly thinking you are hungry because your insulin stays in a high range. Obesity is a hormonal disease. Insulin, a hormone, tells you how much to eat and how much to burn. The body behaves as if the weight is set on a thermostat. So, obesity is not about caloric imbalance. Thus, it makes sense that the idea of cutting calories is totally wrong. You may not be obese. Maybe you have a few obstinate pounds that won’t melt—a jiggle around the middle resistant to diet and exercise. ‘Fat’, ‘plump’, ‘chubby’—whatever you call it, a surplus of insulin is causing it. The longer you have higher amounts of it, the more resistant your body becomes, which produces even more and causes that crazy, never-ending cycle. So what’s the solution? Avoid insulin-stimulating foods like sugar and refined grains. These are the enemy. Eliminate between-meal snacks. Designate mealtimes. Meal timing and insulin levels work together to regulate our weight. We need periods of time when we aren’t eating, so insulin can go down, leaving our bodies in energy burning mode. If we leave more time between meals…. we burn energy. And when we burn energy, we lose weight. To learn more about the other secret to regulating insulin for weight loss, read here.

OB, Preconception Counseling Education

What to Do Before Getting Pregnant

Diane /

You’re considering getting pregnant! Mentally, you’re beginning to commit to the idea, so one of the first few questions you might ask yourself is, “What can I do before getting pregnant? How can I be sure my baby will be healthy? Is there anything I can do ahead of time to make sure everything goes right?” While the physical part of creating new life is pretty simple to comprehend, but many women don’t actually consider that there are ways to prepare their bodies for reproduction well ahead of time. Even if you’re not ready to conceive right away, there’s lots you can do before getting pregnant, and most of it is pretty basic. When you leased your very first apartment, you wanted everything to be just right. Before you even moved in, you eagerly imagined how you would decorate it. You carefully selected the best furniture and matching accessories you could afford. You thought of where you would put your bed and bought food for the refrigerator and pantry. Everything was positioned just right for the new home you were to live in. When you get pregnant, your body is going to be your baby’s ’apartment’ for approximately the next 280 days. Your womb (uterus) will be its bedroom, the amniotic sac will be its bed and the umbilical cord will be its fridge and pantry. Why not prepare your body to give your child the best possible home until its first ‘lease’ is up? There are steps you can take to make that happen. Long before the actual union of sperm with egg, there are numerous measures you can take to optimally prepare your body. You can make gradual, positive lifestyle changes in the months preceding pregnancy. 6 Things to Prepare Your Body for Pregnancy: At Cherokee Women’s Health Specialists, we are committed to giving you the best possible preconception care available to women today in order to ensure the optimum health of both you and the baby you are planning to have. These are only several of the many things you can do before you decide to get pregnant. Our comprehensive staff includes Female Pelvic Medicine and Reconstructive Surgeons (FPMRS), urologists, nutritionists, OB/GYNs, physical therapists and midwives. Their combined decades of experience and expertise can guide you through the preconception process, pinpointing any problems that may inhibit or be detrimental to your pregnancy. Our team of specialists can correct any physical abnormalities that may be hindering the process as well. Your reproductive health and the wellness of your future baby is our primary concern. No question is too trivial or embarrassing and you will be treated with the utmost respect and confidentiality. To book an appointment, please call us at 770.720.7733 or schedule an appointment online.

Ablation Education, Anterior and Posterior Repair Education, Hymen Repair Education, Labiaplasty Education, Perineoplasty Education, Robotic Surgery Education, Sterilization, Vaginal Rejuvenation, Vaginal Rejuvenation Education

