Annual Exam
An annual well-woman exam is part of your overall health maintenance. This exam is important throughout all phases of a woman’s life. The focus of your exam changes as you mature. A well-woman exam can be divided into four components:
- A discussion of your health history with your physician
- A general physical exam, including your weight and blood pressure
- A breast exam, to check for lumps or fibrocystic changes
- A pelvic exam, to check your abdomen, pelvis and vagina for any abnormalities
Your physician may perform a pap smear, depending on your age and your health history. It is important to ask questions if there is any information you don’t understand. Your physician may order lab work or additional testing, depending on your exam.
A gynecologic visit focuses on your reproductive organs and your physical health. Your doctor will ask questions about your health and your family’s health. We know that your first gynecology visit can be intimidating and we want you to be as comfortable as possible. We encourage you to ask questions if there is information that you do not understand. Your physician may ask questions about your health that may seem personal or private. It is very important to be open and honest with your physician. The information you provide will help your physician to keep you healthy and know how best to care your individual needs.
During your gynecological visit, you will have a general physical exam. We will check your weight, height, and blood pressure. We will also ask you questions about your health history and whether you have any special concerns. This visit may also include the following:
- Breast exam: Your physician will check your breasts for any abnormal symptoms, such as lumps or discharge
- Pelvic exam: Your physician will examine your abdomen, pelvis, and vagina
- Pap test: A Pap smear takes a sample of the cells of the cervix, which is the opening of the uterus; This test is used to find abnormalities on the cervix that could lead to cancer; Your physician will discuss when it will be appropriate to have regular Pap tests
Based on the results and findings of your first exam, your physician may make recommendations for any appropriate follow-up care.
Contraception
Birth Control Pills
Birth control pills contain hormones that prevent ovulation. These hormones also cause other changes in the body that help prevent pregnancy. The mucus in the cervix thickens, which makes it hard for sperm to enter the uterus. The lining of the uterus thins, making it less likely that a fertilized egg can attach to it. With typical use, about 8 in 100 women (8%) will become pregnant during the first year of using this method. When used perfectly, 1 in 100 women will become pregnant during the first year. To be effective at preventing pregnancy, the pill must be taken every day at the same time each day. There are two basic types of birth control pills: 1) combination pills, which contain the hormones estrogen and progestin, and 2) progestin-only pills.
Depo Provera
Depo-Provera is a birth control method for women, made up of a hormone similar to progesterone and given as an injection by a doctor into the woman’s arm or buttocks. Each shot provides protection against pregnancy for up to 14 weeks, but the shot must be received once every 12 weeks to remain fully protected. Birth control with Depo-Provera begins immediately after the first shot if given within the first five days of your menstrual period. Depo-Provera is 99% effective in preventing pregnancy and does not prevent spreading of STDs.
IUD
An IUD is a small, T-shaped plastic device that is wrapped in copper or contains hormones. IUDs prevent fertilization of eggs by damaging or killing sperm. IUDs also affect the uterine lining (where a fertilized egg would implant and grow). IUDs are among the most effective forms of birth control available.
Mirena
Mirena is intrauterine birth control that’s over 99% effective at preventing pregnancy. It’s made of soft, flexible plastic and placed into your uterus by your healthcare provider during a routine office visit. Mirena releases small amounts of hormone directly into the uterus and lasts as long as YOU want, for up to 5 years. It is important to note that Mirena is recommended for women who have had a child. Mirena does not protect against HIV or STDs.
ParaGard
ParaGard has been available to women for over 20 years in the U.S. It’s the only reversible birth control that’s more than 99% effective and 100% hormone free. In fact,
it’s one of the most effective forms of birth control available, and it lasts as long as you want: two, five, even up to 10 years. Unlike many other forms of birth control, ParaGard won’t interfere with your natural menstrual cycle. Generally your doctor can place ParaGard within minutes during a routine office visit and your doctor can remove it at any time if you decide you want to have children later; you can even start trying to get pregnant that same day.
