Compared to just a few years
ago, there are now many popularly used methods available to
help couples plan their families and prevent untimely pregnancies.
The Pill Still the most popular method,
oral contraceptives provide predictable, usually lighter,
menstrual periods as well as protecting against pregnancy.
To use the pill effectively you must remember to take it about
the same time each day. The pill does not protect against
sexually transmitted infections (STIs) so some women will
use condoms for additional protection. Contrary to popular
belief, taking birth control pills does not increase your
risk of subsequent infertility, but does in fact protect against
endometriosis and actually lowers the risk of ovarian cancer.
Nuva Ring This is a device that the woman
places in her vagina and removes 3 weeks later. It is left
out of the body for 5 to 7 days. A new ring is used each month.
While the ring is in the vagina, a tiny amount of hormone-
is released into a woman’s body, enough to provide effective
contraception. The ring is not usually dislodged by intercourse,
tampons, or other day to day activities. It is not felt by
the male partner but is easily removed -. The ring offers
convenient hormonal contraception for women who feel they
may not remember to take a pill regularly.
Patches These contain the same type of hormones as
the pill, but because patches are applied to the skin and
changed weekly the dose is lower and blood levels are more
evenly distributed over time. About 1 or 2% of women will
have skin reactions that make this method unacceptable. -For
many women - the convenience of a weekly patch makes this
a desirable method.
Condoms Condoms remain a popular choice. They come
in a wide variety of sizes, shapes, colors, and some -have
added lubricant or spermicide. For optimal use it is advisable
to make sure that no penetration occurs before placement of
the condom. Another way to increase the success of preventing
pregnancy with non-spermicide-containing condoms is for the
woman to insert spermicidal cream or foam while her partner
is placing the condom on.
Diaphragm This is a time-honored method - is still
available today. To work effectively -, a diaphragm must be
inserted into the vagina prior to intercourse. - It is removed
8 to 12 hours later, washed and dried to be ready for next
use. One diaphragm may last for many years and is thus very
inexpensive contraception, but the effectiveness is only about
the same as condoms (around 85% per year). We will be happy
to fit you for a diaphragm if that is your method of choice.
IUD (Intra-Uterine Devices) These are T-shaped sterile
plastic objects that are placed inside the uterus itself.
The best time for insertion of an IUD is either during or
very soon after a menstrual period. IUDs provide long-term
protection against unplanned pregnancy. Fertility generally
returns soon after removal of a woman’s IUD. There are
two kinds now in use, Paragard and Mirena.
Paragard This type of IUD contains copper, which acts
to immobilize sperm. Paragard IUDs can remain in place for
up to 10 years. Menstrual periods are about the same or a
little heavier with this method, so it is probably not the
best choice for someone who already experiences heavy flow
or bad menstrual cramps. www.paraguard.com
This type of IUD contains the hormone progesterone which acts
within the uterus to decrease menstrual flow and decrease
cramping. It also provides excellent protection against pregnancy.
This type of IUD must be removed or replaced after no more
than 5 years.
Implanon is a short flexible rod containing
hormones implanted under the skin of the upper inner arm.
It is highly effective, but requires a small in-office procedure
to place or remove it. Contraceptive effects last for three
years, after which it should be removed or replaced. www.implanon.com.
No woman chooses to terminate a pregnancy
as a form of birth control. However, many women experience an
unwanted pregnancy at some time in their lives. We at Corsica
Women’s Health believe that women need support in this
very difficult decision. We offer problem pregnancy counseling.
For those who choose abortion and are in the first trimester
of a pregnancy, we offer termination services that are safe,
respectful and discreet.
Any woman considering permanent sterilization should first ask
her partner if he would be willing to have a vasectomy.
There are several methods available for female sterilization.
The lapascopic approach has been standard for the last 30 to
40 years, sometimes referred to as having one’s “tubes
tied.” Newer methods are available that do not involve
any incision or stitches. These are called Essure and Adiana.
These can often be done here in the office. www.adiana.com
Most women between about the ages of 12 and
52 menstruate about monthly if they are not pregnant and have
not had a hysterectomy. Lack of bleeding for 6 months or more
is called amenorrhea and could be a sign of hormonal imbalance.
