What are my birth control options?

Choosing the right birth control (contraceptive) method is a very personal decision. There are several options available and only you and your partner can decide which one is right for you. In fact, it’s not uncommon for a woman to change her birth control method several times throughout her reproductive years. The considerations to keep in mind when choosing a contraceptive method are:

  • How effective the method is.
  • Safety
  • How likely you are to use it, i.e. will you use it if you have to put it in place every time? Can you remember to take a pill every day?
  • Cost
  • Protection against sexuality transmitted disease
  • Reversibility

Most contraceptive methods take commitment so make sure you understand the method you have chosen before you begin:

  • Birth control pills

    It is the most popular form of contraception in the United States. Most pills contain estrogen and progestin and work by preventing ovulation. Used correctly (taking it at about the same time every day), it is 99% effective. Pills available today are a much lower dose than the original birth control pill of the 1960's and have fewer side effects.

    • Side effects

      There are some minor side effects associated with the birth control pill. These include: breakthrough bleeding (bleeding between periods), nausea, headaches, and breast tenderness. Many of these side effects decrease during the first three months of usage.

    • Advantages

      The advantages of the pill are that it does not interrupt sexual activity and allows for spontaneity. It offers protection against ovarian, endometrial, and colo-rectal cancers. The pill decreases menstrual bleeding and cramping. The pill also decreases the risk of PID (pelvic inflammatory disease) and can shrink some benign ovarian cysts. It is an easily reversible method.

    • Disadvantages

      The disadvantages are that it offers no protection against sexually transmitted diseases (STD's). It can be expensive; it must be taken consistently every day and can cause mood changes. It can also cause rare, but dangerous complications.Not all women are good candidates for the birth control pill. You should not take the pill if you are over 35 and smoke. You should not take the pill if you begin getting SEVERE migraine headaches after starting the birth control pill. Women who have a history of blood clots or stroke, have heart disease, or high blood pressure, have had breast cancer, have liver problems, have kidney problems or have active gallbladder disease should not take the pill.

  • Intrauterine Device (IUD)

    An IUD is a small, T-shaped piece of plastic that is inserted into the uterus by your doctor. The effectiveness is about 99%. Once the IUD is inserted, it offers protection for 5 to 10 years depending on the IUD used.

    The most common side effect of the IUD is heavier bleeding and cramping with your period. There are several serious complications that can arise from using the IUD’s such as infection, tubal pregnancy (pregnancy located in the fallopian tube), and perforation of the uterine wall.

    Not everyone is a good candidate for the IUD. If you and your partner are not monogamous, the IUD is probably not for you. You should not use the IUD if you are having a problem with unexplained, abnormal uterine bleeding, have a history of endocarditis, are allergic to copper, or are anemic.

    IUD's are probably one of the easiest contraceptive methods to use. You don't have to think about it every day. Once the IUD is in place, you only need to check the string once a month. In order to reverse the method, have the IUD removed by your doctor.

  • Spermicide

    Spermicides kill sperm, preventing the fertilization of an egg and can be purchased from a pharmacy without a prescription in cream, jelly, foam, or suppository form. However when used alone, they are only 79% effective. When used with condoms, the effectiveness increases to 99%. Spermicide has to be inserted in the vagina ½ hour or less before intercourse, and it must be reapplied with each additional act. They are convenient, portable, and relatively inexpensive to use.

  • Condoms

    A condom is a thin shield placed directly over the man's erect penis. It catches the sperm released during ejaculation, thereby preventing the sperm from entering the woman's vagina.

    Most condoms are made from rubber (latex), but some are made from animal tissue. They may be lubricated or treated with a spermicide. Latex condoms, especially those treated with a spermicide, can protect both partners from most sexually transmitted diseases. They can be purchased without a prescription and are sold in a variety of places.

    The condom is convenient, inexpensive, and easy to obtain. They are a good choice if either partner is not monogamous. They can increase the effectiveness of other forms of birth control and reduce the risk of STD's. The disadvantages are a reduction in sexual spontaneity and sensation, along with the possibility of the condom breaking or leaking.

  • Injections

    Depo-Provera® injections are given every 90 days or four times a year and are 99% effective. The shots contain progestin, a hormone, which suppresses ovulation. The side effects include bleeding irregularities (although many women stop having periods after a few months), weight gain, headaches, decreased sex drive, and a delay in the return of fertility. Depo-Provera® injections do not offer protection against sexually transmitted diseases.

    Many women prefer the injections because they only have to think about birth control 4 times a year. Women with menstrual cramps or heavy bleeding enjoy the amenorrhea (absence of periods) that often accompanies the injections.

  • Natural family planning

    Natural family planning is based on fertilization occurring just before, during, and after ovulation. By monitoring yourself daily, you may be able to determine when you are ovulating. In practice, it is the most risky form of birth control and is only 30-70% effective. It is more effective for women with regular menstrual cycles who keep good daily records and are dedicated to the method. It is inexpensive and has no health risks involved. However, if you or your partner are not monogamous this method is probably not for you.

  • Sterilization

    Voluntary sterilization is the most popular birth control method worldwide. Sterilization involves blocking or cutting the woman's fallopian tubes so no eggs can travel to the uterus to be fertilized. It is generally an outpatient procedure and normal activities can be resumed within a few days. Sterilization, a permanent form of birth control, is 99.6% effective.