Management of Abnormal Pap Test
The Pap test checks for changes in the cervix that may become cancer. In women who have regular Pap tests, abnormal changes are almost always caught early. If your Pap results are abnormal, your physician may recommend additional testing such as: a repeat pap smear, HPV testing, or a colposcopy. These tests help us determine whether your results are mildly abnormal or precancerous. Your physician will work with you to find the most appropriate treatment options and help you to develop a plan of care. It is important to follow treatment recommendations made by your physician, as our goal is to keep you as healthy as possible.
Colposcopy
Your physician may perform a colposcopy if your Pap test results show abnormalities that may lead to a more serious condition. A colposcopy provides additional information about abnormal changes in the cervix, and can be used to assess problems such as abnormal bleeding, cervical polyps, or cervicitis. Your physician will apply a mild solution to your cervix that allows easier visualization of the abnormal area(s). Then, she will use a magnifying device called a colposcope to look at your cervix more closely. A biopsy of any abnormal area(s) found on the cervix may be taken during the exam. This involves taking a small tissue sample and sending it to the lab for analysis. Your physician may also take a sample of the cells from the canal of the cervix. This is called an ECC (endocervical curettage). We will develop your plan of care once we receive your lab results. During the exam, you will lie on your back on a table while a moveable x-ray arm passes over your hip and spine. You will not feel any discomfort during the procedure and it will take about 30 minutes to complete. A computer will compare your results to others whose age, sex, and racial background are similar to yours. Your doctor will interpret the results and make the appropriate recommendation.
Loop Electrosurgical Excision Procedure (LEEP)
Loop Electrosurgical Excision Procedure (LEEP) is a safe method to remove abnormal tissue from the cervix called dysplasia, which might otherwise progress to cancer. A colposcope allows the physician to see a magnified view of the dysplasia on the cervix. A local anesthetic is used to numb the cervix and the abnormal portion of the cervix is removed with a thin wire loop carrying a small electrical current. The tissue that is removed is sent to the lab for analysis. You may feel some cramping during the procedure, but the procedure takes only a few minutes. You will have some vaginal discharge and light bleeding after the procedure. This is normal. Usually, the cervix will heal completely in about one month.
PMS
PMS is a collection of emotional symptoms (with or without physical symptoms) related to a woman’s menstrual cycle. While most women of child-bearing age (up to 85%) report having experienced physical symptoms related to normal ovulatory function, such as bloating or breast tenderness, medical definitions of PMS are limited to a consistent pattern of emotional and physical symptoms occurring only during the luteal phase of the menstrual cycle that are of “sufficient severity to interfere with some aspects of life.” In particular, emotional symptoms must be present consistently to diagnose PMS. The specific emotional and physical symptoms attributable to PMS vary from woman to woman, but each individual woman’s pattern of symptoms is predictable, occurs consistently during the ten days prior to menses, and vanishes either shortly before or shortly after the start of menstrual flow.
Two to ten percent of women have significant premenstrual symptoms that are separate from the normal discomfort associated with menstruation in healthy women. Culturally, the abbreviation PMS is widely understood in English-speaking countries to refer to difficulties associated with menses, and the abbreviation is used frequently even in casual and colloquial settings, without regard to medical rigor. In these contexts, the syndrome is rarely referred to without abbreviation, and the connotations of the reference are frequently more broad than the clinical definition.
Infertility
Our providers are dedicated to helping you achieve pregnancy if that is your goal. We strive to provide our patients with the most comfortable experience possible, while providing individualized treatment. During your initial preconception visit, your provider will develop a specialized plan that meets your needs. This plan will serve as a guideline for your care. Your provider will review all pertinent personal and family history. Providing any information about known family genetic disorders is very important. Your provider will also perform a pelvic exam, even if you have had an annual exam within the past year. Please provide documentation of recent labs or diagnostic testing in order to prevent duplication. If at any time there is information that you do not understand, please ask your provider. We encourage our patients to ask questions at every visit! If your plan of care needs to be modified, you may be asked to make an appointment with your physician. Our goal is to facilitate the best care possible for you.
STDs
Sexually transmitted diseases (STDs) are caused by infections that are passed from one person to another during sexual contact. These infections often do not cause any symptoms. Medically, infections are only called diseases when they cause symptoms. That is why STDs are also called “sexually transmitted infections.” But it’s very common for people to use the terms “sexually transmitted diseases” or “STDs,” even when there are no signs of disease.