Other causes include eating disorders or extreme stress. Heavy,
excessive, prolonged, irregular, or unpredictable bleeding are
problems that also can be evaluated and treated. Evaluation
consists of a careful history and exam and possibly also blood
tests, ultrasound, or endometrial sampling (biopsy done in the
office). Treatment options for excessive menstruation include
hormones such as Danazol or birth control pills, endometrial
ablation – which means removal or reduction of the uterine
lining or uterine artery embolization –
a procedure done by radiologists. Definitive treatment for heavy
bleeding for some women is hysterectomy. An alternative to hysterectomy,
however, is a method called NovaSure that uses radio frequency
enery to eliminate the uterine lining. In about 85 to 90% of
cases this method markedly reduces or eliminates altogether
menstrual bleeding. However, this method is only recommended
for women who will never be getting pregnant.
n some cases it may be necessary to have a hysterectomy (removal
of the uterus-) which can be done with or without removing the
(top of page)
The most important single step a person can take to prevent
or avoid cancer is to stay away from cigarettes. Regardless
of lifestyle, however, cancer can develop in any person. Though
cancer can develop at any age, risk does increase as we get
older. Cancer may be detected at early, potentially curable
stages by screening tests done on a regular basis.
Pap Smears(Cervical Cancer) Pap smears are done by
collecting cells from the cervix that are then examined under
a microscope. This test has been improved in recent years
and we now use the Thin Prep (www.thinprep.com
)liquid method that often includes testing for the Human Papilloma
Virus (HPV) which is an underlying cause of cervical cancer,
and Sexually Transmitted Infections STIs such as chlamydia
and gonorrhea. Paps should be done every year- from age 21
to age 30 then every 2 -years if results are normal until
about age 60 70,fter which most women can stop screening.
Women who have had a hysterectomy for reasons other than cancer
and no longer have a cervix do not need pap smears. These
women do still need annual exams.
Mammograms (Breast Cancer) Breast cancer can be detected
early by women examining their own breasts, by a professional
exam, or by breast x-ray called mammography. None of these
methods is fool-proof however, so it is best to do all three.
Women should check themselves monthly, get an exam yearly,
and have a mammogram every 1 to 2 years between ages 40 and
50, then yearly after age 50. These recommendations change
if you have a strong family history of breast cancer. Breast
cancer risk evaluation can be done in our office, and certain
high-risk individuals may benefit from genetic screening with
BRCA-1, 2 analysis, www.cancer.gov/cancertopics/factsheet/risk/brca-or
by referral to a breast specialty center through a site such
as (ww5.komen.org). To
assess your own risk of breast cancer, go to: http://www.cancer.gov/bcrisktool.
Colon (Colonoscopy) After lung cancer, colon cancer
is one of the leading causes of preventable cancer deaths.
Examination of the lower intestine by placing a scope is recommended
every 10 years starting at age 50. This recommendation is
for healthy people with no significant risk factors. If you
need to get this scheduled, we recommend you contact one of
the following: A) Chestertown: Dr. Paul Johnson 410-778-0088
or Dr. Gerard O’Connor 410-778-6303, or B) Easton: Digestive
Health Associates 410-822-6005.
Ovarian Cancer Less than one in one hundred women
will experience ovarian cancer in their lifetime and most
cases occur in older women. Unfortunately good screening tests
for ovarian cancer do not exist. There is a blood test for
a marker of ovarian cancer called CA125 but this should not
be used as routine screening in normal-risk individuals since
false positive results cause more harm than benefit. Studies
so far have also shown that while ultrasound and pelvic exams
can pick up some cases, more often early ovarian cancer goes
This is a condition in which tissue that normally grows only
on the inside lining of the uterus actually starts growing in
other places in the pelvis. Common locations include the surface
of the abdominal lining (peritoneum), tubes, ovaries, and rectal
wall. Symptoms include pelvic pain, especially just before and
just after the onset of periods. Another common symptom is pain
during intercourse. Women who have borne children and women
who have been on birth control pills have a lower risk of endometriosis.
Without treatment, this problem tends to go away on its own
following menopause. Treatment varies according to severity
and age. Some women benefit from taking birth control pills,
while others need surgery, usually laparoscopy but sometimes
Fibroids consist of swirls of muscle and
fibrous tissue. They are non-cancerous and are very common generally
from age 35 to 50. Fibroids grow in the wall of the uterus and
can cause swelling, pressure, pain, heavy bleeding, and sometimes
painful intercourse. Symptoms depend on the number, size and
location of the fibroids. They tend to shrink following menopause.
