Vaginal yeast infections (monilial vulvovaginitis) occur frequently in many women. They have a variety of causes. Pregnancy, birth control users, women who take antibiotics for any reason, frequent swimmers, certain type clothing, diabetics, and no obvious cause are some of the conditions associated with this problem. It is not dangerous but just inconvenient, irritating, and uncomfortable.

The infection usually has a itching and/or burning associated with a discharge. The discharge can be white, yellow, or greenish yellow. It frequently has the appearance of cottage cheese.

The treatment is quite simple. There is a variety of antiyeast medications available over-the-counter. These include Monistat, Mycelex, Gynelotrimin and Femstat. Terazol, a medicine that requires a prescription, is also available. A pill, Diflucan, is also available in a one-dose strength.

If you purchase anti-yeast medication, you should use the cream. You should apply the cream to the lips of the vagina once or twice a day and insert the cream up inside the vagina once a day for three to five days. If intercourse is occurring, you should give the cream to your partner to apply on the penis and the area around the base of the penis. If oral genital sex is practiced, the mouths should be treated and this can be done by chewing a Mycelex vaginal suppository. This tastes like chalk and is not dangerous to swallow. Boric acid douches or inserting a tampon soaked in Boric acid are also useful in treating yeast infections. Drying the area after bathing even using a hair dryer and avoiding tight-fitting, air-occlusive clothing are helpful to prevent yeast infections.

If after 24 to 48 hours no improvement occurs with these methods, another problem may exist and a doctor should be consulted.

Obstetrics/Gynecology

SOUTHEAST TEXAS OB/GYN ASSOCIATES, P.A.

755 N 11th St P4200
Beaumont, TX 77702
409-899-1499

Fax Numbers:
Main Fax – 409-898-0778
Insurance Dept. - 409-899-1354
Front Desk - 409-899-4675

Obstetrics FAQ

Please use the links below to assist you with more specific information that can help your understanding of your situation and how we can help you.

Surprise! You are pregnant! The hormones of early pregnancy may have you thinking you are on a physical and emotional rollercoaster. Elated? Shocked? Ambivalent? All at the same time? Most women have some of these feeling in their first trimester as they get adjusted to the idea of being pregnant. Perhaps you are experiencing cramping or feeling exhausted, nauseated, or bloated. While these signs and symptoms of a healthy pregnancy are a bit uncomfortable, they are usually gone by the time you reach 12 weeks gestation. Try to keep your sense of humor and your sense of wonder as your body becomes the home for a totally unique creation – your baby. Some things to do – take a prenatal vitamin every day. Drink 6-8 glasses of fluids a day and avoid caffeine. Eat a balanced diet if you can. For women with morning/all day sickness, the first trimester diet may consist mostly of carbohydrates as they tend to stay down better and provide comfort and quick energy.

Some Helpful Hints

  • Nausea and Vomiting - eating smaller, more frequent meals (about every 3 hours) may help. You can also try ginger 250 mgs capsules three times daily as well as Vitamin B6 75 mgs three times daily. If your symptoms are persisting, contact your physician.
  • Frequent Urination – Completely normal as your growing uterus puts pressure on your bladder. If you experience bleeding, pain, or urgency with urination, please contact your physician.
  • Bloating and Cramping – your colon slows down a bit while you are pregnant to absorb more nutrients. Be sure to drink a 6-8 glasses of fluids every day and increase your fiber intake including things like whole grains, fresh fruits and vegetables to keep your colon functioning normally. The changes in your uterus are also a source of cramping in early pregnancy – almost like menstrual cramping. This is normal and should lessen as time goes by.
  • Fatigue – Your body is very busy creating an entire human body – including a brain, a heart, lungs, and bones! It takes an incredible amount of energy to accomplish this work of art, so rest as much as you can in the first trimester. You will get your energy back around 16-18 weeks when your baby is almost fully formed.
     

By the second trimester of pregnancy you are starting to feel better – your appetite is back and you have more energy, you are more mentally and emotionally adjusted to the idea of having a baby, and you are ready for the fun part of the journey. You might like to begin a pregnancy journal to keep a record of your experiences as well as your thoughts, hopes, and dreams for this precious little one who has been entrusted to your care. Getting back to some regular exercise will help your sense of well-being as well as increasing your circulation and strengthening your core muscles. Remember to keep your sustained heart rate below 140 BPM. You can enjoy a brisk walk, a refreshing swim, or even plug in your favorite pregnancy exercise video. Plan to exercise for about 30 minutes 4-5 days a week. A good rule of thumb is that if you are out of breath, you need to slow down. Be sure to drink plenty or water before and after you exercise. Now is a good time to focus on eating a balanced diet. We really are what we eat, so making healthy choices during pregnancy is actually an investment in your body’s future. The baby growing inside of you takes vitamins, minerals and protein away from you so your diet is vital to staying healthy during pregnancy. Nutritionally speaking, fresh, organic foods are best.

Daily diet should include the following:

Choose wisely to help you and your baby grow strong and healthy. Try your best to avoid fatty foods and empty calories. But now and then, treat yourself to your favorite dessert or fast food meal! Savor every bite. One of the most thrilling moments in your second trimester occurs when you begin to feel your baby moving inside you. This usually happens between 18-20 weeks. At first you may notice just a faint fluttering. Enjoy the feeling of wonder during these early days because before too long this child will be kicking and wiggling with such force that you cannot miss it! Ligaments stretching as your uterus grows can feel like sharp twinges of pain low in the pelvis on the right and/or left side of the uterus. If these become severe or are accompanied by painful urination or bleeding, contact your nurse or physician.

