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In modern obstetrics, there is a growing trend in expecting mothers’ request for ‘elective’ Cesarean section (‘Cesarean Section on Maternal Request’.) This ‘elective’ cesarean delivery, is a maternal request for Cesarean section delivery, in the absence of any maternal or fetal need (nor medical indication) for Cesarean section birth. (This particular ‘request’ for Cesarean section refers to a maternal request for a first-time Cesarean delivery… not a request for a repeat Cesarean birth, as in the case of a mother with previous Cesarean Section deliveries.) In the U.S. 2.5% of births are performed by Cesarean section for this request. In my experience, concern and anxiety regarding pain in labor seem to represent the most common reason for this request.
In the recent several years, public health initiatives have been underway to increase public awareness of the prevalence of the HPV (Human Papilloma Virus) among the sexually active population, it’s health consequences of genital warts and cervical cancer, and the recommendations for Gardasil, one the available vaccines effective in the prevention of HPV. How much do you know/understand about HPV?
Test your knowledge of HPV here, with this simple quiz:
1. Of sexually transmitted infections, the most common is:
- – HPV (the Human Papilloma Virus)
- – HSV (the Herpes Simplex Virus)
- – HIV (Human Immunodeficiency Virus)
2. The HPV virus is spread by:
- Genital contact, most commonly through sex
- Oral-genital contact
- Straight and same-sex partners
- All of the above
3. The HPV is the cause of most cases of both genital warts, and cervical cancer?
4. The majority of cases of HPV infection cause no (visible) signs of infection at all, and are cleared by our body’s own immune system?
5. The HPV is a ‘newly’ discovered virus, linked with genital warts and cervical cancer?
6. The HPV vaccines are more than 90% effective in preventing genital warts and cervical cancer in femalefemafemifemales vaccinated before their sexual debut?
(See next page for answers...)
Have you had embarrassing episodes of leaking urine? This is actually not uncommon for women. I’d like to simplify the explanation of the 2 most common reasons for urinary incontinence. We’ll start first with the anatomy…
Imagine the bladder as a ‘balloon’ that holds our urine, located centrally just above the mid pubic bone. (It actually dwells right on top of the lower uterus.) This balloon has a short ‘straw’ that empties it (the urethra.) The urethra exits the bladder at about a 45 degree angle, in a ‘locked’ angle disallowing urine’s unexpected release. For urination to actually occur, a complex neurologic system connects the brain’s signal (which we mentally initiate) to the bladder to ‘command’ urination, with the bladder’s function of ‘contracingt’ to empty the urine, and the urethra ‘relaxing’, to allow the urine to actually release.
Have you avoided having a mammogram due to fear of ‘pain’ from the testing? This question came up on a recent vacation, while chatting with some of my (non-medical) girlfriends. They related knowing women who’ve avoided having a mammogram because of concerns of the mammogram being too painful. They suggested I write a post about it.
Having ordered many mammograms for women over the years (and having experienced a few myself), though the occasional woman may relate ‘pain’ with the mammogram, most women do not describe the test as “painful”. Uncomfortable and scary…yes. But then again, pain is a subjective matter. In a recent study polling 200 women on their level of pain with a mammogram, 72% rated the “pain” as that equal to a ‘tight fitting shoe’, or a ‘mild headache’. Which of us hasn’t pushed on through their day with a tight fitting shoe, or a mild headache?
Our breasts tend to be more full and tender the week before our menstrual period. If you’re concerned about pain with the mammogram, I’d suggest scheduling the test just after your menstrual period, and not the week or so before your period. Caffeine can cause breast pain as well, so avoiding caffeinated beverages the week or so before the mammogram may also help. An over-the-counter pain reliever taken prior to the mammogram is an option as well.
Apprehension about having a mammogram is understandable. Our breast on a metal plate, with a second plate coming down to compress it…is scary. But, in my opinion, not scarier than the possibility of a missed diagnosis of breast cancer.
Speak with your healthcare provider about scheduling your mammogram, as well as ways to make the testing more comfortable.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC
Offices in Roseville, Grosse Pointe, Macomb, Rochester, MI
A natural birthing experience is desired by many expecting mothers…But what does ‘Natural Birth’ really mean? For some women it means a vaginal birth with little or no medical interventions, for some it means a vaginal birth without pain medications (or without an epidural), for others it may mean any accomplished vaginal birth, and not a cesarean section.