There are many kinds of sexually transmitted diseases and infections. And they are very common — more than half of all of us will get one at some time in our lives. The good news is we can protect ourselves and each other from STDs. Practicing safer sex allows you to reduce your risk of getting sexually transmitted diseases. And if you’ve done anything that puts you at risk of infection, getting tested allows you to get any treatments you may need. If you are sexually active, you should get tested for HIV, chlamydia, or gonorrhea, three dangerous STDs, with The Check.
Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome, or PCOS, is a hormonal disorder than can cause irregular periods, acne, difficulty becoming pregnant, obesity, or excess hair on the face and body, also known as hirsutism. In order to diagnose PCOS, your physician will do a thorough exam that may include lab work, an ultrasound exam, and a work-up of your personal health history. This is a chronic condition that can be treated with lifestyle changes, such as altering your diet, weight loss, and regular exercise and/or medication. Your physician will discuss different treatment options and help you to develop a long-term plan of care.
Endometriosis
Endometrial tissue, or the tissue that makes up the lining of the uterus, can sometimes grow in other areas of the pelvis. This is called endometriosis. This tissue responds to normal hormonal changes and bleeds like the lining of the uterus. This can cause adhesions, chronic pelvic pain and or painful periods. Sometimes, endometriosis can be a cause of infertility.
Symptoms of endometriosis can be chronic and may range from very mild to very severe. Treatment options range from medication to surgery or both. Your physician will work with you to find the most appropriate treatment options and help you to develop a plan of care.
Fibroids
Uterine fibroids, or leiomyoma, are growths associated with the uterine lining or muscle that can cause abnormal bleeding, painful periods, pelvic pain, or infertility. Fibroids can be detected by a pelvic exam or ultrasound. Some fibroids are small and do not require treatment. However, depending on the size, location, and number of fibroids in the uterus, medication and or surgery may become necessary. Your physician will recommend treatment options based on your symptoms and physical condition.
Menopausal Management
Menopause generally requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. Treatments may include:
- Hormone therapy. Estrogen therapy remains, by far, the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. If you still have your uterus, you’ll need progestin in addition to estrogen. Estrogen also helps prevent bone loss. And hormone therapy may benefit your heart if started within five years after your last menstrual period.
- Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
- Low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. A low-dose antidepressant for management of hot flashes may be useful for women who can’t take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
- Gabapentin (Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can’t use estrogen therapy and in those who also have migraines.
- Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures.
Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.
Bio-identical Hormone Replacement Therapy
Menopause generally requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. Treatments may include:
- Hormone therapy. Estrogen therapy remains, by far, the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. If you still have your uterus, you’ll need progestin in addition to estrogen. Estrogen also helps prevent bone loss. And hormone therapy may benefit your heart if started within five years after your last menstrual period.
- Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
- Low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. A low-dose antidepressant for management of hot flashes may be useful for women who can’t take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
- Gabapentin (Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can’t use estrogen therapy and in those who also have migraines.
- Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures.
Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.
Bio-identical Hormone Replacement Therapy
When going through menopause many women find they can no longer deal with the hot flashes, night sweats, sleeplessness, irritability, mood swings and other menopausal symptoms that come with a vengeance. This symptoms occur because of the estrogen and progesterone depletion in the body. In order to get the symptoms under control and hormone levels back to normal, our providers prefer using bio-identical hormone replacement therapy.
The interest in a more natural approach to hormone therapy has focused attention on bio-identical hormones — hormones that are identical in molecular structure to the hormones women make in their bodies. They’re not found in this form in nature but are made, or synthesized, from a plant chemical extracted from yams and soy. Bio-identical estrogens are 17 beta-estradiol, estrone, and estriol. (Estradiol is the form of estrogen that decreases at menopause.) Bio-identical progesterone is simply progesterone. It’s micronized (finely ground) in the laboratory for better absorption in the body.
Bio-identical hormone therapy is often called “natural hormone therapy” because bio-identical hormones act in the body just like the hormones we produce. Technically, the body can’t distinguish bio-identical hormones from the ones your ovaries produce.
Before deciding on any form of treatment, Dr. Mendes or provider will talk to you about your options and the risks and benefits involved with each. She will review your options yearly, as your needs and treatment options may change.