    The risks with sterilization are the risks associated with any type of surgery. On rare occasions women may have complications from the anesthesia, internal bleeding, and injury to the surrounding internal structures, or infection. Because of its permanent nature women should consider this form of birth control when they no longer feel they want to have children or wish to think about birth control.

  • Essure®

    Essure® is a permanent birth control procedure that works with your body to create a natural barrier to prevent pregnancy. During the procedure, the Essure inserts are placed in the fallopian tubes through the natural pathways of the vagina and cervix, with no incisions and no surgery. Unlike many temporary methods of birth control such as oral contraceptives, the shot, the ring and some IUDs, the Essure inserts do not contain hormones. Therefore, they will not interfere with your monthly cycle nor cause the side effects that many women experience with hormone-related birth control. The Essure procedure is covered by most insurance providers. If the procedure is performed in a doctor's office, your payment may be as low as simple co-pay, depending on your insurance plan.


How important are breast self-exams?

Performing breast self-exams monthly are very important because they will help you become aware of how your breasts normally feel so you can identify a change. Any new lump should be checked by your physician.

The best time to perform the breast self-exam is in the first 7 to 10 days after the beginning of your period before the breasts are swelling.

Why should I perform a monthly breast exam?

Every year more than 200,000 women in the United States are diagnosed with breast cancer. That’s why it is vitally important for a woman to regularly examine her breast. In fact, nearly 90% of breast lumps are found by the woman herself. Unfortunately, many women appear to be hesitant about performing this exam because they are not sure how to do it or what to look for.

However, if you perform a self-exam each month, you will become an expert on your own breasts and you will be able to notice a potential problem before your doctor or midwife. Only by doing this task every month will you become familiar with your breasts and make it more likely to notice any changes. And, changes are what you are looking for. If you find any lump, hard knot or thickening you should contact your doctor or midwife immediately. Don’t worry that it may be nothing. It is much better to be safe than sorry.

When should I examine my breasts?

If you are still having periods, you should do the exam seven days after your period begins. Your breasts are least likely to be tender and swollen at this time. If you no longer have periods, choose a day each month for the exam, such as the first of the month.

How do I examine my breasts?

  • In front of a mirror

    Inspect both breasts with your arms at your sides. Next, raise your arms over your head. Look for any changes in the shape of each breast - swelling, puckering, dimpling, or scaling of the skin. Gently squeeze your nipple and look for a discharge. Report any discharge to your doctor or midwife. Next, put your hands on your hips and press firmly to flex your chest muscles. The left and right breasts will not exactly match - this is normal.

  • In the shower

    Examine your breasts during a bath or shower. Your hands will glide easily over the wet skin. Press the sensitive pads of your fingers flat against the outer part of the breast, moving gently over every part of each breast. Start at the nipple and go around in a circular motion, enlarging the circle each time you reach the point where you began. Completely examine the breast and chest area from your collarbone to the base of a properly-fitting bra, and from your breastbone to your underarm.

  • Lying down

    Repeat this procedure lying flat on your back. Place your left arm over your head and a pillow or folded towel under your left shoulder. This position flattens the breast and makes it easier to examine. Repeat on the other side.


What are fibrocystic breast changes?

Important: This information is provided to answer questions concerning fibrocystic breast changes. If you discover a lump in your breast or have a discharge from you nipple you should contact you doctor immediately!

Fibrocystic breast disease is a benign breast condition affecting about 60% of women during their childbearing years, especially ages 30 to 50, that is characterized by your breast becoming lumpy and painful, especially the week before you period.

The breasts are made up of milk producing glands, fat and fibrous tissue. The glands are linked by thin tubes called ducts. Each month in response to estrogen and progesterone released by the ovaries, the milk glands and ducts enlarge and the breasts retain water which causes the breasts to feel swollen, lumpy and tender. After menstruation the breasts feel less tender and lumpy.


What is premenstrual syndrome (PMS)?

Premenstrual syndrome (PMS) is a term used to describe the abnormal symptoms many women experience one to two weeks before the beginning of their period. Physical symptoms, accompanied by mood swings and depression, are the classic signs. Thirty to forty percent of American women have symptoms severe enough to interfere with their daily lives, while three to five percent have symptoms severe enough to be incapacitating.

PMS symptoms can occur any time after ovulation, approximately two weeks after the beginning of your period.


What is menorrhagia?

Menorrhagia is excessive menstrual bleeding commonly referred to as heavy bleeding and about 1 in 5 women suffer from this condition. If your bleeding lasts seven or more days per cycle, or is so excessive that you need to change protection nearly every hour, you may have menorrhagia. Only your doctor can tell you for sure.

Women suffering from menorrhagia can experience fatigue, anemia, embarrassing accidents, and restricted activity. There are now more treatment options available to you.

What are the treatment options for menorrhagia?

Drug Therapy

Drug Therapy is typically the first treatment option, consisting of oral contraceptives or other hormones that treat hormonal imbalances. This therapy is effective only about 50% of the time, and usually must be continued in order to remain effective. Some women have undesirable side effects, including headaches, weight change, and nausea.

Dilation and curettage (D & C)

Dilation and curettage (D & C) is frequently the second option if drug therapy is ineffective. It is a common surgical procedure that involves scraping of the inside of the uterus. However, for the majority of women with menorrhagia, it's only a temporary solution that reduces bleeding for a few cycles.