The Top GYN Procedures: Dr. Litrel Explains Cosmetic GYN & GYN Terms

Diane /

Have you ever wondered what the difference between vaginoplasty and labiaplasty is but have been to embarrassed to ask? Never fear, here’s a list of cosmetic and GYN glossary terms in plain English, broken down by surgery type. Vaginoplasty: Tightening of the entire vaginal canal from the opening to the cervix (or the apex of the vagina, if hysterectomy was performed). Hymenoplasty: Restoration of the hymen to restore anatomic state, which can be done at the time of vaginoplasty, if patient desires. Cosmetic GYN Surgery on the External Genitalia Labiaplasty: Reshaping the labia minora or inner lips for improvement in appearance and to diminish labial irritation with clothing and during sex. Clitoral Hoodectomy: Removal of excess skin covering the clitoris to create a better appearance and to help with clitoral orgasm. Perineoplasty: Reshaping the external opening to the vagina for a smaller, more youthful appearance. This is performed during vaginoplasty or can be done without vaginoplasty, if vaginal tightening is not desired. Labia Majora Reduction: Reshaping the labia majora or outer lips for a better appearance. Learn more! Download our FREE Vaginal Rejuvenation eBook. Female Reconstructive And Reparative Surgery (Usually Covered By Medical Insurance) Anterior Repair: Repair of cystocele or bulging of bladder using natural tissue or biological graft or synthetic material. Posterior Repair: Repair of rectocele or bulging of rectum using natural tissue or biological graft. Enterocele Repair: Repair of enterocele or the sagging of the top of the vagina using natural tissue or biological graft or synthetic material. Incontinence Repair: Repair of leakage of urine using native tissue, biological graft or synthetic material. Endometrial Ablation: Outpatient or in-office procedure to diminish or eliminate menstrual bleeding without changing hormone status. Hysterectomy: Removal of uterus to stop periods and pelvic pain associated with menses and sexual intercourse (pelvic pain with thrusting motions). Or, to remove tumors or pathology once childbearing is complete. During this procedure, removal of fallopian tubes (or salpingectomy) is strongly recommended to decrease the risk of future cancer. Oophorectomy: Removal of ovary or ovaries for pelvic pain associated with sex or menses or is chronic or for cyst or mass. These are the organs that secrete hormones so removal of both will result in surgical menopause. Removal of one ovary will not affect hormones. Removal of one ovary is recommended once a woman is in menopause if hysterectomy is performed to decrease risk of cancer. If a woman has significant chronic pain on one side of her pelvis during her cycles or sex or chronic, removal of that ovary is considered. Enterolysis: Minimally invasive (laparascopic or robotic) removal of internal adhesions of bowel to pelvic organs that cause pelvic pain with sex, menses, bowel movements or is chronic in nature. Removal/Fulgurtion of Endometriosis: Minimally invasive (laparoscopic or robotic) removal and destruction of endometriosis lesions that cause painful menses or pain with sex or is chronic. Salpingectomy: Removal of tubes for sterilization. Note: Tubal ligation without removal of tubes is not recommended because tubal removal will decrease future cancer risks but tubal ligation will not. Make an Appointment Today Still have questions? schedule an appointment online or call us at 770.721.6060.

GYN Problems, O-Shot Education, ThermiVa Education, Vaginal Rejuvenation Education

Why Is My Sex Drive So Low?

