Gynecology - Routine care
Gardasil HPV vaccination
Cervical cancer is a sexually transmitted disease. The cause of cervical cancer is a virus, called Human Papilloma Virus or HPV. Cervical cancer can be caused by about 10 to 30 types of HPV. About 30 types of HPV are known as genital HPV since they affect the genital area. A relatively new vaccine, Gardasil, helps guard against two of these types—HPV Types 16 and 18. These two types of HPV cause 70% of cervical cancer cases.
You cannot get HPV or any disease caused by HPV from GARDASIL. That's because there is no live virus in the vaccine. The vaccine should be administered to all young women between the ages of 9 and 29. Girls should be vaccinated so they are immune by the time they become sexually active. The vaccine is administered in three separate doses, completed over the course of 6 months.
Gardasil does more than help prevent cervical cancer. The vaccine also helps guard against 2 types of HPV that cause genital warts—HPV Types 6 and 11. These 2 types of HPV cause 90% of genital warts cases.
We strongly encourage all our eligible patients and their daughters to become vaccinated.
Vaginitis
Vaginitis is probably the most common complaint that brings women to the gynecologist. The list of possible causes is surprisingly short.
- Yeast
Yeast infection also is known as candidiasis or monilia. It is the most common type of vaginal infection. Yeast infection is caused by a fungus found in small concentration in the normal vagina. However, when the balance of bacteria and yeast in the vagina is altered, the yeast may overgrow and cause symptoms of itching and burning of the area outside the vagina. The burning may be worse with urination or sex. The vulva may be red and swollen. The vaginal discharge usually is white, lumpy, and has no odor. Some women with yeast infections notice an increase or change in discharge. Others do not notice a discharge at all.
Some types of antibiotics increase your risk of a yeast infection. The antibiotics kill normal vaginal bacteria, which keep yeast in check. The yeast can then overgrow. A woman is more likely to get yeast infections if she is pregnant or has diabetes. Overgrowth of yeast also can occur if the body's immune system, which protects the body from disease, is not working well. For example, in women infected with human immunodeficiency virus (HIV), yeast infections may be severe. They may not go away, even with treatment, or may recur often. In many cases, the cause of a yeast infection is not known.
Yeast infections can be treated either by placing medication into the vagina or by taking a pill, although the oral therapy is much less effective than the vaginal. In most cases, treatment of male sex partners is not necessary. You can buy over-the-counter yeast medication, but be sure to come in for an examination if:
- This is the first time you have had a vaginal infection
- Your symptoms do not go away after treatment
- Your vaginal discharge is yellow or green or has a bad odor
- There is a chance that you have a sexually transmitted disease (STD)
Sometimes a woman thinks she has a yeast infection when she actually has another problem. There are several conditions that cause itching and burning, just like yeast. If there is another cause, it may be harder to find if a woman is taking medication for a yeast infection.
- Bacterial Vaginosis
The bacteria that cause bacterial vaginosis occur naturally in the vagina. Bacterial vaginosis is caused by overgrowth of these bacteria.
The main symptom is increased discharge with a strong fishy odor. The odor may be stronger during your menstrual period or after sex. The discharge usually is thin and dark or dull gray, but may have a greenish color. Itching is not common, but may be present if there is a lot of discharge.
Several different antibiotics can be used to treat bacterial vaginosis, but there are two that are most commonly used: metronidazole and clindamycin. They can be taken by mouth or inserted into the vagina as a cream or gel. When metronidazole is taken by mouth, it can cause side effects in some patients. These include nausea, vomiting, and darkening of urine. Do not drink alcohol when taking metronidazole. The combination can cause severe nausea and vomiting.
Usually we do not treat a woman's sex partner, but, if the woman has repeated infections, treatment of the partner may be helpful because bacterial vaginosis can be contracted sexually. Bacterial vaginosis often recurs. It may require long-term or repeated treatment.
- Trichomoniasis
Trichomoniasis is a condition caused by the microscopic parasite Trichomonas vaginalis. It is spread through sex. Therefore, women who have trichomoniasis are at an increased risk of infection with other STDs.