Endometrial Ablation

If you do not plan to have any more children, your doctor may suggest minimally invasive surgical treatment options. Several methods are currently available:

  • Conventional endometrial ablation removes the lining of the uterus with an electrosurgical tool or laser. This method effectively reduces bleeding in approximately 85% of patients, and most women return to work within 3 days. Risks include perforation of the uterus, bleeding, infection, or even heart failure due to fluids used to open up or distend the uterus.
  • A new generation of endometrial ablation devices is now available. These devices vary in the way they abolish the lining of the uterus. Some use heated fluid, others radiofrequency, and still others freezing. Your provider can discuss the best option available for your specific condition. NovaSure® is an endometrial ablation procedure that can reduce or stop menstrual bleeding. It works by removing the endometrium, or the lining of the uterus (the part that causes the bleeding), with a quick delivery of radiofrequency energy. Your doctor slightly opens your cervix (the opening to the uterus), inserts a slender wand, and extends a triangular mesh device into the uterus. Precisely measured radio frequency energy is delivered through the mesh for about 90 seconds.

Hysterectomy

Hysterectomy or surgical removal of the uterus is the only definitive treatment for menorrhagia. Hysterectomy is a major procedure, performed in the hospital most often under general anesthesia, and is accompanied by surgical risks, hospitalization, and, depending on the technique used, a recovery period of up to 6 weeks.

da Vinci® Surgery

da Vinci Surgery provides precise treatment for gynecologic conditions in a minimally invasive fashion – through a few tiny incisions instead of a long incision. da Vinci offers several potential patient benefits compared to traditional open surgery, including:*

  • Fewer complications
  • Less blood loss
  • Less pain  and less narcotic pain medicine required
  • Shorter hospital stay
  • Faster recovery and return to normal activities
  • Tiny incisions for minimal scarring

When compared to traditional laparoscopic surgery, da Vinci Gynecologic Surgery provides the following potential benefits:*

  • Fewer conversions to open surgery
  • Less blood loss
  • Fewer complications
  • Removal of heavier fibroids
  • Minimally invasive option for larger patient
  • Shorter hospital stay
  • Quicker recovery and return to normal activities
  • Shorter operation

What is a pap test?

The Pap test, or Pap smear, is a screening test for cervical cancer. It was introduced in 1943 and since then deaths from cervical cancer have declined more than 70%. The test can detect changes in the cells on the cervix (the opening to the uterus, or womb, at the top of the vagina). These changes may be cancerous, pre-cancerous, or caused by inflammation. Every woman should have regular pelvic exams and Pap tests beginning at age 21, or three years following the onset of sexual intercourse (whichever comes first). You should not douche 24 to 48 hours before a Pap test. The solution may wash away cells shed from the cervix. You should not use any vaginal creams or gels (including medicinal creams) or have vaginal intercourse 24 to 48 hours before a Pap test. The creams, gels, or seminal fluids may hide cervical cells.


What is a colposcopy?

A colposcopy is the painless viewing of the cervix and the vagina through a high-powered microscope called a colposcope. The colposcope looks like a pair of binoculars attached to a stand. It does not enter the vagina. Direct examination through the colposcope allows the detection of abnormalities on the cervix that cannot be seen with the naked eye.

What preparation is there for the test?

You should make your appointment for a time when you will not be menstruating (on your period). You should also refrain from intercourse and the use of spermicidal jelly, vaginal medications, douches, or tampons for at least 24 hours before the procedure as they can interfere with the accuracy of the test.

If you would like you may take a non-steroidal anti-inflammatory medication such as Ibuprofen or Naproxen Sodium one hour before your appointment to be more comfortable.

What happens during the test?

You will lie on the examining table with your feet in the stirrups, just like a regular pelvic exam. The provider will use a speculum to separate the walls of the vagina, just like during a normal Pap test. The speculum will remain in the vagina throughout the procedure, causing you to feel a little pressure. A vinegar solution (called acetic acid) will be applied to the cervix to remove mucous and debris. The colposcope will be placed near the vaginal opening. The provider will be able to see your vagina and cervix under magnification. Any areas showing abnormal cells will be biopsied. In a biopsy, a tiny sample of tissue will be removed from the area with a tweezers-like instrument. An endocervical scraping from the so (the opening in the middle of the cervix) may be taken as this is often where abnormal cells begin. You may feel a pinch or cramping when the tissue samples are taken. The samples will be sent to a pathology lab to be examined.

What should I look for after the procedure?

If a biopsy was taken, you may have slight bleeding or spotting for a few days following the procedure. Additionally, you may notice a coffee ground or mustard-like discharge. This is normal. You may use pads, but no tampons for 48 hours following the procedure. You should also refrain from douching or having sexual intercourse for one week following the procedure. If you have any cramping after the procedure, you may continue the Ibuprofen or Naproxen Sodium for relief.


What is pelvic inflammatory disease?

Pelvic Inflammatory Disease (PID) is not a single illness but a broad term covering a variety of infections of the internal reproductive organs - the ovaries, fallopian tubes, uterus, ligaments supporting the uterus, and even the abdominal lining. PID is the most common, preventable cause of infertility in the United States. It can cause scarring of the fallopian tubes leading to blockage of the tubes.

PID is also the leading cause of ectopic pregnancy because if the fallopian tube is damaged from PID, the fertilized egg may attach to the inside wall of the tube instead of inside the uterus. An untreated ectopic pregnancy can lead to rupture of the tube, bleeding into the abdomen, and can result in death.

The most common symptom of PID is a dull abdominal ache. Other signs include fever, vaginal discharge (often the first sign), abnormal uterine bleeding, fever and chills and sometimes nausea and vomiting. The symptoms vary among women and some women do not have symptoms at all. Sexual activity and movement often makes them worse.


