Gynecological Services

We provide comprehensive gynecologic care from as early as adolescence all the way through to menopause and beyond. Our services include:

• Abnormal pap smear management/treatment
• Abnormal bleeding (clots, prolonged periods, postmenopausal)
• Adenomyosis
• Adolescent gynecology
• Alternatives to hysterectomy
• Annual gynecological exams (Well Woman exams)
• Breast health/Self breast exam teaching
• Cervical dysplasia/HPV management & treatment (LEEP, Cryotherapy, Cervical Conization)
• Contraception/Birth control/Family planning
• Ectopic pregnancy
• Endometrial Ablation (Novasure or Hydrothermal Ablation (HTA))
• Endometriosis
• Female Sexuality
• Fibroids
• Hirsutism (increased hair growth)
• Hormone replacement therapy
• HPV testing and vaccine (Gardasil)
• Infertility
• Intrauterine device (IUD) placement (Mirena, Paragard)
• Menopause symptoms
• Menstrual cycle irregularities (clots, prolonged periods, spotting that disrupts your normal routine)
• Ovarian cysts
• Osteoporosis
• Over active bladder/Urinary urgency
• Pap smears
• Polycystic Ovarian Syndrome (PCOS)
• Pelvic pain (cramps, ovarian cysts, pain, or endometriosis)
• Pelvic support problems (Prolapsed uterus/bladder/rectum)
• Pregnancy testing
• Premenstrual syndrome (PMS)
• Sexual health/Sexual dysfunction
• Sexually transmitted disease (STD) testing and treatment
• Sterilization (Tubal ligation, Essure, Adiana)
• Stretch and damage from childbirth (loosened and stretched vagina, pelvic pressure)
• Urinary incontinence (uncontrolled leaking of urine with laughter, coughing, jumping)
• Urinary tract infections (UTI)
• Vaginal discharge
• Vulvar conditions and pain disorders

Abnormal Bleeding

Irregular menstrual periods, post-coital (bleeding after intercourse) and postmenopausal bleeding are all examples of abnormal uterine bleeding. Irregular menstrual bleeding lasts longer than the normal cycle, occurs outside the cycle, or has a heavier flow and may even be associated with passage of clots. Post-coital bleeding is any type of bleeding that occurs after intercourse. Postmenopausal bleeding is any bleeding noted in women who are menopausal. The bleeding ranges from light spotting to heavy bleeding and always requires a complete evaluation.

Contributing factors for abnormal bleeding may include weight loss/gain, heavy exercise, illness, medication side effects, cancer and/or infection.

To diagnose the condition, Dr. Smith will review your medical history and may obtain some medical tests. She may also recommend minor procedures like an endometrial biopsy, ultrasound, hysteroscopy, and/or laparoscopy.

Treatment for this condition includes medications, hormone therapy, or surgical intervention.

Adolescent Gynecology

Dr. Smith considers it an exceptional privilege when asked to see your daughters, or any young woman, as they begin the transition through adolescence into womanhood. Dr. Smith and her staff take the time that is needed to establish trust with our young patients in order to make them feel at ease during their visits and to create a good, comfortable doctor-patient relationship that will last a lifetime.

The first visit is primarily educational and includes a thorough medical history as well as an open discussion and education about her development, lifestyle and health habits. Issues that are frequently addressed at the visits include:

• Puberty
• Menstruation concerns (cramps, irregular bleeding)
• Acne
• Weight
• Sex, Sexuality and Safe sexual practices
• Birth control,
• Sexually Transmitted Infections
• Alcohol, Drugs, Smoking

A general physical examination including a visual breast examination and external genital examination MAY be done because it allows assessment of normal development, reassurance, and education. Generally, a pelvic examination is NOT done, although certain circumstances, such as abnormal bleeding or discharge, or abdominal or pelvic pain, may indicate that one is appropriate.

At their first visit, we hope parents and guardians view this time as a prime opportunity for us to help alleviate any fears or dispel myths that their daughters may have regarding gynecological visits. Our goal is to help them understand how life-long habits of good preventive care and thoughtful reproductive health choices will enrich their quality of life now and continue long into their later years.

It is important to understand that the reproductive health care visit does not replace routine visits with your daughter’s primary care provider (family practitioner or pediatrician). Rather, this visit serves to complement the primary care provider’s visit.

Dr. Smith follows the current adolescent health care guidelines recommended by the American College of Obstetricians and Gynecologists which includes the following:

• The first visit is recommended between ages 13-15, and should be followed by annual visits.
• The first Pap Smear (screens for cervical cancer) is performed at age 21.
• HIV screening is recommended annually for all sexually active patients from age 19 to 64.
• Once sexually active, annual screening for gonorrhea and chlamydia is performed up to age 25.
• Immunization status is assessed and appropriate vaccinations are recommended.

Please feel free to ask any of us about initial or subsequent services available for your daughter. Keep in mind that doctor-patient confidentiality as to the content of the visit must be observed in keeping with federal and state privacy laws.

Endometrial Ablation

This procedure is a quick, simple, safe and convenient treatment for women who suffer from heavy bleeding and have completed their childbearing years. It can be performed either in the hospital or the office.

Answer the following questions to see if your menstruation is excessive:

1. Yes/No: Do tampons or sanitary napkins quickly become soaked, causing a frequent need to change them?

2. Yes/No: Do you often experience heavy bleeding with clotting?

3. Yes/No: Do you have a heavy period, even while taking birth control pills?

4. Yes/No: Are you exceptionally tired or week during your period?

5. Yes/No: Have you missed work because of your period?

6. Yes/No: Do you rearrange social events or daily activities to accommodate your period?

7. Yes/No: Do you tend to stay home when you have your period because it’s easier?

8. Yes/No: To be prepared, do you carry large quantities of feminine products or even a change of clothes?

9. Yes/No: Are you unable to donate blood because your iron is too low?

10.Yes/No: Are you on iron supplements for "low blood" or "anemia" because of your heavy bleeding?