Here you are on the last leg of your journey through pregnancy. Baby is taking up most of the room in your abdomen now, reminding you with every wiggle and hiccup that it is time to get the nursery in order and sign up for those childbirth and breastfeeding classes you want to take. Your body begins to slow down and you may notice the following:

  • Leg Cramps – increasing your calcium intake will help. 1200 mg calcium daily is recommended.
  • Milk Leaking from the Breast – normal as your body gets ready to breastfeed.
  • Swelling Feet – increase your fluid intake, avoid salt, and elevate your legs when possible.
  • Heartburn – eat smaller meals. Avoid eating 3 hours before bedtime. Elevate the head of your bed 4 inches. Try antacids. Avoid acidic foods like tomato based foods or citrus products.
  • Increased Clear Vaginal Discharge – normal
  • Hemorrhoids – caused by relaxed blood vessels coupled with constipation from inadequate fluid and fiber intake. Increase your fluids and fiber and try an over the counter medication. If this is a persistent problem, call your physician.
  • Contractions – Braxton Hicks contractions feel like baby is balling up low in the pelvis and are just practice contractions. If you notice real contractions (where the whole abdomen is getting hard and tight for 30-45 seconds) or Braxton Hicks contractions more than 4 in an hour, or if you notice gush of fluid from the vagina or constant fluid leakage, bleeding, or decreased fetal movement, please call your physician immediately.
  • Trouble Sleeping or Staying Asleep – going to the bathroom, inability to get in a comfortable position, anxious thoughts as you prepare for delivery, and changing hormones can all contribute to lack of sleep and make you feel tired and grumpy. Talk it over with your physician.

For most women, pregnancy is a healthy state of being. Remember to take your prenatal vitamin daily, get plenty of fresh air and sunshine (wear sunscreen), drink 6-8 glasses of fluids daily, eat a balanced diet, get regular exercise, and rest when you feel the need. From time to time you may have some symptoms that are troublesome. You should contact your physician immediately if you have the following:

  • Temp over 100.2 F
  • Vomiting and/or diarrhea that lasts more than 12 hours
  • Headache unresponsive to Tylenol /acetaminophen
  • Visual disturbances
  • Swelling that has not resolved after a night’s sleep
  • Vaginal discharge with foul odor or itching
  • Bleeding
  • Painful, urgent urination, or scant urination
  • Fluid leakage from the vagina
  • Increasing pelvic pain
  • Decreased fetal movement
  • Contracting more than 4 times in an hour before 37 weeks
  • The feeling that something is not right

Maintaining a healthy sexual relationship is safe in pregnancy. Some women find with higher hormone levels that they enjoy intercourse more in pregnancy. At times, you may have less interest as you battle nausea, fatigue, and breast tenderness. Positions can be challenging as your abdomen grows. Keeping an open line of communication with your mate is crucial. There are many of ways to express affection, so have fun and be creative. If sex is uncomfortable, discuss it with your physician.

We are honored to be sharing this life-changing journey with you and it is our goal to provide you with the very best health care during your pregnancy. Please feel free to call if you have any problems or questions.

HOW FAR ALONG AM I?
            For women with monthly menstrual cycles, the age of the pregnancy is counted from the first day of your last cycle; there are 40 weeks in the average egg cycle from preparation in the ovary to the end of pregnancy. Assuming that you ovulated 2 weeks after your last cycle started, conception occurred at week 2 of the egg cycle; your baby should be born about 38 weeks later. If you have an irregular cycle, your due date will be based on measurement from your first ultrasound.

SHOULD I BE ON A PRENATAL VITAMIN?
                 1000 mcg Folic acid and 75 mg Vitamin B-6 should be started the month prior to pregnancy to help reduce the risk of spina bifida; more folic acid may be recommended if you have a family history of spina bifida. Prenatal vitamins are multivitamins with folic acid added and are important to take on a daily basis during pregnancy to ensure nutritional balance.
                Calcium may be drawn from your bones or teeth as Baby’s skeletal system begins to form around 12 weeks. To protect you health, we recommend 1200 mgs. calcium daily. This equals 4-5 servings of milk, cheese or yogurt. If you do not enjoy dairy products or you are lactose intolerant, a calcium supplement can be taken; 600 mg twice a day is recommended to optimize absorption. DHA supplements are important to add to your daily nutritional plan if your diet does not include fish 3 times a week. DHA supplements contain Omega-3 and essential fatty acids that help support good brain and eye development.

WHAT’S UP WITH FISH AND DELI MEATS?
                    Certain fish live in contaminated environments and consequently have higher levels of
mercury in their tissues. The FDA recommends avoiding consumption of fish with higher levels of mercury, especially during pregnancy. For a list of what you can safely consume, see what has been provided below.
                    Deli meats and unpasteurized dairy products can contain listeria, a bacterium that has been associated with miscarriage and fetal infection. Please be certain that your dairy products have been pasteurized and heat all processed meats until they are steaming hot to guard against infection. It is best to limit your intake of processed foods (fast food, frozen entrées, and canned goods) as they contain added salt and preservative chemicals that are not in the best interest of anyone’s health.

WHAT MEDICATIONS ARE SAFE TO TAKE?
                Please see the medication list below for safe choices during pregnancy. If you need something that is not on the list, contact your nurse for further assistance.

HOW MUCH WATER DO I NEED TO DRINK?
                During pregnancy it is vital to stay hydrated. Dehydration can lead to early labor and even to miscarriage in extreme cases. Plan to consume 6-8 glasses of fluids daily including: water, milk, decaf tea or soda, fruit juices or soymilk. It is preferable to limit caffeine intake while pregnancy. Common products containing caffeine are coffee, tea, some sodas, and chocolate.