What is polycystic ovarian syndrome (PCOS)?

Polycystic ovarian syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, affecting up to 10% of the population. PCOS is one of the leading causes of female infertility and is associated with long-term health risks of heart disease and diabetes. Three features of PCOS are 1) enlarged ovaries containing multiple, small cysts; 2) excess androgens (male hormone); and 3) chronic amenorrhea (missed periods).


What is endometriosis?

Endometriosis is a common cause of pelvic pain that strikes 10-20% of American women. Normally, during the menstrual cycle tissue builds up and breaks down within the uterus. In endometriosis, endometrial tissue (tissue from the lining of the uterus) is found outside the uterus. During the menstrual cycle this tissue builds up and breaks down in the same way but there is no way for it to leave the body. The implants bleed internally, causing irritation, inflammation, and scarring.

Women with endometriosis have symptoms ranging from mild to severe, although some women have no symptoms at all. Symptoms can include menstrual cramps, pain during sex, low back pain, constipation, pain with bowel movements, and infertility. Some women have chronic pelvic pain. Symptoms are usually at their peak just prior to and with the menstrual period. Symptoms are not indicative of the severity of the endometriosis. A woman with severe pain may have minimal disease, while a woman with severe disease may have no symptoms.


What are fibroids?

Fibroids are tumors consisting of an overgrowth of muscle and connective tissue. Fibroids may grow into the uterine cavity, from the uterine wall to the outside of the uterus, or may be confined within the uterine wall. Twenty-five to fifty percent of women have fibroids and under most circumstances they are benign. The incidence increases with age (20% in their 20's, 30% in their 30's, 40% in their 40's).


What is menopause?

Menopause technically means the "end of menstruation". What is readily apparent to any woman entering this phase of life - the symptoms can begin as many as ten years before the period ends. This transition time is known as peri-menopause. Many symptoms we associate with menopause actually begin during the peri-menopause as the estrogen levels are decreasing. Most women reach menopause between the ages of 45 and 55.

When a female is born her ovaries contain hundreds of thousands of eggs. This number of eggs decreases through the years during ovulation. Throughout the childbearing years, not all of a woman’s eggs reach maturity and are released. Each month the eggs that did not reach maturity were reabsorbed by the body. As a woman approaches menopause, only a few thousand eggs are left

Beginning in the early 30's, the levels of estrogen and progesterone produced by a woman’s ovaries starts to decline. This decline escalates when they enter peri-menopause - usually three to five years up to menopause. When the supply of eggs is finally exhausted, ovulation stops. The levels of estrogen and progesterone eventually drop so low that menstruation stops. A woman knows she has passed menopause when she has no periods for 12 months.


What can I expect with menopause?

The diminishing amount of estrogen produced by the ovaries produces changes in the body. These changes occur slowly over time and are different for everyone. Some women notice very little change while other women find it difficult to cope with the dramatic symptoms caused by these changes.

  • Hot flashes

    Hot flashes are the most common symptom of menopause. They are probably the symptom most associated with menopause, with as many as 75% of women experiencing them. A hot flash is a sudden rush of heat that spreads over the upper body and face. Some women experience a simple warming; others have acute flashes with sweating. Hot flashes can occur any time of the day or night. They usually last from thirty seconds to several minutes. Some women have hot flashes for a few months, other women complain about them for years. Other women do not have hot flashes at all.

  • Sleep difficulties

    Many women complain of problems with sleep as they enter menopause. Some women are awoken from a deep sleep by hot flashes. Others have a harder time getting to sleep or staying asleep.

  • Vaginal and urinary tract changes

    The loss of estrogen causes changes in the walls of the vagina. Some women experience vaginal problems during peri-menopause, others don't have symptoms until they are well past menopause. The vaginal lining becomes thinner, dryer, and less elastic as you age. You may have burning or itching. Some women have bleeding or burning with intercourse. The bladder and urethra can lose muscle tone with lower levels of estrogen. This can lead to a loss of bladder control. You may notice leakage when you sneeze, cough, laugh, or exercise.

  • Bone and body changes

    Lower estrogen levels can result in osteoporosis. The bones lose density and become fragile. Older women are more likely to break bones. The hip, wrist, and spine are the bones most likely to break.

  • Emotional changes

    Minor emotional distress can occur with the changes associated with menopause, along with the social changes that can occur in a woman's life. Contrary to prior belief, studies show there is no increase in serious psychiatric disorders in women entering menopause. The emotional distress felt by most women comes from sleep disturbances or other nuisance symptoms. This is also the time of life when many women's lives may be in an upheaval due to their children leaving home or they may become caretaker for an aging parent. Menopausal symptoms make the stress you are normally under harder to cope with.

Diet and Exercise

As you enter menopause, you should pay close attention to the amount of calcium you are receiving in your diet. Women over the age of 50 should be getting 1,000 mg of calcium each day if they are on hormone replacement therapy, 1,500 mg each day if they are not. The calcium is important to help build strong bones. Ask your pharmacist which calcium supplements contain calcium carbonate, as these brands are best at slowing bone loss.
Eating a balanced diet will help you stay healthy before, during, and after menopause. It is important to eat a variety of foods to make sure you get all the essential nutrients. Exercise is very important as you get older. Regular exercise slows bone loss and improves your overall health. Walking and aerobics are good weight-bearing exercises.


What is hormone replacement therapy?