Diane /

by Michael Litrel, MD, FACOG, FPMRS Every week women ask me why their sex drive is so low. “Help me so I can enjoy sex more and want it more often,” they say. Then they ask me to check their hormones and to give them a physical examination. This is a popular topic among women and it’s everywhere in the media. Patients ask me about the latest fads they’d seen touted as the latest, greatest best thing. They ask about bioidentical hormones. Vaginal rejuvenation. Sexual vitamins. G-spot enhancement. clitoral hood reduction. The list goes on. Treatments of all sorts are advertised to women of all ages to solve a low sex drive. And it’s true that some solutions, when chosen for the right person, can transform a woman’s sexual responsiveness. Sometimes a woman’s sex drive is low for a good reason. But something that’s not broken can’t be fixed. Other times there is something that can be done. Asking the right questions is the key to understanding how to help them. Five Key Questions for Women With a Low Sex Drive 1) Has your sex drive dropped or has it stayed more or less the same? Many women are convinced they have a low sex drive because they compare their desire for sexual contact with their male partner’s. However, men and women typically have vastly different desires for sexual intercourse. The typical woman’s sexual desire usually ranges from once or twice a week to once or twice a month. The typical man’s is once or twice a day. This discrepancy accounts for the feeling many women have that there is something wrong with them. That said, if a woman’s sex drive has suddenly dropped, a woman should consult with her doctor to determine the reason. If it’s always been low, chances are that’s the way you are. 2) What is your childbearing history? There is a myth that women reach their sexual peak in their forties. This is the idea that women in this age range finally becoming sexually liberated from natural inhibitions. The idea is that the forty-year-old woman now has a sexual desire and ability to orgasm that has reached new heights. There are specific circumstances in which this occurs, but it is the exception rather than the rule. Women in their forties who have not yet had children can have a very high sex drive. But oftentimes, there’s a reason for this. Women who have small children will often see their sex drive plummet. When toddlers and grade school children require constant mothering, there is often little left for the woman’s partner. And women who are breastfeeding often have the lowest sex drive of all women. After all, she has a baby feeding off her body all day long and when she puts her head on her pillow at night, the last thing she wants is for more physical contact. Men will often say, “You used to want to have sex, I think there is something wrong with you.” It’s at this point that she’ll seek my help. Or, her partner will send her in to see me. 3) Does sex hurt or do you have pain with your cycles? There are two main reasons why sex hurts. One has to do with vaginal dryness. This is pain with entry, which commonly occurs with menopause. The ovaries stop producing estrogen which leads to thinning of the vaginal lining, which exposes nerves and decreases lubrication. There is more pain and less pleasure and a reduced desire for sex. This can be treated with topical estrogen cream or even more advanced office procedures, such as ThermiVa. Other women commonly hurt with sex because they experience pelvic pain with their menstrual cycles. This is painful sex from the actual thrusting motion. If a woman missed school during her adolescence because of discomfort during her cycle or if her mother needed a hysterectomy for pelvic pain, it’s very likely she has endometriosis or internal scarring of her internal reproductive anatomy. This patient needs a gynecological evaluation, particularly if she has not had children, is experiencing infertility or if she experiences pain more than a couple of days a month. Women with back pain during their cycles often have a tilted uterus that can be corrected by an experienced surgeon during an outpatient laparoscopy. 4) How is your general health? In the same way that a person’s appetite for food drops when they’re not feeling well, so does their appetite for sex. When you are in bed with the flu you don’t want to eat and you don’t want to be sexually active. But if you are chronically unhealthy, your desire for sex will be low as well. The most common reason for poor health in America is lifestyle. As a society, we are sedentary and we eat addictive, poorly nutritious food. Patients with cancer and heart disease don’t come to my office complaining of low sex drives. But overweight patients who consume a steady diet of unhealthy foods and don’t exercise often complain of a lack of sexual desire. Exercise and nutritious plant-based diets raise testosterone levels and other important hormones responsible for not only sex drive but also an overall sense of youth and vigor. 5) Do you have orgasms? Many women cannot have orgasms with sexual intercourse. Clitoral stimulation is the main way for a woman to achieve sexual climax. Unlike a man’s sex drive that ends with ejaculation, many women don’t focus on the biological climax but rather the emotional and physical intimacy. But a woman who does not orgasm can see her sex drive eventually plummet. It’s important to understand your body and to know how you achieve physical gratification from sexual activity. Many women need vibrators applied directly to their clitoral region to achieve climax. The first step is masturbation alone when you can discover for yourself what causes you to climax. This can then be incorporated into sexual activity with your partner. Good communication