Nearly a third of babies in this country are delivered by cesarean section. The more recent adoption of early skin-to-skin contact and intraoperative breastfeeding, not only benefit maternal-infant bonding, but also benefits the baby in terms of earlier success with breastfeeding. It simulates a more ‘natural birthing’ experience, preventing the feeling of ‘disconnect’ for the parents of cesarean section babies, while separated from their baby in the operating suite.
As a practicing Ob/Gyn, I hold no strict or definite definition of ‘Natural Birth’. I allow the patient to decide and define whatever ‘Natural Birth’ means to them.
Suzanne Hall, MD (@drsuzyyhall)
In discussing the concerns of Menopausal Hormone Therapy (MHT) with patients in the office, it’s evident that ‘the fear’ of developing breast cancer from hormone use, by far outweighs the benefits of use, for many women. With breast cancer being the number one cancer diagnosed among US women, and the second leading cause of cancer-related deaths (second to lung cancer,) those concerns are certainly understandable.
Though concern for an association of breast cancer from hormone use have perplexed patients and the medical community for many years, in the last 10 years, that level of concern has escalated to nearly a level of fear. Despite some public perception of hormones as the cause of breast cancer, the medical evidence does not support hormones as a cause for breast cancer. Unlike the causal link between smoking and most cases of lung cancer, a causal link between hormone use and breast cancer has not been established. In fact, the cause of breast cancer is still unknown.
Expecting and new mothers are faced with many decisions in preparation for the care of their newborn baby, the decision to breastfeed, being among one of the most important ones. We’ve all heard the advice of family and friends that “breastfeeding is better for the baby”, but how true do we really know this to be?
The fact is, it is true. Medical research has shown human breast milk, over formula feeding, to benefit the infant in several ways. Some of those benefits include, improvement in gastrointestinal functioning, improvement in immune defenses, thereby reducing the occurrences of several acute illnesses, and enhancing the maternal-infant bonding, possibly reducing infant stress. Because of the proven health benefits to infants, many national health organizations have recommended exclusively breastfeeding infants for the first 6 months of life (i.e., Academy of Pediatrics, the American Congress of Obstetricians and Gynecologist, The World Health Organization.)
As an Ob/Gyn physician, it’s not uncommon for me to hear the question from patients, “Am I actually ABLE to conceive?” For some women who are planning pregnancy, as well as for some others who’ve never had a pregnancy (intended or not)…the question, “Can I get pregnant?” may be a looming concern.
Other than actually attaining a ‘positive’ pregnancy test, there really is no other specific test allowing us to know IF a woman CAN actually achieve pregnancy. What we do know is, that for the normal couple (those without risk factors/or a history of infertility, regularly sexually active,) the chances of conception are actually stacked in our favor. In fact, for regularly sexually active couples, there is a 15-25% probability of pregnancy with each menstrual cycle!
It is expected that nearly 90% of sexually active couples, without contraception, would become pregnant (intentionally or not) within one year. The one year mark is typically used in defining those couples with ‘infertility’…the inability to become pregnant, despite frequent, unprotected sex within one year. An infertility evaluation by your health care provider may be initiated at this time, and even earlier (at 6 months) for those women over 35.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics
An exciting time for expecting parents is the first sensation of fetal movement, medically termed ‘quickening’. Though fetal movement can be seen by ultrasound as early as the first trimester, the perceived, physical sensation of fetal movement generally occurs by around the 20th week of the pregnancy. This sensation of fetal movement may vary among women, and among different pregnancies. Some first-time moms may not perceive this movement until up to 22nd-24th week of pregnancy, while others may recognize the sensation of movement as early as 16-18 weeks.
This sensation of early fetal movement has been described as feeling like the fluttering of a butterfly, a tickling, or a light tap. The differences in the timing of your perception of fetal movement may be based fetal/placental location, or the anatomy of your abdominal wall. Initially, it may be hard to distinguish these movements from a feeling of gas or a hunger pang. But once you recognize the sensation as fetal movement, you’ll most likely be reassured and happy with your baby’s activity!
You may be worried about first visit to the gynecologist. Don’t worry, this is normal, and with a little preparation it can be an empowering and educational experience. Let your doctor know that you are nervous and we can be more effective at walking you through the process. The American Congress of Obstetrician and Gynecologists recommends young women make their first visit to the gynecologist between ages 13-15. Your doctor will want to ask you questions regarding your medical and surgical history, menstruation history, sexual history, exposures to alcohol or tobacco, and review vaccinations you’ve received or may be due for. If these topics seem too personal, or you are uncomfortable discussing them, remember your conversation with the doctor is confidential. It may be helpful to go to the appointment with a parent or friend, but be sure some of the time is spent with you and the doctor in private, so you can voice concerns or questions that might be awkward to discuss around others. You may want to write questions down before-hand, as this is an opportunity for you to gain knowledge regarding your health and well-being.mind well-informed.