CAN I GET MY HAIR COLORED?
              Highlights added to your hair with foils are considered safe in pregnancy as they do not sit on your scalp and so are not absorbed into the bloodstream. There are no studies that prove the safety of color products use during pregnancy, and therefore our best advice is to choose processing that does not sit on the scalp.

CAN I TAKE TUB BATHS?
                Normal temperature baths (98-100 degrees) are safe during pregnancy. Avoid exposure to higher temperature hot tubs or saunas, especially in the first trimester to the reduce risk of spina bifida. If you have frequent yeast infections or bacterial infections, you may want to switch to showers.

CAN I TRAVEL?
              As long as you have an uncomplicated pregnancy, feel free to take trips by car/plane up to 30 weeks gestation; we do not recommend leaving the country unless it is absolutely necessary. Be sure to have a contingency plan in place at your destination and take time to stop and stretch along the way. You have an extra half-gallon of blood in your body when you are pregnant and relaxed blood vessels to accommodate it; consequently, you at greater risk for blood clot formation when you sit for long periods of time. Plan to stand up and walk around for five minutes or so every 2 hours to avoid clot formation and to encourage a rich oxygen supply to the placenta.

CAN I GO TO THE DENTIST?
               Please do! Routine dental care is especially important during pregnancy. If your dentist needs a note from us, we will be glad to provide one; just ask at your next office visit.

HOW DO I PRE-REGISTER WITH THE HOSPITAL?
             St. Elizabeth Hospital is where our doctors deliver. The Center for New Life is located on the third floor of the hospital; that is where you want to go when you are in labor. All the rooms on that floor are private rooms. Unless you deliver by C-section, you can plan to labor and stay in the same room; having Baby room in with you is optional. We encourage you to pre-register for your delivery by the end of your fifth month by going to www.christushospital.org. If you need to make financial arrangements with the hospital, start early! There are discounts for cash deliveries if paid upfront. Prenatal educational classes are offered at no charge to those who deliver at St. Elizabeth; the topics range from prepared childbirth to breastfeeding to infant/child CPR classes. Check out the events calendar at their website for more info!

CAN I KEEP MY CAT?
              Cats that go outside can be exposed to toxoplasmosis via wild food sources. You can be exposed to this parasite if you change the litter box of an infected cat. Cats that never go outside are at a very low risk of contracting toxoplasmosis. Loving on your cat is perfectly safe while you are pregnant, but to be on the safe side, have someone else change the litter box!

CAN I PAINT THE BABY’S ROOM?
              Water based paints are safe to use when you are pregnant. Make sure your room is well ventilated, and take frequent breaks to rest and stretch your muscles. As your baby grows, your center of gravity shifts making you a bit less stable on your feet; we recommend letting someone else paint those hard to reach places!

DO I HAVE TO SLEEP ON MY LEFT SIDE?
                By your third trimester, the weight of the pregnancy could possibly decrease the blood flow in the large blood vessels that are close to your spine. While no evidence exists that lying on your back is harmful to your baby, lying with your abdomen tilted to the left or right would certainly optimize blood flow. Obviously, you are not in control of positions once you fall asleep! Before your third trimester, fall asleep in any position you like! If you have a pre-existing heart condition, please contact your nurse for further clarification.

WHY ARE MY BREASTS SO TENDER?
                 Elevated hormone levels in early pregnancy can cause your breast to enlarge rather quickly and become very sensitive – even to the point of painful! While this condition is uncomfortable, it won’t last forever. As the pregnancy progresses, the tenderness usually fades and breast size returns to normal about 6 weeks after delivery or 6-8 weeks after you wean baby from breast-feeding.

SOUTHEAST TEXAS OB/GYN ASSOCIATES, P.A.
755 N. 11th street, Suite P4200
Beaumont, Texas 77702
(409) 899-1499

Nausea and Vomiting – Emetrol, ginger 250mg three times per day as needed,
Vitamin B6 75mg three times per day

Headaches, Fever and Minor Aches and Pains – Tylenol, Extra Strength Tylenol

Colds and Sinus Congestion – Benadryl, Sudafed and/or Claritin

Nasal Congestion – Ocean or Ayr nasal spray

Cough – Robitussin, Mucinex, Guafenesin, and/or cough drops

Sore Throat – Children’s Sucrets

Indigestion – Tums, Mylanta, and/or Titralac Plus

Gas/Bloating – Mylicon, Simethicone, Phazyme, Maalox, Mylanta and/or Gas-X

Constipation – Metemucil wafer, Citrucel, Colace, Benefiber, Fibercon, and/or Milk of Magnesia

Diarreha – Immodium A.D.

Hemmorrhoids – Preparation H, Anusol H C.

Yeast Infections – Monistat 7

** If you are presently taking any prescription medications, notify your doctor.
*** If you are diabetic, contact your endocrinologist immediately for evaluation.

If you’re pregnant, be careful what fish you eat. The Food and Drug Administration warns that concentrations of methyl mercury accumulated in large fish can harm the baby’s developing nervous system. The consumer organizations Environmental Working Group and the U.S. Public Interest Research Group both claim the FDA warnings don’t go far enough. For more information, visit www.ewg.org. In the meantime, here’s their list of what to avoid and what to enjoy!

