SIMEDHealth

Five Myths About Breast Cancer: Busted

October, most associated with pumpkins, and changing temperatures, is also commonly associated with the color pink for Breast Cancer Awareness Month. According to breastcancer.org, As of January of this year, 3.1 million women have a history of breast cancer in the United States. We talked to SIMEDHealth Gynecologist Dr. Linda Grover about some common myths that still surround this cancer despite the overwhelming amount of pink showcased this month.

1) Finding a lump in the breast means you have breast cancer.

Dr. Grover explains, "Approximately 90% of the palpable breast lumps found in women between the ages of 20-50 are not malignant.”

Breast cancer odds increase with age but what is critical for all ages is a prompt, professional evaluation. While most lumps are not cancer, it isn’t easy to determine this just by palpitations so it’s always a good idea to have them evaluated by your healthcare provider. Never let fear cheat you out of a good outcome. This is to say that if you feel a lump in your breast, don't make assumptions it’s nothing, get it checked out by your physician.

2) Breast cancer is only a women’s issue.

"Interestingly, some reports indicate breast cancer in men has been steadily increasing in frequency in the last 26 years. Most men with breast cancer do not have identifiable risk factors at diagnosis”, says Dr. Grover, “men with known BRCA2 mutations are a higher risk.” Although less than 1% of men receive a breast cancer diagnosis, any apparent breast lump should be evaluated. The classic presentation of breast cancer in a man is a painless firm mass beneath the nipple.

3) If you have a family history of breast cancer, you will get it too.

Having a family history of breast cancer is not a defining risk for developing breast cancer. According to Dr. Grover, "Only 5-10% of breast cancers in women are hereditary. Without any family history of breast cancer, 1 in 8 U.S. women will develop breast cancer. If a patient has one first degree relative (such as mother or sister) with the disease, her risk will increase about twofold. If two first degree relatives have breast cancer, the patient's risk will increase about threefold."

More distant relatives with breast cancer histories have less impact but are useful in formulating recommendations for genetic testing. Other risk factors exist, and it is wise to not only know your family history but how to protect yourself from breast cancer with a healthy lifestyle.

4) A mammogram can cause breast cancer to spread.

So many myths exist about mammograms. Dr. Grover explains, "Mammography screening decreases the breast cancer mortality rate by about 46%, according to studies done on hundreds of thousands of women and seven different statistical models. As multidisciplinary medical management, adjuvant treatment, and additional screening tests (MRI and ultrasound) emerge, these statistics will change and attribute decreased mortality to a broader combination of factors." However, there is no evidence, and under no circumstance should mammography be blamed for the metastasis of breast cancer. Earlier detection and better treatments save lives.

5) If the BRCA1 or BRC2 gene is in your DNA, you will get breast cancer.

“First, it is vital to explain that there is a difference between having the BRCA1/2 gene and having the BRCA1/2 mutation. Everyone has the BRCA1/2 gene, but only about 1 in 400 people have the mutation. Having the mutation carries the risk of developing cancer, but it does not mean you will definitely get it.”

Dr. Grover explains, "by age 70, these specific mutations carry a breast cancer risk of 55-70% for BRCA1 carriers and 45-70% for BRCA 2 carriers. Younger age patients (age30-40) are at risk of earlier-onset disease. Multiple other cancers are also linked to these mutations.

In light of these alarming rates of cancer, national guidelines recommend the removal of the tubes and ovaries by age 35-40 in BRCA 1 carriers and age 40-45 in BRCA2 carriers. Again, it should be noted that less than 10% of women with a familial history of breast cancer carry these specific gene mutations. Before making any decisions, please talk to your doctor about what option would be best for you if you are a BRCA1/2 mutation carrier.

 

Breaking down the myths and knowing the facts is essential to staying healthy and conscious of the signs from your body. Dr. Grover is a gynecologist physician in our Women’s Health Gainesville clinic. Click here to schedule an appointment with her!

Do You Know the Warning Signs of Ovarian Cancer?

Ovarian cancer accounts for 2.5% of cancers in women, according to the Ovarian Cancer Research Alliance. September is Ovarian Cancer Awareness Month, and we talked to SIMEDHealth gynecologist, Dr. Austin Chen all about it. 