If you answer “yes” to any of the questions above, you may be a candidate for this procedure. There are several ablation options for you including the Novasure and Hydrothermal Ablation (HTA) procedures.

Contact Dr. Smith to discuss your options.

Endometriosis

Endometriosis is very common and may run in the family. It is a condition that occurs when endometrial tissue that is normally located inside the uterus grows outside of the uterus in other parts of the body. These growths are called endometrial lesions or implants and can be found on the ovaries, fallopian tubes, ligaments that support the uterus, bladder and rectum. These lesions can form scar tissue, adhesions, inflammation and/or cysts which can lead to pain, irregular bleeding, and problems getting pregnant.

Symptoms include the following:

• Painful periods
• Pain during or following sexual intercourse
• Pain in the lower abdomen before and during menstruation
• Cramps for a week or two before menstruation and during menstruation; cramps may be steady and range from dull to severe
• Pelvic or low back pain that may occur at any time during the menstrual cycle
• Pain with bowel movements
• Note: There may be no symptoms. Some women with a large number of endometrial lesions in their pelvis have no pain at all, while some women with milder disease have severe pain.

Endometriosis is still a fairly “unknown” illness even though it is one of the most common gynecological problems affecting 5.5 million women in North America. It often takes a long time before it is correctly diagnosed. If endometriosis is suspected, Dr. Smith will perform a pelvic examination and may recommend an ultrasound and/or a laparoscopy to confirm the correct diagnosis.

Although there is no cure for endometriosis, appropriate treatment can often limit further growth of endometriotic lesions and relieve the pain. Treatment options are available and may include medications, hormones and/or surgery.

Contact Dr. Smith for an evaluation.

Essure Sterilization

Essure is a permanent sterilization procedure that does not require abdominal surgery. There are no incisions and it can even be performed in the office. Dr. Smith places tiny inserts through the vagina into the fallopian tubes using a special instrument called a hysteroscope. This instrument is a thin tube with a camera that allows her to see inside the uterus allowing for correct placement of the micro inserts. Over the next 3 months, your body heals over the inserts and forms a barrier that prevents sperm from reaching the egg. As you heal, another form of birth control is needed. After 3 months, a confirmation X-ray test is performed to confirm that your tubes are indeed blocked.

You will need to consult with Dr. Smith to determine if this procedure is a good choice for you.

HPV Testing and Vaccine

In the summer of 2006, the FDA approved the use of Gardasil®, a vaccine for 4 types of HPV (human papilloma virus). This virus is responsible for virtually all cases of cervical dysplasia, cervical cancer, and genital warts. The vaccine is highly effective against the 4 types of HPV that account for 70% of cervical cancers and 90% of genital warts. HPV is commonly acquired when women become sexually active, and it is estimated that up to 80% of women are exposed at some point in their lives. WHILE MOST INFECTIONS ARE SILENT AND TRANSIENT, MANY LEAD TO FUTURE DISEASE THAT CAN BE LARGELY PREVENTED BY VACCINATION.

Vaccination Information
1. Vaccination is recommended to be given between ages 9 to 26.

2. Vaccination is best given between ages 11-13, as it is most effective before sexual activity.

3. Vaccination is still appropriate after sexual activity, up until age 26.

4. Vaccination does not prevent the need for annual pap smears once sexually active.

5. Vaccination is NOT treatment.

6. Vaccination gives immunity for 5 years, and perhaps more

7. It is not known if a booster is needed at this time

8. HPV testing is not appropriate in adolescents, whether sexually active or not.

Vaccination Details

1. The vaccination is an injection given at 0, 2 and 6 months.

2. In order to receive the vaccine at Exclusive Women’s Healthcare, patients must establish care first.

3. The vaccination is usually covered by most insurances. Our staff can check with your insurance plan to verify your coverage before your scheduled appointment.

4. The patient is responsible for payment if the insurance company ultimately does not pay for the vaccination.

Pelvic Support Problems

Many women suffer from pelvic support problems described as Pelvic Organ Prolapse. This is a condition where the tissues that support the pelvic floor organs have become weakened, damaged or stretched. As a result, these pelvic organs begin to fall or drop down and press against the wall of the vagina causing a bulge. Symptoms of pelvic organ prolapse depend on which organs are involved and include:

• Feelings of pelvic pressure described as a pulling or aching feeling in the lower abdomen, groin or lower back.
• Pelvic heaviness or fullness.
• Feeling as if "something is falling out of the vagina."
• Leakage of urine with laughter, jumping, sneezing, running or exercise; Frequent urge to urinate.
• Problems having a bowel movement (stool incontinence, difficult defecation).
• Discomfort with sexual intercourse.

The main types of pelvic support problems include Cystocele (bladder), Enterocele (small intestine), Rectocele (rectum), Uterine prolapse (uterus) or Vaginal prolapse (vagina).

These problems may begin with childbirth and can worsen with age. They can also be caused by increases in abdominal pressure due to chronic cough, heavy lifting, constipation or obesity. They can even be caused by inherited weakness of the tissues.

Treatment options include lifestyle changes, special exercises, special devices (pessary), medication, or surgical intervention.

The correct diagnosis and treatment can offer relief from pelvic support problems.

Contact Dr. Smith to discuss your options.