Gulf Coast Oysters
Halibut
King Mackerel
Largemouth Bass
Marlin
Pike Gulf
Sea Bass
Shark
Swordfish
Tilefish
Tuna Steaks
Walleye
White Croaker

Don't Eat

Limit to Once per Week

 Blue Mussel

Canned Tuna
Cod
Eastern oyster
Great Lakes
Gulf of Mexico
Lake Whitefish
Mahi-Mahi
Pollock
Wild Channel Catfish

Go For It!

Croaker
Farm-Raised Catfish
Farm-Raised Trout
Fish Sticks
Flounder
Haddock
Mid-Atlantic Blue Crab
Shrimp
Wild Pacific Salmon
Crawfish

Toll-Free Help line: 1-877-472-1002
An Overview of Postpartum Mood Disorders: Baby Blues, Depression, Anxiety & Psychosis

Onset

Usually within a week after giving birth

Statistics

Can occur in 80 percent of women in the postpartum period

Physical Indicators

Drastic mood swings
Elation and joy followed by sadness
Crankiness
Crying spells

Her Feelings


I have a baby, now what?
Everyone’s admiring the baby, what about me?
Will I be able to handle motherhood?
An infant needs so much attention!
Everyone says I’m supposed to be happy and I
want my old body back.
I feel like I got hit by a truck.
I could sleep for days.

Treatment

Rest
Proper nutrition
Help with the baby and household
Support from family and friends
Avoiding isolation

Onset

Can begin any time after birth, and may appear for up to a year after delivery

Statistics

Occurs in 1 of 10 women in postpartum period

Physical Indicators

Marked weight loss/gain due to appetite changes
Changes in sleeping patterns (increased
sleeping or cant stay asleep)
Despair
Crying spells
Withdraws
Avoiding the baby

Her Feelings

I don’t want to get out of bed in the morning.
Everything is hopeless, what’s the point?
I’m never going to feel good again.
I’m staring into a big, black hole.
I don’t want to deal with anyone.
I wish they would all leave me alone.

Treatment

Assessment by a medical professional
Talk therapy
Support groups
Antidepressants
Sleep medication
Hormone therapy

1) Uterine Contractions

  • Four (4) or more per hour – may be painless

2) Menstrual-like Cramps

  • Felt low in the abdomen – may be constant or may come and go

3) Lower, Dull Backache

  • Lower back pain that may radiate to the sides or the front
    – not relieved by change of position

4) Pelvic Pressure

  • It may feel as though the baby is going to “fall out”

5) Stomach Cramps

  • You may have the feeling of “gas pains” with or without Diarrhea

6) Increase or Change in Vaginal Discharge

  • May become pink or brown-tinted, mucousy or watery

7) General Feeling That Something Is Not Right

  • You may just not feel well, even without a specific cause

** Consult your physician Immediately if you are experiencing any of these symptoms.**

  • 4-6 servings of fruits and vegetables (V8-Fusion drink has a serving of fruit and vegetable in each 8oz glass)
  • 3 servings of protein (lean meats, fish, nuts, beans, eggs, protein bars/drinks)
  • 6-8 servings of cereals/grains (whole wheat breads, brown rice, wheat or vegetable pasta)
  • 3 servings of calcium rich pasteurized foods (milk, yogurt, cheese)
  • 6-8 glasses of fluids (avoid caffeine, enjoy water, milk, fruit juice, decaf tea or coffee, decaf soda)

General Gynecological Services Provided: 

  • Preventive health care
  • Annual breast and pelvic examinations/well-woman exams
  • Pap smears/HPV testing
  • Treatments for abnormal menstrual bleeding
  • Treatment of pelvic and vaginal infections
  • Screening for and treating sexually-transmitted diseases
  • Contraception and sterilization
  • Family planning and counseling 
  •  Infertility evaluation
  • Adolescent gynecology
  • Urogynecology - evaluation and treatment of uncontrolled bladder leakage (incontinence)
  • Menopause and hormone replacement therapy
  • Osteoporosis testing
  • Preconception counseling

Lab work

For your convenience, we have several lab technicians on site to draw your blood should your physician order lab testing.

Bone Density Testing

Osteoporosis, which is the loss of bone mass, is a disease that affects twenty-five million Americans, mostly women. Half of women over the age of 50 have an osteoporosis-related fracture. At Southeast Texas OB/GYN Associates, P.A., we have the technology to evaluate bone density with the use of our DEXA machine. Bone density testing is not commonly performed prior to menopause except for unusual medical conditions.

Often this test can be scheduled at the same time as your visit. You will be asked to lie down on a table while the DEXA machine scans your spine and hips (the procedure is similar to having an X-Ray done except it only takes about 10 minutes and your doctor will have your results the day you have the scan done). If you are over the age of 65, you should have a bone density scan (dexascan) every two years. Bone density testing is covered by most insurance plans.

What is an annual exam?

An annual exam is a once-a-year visit to your primary care provider for a general health check, including a breast exam and pap smear. An annual exam visit does not include discussion of new problems or detailed review of chronic conditions. Annual exams are also called routine check-up, yearly exam, annual pap, and preventive visit.

Please schedule a separate appointment if you have health concerns other than your routine physical exam. Examples are:

  • A list of concerns or questions.
  • New health care concerns or problems found at the time of your annual exam.
  • Ongoing health problems that need more attention.

What should I expect during my annual exam?

