Common Gynecological Problems

changes in cervical cells also known as cervical dysplasia. Often associated with the Human Papilloma Virus (HPV) which is sexually transmitted but male partners typically do not show signs or symptoms. There are varying level degrees of changes in the cervix. Some can even be pre-cancerous. Close surveillance with pap smears, biopsies, and ablative procedures may be indicated. See also... Abnormal Cervical Cancer Screening Test Results

a condition in which menstrual cycles occur irregularly or heavier than usual. This can result in severe anemia. Often times, hormonal therapy can regulate this bleeding. Endometrial polyps and fibroids can be the root of the problem. A dilation and curettage, hysteroscopy, endometrial ablation, myomectomy, or even hysterectomy may be required to treat bleeding. Dr. Dresdner will help guide you to the best option for your specific needs. See also... Abnormal Uterine Bleeding

an inflammation or enlargement of one or both of the Bartholin’s glands, located just inside the vagina. These cysts can come and go and they also can get infected, becoming an abscess. They can be very painful. Warm compresses and sitz baths are first line of treatment. Sometimes they auto-evacuate, but they can recur. Other times, an incision and drainage may be required, as well as placement of a word catheter. In the most severe cases, a marsupilization or gland removal may be necessary and require general anesthesia. Antibiotics may also help when the gland becomes infected.

we encourage self-breast exams 3-5 days after your period each month. If you notice a small lump or nodule, please contact your physician. It also may or may not be accompanied by discharge from one or both nipples. Drs. Dresdner or Simon will examine you and an ultrasound or other imaging may be required. If a biopsy is necessary, you will be referred to a trusted breast specialist. See also... Benign Breast Problems and Conditions

also known as mastitis; most commonly occurs after a milk duct becomes clogged after breastfeeding. It is usually associated with pain, erythema (redness), and high fevers. Your doctor will prescribe you an antibiotic that is safe in breastfeeding. Cool compresses may help alleviate pain and you should continue breastfeeding. In rare occasions, you may have to be admitted to the hospital for monitoring.

also known as mastodynia. There are a variety of reasons for breast pain including pregnancy, menses, and occasionally hormonal birth control. If breast pain is unrelieved by over the counter pain relievers, you should make a consultation with your physician for an exam and assessment. You may have to follow up with a breast specialist at the direction of your doctor.

a benign growth located on the cervix. Most times they are incidentally found and have no clinical significance. They only need to be removed if they cause bleeding i.e. after sexual intercourse.

a condition characterized by cyclic pain; that is with your periods (see dysmenorrhea), as well as painful bowel movements and pain during sexual intercourse. The only true diagnostic modality for endometriosis is a diagnostic laparoscopy (see laparoscopy), but if suspicion is high, your symptoms may be controlled with hormonal birth control. Our doctors are equipped to deal with all stages of endometriosis.

an infection of the uterus after giving birth. It is often characterized by abdominal pain and fevers. It is caused from the upward travel of vaginal bacteria (flora) after rupture of membranes (“breaking water”). It typically shows up early while you are still in the hospital and you may require antibiotics. It can also be associated with vaginally bleeding and can occur in the first few weeks after giving birth. Your doctor should be contacted so that appropriate treatment can be administered. See also... Endometriosis and Chronic Pelvic Pain

a benign growth located in one or more of the three layers of the uterus. Fibroids can be of all sizes and can cause heavy or painful menstrual cycles. Sometimes they can be managed with hormonal therapy, but they often need to be removed surgically. Dr. Dresdner has a great deal of experience with the various methods of fibroid removal. See also... Uterine Fibroids and Dysmenorrhea: Painful Periods

a condition in which the glands of the axilla (underam) and inguinal region (groin) become infected. Warm compresses and sitz baths are first line treatment. Sometimes incision and drainage or removal of the gland is necessary. Antibiotics may or may not be necessary.