What to Expect: The Third Trimester

Diane /

The third trimester begins in the 28th week of pregnancy and ends when your baby officially becomes a newborn. This is a bulkier, less comfortable time, but will soon be over. At the end of this trimester, the fetus will be 17 to 23 inches long, fully formed, and weigh anywhere from 6 to 10 pounds. What Happens Now? Some new symptoms may appear, and familiar ones may intensify. They might include: Restless Leg Syndrome (RLS) and leg cramps: These can occur at any time. RLS is common in about 15% of pregnant women. Support hose, moderate exercise, less caffeine, and more fluids during the day may alleviate discomfort. Nasal congestion and snoring: Estrogen increases blood flow throughout the body, including nasal membranes. Nasal strips and saline drops often help. So can elevating the head during sleep. If snoring becomes intense, your obstetrician may want to rule out sleep apnea. Abdominal aches: The fetus is becoming more active. Growth is accelerating, widening the uterus so that it presses against your bladder, diaphragm and other organs. Discomfort is usually minimal. Fatigue: Finding a comfortable position in bed sometimes becomes difficult. It’s recommended that you not sleep on your back now, as the growing uterus can press on the main vein (vena cava) which pumps blood from your heart to the lower part of your body. Try sleeping on your left side, using pillows as props. Insomnia and/or bad dreams: Anxiety and overactive hormones may rob you of rest. Moderate exercise, a warm bath, massage, cutting caffeine and lowering the bedroom temperature helps enable sleep. Heartburn: Hormones and pressure from the uterus pushing the stomach upward can trigger indigestion. Consult your obstetrician before trying any remedies. Stretch marks: These may become itchy and more prominent. A good moisturizer can help. Varicose veins and hemorrhoids: Extra blood pumping through your body now can make these appear. Both usually diminish or disappear after birth. Clumsiness: Rapid body shape and size changes can make you misjudge distances and bump into surroundings. Try moving slower. This minimizes injury both to yourself and the fetus. Pregnancy fog and distraction: Forgetfulness and distraction are attributable to brain function changes during pregnancy. Research actually shows that women pregnant with females experience pregnancy fog more than those carrying males. This haziness disappears a month or two after birth. Until then, keep to-do lists on hand to jog your memory. Lack of bladder control/ frequent urination: Extra weight and pressure on the pelvic floor can result in leakage and constant bathroom visits. Do your Kegels and wear panty liners. Backache: A growing stomach pulls your center of gravity forward, triggering backache. Elevating your feet, a warm bath, and gentle massage can ease pain. If it’s intolerable, however, your doctor may want to rule out injuries like sciatica. Breast leakage: Your body is preparing for breastfeeding. Nursing Pads aid in preventing staining. Lightening: At about week 36, you