Treatments include hormones (such as Depot Lupron), uterine
artery embolization, or hysterectomy.
(top of page)
Most women will experience pelvic pain of
one kind or another in their lives. Often this is the temporary
discomfort that accompanies ovulation or menstrual cramps. However
longer-term pain can be a sign of other problems such as ovarian
cyst, pelvic infection, tubal pregnancy, endometriosis, or sometimes
a bladder infection. - Most pain is mild, brief, or easily treated,
so - not - a significant problem. For a few women, however,
pain becomes chronic long-term and leads to significant disability
- from normal day-to-day functions such as school, work, family,
or recreation. In these cases, careful history followed by testing
such as ultrasound, x-rays, and sometimes direct inspection
using an out-patient - hospital- procedure. Even then it is
not always possible to totally relieve pelvic pain. The goal
then becomes supportive care, making the patient as comfortable
as possible (with medication, physical therapy, acupuncture,
hypnosis or other means), and enhancing ability to cope with
life’s needs. www.pelvicpain.org
(top of page)
Prolapse and Incontinence
With time, pressure, and sometimes
following vaginal delivery, the pelvic floor can gradually sag
and fall downward. There are three main types of prolapse, but
they often happen in combination or all together. One is cystocele,
or “dropped bladder.” Another is rectocele, in which
the front wall of the rectum bulges down into the vagina. The
- third is uterine prolapse. Cystocele, rectocele and uterine
prolapse all can be graded by severity as - grade 1 (just noticeable),
grade 2 (moderate dropping) or grade 3 (all the way to the vaginal
opening or hanging out). Most women with grade 1 prolapse do
not require any treatment, but more severe grades usually need
surgery. This often includes vaginal hysterectomy, but not in
An involuntary loss of urine or bowel contents
frequently goes along with some degree of pelvic prolapse. Although
sometimes treated with medication, severe cases almost always
require surgery. In some cases we work together with urologists
who install artificial slings to help hold pelvic organs in
place and restore continence. www.webmd.com/.../pelvic-organ-prolapse-topic-overview
(top of page)
Because sexual issues are private and often embarrassing
to talk about, many women carry concerns they do not voice
and so they do not get help. The first step is often to realize
that many or most other women have the same or similar experiences
– but just don’t talk about it.
Loss of interest Decreased or lack of interest in
sex can be very distressing to both the woman and her partner.
Commonly people wonder if there is a problem with their
hormones or maybe they just need a little “female
Viagra” (which in fact does not exist). In a few women
there actually is a hormone imbalance that can account for
the problem – these unusual cases sometimes happen
following removal of both ovaries. Almost always, however,
the problem turns out to be something entirely different,
such as depression, low self-esteem, or interpersonal issues.
Often there are unstated conflicts or lack of trust between
the partners. Counseling and guidance, either as a couple
or on your own, can be obtained locally at Chester River
Behavioral Health in Chestertown at 410-778-5550 or Corsica
River Mental Health Services, Inc. in Centreville, at 410-758-1223.
Lack of orgasm Films, novels, women’s magazines
and the like project an image of women easily having orgasms,
sometimes many at a time. The fact is that many women experience
orgasm seldom, or not at all, or only through certain kinds
of stimulation, or in certain settings. Orgasm is a body
reflex that occurs during a state of high sexual arousal
and pleasure. Just like you can’t make yourself sneeze,
you can’t make yourself orgasm. To have an orgasm,
a person focuses on pleasurable sensations and arousing
thoughts. It helps to be in a safe and secure setting, and
to be comfortable with your body. Some women who seldom
or never experience orgasm may learn to do so by exploring
what feels good. This can be done with a partner but often
it is easier done on one’s own. If you are with a
partner it is best to be able to say to him or her exactly
what you think would feel good, and try to give mostly positive
instead of negative feed-back. Because sex is something
that everyone seems to be interested in learning about,
there is much written on the subject. You could start online
by checking out www.netdoctor.co.uk/sex_relationships/.../orgasmtrouble.htm
Pain When having sex results in discomfort it becomes
no longer enjoyable. Pain at the vaginal opening may be
a consequence of infection like Herpes, or can represent
a problem of spasmodic involuntary contractions called vaginismus.
