GYNECOLOGY

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1.) What is a Pap smear and when should women have them done?
A Pap test is a test to screen for cervical cancer or conditions that may develop into cancer. Pap screen testing should begin at age 21. Routine screening is recommended every two years for women 21-30 years old. For women 30 to 65 or 70 years who have a normal Pap test with a negative HPV test, screening can be done less frequently.

2.) I have an abnormal Pap smear, what does that mean?
There are varying degrees of abnormalities on Pap smears. Many "abnormal" Pap smears are of only minor importance and often do not require more testing or any type of treatment. Some of the abnormalities, which require colposcopy (see below) and may require treatment include:

ASCUS – Atypical Squamous Cells of Undetermined Significance
– Can be positive or negative for high-risk types of HPV

LGSIL – Low Grade Squamous Intraepithelial Lesion

HGSIL – High Grade Squamous Intraepithelial Lesion

3.) What is a colposcopy?
A colposcopy is a visual inspection of the cervix with a special microscope. If any abnormalities are detected, a sample (biopsy and/or cervical scraping) is taken, this is a diagnostic procedure.

4.) How do you treat dysplasia?
Depending on the severity of the abnormality, treatment can range from observation to freezing the abnormal cells (cryotherapy) to removal of the affected tissue with a LEEP procedure, which removes part of the cervix.

5.) What is HPV?
HPV stands for Human Papillomavirus. It is a sexually transmitted infection that is estimated to affect 50-75% of all sexually active women. There are over 80 types of HPV; types 6 and 11 cause over 90% of genital warts, types 16 and 18 causes over 70% of cervical cancers. The vast majority of women infected with HPV will likely clear the virus without treatment; it is women who have a persistent high risk HPV infection who are most at risk for developing cervical cancer.

6.) What is the HPV vaccine?
The HPV vaccine is a vaccine recommended for girls between the ages of 9 and 26. It provides protection against four types of HPV: Type 6, 11, 16, and 18. It is given as a series of three injections: first injection followed by a second one two months later and a third four months after the second. Based on the information available, it is considered extremely efficacious in individuals who have never been exposed to the HPV types in the vaccine. It does not eliminate the need for Pap smears, however, as disease can still result from viral types not covered by the vaccine.

7.) I have vaginal discharge, what should I do?
Vaginal discharge can be normal, but it can also indicate that there is an infection present.
There are three main causes of vaginal discharge:

1.) Yeast Infection
-Characterized by itching and a thick cottage cheese like discharge
-Usually no odor
-Can occur after treatment with antibiotics
-Not sexually transmitted

2.) Bacterial Vaginosis
-Characterized by a fishy odor
-Caused by Gardnerella vaginalis
-Not sexually transmitted

3.) Trichomoniasis
-Characterized by a fishy odor and copious greenish discharge
-Sexually transmitted infection
-Partner must be treated

8.) What are sexually transmitted infections?
Visit the CDC website for more information.

9.) Is breakthrough bleeding normal when taking the birth control pill?
Breakthrough bleeding is the most common side effect seen when women are placed on oral contraceptives, it can take up to 4 months for the pill to regulate your cycle. It is important to continue taking the pill at the same time every day. If abnormal bleeding persists, you should contact the office for evaluation and to possibly change pills.

10.) What should I do if I miss a birth control pill?
If you miss one pill take two pills the next day and continue as normal. Break through bleeding may occur for a few weeks, it is important to continue taking your pills. If you miss two days in a row you may double up on subsequent days, but you must use a back up form of birth control (condoms or spermicides) for two weeks since you have lost the protection of the pills for that month. If you are on a progestin only pill (Micronor) the instructions are different—call your doctor. Since there are different formulations of oral contraceptives, refer to the package insert of your particular one for further instructions.

11.) I had unprotected sex last night, is there emergency contraception available?
Emergency contraception or Plan B is available over the counter if you are 18 years or older. It requires a prescription if you are younger than 18. It must be taken within 72 hours of unprotected intercourse, the earlier the better. It works by delaying ovulation or release of an egg. It does not cause abortion.

12.) I am postmenopausal and had some vaginal bleeding, what should I do?
Any vaginal bleeding after you have had one full year without a period (menopause) should be reported to your physician and investigated.

13.) I recently had surgery, what should I expect?
Pain and fatigue are common following surgery. Pain should continue to improve as you move farther out from surgery. Your activity level should also increase after surgery—don’t over do it. We recommend gradual increases, climbing the stairs is fine; heavy lifting should be avoided to help the body heal. Heavy lifting entails anything that you have to strain to pick up.

