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Dr. N Blog
IUD is Alive and Well
Post June 13, 2013 by admin
I would like to comment in the diverse use of the progesterone/based IUD- Mirena. It is Levonorgestrel releasing that primarily confines itself to the uterus with systemic release. It is beginning to be more than a contraceptive. In our recent “green” journal there were articles addressing some other indications. The key topics that were brought up were- it is safe to use in the teen population, it is safe to use in women that have not had children, it is used to manage very heavy periods, it might be effective in preventing uterine cancer or polyps in high risk patients and the risks are minimal. It’s use has increased from 1.3% in 2002 to close to 9% in 2009 of all contraceptive users. I believe that number will increase as it has become more affordable. Women of all ages are using it and once they experience the freedom of little or no bleeding, they want to do it again. The insertion is done in the office, by a trained provider, and should take less then 10 minutes.
It is an option that I believe more providers need to talk about. Not only for contraception but for other gyn disorders as well. Dr N
Female Embarassment by Dr N
Post June 13, 2013 by admin
I want to write about many women that I provide care for that see me because of EMBARRASSMENT. The majority of consultations for labiaplasty reveal that they have been self conscious about their body for years, sometimes decades. They describe too much skin that makes it hard to clean or difficult to wipe. They describe pulling or trapping of the skin with exercise or intercourse. They talk about being shy about changing in front of other people or with their partner. The majority of women come to this belief on their own. It is not media driven or a message given them by others. I would like to explain to those, that don’t understand, including some physicans and medical boards, or partner, or parents….. that we need to support the right of these women to choose something different that will allow them to feel better about themselves. It is a ‘truth’ that they come to on their own, for themselves. It is enormously rewarding to lift the burden from these women that they have carried for so many years. They are so happy once it is done. I agree, it is not for all women. I do embrace all of our differences. But for those that are embarassed and it persists into young adulthood and it affects their daily lives, we NEED to offer a safe, effective surgical solution that improves their self esteem and makes self care and self expression easier for them. It is not about wanting us all look the same. It is about helping a woman feel good about herself and encourage HER right of self expression, without judgement. I individualize the surgical approach to what they want. The repair leaves a look that is natural and does not leave any scars into the future. It is a healing journey that I am proud to be a part of. Women can have children after the procedure, sexuality is unaltered and the burden is lifted. Dr N
Be Real Dr N Gyn
Post May 3, 2013 by admin
Dear Dr N, Thanks for your office, your staff and your ability to talk about anything. Its real and it is appreciated. signed D.M
Dear D.- Going to the doctor can be uncomfortable at best. It is a choice to be vulnerable and talk to someone who knows more about your health due to their knowledge base. I went into the practice of medicine to be a source of knowledge for patients. I feel a responsibility to help give them the I have an information let them make their own decisions. The comfort starts in the waiting room. Small, personal can feel more private. We handle all information with integrity. My staff is approachable and helps you feel comfortable. We try to balance enough time to listen and still accomplish enough efficiency to run a small business. It is about balance. If we need more time, I will ask you to come back. I want you to feel empowered with knowledge.
We CAN talk about anything. You need a place to go where you can ask real question and get real answers. Thanks for the feed-back. Pass it on. Dr N
Nexplanon, Implant Contraception
Post April 19, 2013 by admin
Dear Dr N- My daughter has a scholarship for college, but she can’t get pregnant or she loses it. How do I, as a parent, help her with this as she goes to college? signed worried parent
Dear Worried- Your daughter is venturing into a great adventure. You want her to be careful and protect the great fortune she has with her scholarship. SHE has to commit to being careful as well. If she is sexually active a great option for her is to have an implantable contraception that does not require compliance. It is in the inside of the arm, and requires no remembering. It lasts 3 years and has few side effects. There is also an injection every 3 months, the Nuvaring that is in the vagina and is changed every month or a DAILY pill. I think the Nexplanon implant is a great option, little considered, simply because people do not know about it. Easy clinic insertion. No remembering. I wish your daughter well. It is progesterone only and only side effect can be spotting. Call your gynecologist and get her protected. Dr N
Anxiety by Dr N
Post April 19, 2013 by admin
I am going to post tonight and talk about Anxiety. There is a tremendous amount of worry and stress in the world. Patients come in and talk about their hormones, and while hormones contribute to a worsening of symptoms……. de novo or new SEVERE anxiety is not hormones only.