Heavy menstrual flow is a common occurrence affecting 10-35% of women, and a common reason for visits to the gynecologist. Though the causes for heavy menstrual periods (menorrhagia) vary, the Novasure endometrial ablation procedure is an excellent treatment option for many women, when child-bearing is completed.
As an Ob/Gyn physician with greater than 10 years of experience performing the Novasure procedure (and with hundreds of satisfied patients having selected the procedure), I thought it may be helpful to discuss common questions from patients considering the procedure as their treatment of choice. Here are my answers to 5 common patient questions regarding the Novasure procedure:
1. How is the procedure performed?/What can I expect from my menstrual flow after the procedure…lighter periods or no period?
The procedure is considered minimally invasive, performed through the vaginal aspect without surgical incisions. The Novasure wand (containing a triangular mesh) is inserted within the uterus, where a short (less than 2 minute) cauterization of the uterine lining occurs. The procedure may be performed in an outpatient surgical setting (with anesthesia) or possibly in your doctor’s office. You should expect to be back to normal activities within a day or so.
Several research studies on the results of the Novasure procedure note over 90-95% patient satisfaction with the procedure. Expected results range from notably lighter menstrual periods (for most patients)…to skipped/or absent menstrual flows (up to 40% of patients.) It’s not possible to predict for patient’s what result they will get, but when questioned overall, most patients are (very) satisfied with the results achieved.
Suzanne Hall, MD, FACOG
At 15 years old I remember asking myself, “Is this what they mean by menstrual ‘cramps’?” The term ‘cramp’ just seemed too mild to explain the horrid, 1 or 2 day experience, which regularly preceded the start of my monthly period. Back pain, ‘front’ pain, nausea, and sweats…felt more like a suffering from the flu…with an elephant stepping on my back!... than what I’d describe as menstrual ‘cramps’. The usual ‘mother’s home remedies’ like a heating pad, hot tea, or over-the-counter pain reliever, hardly ever seemed to do enough, but I adhered to the regimen every month anyway…What else was I going to do?
As a Gynecologist, I now know the significance of the menstrual ‘cramps’. In our rhythmic, monthly, hormonal cycle, and in response to the rise in our ovarian hormones (estrogen and progesterone), our ovaries form the ‘dominant follicle’, which releases the fertilizable egg for that month. At the same time, the uterine lining develops a thick, shaggy layer (like a shag carpet) to enhance implantation of a fertilized egg (egg fertilized by a male sperm=pregnancy.) On the other hand, if no egg fertilization occurs (no pregnancy), the ovarian hormones decline, allowing for release/shedding of the previously developed thickened uterine lining tissue (representing our ‘menstrual flow’), and the obvious sign of menstrual bleeding.
Did you know that up to 10-15% of pregnancies are affected by hypertension? About 5% of those cases are in women previously known to have hypertension (termed ‘chronic hypertension’), prior to pregnancy. Another 5-8%, develop hypertension within the pregnancy (termed ‘gestational hypertension’ or ‘pregnancy-induced hypertension’.)
Hypertensive disorders are characterized by blood pressures consistently ranging 140/90 or greater. Women with chronic hypertension (existing before pregnancy, or diagnosed before 20 weeks of gestation) may require blood pressure medications to control their blood pressure, even throughout the pregnancy. Those medications should be reviewed with your healthcare provider, to assess their safety in pregnancy, even before conception.
Who really likes going to see the Gynecologist? For some women, it probably ranks right up there with getting a tooth drilled at the dentist, or like nails to a chalkboard. But let’s face it, the gynecologic exam/Pap smear is a necessary part of preventative Women’s Health screening. Whether it’s your first visit, or you’re seeing the Ob/Gyn you’ve known for years, here are a few tips that may help to make your visit go more smoothly…
Prepare your questions/concerns
Make a list of your concerns/questions, include your medical history, medications, allergies, ect…
In that the average patient-physician interaction is 10-20 minutes, it’s helpful when your list of problems/concerns is concise. Know your medical/surgical history, medication allergies, and list your current medications. Think about (or write down) your problem list/symptoms, when they began/worsened, what aggravates/or improve the symptoms, and from a gynecologic perspective, if they’re cycling with your menstrual period. Understand that if your list of questions/concerns is long, we may have to address some of them at a subsequent visit.