Hormone Replacement Therapy is the use of two hormones – estrogen and progesterone - to help relieve the symptoms of menopause. Because there are both risks and benefits to HRT, choosing whether or not to take hormone replacement therapy (HRT) can be a difficult decision to make and there has been much made of HRT, both pro and con, in the popular press. Your decision should be based on a number of factors including:

  • The severity of your menopausal symptoms and how they are affecting your life.
  • Your individual risk for blood clots, heart disease, bone loss, breast and reproductive tract cancer.

If you have had your uterus surgically removed, then you will only need to take estrogen. Progesterone is added for those with a uterus to cut the risk of uterine cancer that exists with unopposed estrogen (estrogen without progesterone).


What is osteoporosis?

Osteoporosis is a disease in which the bones lose mass, becoming thin and weak. Some bone loss is to be expected as part of the aging process, but with osteoporosis the bone loss is so severe that it causes the bones to become porous, brittle, and likely to break. The disease affects 25 million Americans, mostly women after menopause.


What are sexually transmitted diseases (STDs)?

While HIV and AIDS are the most feared of all the sexually transmitted diseases and generally the first to come to mind, other STDs are more prevalent. In order to avoid any STD it is important to know how it is spread, its symptoms and its treatment. STDs infect women and men of all races, backgrounds and socio-economic levels. Unfortunately, about 2/3 of these infections are diagnosed in people under the age of 25 with a significant number of these being teenagers.

People who have more sexual partners and young people who become sexually active at an earlier age have an increased risk of STDs.
Unfortunately, many STDs have no symptoms, especially in women. But, these infections can still be spread to sexual partners and the health problems caused by sexually transmitted diseases tend to be more severe for women than men. Some STDs, especially Chlamydia and gonorrhea, can spread from the vagina to the uterus and fallopian tubes causing PID- pelvic inflammatory disease. The scarring left by PID can lead to infertility or ectopic pregnancies (a pregnancy outside the uterus which if not terminated early can lead to death.) HPV can cause cervical cancer and other cancers of the genitals. Undiagnosed STDs can be passed from mother to baby before and during delivery. Some infections are easily cured while others can lead to permanent impairment or death.

If you think you are at risk for a sexually transmitted disease - get tested. Any information you share with your healthcare professional is confidential. When diagnosed early almost all STDs can be treated effectively if not cured. It is important to always finish all the treatment prescribed.

The following are common STD’s:

  • Chlamydia
  • Gonorrhea
  • Genital Herpes
  • Syphilis
  • Hepatitis
  • Molluscum Contagiosum
  • Pubic Lice/Crabs
  • Venereal Warts
  • HIV/AIDS

Chlamydia

Chlamydia is one of the most common sexually transmitted infections in the US, affecting 3-5 million women and men a year. It has been referred to as a "silent epidemic" because the infection has no symptoms in two-thirds of all infected women and half of the infected men. Forty-six percent of females infected with Chlamydia are between the ages of 15 and 19 years of age. Women between the ages of 20 to 24 represent about 33%.

The bacteria that cause Chlamydia in the US, Chlamydia trachomatis, can infect the mucous membranes in the penis, vagina, cervix, anus, urethra or eye. In women, the infection generally begins on the cervix and if untreated can spread to the fallopian tubes or ovaries causing PID (pelvic inflammatory disease.) PID can result in sterility by scarring and blocking the fallopian tubes. In men, Chlamydia can cause epididymitis if it spreads from the urethra to the testicles. Untreated, epididymitis can cause sterility in men.

Gonorrhea

Gonorrhea is a curable sexually transmitted disease caused by the bacterium Neisseria gonorrhea. Gonorrhea is spread through sexual intercourse, whether it is vaginal, oral or anal. Gonorrhea can also be passed to a newborn during delivery.

As with Chlamydia, Gonorrhea is a leading cause of infertility. The most common site of initial infection in women is the cervix and the urethra. If left untreated, the infection can spread to the uterus and fallopian tubes resulting in PID (pelvic inflammatory disease.) PID causes scarring of the fallopian tubes, which may lead to infertility or ectopic pregnancy, in which a fertilized egg is implanted outside the uterus, most frequently in the fallopian tube. Ectopic pregnancy can be life threatening.

Genital Herpes

Genital Herpes is a contagious viral infection, most often acquired through sexual contact. The viruses that cause genital herpes are related to the group of viruses that include chicken pox and mononucleosis. HSV1 (Herpes Simplex Virus 1) most commonly causes sores around the mouth while HSV2 (Herpes Simplex Virus 2) is associated with sores on the genitals. Both viruses, though, can cause sores around the mouth or on the genitals.

It is estimated that 45 million Americans harbor the HSV virus, this is one of every four Americans. As many as 75% of the people infected with genital herpes may be asymptomatic. They can unknowingly pass the infection onto their sexual partners.

Herpes is passed through skin-to-skin contact with the affected area with someone who is infected, generally during sexual activity. HSV can be introduced to the genital area through oral sex. About 20% of the new outbreaks of genital Herpes are the result of oral sex. The virus is spread rarely if ever, through contact with bath towels, toilet seats or hot tubs. The virus does not survive long outside the human body. Once the virus enters the genital area it camps out in the nerves at the base of the spine until it is stimulated to grow again.

The severity and length of Herpes outbreaks varies from person to person. The outbreaks usually become less frequent over time.

Herpes in pregnancy

All women who are pregnant should tell their healthcare provider if she or her partner has a history of herpes. During pregnancy the initial or recurrent infections can be more severe.

