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'women' posts

Do I need a pap smear?

When women come in for their yearly well-woman exam, many are surprised to find out that they may not need a pap smear. This is because the mechanisms through which women develop changes in their cervix that may lead to cervical cancer are now much better understood. This had led to a drastic change in pap smear screening recommendations with the most recent updates to recommendations in 2012. Although, we still recommend regular well-woman exams, it is likely that most women will only need a pap smear every ...

Frequently asked questions about pelvic health

I recently participated in a live chat with Swedish to answer questions that women had on urine leakage, bladder control treatments, pelvic floor disorders, and other pelvic health topics.

Click here to read through the archive of the chat. I also wanted to answer a few other questions I get asked, but didn't come up in the chat:

Having a healthy road to pregnancy

If you’ve been thinking about getting pregnant, here are some steps to take before your pregnancy to ensure a healthy and successful journey to becoming a mom.

  1. Start taking prenatal vitamins at least a month before conceiving. The folic acid in these vitamins (usually between 400 and 800 micrograms) will help decrease risk of a neural tube defect, like spina bifida. The spinal cord forms and closes by four weeks gestation, before many women even know that they are pregnant, so it’s important to get on this early.

  2. Starting pregnancy at a healthy weight decreases your risk of complications of pregnancy like high blood pressure and gestational diabetes. Good control of chronic medical problems will also help a future pregnancy go much more smoothly.

  3. Consider  ...

On breastfeeding & breast cancer survivors

When I was a surgical resident, I donated 150 ounces of breastmilk to a woman I’d never met, a woman who had undergone a bilateral mastectomy for cancer. It was an easy decision – I had more than I could use, she had none that she could provide. This experience became a major one in my decision to specialize in breast surgery. The dichotomy of breasts fascinated me. Breasts are highly sexualized, yet the source of comfort and food to babies. Breasts can make life-sustaining milk, and they can develop a cancer in up to 1 in 8 women that can be life-threatening. It is no wonder that society’s relationship with breasts and breastfeeding is complicated.

I have had many patients (too many) in my practice who were young and pre-childbearing, or even pregnant or breastfeeding at the time of diagnosis. Most experience the same terror that Ms. Wax-Thibodeux felt. Many choose bilateral mastectomies, prioritizing their health and a minimization of future risk. I also care for young women with benign breast disease, that still require surgical biopsies. I do discuss the potential impact of any surgery on breastfeeding. For a lot of women, this is a side effect they hadn’t even considered. It often does not ultimately change their mind about their own most appropriate surgical choice, but there can be a pause. A moment where they consider what that means, when they reconcile themselves to that consequence, when they have the moment to grieve. Unfortunately, I suspect that not all of my colleagues do this. I wasn’t ever trained to discuss it. We spent more time, significantly more time, discussing ...

What you should know about Long Acting Reversible Contraceptives or IUDs

Does it seem that more of your friends are using IUDs or contraceptive implants?  IUDs, intrauterine devices, and contraceptive implants are becoming more popular in the United States.  In this post, we will discuss these birth control methods and why they are gaining in popularity. 

IUDs are plastic devices that are placed in the uterus by a healthcare provider.  There are three products available in the U.S.:

Dealing with vaginal dryness

One of the more annoying situations that many of my patients have been in is having painful intercourse due to vaginal dryness. In general the cause of dryness of the vaginal tissue is lack of estrogen. This can occur postpartum, especially in women who are breastfeeding a baby, and it can occur just before and during menopause.

When estrogen is in the body, one of the effects of estrogen is to ...

Importance of planning pregnancies with Multiple Sclerosis (MS)

A recent study addressed the outcomes of pregnancy in women with MS who were taking fingolimod (Gilenya). Of 66 pregnancies on the medication, 41 attempted to carry the pregnancy to term. 26 of the 41 had healthy newborns. There were, 9 miscarriages, 24 elective abortion, 4 ongoing pregnancies and 1 with an unknown outcome. Of the elective abortions, four were for fetal malformations. There were 5 cases with abnormal fetal development in the 66 pregnancies. Poor fetal outcomes were found in 14.6% of the pregnancies. This contrasts with a 3% rate of poor outcomes for most pregnancies.

This paper highlights the importance of care in planning pregnancies in MS. It is now known that women with MS have ...

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