Annual exams focus on preventive health assessments including a PAP test (depending upon a patient’s age and risk factors), pelvic exam, breast exam and any necessary laboratory testing, STD testing and medication management. Our providers will use this time to review the recommended preventive health measures based on your age and presence of risk factors.
There are all types of abnormal pap smear results, and sometimes a colposcopy is recommended to take a closer look at the abnormal areas of the cervix and to biopsy the areas of concern. The PAP test is a screening measure and not used for diagnosing cervical dysplasia(abnormal or pre-cancer cells). The colposcopy is needed to take a small biopsy of the cervix, so the tissue can be evaluated by a pathologist.
A colposcopy is performed in the office and takes approximately 15 minutes. The provider performing the colposcopy will place a speculum in your vagina and view your cervix through a colposcope. A colposcope is an instrument much like a microscope that allows the provider to see minor changes of the cervix that is not visible to the naked eye. A vinegar solution will then be placed on the cervix. This solution makes the abnormal areas on the cervix become more visible. If abnormalities are found, a small biopsy will be taken from that area on the cervix.
If cervical dysplasia (abnormal or pre-cancer cells) is found on colposcopy, your provider will likely suggest some form of intervention depending upon the severity of dysplasia. This may include more frequent pap smears, a LEEP, cryotherapy or TCA treatment.
Cryotherapy is a treatment for cervical dysplasia (abnormal or pre-cancer cells) and genital warts. This procedure involves freezing of the abnormal tissue with a small, metal probe that cools to sub-zero temperatures using liquid nitrogen. The abnormal cells are destroyed during this process, and your body will shed these cells in a watery discharge over the next few weeks.
Cryotherapy is performed in the office without any need for anesthesia. You may experience some cramping and a cold or hot sensation during the procedure. Taking ibuprofen prior to the procedure is recommended to reduce discomfort.
Loop Electrosurgical Excision Procedure (LEEP)
A LEEP is a well-tolerated office procedure that is often recommended after a pap smear and colposcopy confirm the presence of abnormal or pre-cancerous cervical cells, also known as cervical dysplasia. If a cervical biopsy reveals moderate to severe cervical dysplasia, your provider may recommend a LEEP to minimize your risk of developing cervical cancer.
Prior to the LEEP, your cervix will be numbed with a local anesthetic. LEEP uses a thin wire loop that transmits electric energy to cut away a thin layer of surface cells from the cervix. This procedure is highly successful (90-95% effective) in treating cervical dysplasia and has minimal risk of cervical scarring.
Endometrial biopsies are useful in determining the cause of abnormal uterine bleeding and post-menopausal bleeding. Also, if a pap smear indicates the presence of abnormal cells called glandular cells, an endometrial biopsy may be indicated. The biopsy results will indicate if endometrial hyperplasia, atypical or cancer cells are present.
An endometrial biopsy is most often performed in the office during a regular office visit. Your provider will perform a pelvic exam and insert a speculum in order to obtain a good view of the cervix. A small, plastic tube is gently passed through the cervix and into the uterine cavity. The tube collects a sample of the uterine lining which will be sent to a pathologist for close examination.
A pessary is a plastic device that fits into your vagina and supports your uterus, vagina, bladder and/or rectum if pelvic organ prolapse is present. When symptoms related to pelvic organ prolapse become bothersome, surgery is often indicated. However, if you are not a good candidate for surgery, a pessary may be an option. If the right pessary is fitted properly, it can help reduce symptoms of pelvic organ prolapse, including urinary incontinence and vaginal pressure/bulging.
A pessary fitting can be performed during a regular office visit. Our providers will select a type and size of pessary depending upon the particular problems you are having and your vaginal anatomy. Pessary fitting can be a trial and error process, and it may take a few tries to find the right fit.
Essure® is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. The most obvious benefits of Essure® include that it is hormone-free, and it does not require surgery or incisions. This procedure can be performed in our office in less than 30 minutes with no sedation, or conscious sedation is available if desired by the patient. There is minimal recovery time, and almost all patients return to normal activity in 1-2 days.
No incision is needed for this procedure. Soft, flexible micro-inserts are delivered through the vagina and cervix into the fallopian tubes. Over several weeks, a natural barrier forms around the micro-inserts and prevents sperm from reaching the eggs. This will not affect your body’s ability to ovulate or have menstrual cycles.
Hormone pellets are bio-identical, plant-based formulations of estrogen and testosterone compounded into tiny pellets, similar in size to a grain of rice. The hormone pellets are placed under the skin of the upper buttocks in a quick, painless procedure performed during a regular office visit. The hormones will then be slowly released over the next several months, relieving many of the most common symptoms of post-menopausal hormone imbalance.