Babies born to women during an HSV outbreak may become infected. Most infants who are infected came into contact with the virus as they passed through the birth canal. Infection with the herpes virus can cause serious skin infections, damage to the nervous system, blindness, mental retardation or death.

The risk to the newborn is the highest if this is the mother's first outbreak. Usually if there are no active sores at the time of labor the baby can be delivered vaginally. If there is an active infection a Cesarean section may be recommended.

Medication such as acyclovir may be given during the last month of pregnancy to prevent an outbreak close to delivery.

Syphilis

Syphilis is a sexually transmitted disease caused by a small spiral-shaped bacteria call Treponema pallidum. Where Syphilis once caused devastating epidemics, it now can be easily diagnosed by a blood test and effectively treated with antibiotics. Syphilis occurs in stages. The disease is more easily spread in some stages than in others.

Syphilis is spread through sexual or skin-to-skin contact with someone who is in an infectious stage where the symptoms are present. Syphilis spreads through open sores or rashes containing bacteria that can penetrate the mucous membranes of the genitals, mouth or anus. The bacterium is very fragile so the infection is almost always spread by sexual contact.

Neurosyphilis

The Syphilis bacteria frequently invade the nervous system during the early stages of infection. Approximately 3% to 7% of untreated persons with Syphilis will develop Neurosyphilis during the early stages. Symptoms may include headache, stiff neck and fever due to the inflammation of the lining of the brain. Some people develop seizures. If the blood vessels are affected, symptoms of a stroke may develop with numbness, weakness or visual complaints. The time from infection to developing Neurosyphilis can be as long as 20 years. The course of Neurosyphilis and the treatment may be different with patients with HIV infection.

Human Papilloma Virus (HPV) and Condyloma (Venereal Warts)

HPV, or Human Papilloma Virus, may well be the STD of the new millennium. The virus has been studied for a relatively short time but already 80 different genotypes have been identified in the US. Approximately 20 to 30 are known to infect the genital area. Even though the viruses are not a reportable disease, it is believed that 75% of sexually active adults are infected with one or more types of the virus with an estimated 5.5 million new cases a year.

The virus was named "Papilloma virus" because they are known to cause warts, or papillomas. The strains of HPV that cause warts on the hands and feet are different from the strains that cause genital warts. Not all the viruses, though, cause warts. Sometimes the virus lives on the skin without showing any symptoms. Many people with HPV are not aware they are infected. There are strains of HPV that can cause cancers of the vulva or cervix in women, the penis in men or the anus in men and women.

The HPV types that are responsible for genital infections have been divided between "low risk" and "high risk" types, depending upon whether the virus type is associated with genital cancer.

HPV is usually transmitted by sexual contact. The time period between the exposure to the virus and any manifestation of symptoms is unknown. It can be anywhere from several weeks to years making it difficult to know exactly when a person is infected.

Condoms can help avoidance with the virus, but do not prevent it. The only parts of the genitals protected are those covered with latex.

HIV and AIDS

AIDS (acquired immunodeficiency syndrome) is the most severe form of HIV (human immunodeficiency virus.) AIDS was first reported in 1981 and is now a worldwide epidemic. HIV progressively destroys the cells of the immune system thereby damaging the body's ability to fight off viruses, bacteria and fungus that cause disease. Opportunistic infections develop such as pneumonia, meningitis and certain types of cancers. The microbes causing the infections generally wouldn't cause illness in a healthy person, but for a person with a weakened immune system, the infections can be life threatening.

For more information about AIDS and its impact, please read more at the CDC website.

HIV is transmitted through the blood, semen or vaginal secretions of an infected person. HIV is usually spread by sexual contact with an infected person. It can also spread through sharing contaminated needles or syringes among drug users. Untreated women can pass the infection to their children during pregnancy, birth or through their breast milk.

Although HIV has been found in the saliva of infected people, no evidence exists that the virus is passed through saliva. Saliva appears to have natural compounds that inhibit the infectiousness of HIV. Researchers have found no evidence that HIV is spread through urine, feces, sweat or tears. HIV is not passed through casual contact, through insect bites or stings.

The risk of acquiring HIV from an infected health care worker is extremely low. Worldwide there have been only two cases documented of an HIV-positive surgeon transmitting the virus to a patient.

Having another sexually transmitted disease such as Herpes, Gonorrhea, Chlamydia or Syphilis appears to make a person more susceptible to acquiring the virus through unprotected sex with an infected person.


What is human papilloma virus (HPV)?

Human Papilloma Virus (HPV) is a group of viruses that can cause warts anywhere on the human body. Because it is a non-reportable disease, the actual number of patients infected with HPV is unknown although more than 50 million Americans are believed to be currently infected with the virus. The number is estimated to be growing by almost a million every year. For more information about HPV and the available vaccine, please read more at the CDC website, or view recent stats on HPV.

Venereal warts (also known as genital warts or condylomata) are the "clinical" form of this infection because they can be easily seen and diagnosed. Venereal warts look like a fleshy bump of tissue on the labia, clitoris, or around the anus. The "sub-clinical" version is more common. The infection resides under the skin and cannot be seen. The sub-clinical varieties have been linked to cancers of the genital tract so it is important for sexually active women to have yearly Pap tests to detect pre-cancerous changes.


What are vaginal infections?