  • General physical exam (including breast exam)
  • Pelvic exam (pap smear)
  • Update of life and work situation
  • Update of family health history (any new serious illnesses in your family?)
  • Review of your health history
  • Update of current medications, herbs, and supplements (bring list)
  • Need for medication refills
  • Evaluation of need for health screening tests based on age and personal and family history (such as mammogram, test for sexually transmitted diseases, and colon cancer screening)
  • Update on immunizations

Besides routine check-ups or to obtain contraception, you are welcome to schedule an appointment if you have any of the following symptoms:

  • Abnormal or heavy vaginal discharge that itches, burns, has an odor, or causes you discomfort
  • Heavy vaginal bleeding, missed periods or irregular menstrual cycles
  • Bleeding between periods, also known as spotting or break through bleeding
  • Painful intercourse
  • Menstrual cramps that cause you to miss school or work
  • Any signs of pregnancy
  • Side effects or problems from your birth control method
  • Breast pain, lump, or discharge from the nipple

What is an abnormal Pap test?

As part of your routine gynecologic exam, you will have a Pap test (also called a Pap smear). A Pap test is used to identify abnormal cell changes on your cervix and to screen for cervical cancer.

An abnormal Pap test indicates that cells on your cervix have changed. An abnormal Pap test is not uncommon because the cells of the cervix normally undergo constant change. About 5% to 10% of women who have a yearly Pap test will have an abnormal result, but only a small percentage of these abnormal results indicate changes that may progress to cervical cancer.

What causes abnormal Pap test?

Many abnormal Pap tests are caused by viral infections, such as human papillomavirus (HPV) infection, or other types of infection, such as those caused by bacteria, fungi (yeast), or protozoa (Trichomonas). Natural cervical cell changes (atrophic vaginitis) related to menopause can cause an abnormal Pap test. Usually cells return to normal on their own, after an infection has been treated or has resolved on its own.

In some cases, untreated cervical cell changes that cause abnormal Pap tests may progress to pre-cancerous or cancerous stages. Certain high-risk types of HPV, especially types 16 and 18, have been linked to the development of cervical cancer. However, changes in cervical cells usually progress slowly and take many years to become cancer cells.

What increases my risk for and abnormal Pap test?

Most cervical cell changes are the result of high-risk sexual behaviors by you or your partner, such as having multiple sex partners and not using condoms. These behaviors increase your risk of infections and sexually transmitted diseases (STDs). If you are in a single-partner (monogamous) relationship, an abnormal Pap result caused by HPV may not indicate current high-risk behavior. Since the HPV virus remains in body cells for many years, abnormal cervical cell changes can be a result of an HPV infection years earlier.

Smoking or having an impaired immune system also may increase your risk for cervical changes.

Having regular Pap test screening and follow-up evaluations of any abnormal results can reduce your risk of developing cervical cancer.

Will I have symptoms that indicate cervical cell changes?

Abnormal cervical cell changes themselves do not cause symptoms. An HPV infection—the most common cause of abnormal cervical cell changes—usually does not cause symptoms. This is why regular Pap test screening is so important.

If an STD is the cause of your abnormal Pap test, you may have symptoms from the STD. STDs can have a variety of symptoms, including:

  • Abnormal vaginal discharge, such as a change in the amount, color, odor, or texture.
  • Pain, burning, or itching in the pelvic or genital area during urination or during sexual intercourse.
  • Sores, lumps, blisters, rashes, or warts on or around the genitals.

What will I need to do if I have an abnormal Pap test?

Even though most abnormal Pap tests are caused by infections or inflammation that can be treated, you will need a follow-up evaluation to make sure your abnormal cell changes have resolved. Your treatment choices will vary depending on whether your abnormal cell changes are mild, moderate, or severe.

  • If you have minor cervical cell changes, you may choose monitoring by your doctor (watchful waiting), an HPV test, or in some cases colposcopy.
  • If you have moderate to severe cell changes, you will need further evaluation by colpscopy and possibly a cervical biopsy. Then treatment that specifically destroy or remove the abnormal cells may be recommended depending on the biopsy results.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is a condition of unknown cause. It is associated with problems such as irregular (usually less frequent) menstrual cycles, excessive hair growth, acne, obesity, infertility and the possible development of diabetes and osteoporosis. Treatment for PCOS depends on the associated problems and can include weight reduction, hormones or - in some cases - an operation. Ovarian hormones

Normally the ovary produces large amounts of the female hormone estrogen, lesser amounts of the male hormone testosterone, and the pregnancy hormone progesterone (which is only produced in greater amounts after ovulation and during pregnancy). In PCOS, testosterone levels may be mildly increased.

Causes of PCOS

The causes of PCOS are unknown. In some cases, it seems to run in the family; for other women, the condition only occurs when they are overweight. Recent research suggests that PCOS is related to insulin resistance and the development of diabetes, especially in women who are overweight.

Women who have PCOS may have problems such as:

  • Irregular menstrual cycles - menstruation may be less frequent due to less frequent ovulation, and may be either heavier or lighter than average.
  • Amenorrhea - some women with PCOS do not menstruate, in some cases for many years.
  • Obesity - the cause of this is unclear.
  • Excessive hair growth - may be due to increased testosterone.
  • Acne - the cause is unclear.
  • Infertility - related to less frequent or absent ovulation.

There may also be long-term health risks. Some women with PCOS develop diabetes, especially if overweight. Women with infrequent periods are at risk of osteoporosis.

Diagnosing Polycystic Ovarian Syndrome

PCOS is usually diagnosed based on the woman's history and an examination. It may be confirmed by ultrasound and by measuring hormone levels in the blood. Early diagnosis is important, as it will allow symptoms to be managed and may prevent long-term health problems from developing.

Treating PCOS

It is important that a broad approach (by a general practitioner with interest or expertise in this area or perhaps involving several specialists - for example, an endocrinologist or a gynecologist) be used to manage and treat PCOS. If only one or two symptoms are addressed on a short-term basis, the woman may be left with long-term clinical problems.

