Gynecology

If you are thinking about becoming sexually active

If you are having irregular or extremely heavy periods (bleeding more than seven days out of every twenty-eight and using more than ten pads per day

A pelvic exam and Pap smear can wait until you are 21.

If you’ve had a total hysterectomy (removal of uterus, ovaries and cervix), you still need a yearly physical, but need a Pap smear once every five years.

Don’t panic. While it doesn’t automatically mean you have cervical cancer, you may have some pre-cancerous changes or a condition that will require monitoring and possibly treatment. You may be scheduled for a colposcopy which is an office procedure that is an in-depth, five- to ten-minute Pap smear that can give us some important information about why your test results were not normal and what action that we may need to take.

Generally, your first mammogram should be done at age 35 and then every two to three years from age 40 to 50 (depending on your family history and risk factors); and yearly after age fifty. Please discuss specific guidelines with Dr. Boo, Dr. Graber or Dr. Carroll based on your risk factors.

A dilation and curettage or D&C is a surgical procedure used to diagnose or treat abnormal bleeding from the uterus or following a miscarriage. In this outpatient surgery -- performed at Salina Regional Health Center -- the lining of the uterus is removed and the tissue is sent to a lab for examination.

After the procedure, you will probably be able to go home within a few hours. Anesthesia and prescription pain medication may slow your reflexes and memory for 24 hours, so do not drive, drink alcohol, operate heavy machinery, or sign legal papers following surgery. You will need someone to drive you home. Your throat may be sore from the tube inserted during anesthesia, and you may have mild cramping and spotting or light bleeding. You should be able to resume most of your regular activities in a day or two. Do not put anything in your vagina (tampons, douching, or sex), until you’ve checked with Dr. Boo, Dr. Graber, Dr. Carroll or one of the nurses.

While complications like infection or perforation of the uterus are extremely rare, contact us immediately if your vaginal bleeding is heavier than your normal period, if you have a fever of 101 degrees or higher, if you have severe abdominal pain, or a foul-smelling discharge from the vagina.

Laparoscopy is often used to diagnose causes of abdominal pain or masses; to evaluate infertility; and to perform certain procedures like tubal sterilization. The advantages of a laparoscopy over traditional surgery is that the recovery time is often much shorter. During this outpatient surgical procedure, performed at Salina Regional Health Center, a small incision is made in or near the pubic hair line and navel and then gas (like carbon dioxide) is pumped into the abdomen and swells the abdomen so that the pelvic area can be seen more clearly.

Anesthesia and prescription pain medication may slow your reflexes and memory for 24 hours, so do not drive, drink alcohol, operate heavy machinery, or sign legal papers following surgery. You will need someone to drive you home. Common complaints following surgery include nausea (from the anesthetic or from pain medication), sore throat from the tube inserted during anesthesia, abdominal cramps, a discharge (like your period) that lasts a few days, a swollen abdomen, tenderness at the incision site, or shoulder or neck pain from the air that was placed in your abdomen during surgery. Excessive use of prescription pain medication can cause nausea and constipation. Take acetaminophen (Tylenol) or ibuprofen (Advil) as the label directs for mild pain and increase your intake of water, juice, fruit, and fiber. Resume normal activity as your comfort permits.

You may shower or bathe after 24 hours. Remove the band-aid or wound dressing when you shower. Gently wash the wound with soap and water and pat dry, applying a clean band-aid if desired. If you have dissolvable stitches, they will begin dissolving in a few days.

Your menstrual cycle should not change. If you had a tubal sterilization and are currently taking birth control pills, finish your current package prior to discontinuing the pills.

Although problems seldom occur with laparoscopy, there can be some complications like injury to blood vessels, or other organs like the lower abdomen, the bowel, or the urinary tract. Contact us immediately if your vaginal bleeding is heavier than your period; if you have a fever of 101 degrees or higher; if you have severe abdominal pain; or if you have nausea or vomiting and are unable to keep fluids down for 24 hours.

Essure and Adiana are new ways of doing tubal ligations – without an incision. They are simple, outpatient procedures for permanent birth control. Both are approved by the FDA and they have greater than 98% effective at preventing pregnancy. Essure and Adiana are covered by most insurance plans.

Both Essure and Adiana procedures consist of passing “micro-inserts” through the body’s natural pathways (vagina, cervix, and uterus). These inserts are then placed into each fallopian tube from the inside. The micro-inserts are made with materials that have been used in medical devices for many years. They do not contain or release hormones.

During the first three months following the Essure and Adiana procedures, your body and the micro-inserts work together to form a scar tissue barrier so that sperm cannot reach the egg – and preventing pregnancy. You will need to use another form of birth control during this three-month period, until an e-ray test called an HSG confirms that your tubes are completely blocked.

No. You should not have the Essure or Adiana procedure unless you are sure that you are done having children.

Call us for more information.

You may experience a temporary change in your period (either lighter or heavier). Only a few women experience permanent changes in their periods.

Call us for more information.

Because there’s no incision involved, it takes about 35 minutes to place the micro-inserts and confirm that they are in place. Most patients are ready to leave the hospital several hours after having the procedure. You should be able to return to normal activity the following day.

Remember, you will need to use another form of birth control during this three-month period, until an x-ray test called an HSG confirms that your tubes are completely blocked. Occasionally, it will take up to six months for the barrier to form. You must have an positive HSG before you stop using another form of birth control.

As with any procedure, there are risks associated with Essure or Adiana. Please consult Dr. Boo, Dr. Graber, Dr. Carroll, Beth, Kim, or Marsha and take advantage of our materials. Essure or Adiana does not protect against HIV or other sexually transmitted diseases. If at any time you think you are pregnant, call our office immediately to rule out the possibility that you have an ectopic pregnancy.

What should I expect during the HSG?
What should I expect after the HSG?
What else should I know about the HSG?

The HSG (hysterosalpingogram) is a an x-ray test used to diagnose problems with fallopian tubes and the uterus, including infertility.

Much like a Pap test, you lie on an exam table with your knees bent. A speculum is inserted in the vagina to hold it open and a thin tube called a catheter is guided through the cervix and into the uterus. The radiologist positions the x-ray machine over your abdomen and contrast fluid is then inserted through the catheter. As the fluid flows through the uterus, x-rays are taken and displayed on a monitor.

HSG tests cause minimal discomfort and generally take less than thirty minutes. You may go back to your normal routine right away. You will likely have a thick discharge as some of the dye drains. Use pads, not tampons, until the discharge is gone. It's usually recommended to take two Aleve 30 minutes prior to the procedure to minimize cramping, but you may have minor cramping for a few hours and can take over-the-counter pain medication. Dr. Boo, Dr. Graber or Dr. Carroll may tell you not to have sex or douche for a day or two. Call the office, Dr. Boo, or Dr. Graber if you have severe or increasing pelvic pain; heavy vaginal bleeding (more than a pad an hour for over two hours); a fever over 101; or foul-smelling or unusual discharge.

The HSG is a very safe test, but it does carry very small risks of infection and an allergic reaction to the dye used. Make sure that you tell your doctor if you are allergic to shellfish, iodine, or contrast fluid.

If you ever have any questions or concerns, do not hesitate to call the office. We are here to help you!