Reasons to call the doctor:

–Worsening pain: Pain that continues to worsen and does not respond to pain medicine

–Fever: Temperature greater that 100.5 F or 38.2 C

–Nausea and vomiting: Immediately following surgery this can occur as a result of the anesthesia medicine. If this occurs, limit your diet to clear liquids and increase as you feel comfortable. If nausea and vomiting occur greater than 24 hours after surgery and is not improving, call your doctor.

–Constipation: It is not uncommon following surgery to have some constipation, usually as a result of narcotics and immobility. It can be treated with Colace, Milk of Magnesia or a Fleet’s enema and increasing your water intake. If you are in pain and unable to pass gas contact your doctor.

–Bleeding: It is not uncommon after gynecological surgery to have some vaginal bleeding which should subside with time, if you are having continuous vaginal bleeding that appears to be worsening, contact your doctor.

–Incisional redness or drainage: Contact your doctor as this could be a sign of a wound infection.

PREGNANCY

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1.) I have just found out that I am pregnant, what should I do?
Contact the office for your first prenatal appointment. In the meantime, if you have not been taking a prenatal vitamin begin taking one, don’t smoke, avoid alcohol and medications, which have not been prescribed.

2.) Is vaginal bleeding normal during pregnancy?

**If vaginal bleeding is heavy, you should contact your doctor immediately**

Vaginal bleeding in the first trimester is seen in about thirty percent of pregnancies. It can vary from brownish discharge to reddish in color. If it is brown it usually indicates that it is old blood. It is important for us to verify that, although rare, there is no tubal or ectopic pregnancy, as this can be a life-threatening emergency if it goes untreated. If there is no evidence of an ectopic pregnancy, the well being of the pregnancy can usually be diagnosed by ultrasound and following serial blood tests. Remember that miscarriage is very common in the first trimester, occurring in about one in six pregnancies.

In the second and third trimesters, a small amount of bleeding can occur if the cervix is irritated ie. after intercourse. Bleeding and cramping can be a sign of preterm labor and if you experience this, you should contact your doctor. Lastly, any significant blow to the belly during pregnancy may cause the placenta to separate from the uterus and lead to bleeding; this should be evaluated promptly.

3.) How common is miscarriage?
Miscarriage is quite common; in fact people often have miscarriages before they even are aware that they are pregnant. One in six pregnancies ends in miscarriage.

In most cases nothing can be done to prevent this. After the heartbeat is heard (around 10 weeks after the last period), the risk of miscarriage decreases considerably. You may not want to tell everyone of your pregnancy until we have heard the heartbeat.

4.) I am experiencing nausea, is this normal?
Morning sickness or nausea and vomiting, are common symptoms of early pregnancy and usually diminish by 13 weeks. Frequent, small meals as well as Vitamin B6 tablets (25-50mg) may alleviate your symptoms. Stronger medications may be prescribed if necessary. There is a severe form of this in pregnancy known as hyperemesis gravidarum, in which a woman has difficulty keeping any food down for prolonged periods of time. Dehydration can cause significant problems in pregnancy, so contact your doctor if you cannot keep fluids down for over 24 hours.

5.) When will I start to feel the baby move and how often?
Women usually start to feel 'quickening' or fetal movement by 20 weeks. By 24-28 weeks fetal movement should be noticed almost hourly. Four to five movements an hour is normal. No fetal movement for 2 hours or more at this stage is abnormal. Also, it is important to remember that the fetus goes through sleep cycles which can last up to 90 minutes. If you have any concern over fetal movement, contact your doctor.

6.) Can I eat fish during pregnancy?
Yes! Limit your consumption of fresh-water fish caught by family and friends to one meal per week. You can safely eat an average of 12 ounces per week (cooked weight) of other types of fish. Avoid shark, swordfish, king mackerel, and tilefish. Avoid refrigerated smoked seafood except in a cooked dish. You may eat canned fish.

7.) Can I dye my hair if I am pregnant?
We are often asked about the adverse effects of hair coloring, perms or other hair treatments. There are no known adverse effects to the fetus. However, due to the hormonal changes, your perm may not take as well.

8.) Can I exercise during pregnancy?
Moderate exercise during pregnancy is encouraged. If you were on an exercise program before your pregnancy began, there is no reason to stop now. Running, low-impact aerobic exercises, dancing and tennis in moderation do not in anyway endanger your pregnancy. The recommendation is to exercise to fatigue – not exhaustion.