Signs of trichomoniasis may include a yellow-gray or green vaginal discharge. The discharge may have a fishy odor. There may be burning, irritation, redness, and swelling of the vulva. Sometimes there is pain during urination. Trichomoniasis usually is treated with a single dose of metronidazole by mouth. Do not drink alcohol for 24 hours after taking this drug because it causes nausea and vomiting. Sexual partners must be treated to prevent the infection from recurring.
- Atrophic Vaginitis
This condition is not caused by an infection but can cause a discharge and vaginal irritation. It may occur any time when female hormone levels are low such as during breastfeeding and after menopause. Symptoms include dryness and burning. Atrophic vaginitis is treated with estrogen, which can be applied as a vaginal cream, ring, or tablet. A water-soluble lubricant also may be helpful during intercourse.
Endometriosis
The lining of the uterus is called the endometrium. Sometimes, endometrial tissue grows elsewhere in the body. When this happens the condition is called endometriosis. Endometriosis can cause pain before and during the menstrual period and during sex. For some women, the pain is mild. For others, it can be severe. Endometriosis also may lead to infertility. We at Women’s Health Associates employ all available modalities to treat and hopefully cure this common disease.
The lining of the uterus responds to changes that take place during a woman's monthly menstrual cycle. First, the endometrium grows and thickens to prepare for a possible pregnancy. If pregnancy does not occur, the endometrium is shed by bleeding and then thins. These changes are triggered by hormones (estrogen and progesterone) made by the ovaries. With endometriosis, endometrial tissue is found in other areas of the body. It looks and acts like tissue in the uterus, but when this endometriotic tissue bleeds, there is not place for the blood to go causing inflammation, pain, and scarring. Endometriosis most often appears in places within the pelvis:
- Ovaries
- Fallopian tubes
- Surface of the uterus
- Cul-de-sac (the space behind the uterus)
- Bowel
- Bladder and ureters
- Rectum
Endometrial tissue may attach to organs in the pelvis or to the peritoneum, the tissue that lines the inside of pelvis and abdomen. In rare cases, endometrisis also may be found in other parts of the body outside of the abdomen. Endometrial tissue that grows in the ovaries may cause a cyst (also known as an endometrioma) to form.
The symptoms of endometriosis often worsen over time. In many cases, treatment may help keep the condition from getting worse. The amount of pain does not always tell you how severe your condition is. Some women with slight pain may have a severe case. Others who have a lot of pain may have a mild case.
Endometriosis is most common in women in their 30s and 40s, but it can occur any time in women who menstruate. Endometriosis occurs more often in women who have never had children. Women with a mother, sister, or daughter who have had endometriosis also are more likely to have it. Endometriosis is found in about three quarters of the women who have chronic pelvic pain. Pain may occur with sex, during bowel movements or urination, or just before or during your menstrual cycle. Menstrual bleeding may occur more than once a month. Endometriosis also may cause infertility.
No one is certain of the cause of endometriosis. For most women, a small amount of blood and cells flow through the fallopian tubes into the abdomen during their periods. For women with endometriosis, the cells in the blood that flows through the tubes attach to other places and grow. Endometrial cells also may be carried through the blood and lymph vessels.
Many women with endometriosis have no symptoms. In fact, they may first find out that they have endometriosis if they are not able to get pregnant. Endometriosis is found in about one third of infertile women. On the other hand, women often find that symptoms are relieved while they are pregnant. In fact, many of the drugs used to relieve symptoms of endometriosis are based on the effects of hormones produced during pregnancy.
Endometriosis can be mild, moderate, or severe. The extent of the disease can be confirmed by looking directly inside the body by laparoscopy. Sometimes a small amount of tissue is removed during the procedure. This is called a biopsy. Endometriosis also can be treated during a laparoscopy using laser or other techniques to destroy the diseased tissue on the spot.
But treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. It may be treated with medication, surgery, or both. Although treatments may relieve pain and infertility for a time, symptoms may come back at a later time.