might notice your shape changing. Your stomach will drop lower and you could start waddling. Your baby is changing position to prepare for birth. Your breathing will be easier, heartburn may diminish, but urination may become more frequent. Mucus plug: A clear gelatinous plug may detach from the uterus weeks or immediately before labor. This means the cervix is softening and preparing for delivery. Braxton Hicks: These irregular contractions are often mistaken for the real thing by first time moms. They can occur intermittently weeks before you actually go into labor. Bloody show: Pink or brown tinged mucous indicates that you are effacing and dilating. Labor is close at hand, but it can still be several days to a few hours away. Blood should not be bright red or excessive though. Call your doctor if it is. Water breaking: The amniotic sac has ruptured and labor is approaching. If steady contractions have not begun within 24 hours, labor might be induced to avoid infection. Contractions: These are regular and stronger than Braxton Hicks and will not diminish. Your doctor will advise you as to how long to wait before leaving for the hospital. What Precautions Can I Take During This Time? You can continue to do exactly what you’ve been doing all along- take care of yourself and your baby. Eat well but watch your weight. Rest when necessary, but avoid becoming inactive. Moderate exercise will make your labor and delivery easier. Avoid strenuous activity or heavy lifting. If you are uneasy about anything or notice radical symptoms that worry you, consult your doctor. How Important Are Fetal Kick Counts? (Very!) Dr. Litrel discusses the importance of counting fetal kicks during your pregnancy. Fetal Kick Counts Your baby’s movement may provide information that help us care for you during this pregnancy. During a convenient hour each day, after eating and emptying your bladder, please lie down (on your side is best) and concentrate on your baby’s movement. Note each movement. Smoking may interfere with the movements and should be avoided during pregnancy. Count the number of movements for thirty minutes. Your baby should move at least five times in that thirty minutes. If your baby moves less than five times during that thirty minutes call your physician or go to the hospital. Call your doctor if you experience: Decreased fetal movement Rupture of membranes (water breaking) Contractions every 2-5 minutes (more than five per hour) Cramps in the lower abdomen with or without diarrhea Low, dull backache felt below the waistline Temperature over 100 degrees Vaginal spotting or bleeding. Helpful Hints: Be sure to drink at least 8-10 glasses of water every day (in addition to anything else you drink). Eat small frequent meals to avoid heartburn. Use Tylenol for minor aches and pains. You may take warm baths or showers, place a heating pad on your back using low heat setting and rest with your feet elevated. What Tests are Performed During the Third Trimester? By this time, most precautionary tests have been completed, and only these regular routine tests are done