You should also avoid activities which could cause you to fall on your abdomen, i.e., snow skiing, water skiing, roller blading, etc. If abdominal discomfort or bleeding should begin during an exercise session, you should stop what you are doing and notify the office. Hot tubs, saunas and whirlpools should be avoided at this time.

9.) Can I travel in an airplane during pregnancy?
If you have an uncomplicated pregnancy, flying in an airplane is permitted up until 36 weeks. If it is a long journey, be sure to get up and move your legs frequently to prevent a blood clot.

10.) What can I take for a headache during pregnancy?
Headaches can be common during pregnancy and are treated with regular or extra strength Tylenol. If you are greater than 20 weeks and you have a headache that is not resolved with Tylenol or experience visual changes contact your doctor..

11.) How much weight should I gain with pregnancy?
Weight gain and diet are major concerns for most pregnant women. A balanced diet with selections from the basic food groups and about 1800 calories/day will be sufficient for most women. During pregnancy you actually only need an extra 300 calories per day over your pre-pregnancy requirements. The normal weight gain during pregnancy is 25-35 lbs. Avoid empty calories of sweets, fast food and high calorie beverages. Eat a healthy well rounded diet with lots of water, fruits, vegetables and lean meats.

12.) I am pregnant and have heartburn and constipation, what can I take?
Indigestion and constipation are annoying symptoms which may stay with you throughout your pregnancy. Over-the-counter antacids such as Maalox, Mylanta, or Digel may be used as needed and bulk laxatives such as Colace or Metamucil, along with lots of water are helpful when taken on a daily basis. For immediate relief of constipation we recommend Milk of Magnesia or a Fleet’s enema. If on the other hand, diarrhea should develop, Kaopectate can be taken as directed. If any of these conditions do not resolve in 24-48 hrs, notify the office.

13.) I am pregnant and have a cold, what can I do?
Most women during their pregnancy will get a common cold. Colds in pregnancy usually last for 10-14 days rather than the usual 3-4 days when you are not pregnant. The treatment is basically the same with increased fluid intake, increased humidity, increased Vitamin C rich foods and drinks. You may take plain or extra strength Tylenol, Tylenol Sinus or Tylenol PM (acetaminophen) for aches or a fever. Robitussin is recommended for a cough. Benadryl, Sudafed or Ocean Nasal Spray is recommended for other cold symptoms. Cough or throat lozenges without zinc are permitted. These medications may be taken according to package directions. Of course, if your symptoms are mild, we prefer you not take any medication during pregnancy.

14.) What is Group B Strep?
Group B Strep is a bacteria that colonizes the vagina and/or rectum in up to 30% of women. It is routine to screen all women at around 36 weeks of gestation. Group B Strep does not pose any risk to the women who carry it; however it can be transmitted to the baby and cause a serious infection. Consequently, women who are carriers are treated with IV antibiotics when they are in labor.

15.) When can I find out the sex of the baby?
This is usually revealed during the ultrasound performed around 20 weeks, when we evaluate various body parts of the fetus.

16.) How do I know if I am in labor and when should I call my doctor?
Labor is characterized by frequent, regular contractions. If you contract every five minutes and they increase in intensity over 2 hours, call your doctor. Sometimes, the bag of water breaks prior to the onset of contractions- it is characterized by a gush or constant leaking of fluid. If you are concerned that you may have ruptured your membranes contact your doctor. Other reasons to call your doctor include: decreased fetal movement, bright red vaginal bleeding, severe headache, and fever over 101.

17.) What is round ligament pain?
The round ligaments attach the uterus to the pelvis and are located in the groin region. As the uterus grows, these ligaments must stretch to accommodate its size. This stretching can manifest as pain or cramping in the inguinal area. These pains are usually short lived and can be treated symptomatically with Tylenol and a heating pad if necessary.

18.) What should I do if I think I have depression during pregnancy?
The most important thing to do is talk with your doctor; depression is seen frequently in pregnancy and the postpartum period. Depressive symptoms include: feelings of sadness and hopelessness, inability to find pleasure in anything, emotional lability, and thoughts of hurting yourself or others. If you have suicidal thoughts or thoughts of harming your baby, call your doctor immediately or go straight to the emergency room.

Treating depression during pregnancy is appropriate. SSRIs are the most common class of antidepressants used in pregnancy. There is some controversy regarding their use during pregnancy, but many commonly used drugs have not been associated with any long-term developmental delays or major congenital defects. Typically, a depressed mother is a greater risk to both herself and her fetus than the medicine itself..