I had a patient today who insisted on staying on birth control because she was terrified of getting pregnant.  She’s fifty three.  I have come to realize that many women believe, fiercely, that they are still fertile way into their 40s and 50s.  They believe that spin classes and eight servings of bottled water a day, will mean that they can wait until they are in their 40s to start thinking about children….just like Halle Berry.  On this point, I have always thought it unfair that many celebrities do not disclose the emotional and financial costs of getting pregnant when older.  Invitro fertilization, donor egg (using the egg of another or younger woman), even donor sperm, all costs money!  And, depending on the State in which you live, these interventions may not be covered. Read more…

Interestingly enough, even as a gynecologist, I hear a lot about erectile dysfunction (ED)—the inability to achieve or maintain an erection to complete sexual activity.  Women do get frustrated when their sexual partners cannot perform.

Keep in mind, men suffer from some of the same ailments that women do, namely emotional and relationship problems that get them down…no pun intended.

But, I wanted to alert you about the fact that erectile dysfunction can be a sign of serious medical problems like coronary heart disease, hypertension and diabetes.  Diabetes can affect the penile nerves and atherosclerosis (build up of fatty material like cholesterol in the arteries) also affects the penis! Read more…

A myomectomy is another option for the treatment of leiomyomas (lie-o-my-o-mas), generally known as fibroids.  This too can be done via an abdominal incision, laparoscopically or via the vagina.  The location, size, number of fibroids and the desire to preserve future fertility are the four major factors that determine which route is used.

In general, this procedure is reserved for patients who want to keep their uterus for future childbearing. Incisions are made in the uterus itself and the fibroids are “shelled out”.  Because the uterus has such a vibrant blood supply and because the technique involves multiple cuts into the uterus, there can be a fair amount of bleeding.  Sometimes, 1/1000, the uterus cannot be saved because it has been completely ‘taken over’ by the fibroids and the patient will need a full hysterectomy. Read more…

Most women are terrified of Human papillomavirus (HPV).  But, once you enter the world of sex, an infection with HPV is almost inevitable.  If you have one lifetime partner, who in turn, has only had sexual relations with you, you might have a shot.  Keep in mind that HPV is transmitted even without penile penetration. Contact with the genitalia is enough!  The good news is that a healthy immune system, one not weakened by chronic disease, smoking or certain medications, will usually clear the virus in a matter of months.  It’s true that some women continue to harbor the virus and these women are most at risk for abnormal pap smears that signal worrisome changes on the cervix (also referred to as dysplasia or ‘pre-cancerous changes’).  Don’t have a melt down!  It takes many years to progress from an abnormal pap smear to cervical cancer.  For most, close monitoring is all that is needed.  For others, a simple procedure to remove the abnormal area on the cervix can be done in about ten minutes.

Testing for HPV helps us to target those women who need to be followed closely.  It’s up to you to remember to keep your annual gynecological visits.

There you have it, now spread the word!

What are the treatment options for women with fibroids? With the next few posts, I’ll review each one.

Hysterectomy is still the most common treatment for uterine fibroids.  The uterus can be removed via the abdomen with a “bikini cut”, via the vagina or by way of a laparoscopic procedure.  A laparoscopic procedure involves placing narrow instruments through small incisions; the uterus is cut into small pieces and removed with a special device.  The benefit of a hysterectomy is that it is final.  The fibroids will be gone and so will your monthly periods.  And, you will never have to worry about getting pregnant.

Here are two very important things to keep in mind when discussing a hysterectomy with your doctor. Read more…

As promised, this article is about Uterine Fibroids.  They are also referred to as myomas or fibromyomas.  The medical word for them is Leiomyomas (Lie-o-my-o-ma).  Big Topic.  I’l have to do it in two parts because I really want you to have all the available information.

Fibroids are very common.  By the age of 50, 80% of a African American women and 70% of Caucasian women will have fibroids.  Two thirds of the time these women will not have symptoms and will not seek treatment for their fibroids.  As women get older they tend to develop fibroids.  Also, women who have no or few children, those who eat a high fat diet, those taking a certain drug called tamoxifen (used to treat breast cancer) and those with a family history are most at risk.  What is a fibroid?  It is a tumor of the muscle fibers that make up the uterus.  Basically, it starts with a damaged muscle cell, this cell then multiples until it forms a noticeable lump in the wall of the uterus.  Fibroids get bigger in the presence of estrogen and that is why they usually shrink after menopause and can get bigger when a woman is pregnant.  Some reports suggest that taking birth control pills can also make the fibroids get bigger while other reports disagree with this notion.  The jury is still out on this one.  What causes damage to that one cell?  Who knows. Is is diet?  Is is smoking?  Is it because someone is overweight? Is is alcohol?  Is it the hormones and chemicals used to increase food production?  I have done surgery on vegetarians, skinny women, women who work out six days a week  and women who don’t drink and shop at Whole Foods. Read more…

Breasts are above the bellybutton.  Gynecologists, however, are the primary consultants for breast problems.  A good friend of mine was recently told that she needed a biopsy; this prompted me to write about a benign condition called fibrocystic breast disease.  The word disease is quite misleading since fibrocystic changes occur in many normal breasts and is most commonly found in young women between the ages of 20 and 50.  Also, take note of the word benign which means not malignant, not cancer and won’t directly lead to death. On exam, either by you or your doctor, there are areas where the breast feels thick and lumpy! Some of the lumps are rubbery while others may feel like tiny balloons filled with water.  Basically the breasts respond to hormones by forming cysts or solid lumps (called fibro adenomas).  Women who have fibrocystic breast changes may also have breast pain; this symptom is usually more intense at the time of menstruation.  Don’t panic. Read more…

That fishy, malodorous discharge is called Bacterial Vaginosis (BV) and is the most common cause of abnormal vaginal discharge.  Yes, it’s more common than yeast infections.  Up to about half of all women will be treated for BV at some point in their lives.

It is not technically considered a sexually transmitted disease but rather described as a shift in the vaginal flora. That doesn’t sound so bad.  BV is an overgrowth of certain bacteria that are normally found in the vagina.

Women who douche, even if it is only once a month, are more prone to BV.  Stress is also a huge factor.  And of course, multiple sexually partners can affect your vagina.  So if you practice ‘free love’, use a condom.  A new partner may also prove to be problematic–use a condom and give your vagina some time to get to know him.  A poor diet is also another culprit.  I say to patients all the time, slow down on the cigarettes and margaritas and eat an apple.  BV is also prevalent in women who have sex with women; wash the toys girls!  Lastly, some women have simply lost the protective bacteria, lactobacilli, and are therefore prone to recurring infections.  Read more…