I can feel the anxiety when I walk in a patients exam room. There are many variations to this including tears that are being held back, pressure of speech, perseverating on fears, thoughts, ideas without rationale basis. I have had patients say “I am not a worrier” but “I go to an emergency room at least every 6 months with my heart racing and they can never find a cause”. I have patients state “I just need something to help me sleep” because they cannot stop thinking about their day or focusing on the next day. I have people say “I get up to see if my children are breathing” or “I think spiders are going to crawl up my sheet if they touch the floor” or “I can’t stop thinking that this pain is cancer” . But, when I ask, are you anxious or worried? They say no….. and they are the most resistant to therapy or medications because they are “concerned” about how the medication might make them feel or the long term effects of the medication. THIS IS ANXIETY. I listen and treat is every day. I feel like patients need therapy, psychiatrists- an avenue to talk about it. Primary care physicians often just hand out a prescription because they don’t want to talk about it. Psychiatrists are far and few, not covered by insurance and ALSO hand out prescriptions without talking about the fears. Anxiety can be chemical but frequently, it has a root. Learned behavior, trauma, phobias, depression , unhealthy home or work environments, body image, fear of death, spiritual crisis…. the list goes on. If someone would pay me to help patients with anxiety, if I could bill for the time- or physicians could take the time to talk to patients to guide, educate or help them- they wouldn’t be so quick to hand a prescription to them. I feel we have a society that medicates the problem rather than listens, guides, counsels. Sometimes people just need a sounding board from a compassionate listener and a counselor to help them find a way through their fears. I will treat with hormones at times, sometimes I listen, sometimes I make suggestions but the resources I have, as a provider are nil. Just wanted to talk about it. Dr N
Low Libido by Dr N
Post April 2, 2013 by admin
Dear Dr N- What about my low libido, I’m just not interested. signed discouraged
Dear Discouraged- This topic has SO many answers for women! Don’t be discouraged, there is hope for women of all ages but the issues vary with every woman. There are many variables that contribute to a low sex drive for women. The hormones of desire for women are primarily Estrogen, to take care of the vaginal tissues/breast/and secretions and Testosterone that stimulate that ‘hunger’, leads to more aggression/assertiveness/appettite … I saw a patient today that presented a very interesting concept and was very open about it. She has had many children vaginally and loves them dearly. Since having children she felt a sense of shame about the appearance of her genital structures because things just didn’t look or feel the same. She honestly admitted that she avoided intercourse because of this. Not because she did not want it, or desire to be wanted by her loving husband, but she could not feel comfortable with her body as it was and did not know who to talk to. Fortunately she did her reading, she and her husband talked about it and she found her way to me to talk about vaginal reconstruction or rejuvenation as it is termed. She is now 3 weeks after surgery and feels like a different, more confident person and did not realize what an affect it had on her sex drive. She and her husband are patiently waiting for surgical recovery and are looking forward to being reunited! I am so happy for them and am astounded by her open-ness and maturity about the subject. She had buried her desire subtley to avoid her own discomfort with her body. Sometimes surgery is not required and physical therapy or other measures can help. Sometimes surgery is a great turning point! Thanks for the question- I am sure it will stimulate more. Dr N
Vaginal Lubricants by Dr N
Post March 6, 2013 by admin
Dear Dr N- Things are a little dry, not sure where to turn. Help.
Dear Help- This IS a confusing topic. There are many otc lubricants and some on line. It is a very personal choice for you and your partner. First of all make sure there is adequate foreplay for a woman. This is what lead to lubrication through the vaginal walls, arousal. What arouses one, does not another. It can take longer than 5″ , I suggest couples work on the ten minute kiss and find erogenous zones for each other. Then there are glycerine based, water based, silicone based lubricants and also natural oils that are safe to use. Samplers can be purchased on line to see which one works best for you. I also recommend coconut oil or organic vegetable oil that is odorless, it has a nice consistency and does not have alot of additives or preservatives. Remember, what goes in the vagina can be absorbed into odothe body. The warming agents can be irritating or arousing, it is an individual choice, but usually not well received. Also make sure it is not a hormonal problem because estrogen can improve the ability of the vagina to lubricate and can be placed directly there to avoid systemic effects. Good Luck- hope that helps. Dr N
Primary Herpes
Post February 14, 2013 by admin
Dear Dr N, I got herpes for the first time a month after sleeping with my boyfriend. He did not know he had it, but I got it really bad! I have sores all over and it is hard to pee. He feels bad, I feel bad, what happened???
