It is not ideal to attempt a Pap smear during menses. Ideally, douching, vaginal medications, and intercourse should also be avoided for 48 hours prior to the Pap smear. If the patient is menstruating during the Pap smear, blood can obscure accurate readings of the cervical cells, especially if this is more than just light spotting

Spotting after a hysterectomy, or any vaginal surgery or D & C, is a fairly common finding. Simply avoid using any tampons or douching and abstain from intercourse. If the bleeding is becoming heavier, like a period, you are having severe pain, or running a fever you should call your physician or go to the emergency room for further evaluation.

Unfortunately, most ovarian cancers are discovered at later stages, or when it is further spread throughout the abdomen. Part of this reason is that the symptoms can be subtle, such as abdominal pain, decreasing appetite, and a bloated or distended abdomen. Currently, there are no good methods for screening for ovarian cancer in asymptomatic women, including ultrasounds and a blood test- CA 125. Whereas these are helpful during the diagnosis and subsequent management of the disease, they are not good at separating those individuals that have cancer from those that are normal. We are currently still looking for a good test to identify ovarian cancer early. For further questions, please consult your doctor.

Interstitial cystitis is a problem that results in a breakdown of the protective lining inside the bladder. As a result, your own urine begins to cause pain and irritation. Women frequently present to their doctors with a history of pelvic pain, possibly a prior diagnosis of endometriosis, pain with urination (sometimes like “spasms”), or frequent urination. Dietary factors can make the pain worse, as well as caffeine or tobacco use. This condition is treatable and frequently does not require surgery. The evaluation can usually be completed in 1 – 2 clinic visits. Please contact your physician for appointment if you appear to have any of these problems. Also, for more information, look at: www.ichelp.org

This is a situation where a woman has uterine bleeding that is not at the normal time for her menses. This is not normally due to uterine fibroids or endometrial polyps or other known causes. It is thought to be due to a lack of normal response of the endometrial tissue to the natural monthly cycle. It can be treated in a number of ways including oral contraceptives or hormone therapy, dilation and curettage, endometrial ablation, or hysterectomy.

Patients who just begin using birth control pills can often expect spotting in the first two months of the pill. Taking the pill at the same time and not missing pills helps to minimize episodes of spotting. With low dose pills, which are commonly used today, timing has become more important than ever in order to minimize spotting. If spotting continues after the first two to three cycles, other causes of this bleeding should be considered with your physician.

The term for this is amenorrhea. Usually women have a period every month, but occasionally they may skip one. Lack of menses can be caused by many things including pregnancy, thyroid problems, stress, weight gain or loss, polycystic ovarian disease or a sudden change in excessive exercise. Some types of contraception can also make you miss periods. If you miss a period, take a pregnancy test. If it is negative, then just wait. If you go three months without a period, you should contact your doctor because blood work and other tests will need to be performed.

Lupron is a medication administered by injection either monthly or every three months for a six month treatment course. The medication acts by suppressing ovarian function. Typically it is used to treat endometriosis, reducing uterine fibroid size, and occasionally by fertility specialists. It essentially lowers estrogen level similar to that of menopause. As a result, you will often experience symptoms suggestive of menopause such as hot flashes, night sweats, or mood swings. These symptoms will reverse and go away once the medication is out of your system.

The IUD, or intrauterine device, is becoming a very popular choice for birth control. It is a small T shaped device placed within the uterus. In the United States we have two choices of IUD's, the Paraguard and the Mirena. They can be placed in the office, are immediately effective, and work for several years. These IUD's are very safe and are used worldwide.

This is a small soft and flexible plastic ring that is placed into the vagina for three weeks each month to prevent pregnancy. It is removed for one week; then replaced with a new one. The NuvaRing should not be felt by the woman or her partner. Should the NuvaRing fall out during sex, bowel movements, or exercise, it should be rinsed and may be reinserted. Many people who have experienced nausea with birth control pills will not have that side effect with the ring. Its protection against pregnancy is equal to that of the birth control pill.

Proper diagnosis and treatment of a urinary tract infection requires submission of a urine specimen for evaluation. We do not routinely prescribe medication over the phone for a bladder infection without the benefit of a urinalysis. After office hours, this diagnosis would require a visit to an emergent care facility or an emergency room. We would recommend, however, that you increase fluids and perhaps use a medication such as Uristat to soothe the discomfort of the bladder until you can be seen in your doctor's office.

Bacterial Vaginosis is the proliferation of certain bacteria, called anaerobic bacteria, in the vagina. These bacteria are normally there, but in lower quantities because they are suppressed by another bacterium, lactobacillus, which maintains the vagina in its normal state. Bacterial vaginosis develops when the normal bacterial area killed or washed away with such things as antibiotics that you might take for a sinus infection or activities like douching. This is, however, not a sexually transmitted disease. Typically symptoms include a white vaginal discharge, odor, and irritation. This is typically treated with antibiotics, vaginal creams, or vaginal suppositories. Unfortunately, these infections often recur and may require further treatment. This infection is actually more common than yeast infections.

Yeast is a very common infection in women and is usually characterized by a thick clumpy white discharge and itching. Recent antibiotic use, vigorous exercise, diabetes, obesity, and hormonal changes may all place a person at higher risk for a yeast infection. The best way to know for certain is to make an appointment and be tested. This avoids treating the problem incorrectly. More often than yeast, bacterial vaginosis is the cause for most women's vaginal infections. It will respond slightly to over-the-counter medications but will immediately return to a full-blown infection status within days or a week. We recommend against self-treating infections. It would be best to be seen in the office to have the proper testing done to determine exactly what type of infection you have so that we may give you the appropriate medication. We do not phone in medications for any type of vaginal infection without being seen in the office. If you have self medicated, it is not of any value for you to be seen in the office for 24 to 48 hours after the last dose of medication.