Osteoporosis
Osteoporosis causes bones to become weak and brittle — so brittle that a fall or even mild stresses like bending over or coughing can cause a fracture. Osteoporosis-related fractures most commonly occur in the hip, wrist or spine. Bone is living tissue, which is constantly being absorbed and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the removal of old bone. Medications, healthy diet and weight-bearing exercise can help prevent bone loss or strengthen already weak bones.
DXA Scan
Dual X-ray absorptiometry (DXA) is the preferred technique for measuring bone mineral density (BMD). DXA has also been called dual energy X-ray absorptiometry, or DEXA. DXA is relatively easy to perform and the amount of radiation exposure is low. A DXA scanner is a machine that produces 2 X-ray beams, each with different energy levels. One beam is high energy while the other is low energy. The amount of X-rays that pass through the bone is measured for each beam. This will vary depending on the thickness of the bone. Based on the difference between the two beams, the bone density can be measured. At present, DXA scanning focuses on two main areas — the hip and spine. Although osteoporosis involves the whole body, measurements of BMD at one site can be predictive of fractures at other sites. Scanning generally takes 10 to 20 minutes to complete and is painless.
Pelvic Ultrasound
Ultrasounds, also called sonograms, are exams that use sound waves to create images of internal organs. Ultrasounds are done to assess possible gynecological medical conditions, such as pelvic/abdominal masses, fibroids, and to determine possible causes for pelvic pain and or abnormal bleeding. During pregnancy, ultrasounds are used to assess the well-being of the fetus. Typical obstetric ultrasounds can show the placement of the fetus and the placenta, the number of fetuses, the heart rate, growth, breathing, and movement of the fetus, and the estimated gestational age of the fetus.
There are two types of ultrasounds: transabdominal and transvaginal ultrasounds. A transabdominal ultrasound is performed by rolling a device called a transducer back and forth across the abdomen. A transvaginal ultrasound is performed by inserting a wand-shaped transducer into the vagina.
Gynecology Surgery
Hysterectomy
There are 3 types of hysterectomy vaginal hysterectomy; abdominal hysterectomy and laparascopic hysterectomy.
Vaginal Hysterectomy
In a vaginal hysterectomy, the uterus is removed through the vagina. Because the incision is inside the vagina, the healing time may be shorter than with abdominal surgery. There may be less pain during recovery. Vaginal hysterectomy causes fewer complications than the other types of hysterectomy and is a very safe way to remove the uterus. It also is associated with a shorter hospital stay and a faster return to normal activities than abdominal hysterectomy.
Abdominal Hysterectomy
In an abdominal hysterectomy, the surgeon makes an incision through the skin and tissue in the lower abdomen to reach the uterus. This type of hysterectomy gives the surgeon a good view of the uterus and other organs during the operation. This procedure may be chosen if you have large tumors or if cancer may be present. Abdominal hysterectomy may require a longer healing time than vaginal or laparoscopic surgery, and it usually requires a longer hospital stay.
Laparoscopic Hysterectomy
In a laparoscopic hysterectomy, a laparoscope is used to guide the surgery. A laparoscope is a thin, lighted tube that is inserted into the abdomen through a small incision in or around the navel. It allows the surgeon to see the pelvic organs on a screen. Additional small incisions are made in the abdomen for other instruments used in the surgery. In a total laparoscopic hysterectomy, the uterus is detached from inside the body and then removed in small pieces through the incisions or through the vagina. In a laparoscopic assisted vaginal hysterectomy, the uterus is removed through the vagina, and the laparoscope is used to guide the procedure. In a robot-assisted laparoscopic hysterectomy, the surgeon uses a robot attached to the instruments to assist in the surgery.
Laparoscopic Tubal Ligation
A tubal ligation “getting your tubes tied” is considered a permanent method of birth control. The fallopian tubes are cut or blocked, which prevents pregnancy by blocking the egg’s path to the sperm and uterus. Laparoscopy makes it possible to see and do the surgery through small incisions in the abdomen.
For a laparoscopic tubal ligation,the surgeon makes two small incisions-one in or just below the belly button (navel) and one at the upper edge of the pubic hair. The abdominal cavity, where the reproductive organs are, is inflated with air or a harmless gas so that the surgeon can see and avoid injuring abdominal organs or the inside of the abdomen.
