We specialize in providing the most up to date and effective medical services available, while at the same time treating you with respect and the time it takes to ensure that your treatments are their most effective.
We specialize in the treatments listed below. Please click on each treatment for more information.
This is now the most common method for treating excessive menstrual bleeding in the U.S. This procedure uses local or sedation anesthesia and destroys the endometrial lining using radio frequency energy. You can resume work and most normal activities a few hours later. This method is provided by a machine that carefully controls the depth and timing of the 90 second procedure. 40-50 of our patients never bleed again or if you do, your bleeding should be greatly reduced. This method can be combined with a tubal ligation or other needed surgery and is reserved for patients who are finished with childbearing, have permanent birth control and don't have problems best treated by hysterectomy. If you feel controlled by heavy menstrual periods and thought your only options were to wait for menopause or have a hysterectomy this may be a new choice for help without major surgery, pain or weeks of recovery.
The Pap smear has been the best test to find and prevent cancer that medicine has ever discovered. Cancer of the cervix has afflicted women since the beginning of recorded history. It is caused by a virus carried by up to 70% of sexually active people that have had more than one partner. The name of this sexually transmitted virus is Human Papilloma Virus or HPV. Only a few of the strains of HPV attack the cervix causing atypical cells. Other strains cause bumps and warty growths in the vaginal area. In the U.S., the Pap smear became a routine part of a woman's gynecologic exam in the 1950s. It changed cancer of the cervix from the leading cause of death due to malignant disease in women to a disease that is rare except in those who haven't had pap smears. The reason it works so well is that it picks up pre-malignant dysplasia years before it can be seen with the naked eye and years before it becomes invasive and therefore malignant. The original Pap smear introduced in 1941 was performed with a wooden stick or spatula much like an ice cream bar stick and the cells scraped from the cervix were smeared onto a glass slide and sprayed with a fixative (hair spray works fine!). In the laboratory these slides are stained and viewed under a microscope by a trained cytotechnician or pathology doctor to identify atypical and pre-malignant cells. In the early days the results were reported in Classes from I (normal) to V (Cancer) with II, III and IV representing pre-malignant dysplasia. The word dysplasia means altered cells. Later pap smears were reported as normal, inflammation, mild-, moderate-, or severe-dysplasia, a spot of cancer (carcinoma-in-situ), and invasive cancer. In the 1990s the same smears were reported as normal, inflammation versus CIN I, CIN II and CIN III, and invasive cancer. In 2002 we are getting our results in the language of the second revision of the Bethesda Pap Smear Classification system that reports even finer divisions of abnormality and suggests which further diagnostic steps to take. The Pap test can suggest that glandular cancers of the cervix and uterine cavity above need to be investigated. The cells don't tell us about cancer of the fallopian tubes, ovaries or other internal organs.
Improvements in how the Pap test is taken have also occurred. In the 1970s it was clear that placing a cotton swab into the cervical canal added important cells to the slide that the wooden spatula missed. In the 1980s it was shown that a small round brush collected even better cells from the canal of the cervix. Plastic spatulas with a narrow point to go into the cervix were not as productive of diagnostic cells. In the late 1990s liquid preparations of cells collected with a brush from the cervix have improved diagnostic accuracy by floating debris and blood away. This type of Pap test uses both a large cervical brush and a smaller endocervical brush. Each brush is stirred to release cells and then the vial of fixative is sent to the laboratory . The cells are separated from the liquid and viewed on slides. This method is called ThinPrep and is how we do all of our pap tests.
We were one of the pre release trial sites for a new method of contraception called NuvaRing. This method of birth control is a thin flexible transparent ring that delivers low dose estrogen and progestin hormones for three plus weeks. You put it in yourself for three plus weeks and take it out for 4 days. It protects you from pregnancy for the entire month. It works like the birth control pill without having to remember a pill every day. It goes with you wherever you go and should not interfere with sex or any other normal activities. It comes with the same warnings as the birth control pill. Most women have found it easy to insert and remove even the first time. Ask us if this method is right for you.
Urinary Incontinence Means Knowing Where Every Bathroom Is and How Far!
An estimated 20 million Americans, 85% of them women, have urinary incontinence. Loosing control of your bladder is usually due to stretching of the support structures after childbirth and/or weakness of the pelvic floor muscles. Urinary leakage happens in a minor way to all women and deserves evaluation and treatment when you need to wear a pad on a regular basis to prevent wetting your clothes or when you are prevented from exercising because of accidents. Stress incontinence happens when you cough, sneeze or change position and then lose small amounts of urine. Urge incontinence is often due to uncontrolled bladder muscle contraction and causes larger amounts of leakage before you can reach the bathroom. Overflow incontinence may have a neurological cause and happens when the bladder fails to tell you it is full and simply spills out.
Evaluation of incontinence starts with your medical history and the details of your current problem. If you can't stop the flow of urine while voiding, the pelvic floor muscles may be weak. Caffeine, spicy or acidic foods, and alcohol can irritate the bladder. Medicines you take can make the bladder unstable, especially diuretics, tranquilizers, narcotics and blood pressure medicines. Lack of estrogen years after menopause can cause the loss of bladder control. Physical examination and the Q-tip test can show how far down your bladder neck falls. Muscle contraction of the pelvic floor can demonstrate weakness and loss of sensation. Laboratory evaluation is helpful to rule out infection, diabetes, and thyroid disease. We often look inside the urethra and bladder (cystoscopy) and measure bladder filling pressures (cystometrogram) to diagnose irritable and unstable bladder contractions. Urethral pressure measurement can document closing pressure weakness. Treatment is determined by what kind of incontinence you have. An irritable, unstable bladder is best treated with medications such as Detrol or Ditropan to relax the bladder muscle. A weak urethra after menopause often responds to estrogen and pseudoephedrine therapy. A rigid urethra due to infected peri-urethral glands will respond to gentle urethral dilations. An antidepressant, Imipramine, can help some patients regain conscious bladder control. Fitting you with a plastic ring or arch pessary can lift the bladder and stop daytime leaking when worn comfortably. Kegel exercises can strengthen pelvic floor musculature and reduce leaking. Biofeedback and electrical stimulation of bladder muscles report better success rates than Kegel exercises. Holding in a vaginal weight for 15 minutes twice a day can build bladder control. The newest and most effective of the non-surgical treatments is now available in our office and involves painless magnetic stimulation of pelvic floor muscles. This physical therapy is prescribed twice a week for two months and is provided while you sit in a special chair fully clothed. If the bladder neck has fallen, surgery through the vagina or the abdomen can put it back in place and restore bladder control. The newest method of support is the placement of a sling of fabric under the urethra during outpatient surgery.
We have a new, painless solution for bladder control problems called NeoControl. (See the article I've written on urinary incontinence for more details about this problem.) This new technology, named Extracorporeal Magnetic Innervation (ExMI), is a form of physical therapy and is given while you sit fully clothed in a special chair. A computer-controlled electromagnet exercises and builds strength in the bladder control muscles while you relax and talk to the nurse about how you are improving. A treatment session involves two phases of muscle contraction and takes 22 minutes. The full course of strengthening sessions is given twice a week for 8 weeks. This treatment program is FDA and Medicare approved and covered by most insurance programs. Some evaluation and diagnosis by the doctor is required to rule out other therapy and to prescribe magnetic exercise therapy. So far every patient we have treated is improved. You shouldn't have to wear protection at any age because of urinary leakage. We can help!