Vaginal infections are the most common gynecologic disorder and are usually caused when the normal vaginal flora that are found in the vagina become imbalance. Symptoms of vaginal infections can range from mildly annoying to extremely uncomfortable. The key to successful treatment lies with an accurate diagnosis of the agent causing the infection. Therefore, before you use any over the counter medication such as a treatment for vaginal yeast infection you should be sure it is the right drug to treat the problem. Using the wrong sort of medication may make the situation worse. If you have any doubt you should consult your doctor or mid-wife.

The Most Common Vaginal Infections

  • Yeast infections

    These infections are caused by a fungus called Candida. Yeast may be found in small amounts in the normal vagina. When there is an imbalance in the normal vaginal flora, the yeast can take hold and overgrow. Taking antibiotics that may kill the lactobacilli found in a normal vagina can cause this imbalance.

    Lactobacilli excrete hydrogen peroxide, which is a natural disinfectant that acts to maintain the normal balance of organisms in the vagina. Other factors that may lead to the imbalance are pregnancy, taking oral contraceptives, steroid use, obesity, diabetes, wearing clothing that traps heat and moisture (such as nylon), and a diet high in sugars and starches.

    The classic symptoms of a yeast infection include vulvar itching, redness and irritation. In severe cases, the vulva may be swollen with fissures, or breaks in the skin. When there is a vaginal discharge, it is thick, white and "cheesy" or curd-like. Your health care provider can diagnose the infection by vaginal culture, or looking at a drop of the vaginal secretions under a microscope.

    There are many treatments for yeast infections including oral and vaginal medications, prescription and over-the-counter.

  • Bacterial Vaginosis (BV)

    Bacterial Vaginosis is the most common vaginal infection. The bacteria that cause the infection occur naturally in the vagina. The infection occurs when there is an overgrowth and the normal vaginal bacteria are replaced.

    The primary symptom of BV is a thin, white, or grayish discharge with an unmistakable fishy odor. The odor usually increases after intercourse or during menstruation. There may be mild irritation or itching, but quite often it is the offensive odor that causes the woman to seek treatment. The diagnosis is made by checking the vaginal pH (it is abnormally high with BV), evidence of the discharge upon exam, the fishy odor, and the abnormal appearance of cells that line the vaginal wall.

    BV is treated with antibiotics, either orally or intravaginally. These medications are only available with a prescription. It is important to finish all the antibiotics as prescribed.

  • Trichomoniasis

    "Trich" is a common sexually transmitted disease (STD) that is caused by a parasite. Although it is usually transmitted through sexual intercourse, in rare instances it has been passed through wet towels, washcloths or bathing suits. Trichomoniasis can occur without symptoms. When there are symptoms, they are usually within 4 to 20 days after exposure, although it may be years before the symptoms appear. The symptoms in women include a yellow-green vaginal discharge that may be frothy. The labia may be irritated, red and itchy. There may be spotting after intercourse, and a foul vaginal odor. If the infection involves the urinary tract, there may be burning with urination.

    Trichomoniasis is usually diagnosed by culture or by identifying the parasite under a microscope. Sometimes the infections may be picked up on Pap Smear. The infection is treated with oral antibiotics for the woman and her partner. It is important that both be treated so as to prevent re-infection.

What are thyroid disorders?

The thyroid is a butterfly shaped gland located across the base of the neck below the Adam's apple and in front of the windpipe that regulates the body's metabolism and organ function. This gland produces hormones that affect nearly every tissue in the body.

Some of the functions the thyroid hormones are involved in include the breakdown of fat tissue, the pace of cell activity, menstrual cycling, heart rhythms, and protein building and breakdown. The thyroid also helps to maintain blood pressure and regulates tissue growth and development. Disorders of the thyroid can affect the cardiovascular system, reproductive system and major organs.

About 20 million Americans have a thyroid disorder of some form, most of them women. The most common thyroid disorder is an under-active thyroid, or hypothyroidism, where the thyroid fails to produce enough hormones. Hyperthyroidism, or an over-active thyroid, occurs when too much thyroid hormone is produced. Sometimes there can be an overgrowth of tissue causing a small lump, or nodule, on the gland. Most nodules are benign, but a small percentage may be cancerous.

How the thyroid works

The thyroid gland produces the thyroid hormone levothyroxine (T4) which in turn is converted to another hormone triiodothyromine (T3) in other body tissues. These two thyroid hormones, T3 and T4, travel to all parts of the body where they influence metabolism. One of the roles of the pituitary gland is to regulate the amount of thyroid hormones that are produced. As the pituitary monitors the thyroid hormone level in the blood, it produces its own hormone - thyroid stimulating hormone (TSH), which travels in the blood to the thyroid to stimulate the production of thyroid hormone.

Hypothyroidism (underactive thyroid)

When too little thyroid hormone (TH) is released, the body's metabolic rate decreases and the body slows down. With mild hypothyroidism, there may be no obvious symptoms, but as the thyroid failure progresses, symptoms may begin to emerge. Symptoms of hypothyroidism include:

  • Fatigue
  • Intolerance to cold
  • Depression
  • Dry, coarse skin and hair, hair loss
  • Brittle nails
  • A slow heart rate
  • Constipation
  • Trouble with concentration
  • Poor memory
  • Irregular or heavy periods
  • Infertility
  • Muscle aches
  • High cholesterol
  • Goiter (or enlarged thyroid gland)

Hyperthyroidism (overactive thyroid)

When too much thyroid hormone is released, metabolism increases and the body speed up. Symptoms of hyperthyroidism include:

  • Tremors
  • Rapid pulse
  • Nervousness or irritability
  • Heat intolerance
  • Difficulty sleeping
  • More frequent bowel movements
  • Decreased menstrual flow
  • Weight loss
  • Bulging of the eyes (exothalmos)
  • Muscle weakness
  • Goiter (enlarged thyroid gland)

The leading cause of hyperthyroidism is Grave's Disease. Grave's Disease is an autoimmune disease. The body's immune system mistakenly attacks thyroid tissue, causing excessive growth of the tissue leading to an enlarged thyroid. This leads to an overproduction of thyroid hormone. The antibodies may also attack eye muscle and the skin.

