In addition to providing regular gynecological exams, we are experts in treating women’s issues such as pelvic organ prolapse, urinary incontinence, fibroids and more.
Many women suffer with pelvic floor and pelvic health issues in silence. Our team includes top providers with subspecialties in female pelvic medicine and reconstructive surgery.
If you have pelvic pain, urine leakage or other symptoms, consult with our experienced providers and get back to the activities you enjoy.
During normal menstrual cycles two hormones are produced (estrogen and progesterone). Together these hormones go through cycles that cause the lining of the uterus to grow and then shed (this shedding is the bleeding of your period). Abnormal bleeding is any of the following: bleeding between periods, bleeding after sex (postcoital bleeding), spotting anytime, bleeding heavier than normal or for more days than normal, bleeding after menopause, bleeding for longer than 35 days or less than 21 days, or a lack of periods for 3-6 months.
Causes: Causes of abnormal bleeding include pregnancy, miscarriage, ectopic pregnancy, adenomyosis, some birth control, infections, fibroids, polyps, blood clotting disorders, PCOS, and rarely cancer or precancer of the uterus, cervix or vagina.
Diagnosis: Your age group will determine a lot of the questions and exams that are done. Questions asked will involve your medical problems, medications, birth control, weight, eating and exercise habits and stress. The following tests may be appropriate: ultrasound,
Treatment: Treatment depends on the cause of bleeding, your age, and whether or not you want children. Options for treatment include hormonal contraception, NSAIDs, Lysteda (a medication that is used specifically to decrease heavy bleeding), uterine artery embolization, hysteroscopy, endometrial ablation, or a hysterectomy.
Uterine fibroids are masses in the uterus that are not cancerous. They are very common in adult women. They can range in size from small pea-sized growths to very large one the size of a grapefruit or even a basketball. They can remain small for years or start to grow suddenly.
Causes: We don’t know what causes fibroids but they only seem to grow when a woman is making
hormones before she goes through menopause. Fibroids can shrink slightly when menopause occurs.
Symptoms: Women can have varying signs: heavy periods, pain in the pelvis, pressure in the pelvis, a large abdomen (in the case of very large fibroids), miscarriages, and infertility.
Diagnosis: A physical exam and an ultrasound can diagnose fibroids.
Treatment: Many fibroids do not require treatment. They can be small and cause no problems. Some medications can help with the problems caused by fibroids including hormonal birth control and Lupron. Surgery can be used in some cases. Surgical removal of fibroids is called a myomectomy and can be accomplished using Robotic Surgery or laparoscopy or a laparotomy (a large abdominal incision). Removing fibroids can cause excessive blood loss and should be discussed with your doctor at length before choosing this option. An endometrial ablation destroys the lining of the uterus permanently and can be used to decrease bleeding and pain caused by fibroids. A uterine artery embolization can be used to cut off the blood supply to the fibroids causing them to stop growing or shrink. Hysterectomy is used as a definitive treatment for fibroids, removing the uterus and all the fibroids in one surgery.
Leaking urine is called “incontinence of urine”. It is a very common problem for women and it can be mild or very severe. There are a few different types of incontinence. Stress incontinence is leakage of urine with coughing or sneezing. Urge incontinence is when urine leaks after a strong urge to urinate sends you running to the bathroom and you can’t make it. Mixed incontinence is when you have both stress and urge. Overflow incontinence is when a woman has small steady leaks of urine.
Symptoms: A strong urge to urinate, frequent urination, night-time urination, painful urination, or bed wetting can all be associated with urine leakage.
Causes: There can be many causes of incontinence – some are short-term and some are long term. Short-term causes can be due to bladder infections, pregnancy, or medications. Long-term causes can be due to pelvic organ prolapse, abnormalities in the urinary tract, and medical problems like diabetes, strokes or multiple sclerosis.
Diagnosis: A history from the patient is very useful in diagnosing what type of incontinence and its possible causes. A diary is a useful tool – this is when a woman writes down when she loses urine and what she has had to eat or drink during the day. A pelvic exam is always part of the diagnosis. Complex tests called Urodynamics may be used when incontinence is complicated.
Treatment: Options for treatment depend strongly on the type of incontinence. For most types of incontinence, lifestyle changes can help: losing weight (if overweight or obese), avoiding constipation, drinking less caffeine, and smoking cessation (very important).
Stress incontinence: There are many available treatments including bladder training and physical therapy with or without InTone treatment.
Urge incontinence: Treatments include bladder training and physical therapy. Medications are used for many patients but can have side effects such as dry mouth and constipation. An implanted device called Interstim can be used in some cases as a permanent fix.