Dear Feeling bad- I am sooo sorry to hear this is happening to both of you. Herpes is a virus that can live in the mouth or the genitals or other places like herpetic Whitlow (on the hands) or in the tailbone or on the buns. It use to be HSV 1 was oral and HSV 2 was in the genital area but with orogenital contact now 1 and 2 can be in either place. Sometimes partners have viral shedding before they have a lesion. Or sometimes partners have oral herpes and do not know that it can be passed to the genital area. There can also, in rare cases be asymptomatic viral shedding. There is a blood test that checks to see if there are antibodies in the blood to the herpes virus but it does not state where in the body the virus is residing. All that being said, primary herpes can be terrible. There are many sores and you can have a flu-like illness. When it recurs it is much less intense and more focal but usually comes back in the same place. Things that trigger a lesion are stress, sleep deprivation and lowering the immune response with multiple stresses. The treatment regimens are different for primary ( the first case) or secondary ( the second time it shows up) breakouts. There is also a treatment for suppression to keep viral shedding from happening or breakouts from occurring. The medications are prescription and include acyclovir, valcyclovir and famvir. You need to see your doctor to get a prescription for treatment. It is alot of information , but there is treatment, and although it is very stressful, it does not cause long term , debilitating disease. See a doctor, get some help, read about it. Dr N
The Vagina
Post February 1, 2013 by admin
This elicits different thoughts from different audiences. I am talking about it as a doctor, a gynecologist. I truely believe , the vagina is an amazing organ. And it is complicated. As a surgeon I am aware that it is 3 dimensional and there is a compartment under the bladder which also contains the elusive G shot. There is a compartment over the rectum and the wall between these two structures is the recto-vaginal septum. The upper most part of the vagina is the cervix which is the portal of the uterus. There are ligaments that extend from the back wall and the sacrum called the uterosacral ligaments and ligaments lateral that are more like a fan of collagen-like tissue called cardinal ligaments. It is surrounded by a complex arrangement of muscles, nerves and the urogenital diaphram. The skin is designed like an accordian, that is dependent on adequate blood supply, AND hormonal stimulation to the receptors to keep it, accomodating. This means it will stretch to allow that which wants to enter such as a baby, a person or a thing. The vagina will recoil due to its fibroelastic tissue but if the fascial structures are weakened under the skin, hernias can develop such as a cystocele, rectocele or enterocele. Glands produce mucous and normal discharge and there is a delicate balance of bacteria of many different varieties to allow an environment that is permissable to the passage of sperm upward in search of the elusive egg. It is warm and soft and the subject of much romantic thought, discussion and fantasy. If the accordian is not recoiling properly or if the folds are lost due to the loss of hormones , surgery or radiation, the VAGINA can either be too tight, too loose or does not feel right. Patients are trying to get it feeling better, back in balance or more physico-aesthetically pleasing. It is the source of many appointments, discussions, medications or surgeries. It can be the source of great pleasure or great anxiety. There can be infections, trauma, pain or confusion about it. It is very complex and not to be minimized. It commands respect. Dr N
Sexuality after Breast Cancer
Post January 16, 2013 by admin
I am writing tonight to raise awareness for sexuality after the diagnosis of Breast Cancer. I am a part of a panel that wants to help couples maintain the health and pain free choice to remain vaginally active following the diagnosis and treatment of breast cancer. Women will often enter menopause or stop using hormones which often leads to shrinkage of the vaginal tissue and less lubrication and accomodation. I would suggest that even without the use of hormonal intervention a woman can use mechanical dilators and lubricants and physical therapy to keep the vagina arousable and enjoyable. There just is not enough information out there and in the early stages of breast cancer treatment, this is not a priority. I am here to say, there are things that can be done that are not hormonal and the intimacy is important. Get some help from professionals that are aware of the treatments and options.
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