The treatment for PCOS will depend on the problems the woman has. For example, if the woman is suffering from irregular, heavy periods, the oral contraceptive pill is often prescribed to regulate the cycle and prevent the lining of the womb from overgrowing. If the woman has infrequent periods, the oral contraceptive pill is used to reduce the risk of osteoporosis. Weight loss is very important, as it will reduce the risk of diabetes developing and can reduce other symptoms. An operation called ovarian drilling can be used to treat women with PCOS who want to become pregnant and are not ovulating.

One of the most frightening times in a woman's life is when the gynecologist calls and says that her Pap smear results are abnormal. Although you might think an abnormal Pap smear means that you have cervical cancer, the fact is that the majority of abnormal Pap smears are not caused by cervical cancer. The more likely cause of abnormal Pap smear results is inflammation or a vaginal infection.

Because the Pap smear can only screen for potential problems, not diagnose them, your gynecologist may want to take a closer look at your cervix to determine the cause of your abnormal Pap smear results. He will perform an examination called a colposcopy. Your doctor may order this procedure if you have Pap smear results that:

  • Indicate cervical dysplasia or cervical cancer
  • Show evidence of HPV
  • Show first-time or repeat atypical squamous cells of undetermined significance (ASCUS)

Your gynecologist may also order a colposcopy if your cervix appears abnormal during your pelvic exam and Pap smear or if you have a history of prenatal DES exposure.

Colposcopy is a simple, 10- to 15-minute procedure that is painless and performed in a gynecologist's office. You are positioned on the examination table like you are for a Pap smear, and an acetic acid (such as common table vinegar) is placed on the cervix.

Your physician will use a colposcope -- a large, electric microscope that is positioned approximately 30 cm from the vagina -- to view your cervix. A bright light on the end of the colposcope lets the gynecologist clearly see the cervix.

The Colposcopy Exam

During the colposcopy, the gynecologist focuses on the areas of the cervix where light does not pass through. Abnormal cervical changes are seen as white areas -- the whiter the area, the worse the cervical dysplasia. Abnormal vascular (blood vessel) changes are also apparent through the colposcope. Typically, the worse that the vascular changes are, the worse the dysplasia.

If your physician can view the entire abnormal area through the colposcope, a tissue sample or biopsy is taken from the whitest abnormal areas and sent to the lab for further evaluation.

Cervical cryosurgery or cryotherapy is a gynecological treatment that freezes a section of the cervix. Cryosurgery of the cervix is most often done to destroy abnormal cervical cells that show changes that may lead to cancer. These changes are called pre-cancerous cells. Your gynecologist will probably use the term cervical dysplasia.

Cryosurgery is done only after a colposcopy confirms the presence of abnormal cervical cells. Cyrotherapy is also used for the treatment of cervicitis or inflammation of the cervix. Cryosurgery is not a treatment for cervical cancer.

What happens during cryosurgery?

Cryosurgery is performed in your doctor's office while you are awake. It is similar to a pelvic exam:

  • You will be asked to undress from the waist down,
  • Lie on an exam table with your feet in stirrups,
  • A speculum is inserted into your vagina to hold the vaginal canal open so that your cervix can be seen.

However, that's where the similarity ends.

  • Cryotherapy uses special instruments called cryo probes.
  • During cryosurgery the cyro probes are inserted into your vagina until they firmly cover the abnormal areas of cervical tissue.
  • Next, liquid nitrogen begins to flow through the cryo probes at a temperature of approximately -50 degrees Celsius.
  • This causes the metal cryo probes to freeze and destroy superficial abnormal cervical tissue.
  • The most effective treatment result is obtained by freezing for three minutes, letting the cervix thaw, and repeating the treatment for three more minutes.

How will I feel during cryosurgery?

  • You may feel some slight cramping.
  • You may experience either a sensation of cold or of heat.

How effective is cryosurgery for cervical dysplasia?

Cryosurgery is an adequate treatment for most cases of cervical dysplasia destroying all of the abnormal cervical tissue in over 85 percent of cases. However, when the cervical changes are located in the upper section of the cervix a cone biopsy, rather than cryotherapy, is recommended.

What happens after cryosurgery?

You can return to most normal activities the day after cryosurgery; however, there are a few things you should take note of for the first two to three weeks following treatment:

  • It is normal to experience a watery discharge for the first few weeks. This is caused by the sloughing of dead cervical tissue.
  • Do not insert anything into the vagina for at least two to three weeks. This means no tampons, no douches, and no sexual intercourse.

You should call your health care provider if any of the following occur:

  • Fever. Your doctor should inform you before you leave the office what amount of fever is cause for alarm following cryosurgery.
  • Vaginal bleeding that is heavier than you normally experience during your menstrual cycle.
  • Pain. Some slight cramping is normal; however, any severe or increasing pelvic pain should be reported to your doctor immediately.
  • Foul smell or yellowish vaginal discharge. These can indicate an infection which may need immediate treatment.

Cryosurgery is relatively risk-free, producing fewer complications than any other gynecological procedure. After cryosurgery you will need Pap tests every three to six months for a period of time. Once you have had several normal Pap smears in a row, your doctor will discuss with you how often you need future screening for cervical cancer.

The uterus is made up of three special layered linings of tissue and muscle.

  • The innermost layer is called the endometrium, the second layer- myometrium and the third layer- the serosa

Endometriosis is a condition where the innermost layer of uterus, the endometrium, grows in locations outside the uterus. Endometriosis may cause adhesions on the uterus. The uterus can become stuck to the ovaries, fallopian tubes and bowel. Although many patients experience extreme pain, some women with endometriosis do not experience any symptoms (asymptomatic). Usually it causes pain around the time of the menstrual period but, for some women, the pain is almost constant.