Painful intercourse is called dyspareunia in medical language
and is sometimes the result of scarring following an episiotomy
or other vaginal surgery. There is another whole set of
possible causes of dyspareunia when the symptom is associated
only with deep penetration. In those cases we look for conditions
such as endometriosis, chronic inflammation (sometimes referred
to as PID or pelvic inflammatory disease), uterine fibroids,
or ovarian cysts. The treatment or cure for pain with sex
depends on the cause in each specific case. For women who
are menopausal, sometimes for instance the problem is reduction
in natural lubrication as a result of hormonal shifts. This
problem can be addressed by restoring the hormones or using
extra lubrication, such as Astroglide or KY jelly.
(top of page)
Chlamydia This infection is common especially
in younger women who have had multiple partners. The symptoms
can be rather mild and most male partners have no symptoms
at all, so they don’t realize they carry a transmittable
disease. There may be a mild vaginal discharge and mild
to moderate pelvic discomfort. Sometimes there is discomfort
with urination as well. Chlamydia is readily treated with
antibiotics, but law requires that each case also be reported
to the local health department so all contacts are also
Gonorrhea Gonorrhea is less common than Chlamydia
but is more likely to result in tubal infection, inflammation,
and sometimes infertility. Other than pain and sometimes
fever, there are few symptoms. Many males with gonorrhea
will experience burning with urination, but some have
no symptoms at all. Treatment of both partners with antibiotics
should be done simultaneously to prevent re-infection.
Herpes In contrast to Chlamydia and Gonorrhea,
Herpes is contracted by virus and so does not respond
to antibiotics like penicillin. Anti-viral medicines such
as Acyclovir and Famvir are available to reduce the frequency,
intensity or duration of herpes outbreaks. However, even
between outbreaks which are sometimes years apart, the
individual still has the disease and can transmit it to
a partner even if no symptoms of pain, blister, etc are
present. We used to think of Herpes Simplex type I as
being oral (cold sores around the mouth) and Herpes Simplex
type II as being the genital kind, but actually it is
not so clear since either type can be found in either
location. Use of condoms can help reduce the chances of
giving herpes to a partner, but is not a guarantee, and
spread can occur despite this precaution. People with
herpes who have partners that do not have herpes can take
medication every day to drastically reduce the chances
of transmission. www.nlm.nih.gov/medlineplus/herpessimplex.html
HPV Human Papiloma Virus, is commonly
referred to as HPV. There is a proven relationship with
certain types of HPV and the development of cervical changes,
even - cervical cancer. On the other hand, it is important
to realize that there are literally a hundred different
kinds of HPV, and that most Americans harbor at least
one if not many different types with no symptoms whatsoever.
So it is a good idea to remain calm -about this topic.
Some of the HPV subtypes are much more likely than others
to contribute to cervical cancer, and a few are likely
to cause genital warts. People with immune system suppression
are more vulnerable to having problems with HPV, since
a healthy normal immune system will generally keep these
viruses in check. Vaccination is now available and is
very effective against the most troublesome types of HPV.
The vaccine in our office is called Gardasil, and should
be given as a series of 3 injections over 6 months to
women between the ages of 9 and 26 years. See www.gardasil.com
for more information.
HIV / AIDS This highly feared condition is caused
by a virus that specifically attacks the immune system.
When first discovered three decades ago it was felt to
be generally fatal, but now there are medications that
can keep a person with HIV healthy and functional. To
get HIV there needs to be a sharing of bodily fluids:
IV drug users sharing needles, sexual intercourse, and
blood transfusions are some examples (though with blood
transfusion the risk seems to be only about 1 out of 70,000).
Women with HIV are more vulnerable to cervical dysplasia,
so it is recommended for them to get pap smears every
6 months. The only way to know if you have HIV is to have
a blood test, which anyone can request. People at highest
risk of HIV are men who have sex with men, prostitutes,
and partners of men who are bisexual. However, anyone
with a desire to be sure they are free from HIV can have
a test done.www.cdc.gov/hiv/
(top of page)