Hormones may help slow the growth of the endometrial tissue and prevent the growth of new adhesions, but will not make them go away. Hormone treatment is designed to stop the ovaries from producing estrogen that stimulates growth of endometriosis. Some of the hormones most often prescribed include:
- Oral contraceptives
- Gonadotropin-releasing hormone (Lupron)
- Progestin (Progesterone)
These medications are not for all women. As with most medications, there are some side effects linked to hormone treatment. Some women may find the relief of pain is worth the side effects, but these medications do not relieve pain in all women.
Surgery may be done to remove endometriosis and the scarred tissue around it. In most severe cases of endometriosis, surgery often is the best choice for treatment. Surgery most often is done by laparoscopy. During laparoscopy, endometriosis can be removed or burned away. Unfortunately, not all cases can be handled with laparoscopy. Some patients can only be helped by total hysterectomy.
Well woman care
Women’s Health Associates is unique in the Danbury service area because of the availability of both physician and midwifery care. Both practices provide not only obstetrical services, but also routine gynecologic and family planning care as well.
An annual checkup is the single best thing a woman can do to protect her health. Our patients receive a comprehensive examination that includes:
- Pap smear (we use only "thin prep" smears and HPV testing because of their superior accuracy)
- Clinical breast exam
- Mammogram and ultrasound breast exam referral (routinely starting at age 35); MRI may be recommended if further clarification is needed
- STD screening, if appropriate
- General health screenings for cardiovascular disease, hypertension, anemia and high cholesterol, if appropriate
- Contraception
Today, "the pill" is just one of many safe, reliable contraceptive methods including the vaginal ring (Nuvaring), IUD, Implanon, diaphragm and in-office Essure treatments. Each method has its own unique advantages. We take the time to explain all of the options so each patient can choose the method that’s best for her.
- Adolescence
For a young woman, the first gynecological visit is an emotional experience. For a physician, it's the first opportunity to create a trusting doctor-patient relationship. We start with a general introduction to the office & staff and then move on to a discussion of the young woman's monthly cycles. If she is sexually active, we discuss STD prevention and contraception options. If she is not sexually active and there are no indications of problems with her cycle, we forgo the first pelvic exam until a future visit when her comfort level is higher. The first visit is recommended at age 17, or sooner if the young woman is sexually active.
Beth Harple, our certified physician assistant, has extensive experience treating and counseling adolescents. We welcome new patients who require this unique service.
- Menopause
Until recently, menopausal symptoms (hot flashes, night sweats, sleep disturbances, vaginal dryness, irritability) had been routinely treated with hormone replacement therapy (HRT), a method that has come under much scrutiny because of research linking HRT to certain types of cancer. We now often provide alternative treatments, but continue to offer HRT for patients who have truly disruptive symptoms.
Menopause is an important time for osteoporosis detection (we recommend a DEXA bone density scan) and prevention (calcium, exercise and, if needed, medication therapy). We also screen our menopausal patients for cardiovascular disease, hypertension, STD, anemia and high cholesterol, when appropriate.
Physician care
The physicians of Women’s Health Associates provide the full range of obstetrical and gynecologic services. We are available 24 hours per day for emergencies. We have a long history of early adoption of new but proven technologies. We were the first practice in Connecticut to provide the Essure sterilization procedure, and we are also the only physicians in our area to offer in-office hysteroscopy and endometrial ablation.
Midwifery care
The midwives of Women’s Health Associates practice at the Connecticut Childbirth & Women’s Center in Danbury. We believe in gentle, comprehensive and preventative care for women throughout their lives. Excellent health care is best fostered in an atmosphere of relationship and trust, and where women are empowered to work collaboratively with their caregivers. We take the time to listen to your needs and identify your areas of strength. Most women who birth with us stay with us for their lifelong gynecology needs.
Full scope care also includes family planning and preconceptual counseling. You may count on us to order appropriate testing including mammogram, laboratory and ultrasound screenings as needed. We are also able to write prescriptions for any necessary medications including antibiotics or birth control pills.
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