Symptoms
The symptoms of endometriosis vary widely from woman to woman and the severity of symptoms is not necessarily related to the severity of the endometriosis. Symptoms depend on the extent and location of the endometrial implants and the affected structures. While some women have few or no symptoms, others experience severe and incapacitating pain that recurs each month for many years.

Many women think that painful periods are normal. If you have bad period pain, you should see your doctor.

Symptoms include:

  • Period pain (dysmenorrhoea)
  • Pain during sexual intercourse (dyspareunia)
  • Pelvic and abdominal pain outside of menstruation
  • Abnormal bleeding - including heavy bleeding, clotting, prolonged bleeding, irregular bleeding, premenstrual spotting
  • Bowel disturbances - including painful bowel motions, diarrhea, constipation, bleeding from the bowel
  • Difficulty in getting pregnant
  • Painful urination
  • Lower back, thigh and/or leg pain
  • Premenstrual syndrome

The anticipation of recurrent pain or discomfort each month may also lead to feelings of anxiety, stress and depression. It is important to acknowledge these emotional difficulties that may arise from endometriosis.

Special tests to diagnose endometriosis

The tests used to help diagnose endometriosis are:

  • Laparoscopy - a medical instrument with a video camera attached is used to examine your uterus.
  • Ultrasound - an instrument which uses sound waves to create a video image.
  • Colonoscopy - a medical instrument with a video camera attached is used to examine your bowel. This is done if it is thought that the endometriosis could also be affecting your bowel.

Treatment

Treatment for endometriosis depends on a number of factors including:

  • The severity of symptoms
  • The extent of the endometriosis
  • The woman’s age and
  • Her outcome requirements (e.g. reduction in pain, improved fertility)

No treatment can absolutely prevent endometriosis from recurring but a combination of regular medical follow-up, hormone medication and/or surgery can control the condition.

Having a baby may improve the condition. While endometriosis is suppressed during pregnancy, symptoms may recur in time, even as early as a few months after giving birth.

Medical treatment is essential for this condition. Hormones can usually treat endometriosis; sometimes surgery may be indicated.

Drug therapy

Drugs used to treat endometriosis include:

  • The oral contraceptive pill (occasionally)
  • Anti-inflammatory medications
  • Painkillers
  • Hormonal treatments (for example, Danazol, Lupron, Provera and Zoladex. Side effects of these drugs may include depression, hot flushes, mood swings, night sweats, loss of libido and headaches.)

Surgery

Surgical options for endometriosis treatment include:

  • Laparoscopic surgery - is performed to diagnose endometriosis. Laser surgery may be used to try and remove the adhesions. This may be done to reduce pain and to improve the chances of you becoming pregnant.
  • Laparotomy - is used to cut out or burn tissue, or remove cysts
  • Bowel resection - for example, if the bowel has also developed endometriotic adhesions
  • Hysterectomy - may be an option if endometriosis prevents you from having a normal life and other treatments have not worked

Often used to diagnose or treat abnormal uterine bleeding, D&C is one of the most common surgical procedures performed on women. Dilation and Curettage also provides important information about whether uterine cancer is present.

Before you can understand D&C, you need to know a little about the uterus and cervix. The uterus is a pear-shaped, muscular organ that sits in the lower abdomen. The top of the uterus is wide and it narrows like the neck of a bottle at the bottom. The lower third portion of the uterus is its neck, which is called the cervix. The cervix is round and has a small opening called the OS. During your GYN exam, your physician can see the cervix by using a speculum - an instrument used to separate the walls of the vagina.

The inner wall of the uterus is lined by endometrial tissue; the endometrial tissues thicken during the first part of your menstrual cycle. Once ovulation occurs, progesterone acts to stop this thickening and changes the endometrial lining so that it is ready to accept a pregnancy should it occur. If pregnancy doesn't occur, hormone production ceases and the endometrium breaks up and is shed as menstrual blood.

Who Needs A D&C?

A D&C may be required to diagnose and/or treat a problem such as heavy or prolonged menstruation, as well as unexplained bleeding between periods. There are many possible causes for these menstrual abnormalities, one of the most common being a hormonal imbalance. Hormonal imbalance causes a thickening of the endometrium which sometimes causes irregular or prolonged menstrual cycles. Although this can happen at any age, it most commonly occurs in young women just starting menstruation and in older, pre-menopausal women.

Abnormal uterine bleeding is also a warning of various types of growths, which are most often non-cancerous. One of these benign growths are polyps which attach either by a stem or a stalk most often to the lining of the uterus or the cervix. Polyps inside the uterus can usually be removed by D&C. Fibroid tumors are another common benign growth that occurs in the uterus. Fibroids can be silent causing no symptoms, or they can cause heavy bleeding and painful cramping. Although fibroid tumors are sometimes detected during dilation and curettage, another surgical procedure is necessary to remove them.

Abnormal bleeding is sometimes a sign of endometrial cancer, particularly in women over 40. Women over 40, especially those past menopause, may have a D&C or another procedure called an endometrial biopsy. Occasionally a hysteroscopy is performed at the same time as a D&C, allowing the doctor a better view of inside the cervix, vagina, and uterus.

Dialation and Curettage is also commonly performed following miscarriage or abortion in cases where the uterus fails to fully empty its content. Abortions induced before the 12th week of pregnancy are performed in a manner which is similar to the D&C.

Where Is Dilation and Curettage Performed?