various reactions of the vulvar tissue (external female genitalia). There are a few types: lichen planus, lichen simplex (chronicus), and lichen sclerosus. Each depigmentation/rash is unique and long courses of topical steroids are often required. Sometimes a biopsy of the skin may be necessary. See also... Disorders of the Vulva: Common Causes of Vulvar Pain, Burning, and Itching

• Female sexual interest/arousal disorder-decreased libido or arousal in 75-100% of sexual encounters
• Female orgasmic disorder-anorgasmia or decreased pleasure
• Genito-pelvic pain/penetration disorder-pain or fear of pain (i.e. vulvodynia); involuntary contraction of muscles (i.e. vaginismus)
• Substance/medication induced sexual dysfunction
• Unspecified sexual dysfunction

See also... When Sex Is Painful and Vulvodynia

a climacteric change in a women’s life which is characterized by low levels of estrogen. The average age is 51 but genetics and lifestyle choices i.e. smoking can bring on menopause earlier. “Menopause” is achieved after 12 consecutive months without a menstrual cycle. “Perimenopause” can occur for years up until achieving menopause. You may only have 2-3 menstrual cycles in a year and they may be heavy. Vasomotor symptoms or “hot flushes” may interfere with your activities of daily living. Vaginal dryness and sexual dysfunction may also occur. Speak to Drs. Dresdner or Simon about treatment options. We do offer hormone replacement therapy to select individuals based on a risk assessment.

See also... The Menopause Years

benign fluid-filled cysts on the cervix. They can be as large as 1cm and sometimes appear white. They rarely need to be removed.

after 65 years of age, you will require a bone density (DEXA) scan. A select few other conditions require close monitoring of bone health. After the test, you will receive a T-score and your doctor will provide you with appropriate management, medications and possible referral if necessary. It is always beneficial to supplement with vitamin D and calcium and perform weight-bearing exercises in order to encourage bone health (unless otherwise instructed to avoid). See also... Osteoporosis

every woman makes a small follicular cyst (1-2 centimeters) with each menstrual cycle. Sometimes large simple cysts can be managed with hormonal therapy. If a cyst becomes too large or is complex (hemorrhagic, endometrioma, dermoid), it will be followed with serial ultrasounds and/or be removed surgically. Variations of ovarian cyst are paratubal cyst, para-ovarian cyst, adnexal mass, tubo-ovarian abscess. Dr. Dresnder has vast knowledge and experience managing each of these.

also frequently characterized by “nocturia” (needing to void several times through the night)

can be an acute or chronic process. Often is caused by a previous infection with gonorrhea or chlamydia, but other organisms can cause. It is characterized by pelvic pain, fevers (sometimes), and sometimes infertility or even ectopic pregnancy due to pelvic adhesions.

See also... Pelvic Inflammatory Disease (PID) and Chronic Pelvic Pain

pain that occurs in the pelvis when other sources have been excluded i.e. gastrointestinal disorders. A pain diary should be kept detailing your symptoms so your doctor will best understand them. A history and physical are often necessary. Blood work and pelvic ultrasound may also be necessary.

• Dysmenorrhea-pain that occurs during menstrual periods.
• Dyspareunia-pain that occurs during sexual intercourse.

a condition which is often characterized by irregular periods, hormonal imbalance, and hirsuitism (male-pattern hair growth). Insulin reistance is often associated and sometimes metformin or other medications to control your glucose may be necessary. Ovarian cysts are not necessary to receive the diagnosis, despite the name, however they may occur and should be followed closely.Women with polycystic ovarian syndrome many times have anovulatory cycles (without ovulation) and therefore may have difficulty getting pregnant. Our doctors are well equipped with tackling this problem and can offer you medication i.e. clomid and a conception plan tailored especially to your needs. Many of our patients with polycystic ovarian syndrome achieve conception.

See also... Polycystic Ovary Syndrome (PCOS)

a condition characterized by irritability, fatigue, etc during the 1-2 weeks prior to your menstrual cycle.