One-half of women have pelvic organ prolapse. This happens when the pelvic organs are no longer well supported by the muscles and fascia of the pelvic floor and the organs can drop downward, protruding from the vagina.
Symptoms: Symptoms include feeling a bulge out of the vaginal opening or a sensation of fullness in the pelvis. Urinary and fecal incontinence can happen with the prolapse.
Diagnosis: This includes a pelvic exam and sometimes an evaluation of the bladder.
Treatment: These options vary from person to person. They can include Physical Therapy and Kegel exercises or a Pessary which is a small plastic device placed in the vagina. Pessaries can be left in the vagina for weeks or months and removed and cleaned and reinserted in your own home or in the doctor’s office.
Surgery is also an option but is usually reserved for patients who are done with their childbearing years. The types of surgery include:
This is a medical condition that occurs when the lining of the uterus (the endometrium) is found outside of the uterine cavity. It can be found on the ovaries or fallopian tubes or many other locations in the abdomen and body. It occurs in approximately 1/10 women.
Symptoms: Signs of endometriosis range from nothing to severe pain and sometimes infertility. This can be found in women who are newly menstruating in their teens up into your 40s.
Diagnosis: This disease can be diagnosed through a pelvic exam and a detailed history of other issues. The history of the patient can lead to a presumptive diagnosis but the only way to definitively diagnose endometriosis is through surgery. An exploratory laparoscopy is a surgery where a small incision is made in the belly button and a camera is placed in the abdomen so that the pelvis can be inspected. Endometriosis can be visualized and removed.
Treatment: Once endometriosis is suspected or diagnosed via surgery it can be treated with a number of medications. NSAIDs like Ibuprofen can be used but the mainstay of treatment is Birth Control Pills or any hormonal birth control like a Mirena IUD or Depo Provera Shot. Another treatment option is Lupron which is a medication that stops the ovaries from making hormones. The endometriosis shrinks and stops causing as much pain while the Lupron is working. Sometimes people with endometriosis have multiple surgeries or even a hysterectomy as
Pain with periods is called Dysmenorrhea. It is the most common side effect of periods. Primary dysmenorrhea is when a period hurts due to the period itself (instead of other problems in the pelvis). This is caused by a high level of hormones on the day of the period itself (they’re called prostaglandins). These hormones decrease as the days go by which is why the first days are usually the worst. Secondary dysmenorrhea is when other problems cause painful periods. This can be caused by endometriosis, adenomyosis, fibroids, or even infectious diseases.
Diagnosis: Diagnosis can be made by a history and a physical exam. Sometimes ultrasounds or surgery like laparoscopy is necessary for diagnosis.
Treatment: There are many ways of finding relief from painful periods. Exercise helps produce pain-blocking chemicals. Applying heat helps, as does sleeping well. Relaxation techniques such as meditation or yoga may also help. Medications that may help include hormonal birth control like Birth Control Pills or a Mirena IUD. Surgery may be needed in extreme cases.
Painful sexual intercourse is called Dyspareunia. This pain can occur occasionally or every time a woman has sex. Lack of desire to have intercourse can be part of painful sex and can be associated with
Symptoms: Pain can occur because of issues with the vulva (the outside lips of the vagina) or the vagina itself or pain from deep within the pelvis.
Diagnosis: A diagnosis is made with a full physical exam, sometimes a pelvic ultrasound or even a surgery such as a laparoscopy. Questions that may help figure out the etiology of the problem: How long has this happened? At what point during sex do you feel the pain? Do you feel arousal during sex? Is a tampon or finger placed in the vagina painful?
Treatment: Qualified sex therapists can be found at the American Association of Sexuality Educators, Counselors and Therapists http://www.aasect.org.
The ovaries are small oval-shaped organs that make hormones and the eggs that create a pregnancy when combined with sperm.
Types of cysts: Some ovarian cysts are normal and happen every month (these are called functional cysts). Other
Symptoms: Most cysts cause no symptoms however some may cause pain or a dull ache in the abdomen. In some cases, a cyst may be cancerous or precancerous but simple cysts are rarely cancerous.
Diagnosis: Vaginal ultrasound is used to evaluate most cysts but they are often found initially on physical exam or by symptoms a patient describes.
Treatment: Laparoscopy can be used to remove cysts and give a definitive diagnosis. However many cysts do not require removal because they will resolve on their own. Watching cysts over several months can be an easy way of avoiding unnecessary surgery. Usually, a cyst can be removed from the ovary but sometimes one ovary is removed during the surgery. If one ovary is removed it does not necessarily affect any fertility or future hormone production.