The advantages of hormone pellets over more traditional forms of hormone replacement therapy include that it is hassle-free and provides a consistent, more physiologic release of hormones. Usually, it only takes 1-3 days to obtain relief of menopausal symptoms after the pellets have been placed, and the positive effects from the pellets can last from 3-6 months.
Endometrial Ablation (NovaSure®)
Endometrial ablation is indicated for the treatment of heavy, abnormal uterine bleeding of benign cause in pre-menopausal women who do not desire future fertility. In the appropriate patients, endometrial ablation is a safe and effective alternative to hormonal treatments for heavy bleeding or hysterectomy. The procedure is relatively quick (15-20 minutes), free of incisions and results in little to no pain following the procedure. Endometrial ablations are performed in the office with local anesthesia and conscious sedation performed by on-site anesthesia personnel. Recovery from endometrial ablations is very quick, and you should be back to regular activities in a day or two.
The vast majority of women report lighter periods following an endometrial ablation, and many stop having periods all together. An endometrial ablation will not affect your hormones in any way and will not resolve any hormonal symptoms you may be experiencing. It is important to use an effective method of contraception following endometrial ablation, as you should not get pregnant after having this procedure.
Dilation & Curretage
Dilation & Curretage (D&C) is common procedure most often performed when irregular, heavy and/or post-menopausal bleeding is present. It can also be used to clean the uterine lining after an incomplete miscarriage. This procedure involves dilating the cervix and using a curette to remove endometrial (uterine lining) tissue for examination by a pathologist to help diagnose the cause of abnormal uterine bleeding. Additionally, uterine polyps and small fibroids that extend into the uterine cavity can be removed during a D&C.
This procedure can be performed in the office with a local anesthetic and conscious sedation by on-site anesthesia personnel. Recovery from endometrial ablations is very quick, and you should be back to regular activities in a day or two.
A hysteroscopy is performed by inserting a thin, lighted camera through the vagina and into the uterus to assess the uterine cavity. This technique is used in the diagnosis and treatment of certain gynecologic conditions, such as endometrial polyps, hyperplasia, post-menopausal bleeding and abnormal uterine bleeding.
A hysteroscopy can be performed along with other surgical procedures in the hospital setting, or this can be performed in the office with a local anesthetic and conscious sedation by on-site anesthesia personnel. It is useful in diagnosing intrauterine conditions when performing a dilation & curettage or endometrial ablation.
A labiaplasty involves surgical reduction of the inner labia to enhance comfort and improve cosmetic appearance. This procedure will result in smaller and more symmetrical labia. Labiaplasty can be performed in the office with local anesthesia and takes approximately 30 minutes.
An IUD (intrauterine device) is a convenient, long-term birth control option that is 99% effective in preventing pregnancy. There are two types of IUDs available in the U.S., ParaGard® and Mirena®. The ParaGard® is hormone- free and lasts up to 10 years. The Mirena® contains a form of progesterone (levonorgestrel) and is proven to reduce heavy menstrual bleeding; it lasts up to 5 years.
Ideally, an IUD should be placed during your menses as this makes insertion easier. The IUD is a small, plastic device that is inserted through the cervix and into the uterus via a small plastic tube. There is discomfort and cramping associated with IUD insertion, and taking over-the-counter pain relief medication before the procedure may help. IUD removal is usually quick and painless, and you can try to become pregnant as soon as the IUD is removed.
ThermiVa is an in-office, non-surgical procedure for labia and vaginal tightening. A radio frequency generator, made by Thermi Aesthetics powers a “S” shaped hand piece that tightens external and internal vulvovaginal tissue via a thermistor tip which is able to control heat delivered. The tip has gentle curves that provide comfort. download the Thermiva FAQ
Thermi was founded on a philosophy of engaging the physician owner in the advancement of his/her specialty area of medicine. Each Thermi physician is invited to participate in our Clinical Advisory Council (CAC), an independent body that encourages collaboration and the free exchange of ideas among peers. This collegial participation accelerates learning while optimizing both clinical and financial success.
Sacral Nerve Stimulation (InterStim®)
Sacral nerve stimulation with InterStim® therapy is indicated to reduce symptoms of overactive bladder (urge incontinence and urinary frequency) and urinary retention in patients who have failed or are unable to tolerate treatment with medications. InterStim® enhances the communication between the sacral nerves and the bladder with mild electrical pulses that are delivered by a small device placed under the skin of the upper buttock.
First, a urodynamic study will be performed to evaluate your bladder condition. If sacral nerve stimulation is recommended, we will schedule you for an InterStim® trial performed in the office. A temporary wire will be placed near the tailbone and a small stimulator device will be worn on the outside, like a paging device. If you experience a significant reduction in symptoms during the evaluation period of 3 to 7 days, a long-term neurostimulator can be placed under the skin during a minimally-invasive, outpatient procedure.