See also... Premenstrual Syndrome (PMS)

a more serious condition characterized by anger, depression, anxiety, or other symptoms during the 1-2 weeks prior to your menstrual cycle. Hormonal therapy, anti-depressant therapy, and/or behavior counseling may be necessary.

vaginal bleeding which occurs during or after sexual intercourse

vaginal bleeding after achieving menopause (12 consecutive months without a menstrual cycle). Please contact your doctor immediately. The most common cause of postmenopausal bleeding is vaginal dryness or atrophy, but more serious complications i.e. endometrial, cervical or vaginal cancer should be excluded by a medical professional. An endometrial biopsy and/or dilation and curettage are often required. Our doctors are equipped to perform these and analyze the results.

See also... Perimenopausal Bleeding and Bleeding After Menopause

Sexually Transmitted Illnesses (STI) Screening under well-woman-exam.htm

See also... How to Prevent Sexually Transmitted Infections (STIs) and Chlamydia, Gonorrhea, and Syphilis and Genital Herpes and Testing for Human Immunodeficiency Virus

involuntary loss of urine often due to pelvic floor weakness. A urine diary (how often, how much, etc) should be kept as well as food diary, as some foods can be irritating to the bladder. There are many types and each may require specific treatment.

• Stress Incontinence -leakage of urine when coughing, sneezing, or exercising. Kegel exercises, pelvic floor rehabilitation, behavioral modification are often necessary. Surgical therapy via transobturator or transvaginal sling may be required. After urodynamic testing and initial management, we would refer you to a trusted urogynecologist if this particular procedure were necessary.
• Urge incontinence-leakage of urine with a frequent sensation of “gotta go, gotta go!” It is characterized by frequent trips to the restroom with small amounts of urine emptied each time. Various therapies are available including medication and pelvic floor rehabilitation which we perform in the comfort of our own office.
• Overflow incontinence-leakage of urine without sensation. Some medical conditions and medications can cause this. Kegel exercises and timed voids are often necessary.
• Mixed incontinence: any combination of the three above types.

See also... Urinary Incontinence

also known as cystitis, is an inflammation of the bladder typically caused by an infectious process. The most common symptoms are pelvic pain, burning on urination, frequency of urination, and back pain. Fevers occur occasionally and antibiotics are often required. Urinary tract infections are common and important to treat so that the infection does not spread to the kidneys. In the case of a kidney infection, pyelonephritis, hospitalization may be necessary.

• Interstitial cystitis is an inflammation of the bladder that is not frequently associated with urinary tract infections. A referral to a urogynecologist or urologist may be necessary if basic modalities don’t help.

inflammation and sometimes infection of the vaginal walls. Often caused by a disruption of the normal vaginal bacteria or flora. There are many types. The most common include:

• Atrophic vaginitis-vaginal dryness typically seen in post-menopausal women due to lack of estrogen. The tissue can be itchy and painful, particularly with urination and sexual intercourse. There are a variety of treatments (oral and vaginal preparations) available to relief this dryness.
• Bacterial vaginosis-a thin, yellow/grey/tan, malodorous discharge. This typically results after the normal vaginal flora is washed away, allowing other bacteria to emerge. An antibiotic (oral or vaginal preparation) will often relieve symptoms. Women who get regular infections may be able to prevent future instances by taking a probiotic (Lactobacillus) or using a variety of gels that restore pH imbalance.
• Yeast-a white, thick, “cottage-cheese” like discharge. The fluid is usually without odor but often causes itching. Yeast also occur due to a pH imbalance and often emerge after an antibiotic course for another issue i.e. sinus or ear infection. They also are common around the time of menses. Antifungal pills and creams are available. Women who suffer from frequent infections may benefit from taking a daily supplement called acidophilus. This or eating a daily yogurt could help prevent but will not treat yeast infections.

a growth on the external female genitalia. There are varying types from benign skin growths i.e. skin tags, lipomas to (genital) warts to malignancies. A biopsy is often required as a tissue diagnosis will permit your doctor to assess and treat your condition.