Where your D&C takes place depends on individual factors about your health. It can be performed in a hospital setting using general anesthesia or in your doctor's office using a local anesthetic. An injection around the cervix will minimize pain or discomfort from the procedure and produce numbness in the area.

How Am I Prepared for D&C?

  • Do not eat or drink anything before surgery for a time period to be determined by your doctor.
  • Before the surgery starts an antiseptic will be used to cleanse the skin around the vagina and cervix.

Be sure to ask your doctor if there are any additional preparations that you should make before your Dilation and Curettage.

What Are The Steps For Dilation And Curettage?

  • The doctor completely inspects the pelvic reproductive organs for any abnormal changes.
  • Next, a speculum is inserted into the vagina to open the walls so the doctor can see the cervix.
  • A clamp-like instrument holds the cervix in place.
  • The cervix is dialated with a series of tapered rods of increasing widths which are inserted into the cervical opening (the OS).
  • A curette is passed through the uterus and used to scrape the uterine walls. This loosens pieces of the lining which are removed and sent to a lab for microscopic examination. Another method of obtaining a sample of the uterine lining is by applying suction through a narrow tube.

What To Expect After Surgery

You may have some discomfort from general anesthesia which can include nausea, vomiting, and a sore throat that can last a few days. Many women will notice mild cramping for a few days following D&C, as well as spotting or slight bleeding for up to a week. Your next period may be early or late.

You will need a friend or family member to accompany you home a few hours after your D&C. The affects of anesthesia wear off at different rates for each individual; however, you should be able to drive and return to normal activities within a few days.

Points To Remember After D&C

  • To prevent bacteria from entering the cervix following D&C, you should refrain from sexual intercourse, tampon use, and douches for at least a week.
  • Showering, bathing, or swimming is permitted as soon as you feel well enough.
  • Notify your doctor if fever, abdominal pain, heavy bleeding, or a vaginal discharge with a bad odor occurs.
  • Make sure you follow up with your doctor as recommended after the surgery.

Complications of Dilation and Curettage

As with any surgical procedure, it's important for you to understand any possible complications or risks. Although complications with D&C are rare, they can include:

  • A perforation of the uterine wall caused by the tip of the surgical instrument. This injury rarely requires treatment (additional surgery) and heals on its own.
  • Excessive bleeding is always a risk during surgery.
  • Another rare complication is infection with pain and fever.

If your doctor has told you that you need to have a LEEP procedure, it's because your annual Pap smear indicated the presence of abnormal cervical cells, or cervical dysplasia. While the loop electrosurgical excision procedure, or LEEP procedure, may make you wonder if your doctor wants you to jump. The LEEP procedure has nothing to do with jumping. The LEEP procedure is one of several procedures your doctor has available to help diagnose and treat abnormal cervical cells. Other procedures your doctor may want you to have either before or during the LEEP procedure include a colposcopy and/or a cone biopsy.

LEEP uses a thin wire loop electrode, which is attached to an electrosurgical generator. The generator transmits a painless electrical current that quickly cuts away the affected cervical tissue in the immediate area of the loop wire. This causes the abnormal cells to rapidly heat and burst and separates the tissue as the loop wire moves through the cervix.

This technique allows your physician to send the excised tissue to the lab for further evaluation, which insures that the lesion was completely removed, as well as allowing for a more accurate assessment of the abnormal area.

You may want to ask your doctor if it's OK to take an over-the-counter pain reliever such as ibuprofen before your procedure to help minimize any pain. Never take any drug before any medical procedure without explicitly asking your doctor about it. Always follow your doctor’s instructions for preparation for the LEEP.

What happens during the LEEP procedure?

The LEEP procedure takes about 20-30 minutes and is usually performed in your physician's office. In some ways it may seem much like a normal pelvic exam because you will lie on the exam table with your feet in the stirrups. A colposcope will be used to guide your doctor to the abnormal area. Unlike a normal colposcopy, a tube will be attached to the speculum to remove the small amount of smoke caused by the procedure.

An electrosurgical dispersive pad will be placed on your thigh. The pad is a gel-covered adhesive electrode, which provides a safe return path for the electrosurgical current. A single-use, disposable loop electrode will be attached to the generator hand piece by your physician. Your cervix will be prepared with acetic acid and iodine solutions that enable your physician to more easily see the extent of the abnormal area. Next a local anesthetic will be injected into the cervix; the electroloop will be generated and the wire loop will pass through the surface of your cervix.

After the lesion is removed, your physician will use a ball electrode to stop any bleeding that occurs; he may also use a topical solution to prevent further bleeding. You can leave your physician's office soon after the procedure.

Are there any complications associated with the LEEP?

Complications are usually mild but can include:

  • Mild pain or discomfort
  • Bleeding

You should call your physician if you experience bleeding that is heavier than a normal period or if pain is severe. Other symptoms that should be reported to your physician include any heavy vaginal discharge or strong vaginal odor.

After the LEEP, you should not:

  • Have sexual intercourse for as long as recommended by your physician
  • Lift heavy objects
  • Use tampons
  • Douche
  • Take tub baths--take showers only to prevent infection

It's important for you to remember that having cervical dysplasia does not mean that you have cervical cancer. However, treatment of the abnormal area is imperative to prevent abnormal cervical cells from developing into cervical cancer

After the LEEP procedure, make sure to follow your doctor's instructions precisely. Your doctor will tell you when to return for follow-up Pap smears and / or colposcopies. Keeping these follow-up appointments is necessary to verify that all of the abnormal cervical tissues have been removed, as well as to make sure that if abnormal cervical cells redevelop they are caught early and treated appropriately.

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