What to Expect: The Second Trimester

Diane /

The second trimester takes place from the 14th to the 27th week of a woman’s pregnancy. This is usually the most comfortable and pleasant time. Mercurial Jekyll/Hyde moods begin to balance out. You no longer sob uncontrollably over a run in your hose, or laugh maniacally when someone passes gas. Morning sickness is becoming a distant memory, and you can now start showing off that baby bump in all those maternity tops you’ve carefully selected. Even that sex drive that may have waned somewhat during the nausea, exhaustion and general malaise of your first trimester may return. What Happens Next? The egg (zygote) evolved from being the size of a pinhead into a recognizable little human being, first called an embryo and, after 8 weeks of gestation, a full-fledged fetus. New symptoms may occur, but generally, they are more tolerable than the previous three months. These may include: Nightmares: Stress, hormonal change and anxiety can affect sleep, causing you to dream about outrageous, even horrible scenarios. Waking up in a cold sweat may happen more often. Abdominal discomfort: Aches and pains caused by a stretching uterus and ligaments is normal. Excruciating pain, however, is not. Call your doctor if you experience anything other than moderate discomfort. Quickening: This is the term given to feeling the fetus stir inside you. At about 16 to 20 weeks, you will feel a slight flutter. As the baby grows and takes up more room, movement is felt more distinctly. Blips: An odd bubbling sensation that turns into a stronger methodical twitch as pregnancy continues is simply the fetus experiencing hiccups. Don’t worry. He or she is not having seizures. Your dinner probably just didn’t agree with it. Breathlessness: The uterus can crowd the lungs as the fetus grows, disrupting smooth air flow. Unless you are gasping for air, some breathlessness is normal. Body shape changes: The waist thickens, hips expand, your derriere can widen, and even your face may produce an extra temporary chin if you gain too much weight too quickly. By the end of the second trimester, you will have probably gained 16 to 22 pounds. Only two can be attributed to the baby. The rest is placenta, uterus, amniotic fluid, body fluid and blood. Your body also stores about 7 pounds of fat throughout pregnancy to prepare you for breastfeeding. Stretch marks: Your tummy and thigh skin, elastic as it is, can only stretch so much at a rapid pace before the middle layer of skin (dermis) tears, exposing the deeper layers. Most of these marks diminish or disappear after birth. Bleeding gums: Many women experience sensitive, bleeding gums due to hormonal changes. Use floss gently and get a softer toothbrush, but don’t skimp on your dental hygiene habits. Heartburn, constipation and hemorrhoids: All are common. Smaller meals are recommended, along with more fiber and fluids. Try Sitz baths and speak to your doctor about an ointment or cream to relieve irritation. What Precautions Can I Take During This Time? Keep in shape with moderate, low impact exercise. Eat healthy and keep junk food to a minimum. The more weight you gain, the harder your labor can be, and losing excess pounds afterwards may be difficult. Avoid unnecessary medical procedures such as Botox injections, chemical peels etc. Even whitening your teeth or coloring your hair can be harmful. Take no medications without speaking to your obstetrician. Keep all your prenatal appointments. You will probably be seen once a month during this time, more often if problems are detected. It’s important to monitor your progress. What Tests Are Performed During the Second Trimester? Urine tests: These will be requested at every visit to monitor protein levels. Maternal serum alpha-fetoprotein (MSAFP) and multiple marker screening (MMS): One or the other are offered for genetic screening and are optional. They are used to measure specific fetal protein output to determine if there is a possibility of Down syndrome or spina bifida. If positive, an ultrasound or amniocentesis is done for confirmation. Sonogram: This non-invasive procedure can be done at any time during pregnancy, but is typically conducted at the end of the first trimester or during the second to confirm gender and due date. It can also reveal such conditions as placenta previa, cleft palate, and many other developmental or growth problems. Glucose screening: This checks blood sugar levels for gestational diabetes. If readings are elevated, a glucose tolerance test may be ordered. Fetal Doppler ultrasound: Sound waves determine if fetal blood flow is normal. How Big is My Baby Now? The fetus is about 14.5 inches long and weighs a little less than 2 pounds. It is about the size of a cantaloupe and is able to blink, sleep and wake up. The brain is very active and developing rapidly. Its maturing taste buds can now taste what you eat. Experts even believe dreaming is possible. Hearing is becoming more acute and sensitive eyes may react to light. Each trimester has its own unique milestones, and our doctors have the knowledge and expertise to make sure that your pregnancy is progressing safely and well. For more information, visit Northside Hospital Cherokee. For an appointment, call our clinic at 770.720.7733.

