The physician examines the external genitals (vulva and perineum), the vagina and the cervix with a speculum, and the uterus and the ovaries to determine overall health.  A pelvic exam is recommended annually.

A pap smear is a simple screening procedure for cervical cancer and pre-cancer. Cervical cancer is caused by the Human Papilloma Virus (HPV). HPV is a common, sexually transmitted virus and usually has no symptoms or warnings. The new vaccine to protect against HPV is now available in our office for patients between the ages of 9 and 26. HPV testing may also be done with the pap smear.

We recommend women in their twenties have a pap smear bi-annually, or more often if you are classified as high risk. Your first pap smear should occur at age 21. Between age 30 and 70, your doctor will advise you on the recommended frequency of pap smears based on your individual risk factors, though generally the pap smear will be done less than annually.

As part of your routine pelvic exam, your doctor will gently manipulate your breasts to feel for any lumps or irregularities. She will also examine your breasts for unusual discoloration, dimples or puckering of the nipple.

The purpose of breast self-exams is to learn what your breasts feel like so you can notify your doctor of significant changes. We encourage our patients to perform breast self-exams at least once a month. Most women find this easiest to do in the shower or lying flat on their backs. Use a gentle rotating motion to feel your breasts and call your doctor if you feel any lumps or notice an external change such as discharge from the nipple, dimpling or puckering of the nipple, redness or scaliness. The American Cancer Society offers an excellent description of how to conduct a breast self-exam:

http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-detection

There are a number of options available to women seeking to prevent pregnancy, although no method is 100 percent guaranteed. They include:

• Diaphragms
• Oral contraceptive pills, patches or rings
• Progesterone injections
• Intrauterine devices
• Sterilization
• "Natural" methods such as timing intercourse to avoid ovulation

The colposcopy is performed in the office and takes about 15 minutes. We examine the patient's cervix under magnification, rinse the cervix with several solutions and obtain very small biopsies after using local anesthesia. Patients might have some light bleeding afterwards with some mild cramping, but can resume normal activities immediately. Results take a little over a week.

Our doctors administer a local anesthetic (lidocaine) and perform this brief procedure. We remove the abnormal cells and some of the surrounding cervical tissue. Afterwards, patients might experience some discharge, bleeding and cramping for a couple of days, and they are asked to refrain from sexual intercourse for two weeks following the procedure.

Yes, this is a very common procedure done in the office where we obtain tissue samples from the lining of the uterus. Patients might feel cramping during the procedure and some mild cramping and spotting afterwards, but normal activities can be resumed the same day.

Fibroid tumors grow in the uterus. Most are benign, but very rarely they can be malignant. Symptoms can include pelvic pain, increased menstrual flow, infertility, constipation and bloating.

Myomectomy is the surgical removal of fibroid tumors. It ranges from hysteroscopic removal to laparoscopic procedures where the fibroid is destroyed, to a more traditional surgical approach where an incision is made and the fibroid is removed.

Hysterectomies are performed to treat a variety of conditions including symptomatic fibroids, heavy menses, prolapse, various cancers of the reproductive organs, severe endometriosis and chronic pelvic pain. It is sometimes recommended for patients as a preventive measure if they have a strong family history of reproductive organ cancers.

A hysteroscopy is a minor surgical procedure used to evaluate and possibly treat the cause of abnormal bleeding or possible abnormalities in your uterus. Your doctor inserts a very thin sterile telescopic device attached to a camera through the cervix and into the uterus so she can see if there are any growths or abnormalities. It is performed along with a D&C.

Known as a "D&C", this procedure is used to obtain a sample of the lining of the uterus for examination. The cervix is dilated and the lining of the uterus is gently scraped with an instrument known as a curette. This is sometimes done to complete a miscarriage.

After testing positive with a  pregnancy test, please call our office  and we will schedule an appointment approximately 8 weeks after your last period.

It is best during pregnancy to avoid fish that contains Mercury (swordfish, shark and mackerel). We also suggest avoiding alchol, processed deli meats, unpasteurized chees and undercooked meat, poultry and fish.

For most women, sex is safe during pregnancy. However if if  has been determined that your pregnancy is high risk or  you have a specific concern please speak to your provider directly.

Moderate excersice is safe during pregnancy and may even help with  labor. Speak to your physician about your excise regimen before beginning.

Past 35 weeks we do not recommend air travel. Speak to your physician if you need travel afer 35 weeks. There are precautions you can take to minimize the risk of  blood clots  when traveling.

We do recommend receiving a flu shot during pregnancy.

Menopause is the end of menstruation, and typically occurs between the ages of 47-55, although perimenopause may begin years earlier. Many women experience irregular periods, vaginal dryness, night sweats or sleep problems indicating they are entering the transition to menopause. Blood tests to measure hormone levels to  determine if you are experiencing menopause may be done, if necessary.

Replacement hormones may be used to treat symptoms of menopause and prevent or at least postpone some of the symptoms from the  lack of estrogen. We work individually with each patient to determine the most effective treatment, which may or may not include hormone replacement therapy.

Continue using your birth control method for a year after your final period.