The surgeon inserts a thin, lighted viewing tube (laparoscope) through the incision. The laparoscope has a lens that magnifies what the surgeon is viewing. The instrument that the surgeon uses to cut (ligate) the tubes may be inserted alongside the laparoscope or through the incision just above the pubic hair. The surgeon looks through the laparoscope while moving this instrument to get the tubes cut in the correct location.
Essure Tubal Occlusion
While both Essure and tubal ligation, or “getting your tubes tied” offer women a permanent birth control solution, the Essure procedure is a quick surgery-free procedure that does not require general anesthesia and has a faster recovery time. During this quick procedure, a doctor places the soft, flexible Essure inserts into your fallopian tubes through the natural pathways of your vagina and cervix, so no incision is necessary. The inserts are made of the same material that is used and proven safe in heart stents and other medical devices.
Over the next three months, your body works with the inserts to form a natural barrier in your fallopian tubes. This barrier prevents sperm from reaching the egg so that pregnancy cannot occur. During this three-month period, you must continue to use another form of birth control.
Endometrial Ablation
Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used.
Endometrial ablation destroys a thin layer of the lining of the uterus and stops the menstrual flow in many women. In some women, menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be required.
MonaLisa Touch®
MonaLisa Touch® is a new and exciting vaginal rejuvenation laser treatment performed by Dr. Celia Mendes. If you suffer with symptoms such as vaginal dryness, irritation, laxity, burning, pain during sexual intercourse, or mild urinary urgency or incontinence, this treatment can change your life. MonaLisa Touch® is a simple and safe non-surgical approach to gynecological health that is performed in the office. It treats the symptoms of vaginal health by generating new collagen, elastin and vascularization of the vaginal mucosa using a gentle fractional CO2 laser with a vaginal probe. With three less than 5 minute treatments every 6 weeks, this virtually painless procedure is clinically proven to bring lasting relief with overwhelming positive and immediate results.
What are the benefits of this treatment?
MonaLisa Touch® allows for a functional restoration of the vagina (Vaginal Laser Rejuvenation), which helps fighting and attenuating symptoms related to vaginal atrophy, a widespread problem among pre and postmenopausal women. Thanks to its action on factors that determine dryness, fragility and loss of mucosal elasticity, this treatment can eliminate troublesome itching, irritation and pain, which become particularly acute during intercourse. The interaction with laser is, in fact, the ideal method to stimulate the collagen contained in the vaginal walls for the rehydration and functional tissue restoration. Its beneficial action can contribute to improve self-confidence and sexual pleasure.
For which women is MonaLisa Touch® laser treatment most suitable?
For any woman who wants to prevent or treat the vaginal symptoms due to estrogenic decrease (in menopause, after a childbirth, after a cancer treatment, or after an eating disturb –anorexia) . Most common symptoms vaginal dryness, irritation, laxity, burning, pain during sexual intercourse and mild urinary urgency or incontinence. MonaLisa Touch® is the ideal treatment for those who are looking for a less invasive procedure. Talk with Dr. Mendes to see if this procedure is right for you.
What type of results can I expect?
Most treated patients report a reduction in dryness, burning sensation, pain during intercourse, and urinary symptoms which contributes to a substantial improvement in the quality of life. These results are possible, thanks to the stimulation of the mucosa, which regenerates and rejuvenates.
Can MonaLisa Touch® be used to treat vaginal laxity?
The term “loose vagina” refers to a condition where the diameter of the vagina has increased. This is often caused by natural yet traumatic events, such as giving birth or tissue relaxation due to a natural ageing process. In these cases, it is essential to evaluate the cause and the state of the vagina to exclude a prolapse or an involvement of the muscles. The CO2 fractional laser allows treating those cases where the “loose vagina” is due to a mucosal tone loss.
Is it painful?
No, it is virtually painless. No anesthesia is required. The sensation is a light vibration.
How many treatments are needed?
It depends on how serious the symptoms are. It is recommended to get 3 treatments, 6 weeks apart, followed by an annual maintenance treatment. In any case, it will be up to Dr. Mendes, after careful examination, to evaluate and recommend the best treatment plan for you.