What to Expect: The First Trimester

Diane /

Congratulations, you’re pregnant! If you’re already a parent, you know what to expect, but if this is your first child, pregnancy can be a mysterious, sometimes almost frightening process. Today’s pregnancy tests are so precise, that they can detect the presence of human chorionic gonadotropin (Hcg) levels within days following fertilization. Immediately after a fertilized eggs attaches to the woman’s uterine wall, her body produces this hormone. A pregnancy strip can confirm conception has taken place by identifying Hcg presence in only a few drops of urine. What Happens Next? The average pregnancy lasts 280 days or 40 weeks, calculated from the first day of the woman’s last menstrual period. The first trimester covers week 1 to 12. As soon as the fertilized egg (zygote) latches on to the uterine wall, both the umbilical cord and placenta begin to form. Hormonal changes rapidly begin taking place in your body. Often, early symptoms of pregnancy are mistaken for PMS. These symptoms and others include: Spotting or bleeding Fatigue Dizziness (and possibly even fainting) Aversion to certain foods Queasiness or nausea Headache Cramps Bloating Moodiness Backache Breast tenderness More frequent urination (micturition). Can Anything be Done to Counteract These Symptoms? When the egg implants itself into the uterine wall, spotting may occur, but it’s always wise to report any bleeding to your doctor to rule out the possibility of miscarriage, ectopic pregnancy or infection. Additional progesterone can elevate blood pressure, dilate vessels, overheat the body, and force the heart to beat faster when sending blood to the uterus. All these changes can bring about fatigue, moodiness, dizziness and possible fainting. Progesterone can also slow some body functions down, including digestion which causes nausea, vomiting, constipation, and indigestion. The body reacts by trying to purge what is upsetting it, resulting in morning sickness. Higher Hcg in the body, especially in a multiple pregnancy, can also trigger nausea. It’s best to avoid foods that repel you during this stage. For intolerable nausea or vomiting, inquire about supplements or devices that can ease discomfort. If you experience dizziness, move slowly, especially when you get up from sitting or lying down. Should faintness occur, sit down with your head between your knees. Rest when possible. Moderate headaches may be relieved with acetaminophen, but never without consulting your physician. If symptoms are excessive, speak to your doctor. Cramps, bloating and backache can also be attributed to hormonal fluctuations. Frequent urination, even in this early stage, is usually the result of uterine growth and pressure against the bladder. Fluid intake should not be limited, as this is a normal occurrence. Breast tenderness is also hormonal. The breasts are preparing themselves for the baby’s upcoming nutritional needs. Investing in a good support bra may help. What precautions can I take during this time? Don’t smoke, and avoid exposure to second hand smoke. Don’t drink alcohol or use recreational drugs. Mention any prescription drugs you use to your doctor. Avoid caffeine Disclose any work hazards to your obstetrician, such as exposure to harmful chemicals, radiation, dangerous metals, toxic waste, etc. Do not eat or handle raw meat. Wash all fruits and vegetables thoroughly. Wear gloves while handling soil. If you own a cat, have someone else change the litter, and wash hands diligently after animal contact to avoid risk of toxoplasmosis which can harm your baby. Discuss your diet with your doctor and make necessary recommended changes. Take any vitamins, supplements and minerals your doctor prescribes regularly. Is it Safe to Engage in Sex During the First Trimester? Unless you have a specific medical condition of concern, it is safe to have sex. How Big is My Baby in the First Trimester? Between week four and twelve, your baby grows from the size of a tiny fig seed to roughly the length of that credit card you’re probably beginning to max out in happy anticipation. He or she is almost 3 inches long, weighing approximately one ounce and is about the size of a golf ball. Yet, by now, those tiny fingers have fingerprints. Organs are formed, functioning, and are visible through almost transparent skin. A heartbeat can be detected. The body is beginning to catch up with the head that still accounts for one third of body size. Reflexes are becoming sharper. The fetus can make sucking motions and respond to stimuli such as prodding. Eyes are close together on the face instead on either side of the head. Ears are forming and almost in position. The skeleton is made of cartilage that will gradually become bone. Gender is discernable. What Tests Are Performed During the First Trimester? Your blood will be will screened for type, count, RH factor, anemia, German measles (rubella), hepatitis B, HIV and other sexually transmitted diseases, along with exposure to diseases such as toxoplasmosis and varicella. Other test will look for genetic problems such as sickle cell anemia, Tay- Sachs disease, cystic fibrosis, etc. A combination blood/ultrasound nuchal translucency for Down syndrome and other chromosomal abnormalities may be offered during the latter part of this trimester. Glucose levels will be analyzed for signs of diabetes and urine checked for albumin which may indicate preeclampsia An ultrasound, usually near the end of the first trimester, will determine a due date, gender, and normal fetal progress. Although your baby develops throughout your entire pregnancy, extra precaution during the first trimester when fetus growth is so accelerated is vital. Our doctors can guide you in all the ways possible to ensure both your health and that of your child. For more information, visit Northside Hospital Cherokee. For an appointment, call our clinic at 770.720.7733.

Anterior and Posterior Repair Education, Mesh Education, Vaginal Rejuvenation, Vaginal Rejuvenation Education

What is Vaginal Shortening?