A thyroid nodule that overproduces TH can also cause hyperthyroidism. It can develop during or after pregnancy, or after treatment for hypothyroidism with too high a dose of synthetic hormone.

Thyroid nodule

A nodule is a lump in the thyroid gland. The nodule will probably be checked with ultrasound or a biopsy to see if it is cancerous or benign. Ninety to ninety-five percent of thyroid nodules are benign. Most nodules don't have symptoms and may never be detected. Some nodules grow large enough to press against the windpipe and cause difficulty with swallowing.

If the nodule is found to be benign, a thyroid hormone may be prescribed to shrink the size of the nodule or it may be removed surgically. If the nodule is found to be cancerous, further treatment will be necessary. Thyroid Cancer can usually be successfully treated. 


What is a loop electrosurgical excision procedure (LEEP)?

Cells on your cervix are constantly growing and changing. Unfortunately, these cells sometimes grow and change abnormally. These abnormal cells are usually first noticed on a Pap test. If you’ve had a Pap test or cervical biopsies come back showing dysplasia, a LEEP may be recommended as treatment for these cells. Dysplasia is not cancer, but can lead to cervical cancer if not treated. During a LEEP, your doctor can remove the affected tissue, including the transformation zone (where many problems begin). It is sent to the pathologist to be sure that:

  • There is no cancer, and
  • That the margins are clear - which means all the affected tissue was removed.

About 95% of patients are cured of their problem following a LEEP.

The LEEP will be scheduled during the first half of the menstrual cycle, after you have stopped bleeding. The procedure begins like a Pap test in that you will put your feet in stirrups and a speculum will be inserted into your vagina and opened. Your cervix will be numbed with a local anesthetic and a mild vinegar solution (called acetic acid) will be applied. This solution turns the affected cells white. The doctor will use a colposcope (it looks like binoculars on a stand) placed outside your vagina to look at your cervix microscopically. This will help them decide the size and shape of the loop used to excise the abnormal tissue.

A fine wire loop with a high frequency current (hence the name - loop electrosurgical excision procedure) is used to remove the abnormal tissue from your cervix. The loop will seal blood vessels as it cuts, decreasing bleeding. To further decrease bleeding, a medicated paste or solution may be applied to your cervix. This solution often causes a dark coffee-ground like vaginal discharge for a few days after the procedure. The tissue removed will be sent to a pathologist for diagnosis.

Following the procedure, you may feel a few mild cramps for a few days and you will have a vaginal discharge sometimes for up to 4 weeks. You should not put anything in your vagina (including tampons or sexual intercourse) for three to four weeks after your procedure. You should also avoid heavy lifting and vigorous exercise for three to four weeks.

Your doctor will want to monitor your Pap test for at least two years following your LEEP. To catch any problems early, it is very important that you see your doctor as directed.

You must call your doctor if you:

  • Suffer from heavy bleeding or bleeding with clots (a "coffee ground" discharge is normal)
  • Experience severe abdominal pain
  • Have a fever
  • Have a severely foul-smelling discharge

What is a laparoscopy?

A laparoscopy is a procedure that allows your physician to look directly at your reproductive organs using an instrument called a laparoscope. This procedure is diagnostic in that it allows the doctor to see problems that could not be seen with a pelvic exam, X-Rays, or Ultrasound. Often, the problem can also be treated during the procedure. Normally, you can go home the same day the procedure is performed.

When is the laparoscope used?

There are many conditions that are diagnosed and treated with the use of a Laparoscope:

Adhesions

When tissues in the abdomen stick together, and this forms scar tissue, called adhesions, the laparoscope may be used. Adhesions can result from infection, previous pelvic surgery, or endometriosis. They can be a cause of pelvic pain. The tissues can be separated during a laparoscopy.

Endometriosis

When uterine tissue (endometrium) is found outside the uterus the condition is called endometriosis. This tissue bleeds each month with the menstrual cycle but these products cannot escape the body. This can result in pelvic pain and adhesions. Endometriosis is diagnosed by laparoscopy and many times can be treated through the laparoscope.

Infertility

If a woman is having trouble conceiving, the physician may perform a laparoscopy to look for endometriosis and to look at the fallopian tubes. If the tubes are blocked, the egg and the sperm cannot meet.

Ectopic Pregnancy

An ectopic pregnancy is a pregnancy that has implanted outside of the uterus. Most of the time, it has implanted in a fallopian tube. A laparoscopy can be used to diagnose, and many times treat this problem.

Ovarian Cysts

An ovarian cyst is a pouch containing fluid or solid material attached to or around the ovary which may be painful. Often the cyst will resolve on its own. If it doesn’t then it can often be treated through the laparoscope.

Fibroids

Fibroids are tumors made up of fibrous tissue that can grow inside, outside, or within the walls of the uterus. Sometimes a laparoscope is used to diagnose fibroids.