Diane /

Vaginal shortening, or iatrogenic vaginal constriction, is a condition that occurs in women usually as a result of undergoing gynecological surgery. After removal or correction of organs within the pelvic area, post-surgical tweaks are always necessary to close any internal incisions, suture tissue together, and to restore the vagina back to its previous corridor-like shape. Depending on the extent of the surgery, sometimes it’s necessary to stitch together a great deal of a woman’s remaining tissue, leaving the vagina shorter — the same way gathering fabric to repair a hole in the toe of a sock would alter its size. Subsequent scarring in the area over time may also contribute to narrowing and reduction. Vaginal Shortening Can Lead to Painful Sex Vaginal tissue is extremely elastic and stretchable. However, a substantial shortening may result in uncomfortable and even painful intercourse, especially during the natural penile thrusting stage of a sexual encounter. What Causes Vaginal Shortening? Most surgeries that involve the removal or correction of vaginal organs may contribute to this problem. Some of these procedures include: Vaginal mesh surgery – A transvaginal surgical mesh that may have been used to repair a woman’s urinary stress incontinence or pelvic organ prolapse (POP) can cause future problems. Mesh is sometimes used to support ligaments and organs that have slipped out of place. Its purpose is to reinforce the pelvic floor or weakened vaginal wall. Sometimes the mesh can cause infection, fuse with organs and tissue, or perforate its surrounding structures, making removal necessary. Much like cement sticking to the webbing used to adhere stucco to walls in home construction projects, tissue and organs may have stuck to the transvaginal mesh, making is difficult to remove without causing damage. When this damage is extensive, additional tissue is needed to repair the vagina, thus shortening it even more. Bladder tack surgery/bladder suspension surgery – This procedure is used to minimize or correct stress incontinence in women by creating a hammock shaped sling made of a mesh tape. The material is different from transvaginal mesh, but with similar complications. If rejection, fusion, or infection arise, the methods used to correct these post-surgical problems may result in vaginal shortening. Anterior repair/posterior repair (colporrhaphy) – Anterior repair surgery tightens the front wall of the vagina when the bladder has drooped or fallen out of place (cystocele or dropped bladder). Posterior repair surgery tautens a rectum that has sagged or dropped (rectocele or rectal prolapse). Though both procedures are minimally invasive, complications may occur that require surgical attention and subsequent suturing, in turn shortening the vagina. Enterocele repair – This reparation is necessary when intestines (small bowel) bulge through the weakened tissue at the top of the vagina. As with anterior or posterior repair, risks are uncommon but may occur, needing attention that might impact vaginal proportion. Sacrospinous ligament/vault suspension – This procedure lifts the top of the vagina and holds it in place after complete vaginal prolapse. As with several of the previous surgeries mentioned here, postoperative stitches are necessary using a woman’s available tissue. This can minimize the original size of the vagina. Hysterectomy – In a hysterectomy, all or part of the uterus is removed. In some cases, it may also be necessary to extract the ovaries, cervix and/or fallopian tubes. The more radical the procedure, the more internal trimming and stitching may be necessary. Hysterectomy is possibly one of the biggest causes of vaginal shortening. Cervical or uterine cancer – Due to removal of cancerous organs, and scarring that can occur as a result of follow up radiation, both vaginal capacity is usually reduced. Learn more. Download your FREE Vaginal Rejuvenation eBook Can Vaginal Shortening Be Repaired? Often, following surgery, the vagina may simply feel shorter due to swelling, inflammation, tenderness, bruising, and the presence of stitches. Vaginal tissue is very elastic, and though it may feel tight immediately after your operation, size often returns to normal after a short recovery time. If actual shortening has occurred, repair can sometimes be complicated, depending on the extent of the surgery or cause of the diminishment. Though it is possible to approach correction by using more drastic measures such as muscle flaps, biological animal grafts, skin grafts, or even a woman’s own bowel tissue, these methods can cause further complications and we prefer to avoid them. We opt for the least physically intrusive methods first to repair vaginal shortening. Several of these options are: Pelvic floor massage – Internal and external massage can relax tenderness, muscle tightness and trigger points that cause pain, gently stretching or tightening the pelvic floor muscles and connective tissue. Pelvic floor physiotherapy – These exercises stretch and strengthen the pelvic floor muscles. Vaginal dilators – Plastic tubes that gradually increase in size are inserted to gently stretch the vagina over time. If these procedures prove to be ineffective, laparoscopic surgery, which is minimally invasive and generates less blood loss, scarring, and a quicker postoperative recovery time may be beneficial. How Can Cherokee Women’s Health Specialists Help? Cherokee Women’s Health Specialists is a broad-based OB/GYN practice consisting of three double board-certified urogynecologists with certification in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS), a highly coveted credential approved only under the most stringent criteria set forth by the American Board of Medicine (ABM). Our surgeons at Cherokee Women’s Health offer a combined experience of over 35 years of performing vaginal rejuvenation procedures. Whatever the reason for vaginal shortening, we can recommend the safest and most effective approach to try and correct the problem. To make an appointment, call us at 770.721.6060. Vaginal Lengthening Articles

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