1. Where is the ovary located in the body, and what does it do?

 Ovaries come in pairs. One on each side of the body. When standing, the ovaries are located below the hip bone and produce eggs at regular intervals after hitting puberty. It contains the chromosome and genetic material of the body. Dr. Chen says, "The ovaries also produce several hormones, estrogen, progesterone, and testosterone. These hormones tell the uterus when to have menstrual cycles, support fertilization, and pregnancy in its early stage. The ovarian functions interact with the environment, lifestyle, aging, and other hormones from other glands such as thyroid." 

2. What are some symptoms of ovarian cancer?

 "There are no unique or specific symptoms ascribed to ovarian cancer, says Dr. Chen. Vague changes in bowel habits, weight, and appetite can happen as ovarian cancer progresses. This vagueness and non-specific quality make recognition of cancer's presence challenging for both doctors and patients. Furthermore, ovarian cancer, at early stages (I & II), tends to be silent.

3. How is ovarian cancer diagnosed?

 Dr. Chen says, "Discovery of cancer occurs during either an unsuspecting surgery as a surprise or is highly presumed before planned surgery." So basically the doctor and patient will have no idea or are highly suspicious. If it is discovered during unsuspecting surgery or after a pathology result returns, there is a good chance it is in its early stage. If the symptoms and an exam are highly suspicious, the patient will go to a gynecologic oncologist. A physical exam, blood test, CT scan, MRI or ultrasound, are all tools used to determine if an ovary is cancerous.

4. What are the treatment options for someone diagnosed with ovarian cancer?

 Surgery and chemotherapy are the most common treatments the majority of the time; it is a combination of both. Gynecologic oncologists and medical oncologists work together to coordinate the chemotherapy and figure out what will work best for the patient and their cancer, says Dr. Chen.

5. Does the use of birth control increase the risk of ovarian cancer?

 Dr. Chen says, "No. On the contrary, women with present or past exposure of birth control pill for five years or more will have a 50% reduction of ovarian cancer risk."

6. What is the difference between ovarian cancer and ovarian cysts?

 A cyst is a fluid-filled sac. Most commonly, cysts are formed during ovulation and are entirely harmless. One type of ovarian cysts is follicular cysts. These follicular cysts can be seen on the ultrasound and occur when an egg grows inside a follicle sac. Eventually, the pouch should break open, but if it does not a cyst form. Another common type of cyst is called corpus luteum cysts. These occur when follicle sacs break free, but the mass of cells does not shrink. The sac reseals itself and forms a cyst. Both of these types of cysts go away on their own, or if they are serious, they can shrink them with medication. 

 We use imaging studies (ultrasound, CT, MRI) to help determine if a cyst requires medical attention or not. Dr. Chen adds, "The doctor may also order blood tests to help to make a decision." 

 

Dr. Chen sees patients in Gainesville and Lake City. Click here to schedule an appointment with her!

VIDEO: Get to Know Our New Gynecologist Dr. Austin Chen

We sat down and talked to our newest physician of SIMEDHealth, Dr. Austin Chen. Dr. Chen is a board-certified OB-GYN specializing in robotic surgery. Dr. Chen is now accepting patients. If the video is not shown, click here.

 

 

 

Dr. Austin Chen Joins SIMEDHealth Women's Health

SIMEDHealth is pleased to welcome our newest physician and surgeon to Women's Health Dr. Austin Chen!

Chen received an undergraduate degree and a medical degree from the State University of New York (SUNY) at Stony Brook. She then went on to complete her residency at Columbia Presbyterian College of Physician & Surgeons at Harlem Hospital. 

After completing her degree, Chen went on to teach at NYU Medical School and the University of Nevada School of Medicine. She created and built her own successful practice in New York, and was the senior Ob-Gyn consultant for St. Mary's Hospital Lacor in Gulu, Uganda. Dr. Chen's time in Uganda was very impactful as she was able to help not only many patients, but also her fellow staff members. Cervical cancer is rampant in places such as Uganda, and Dr. Chen took initiative and implemented a district-wide free cervical cancer screening program for the healthcare workers. About 400 people in total has screenings done and three early cancers were found and treated. Chen also brought the first laparoscopic system to northern Uganda and in the future is working towards building a laparoscopy training program there.

Dr. Chen is available to start taking patients on March 1st, 2019.  

VIDEO: SIMEDHealth Women's Health Gets New Technology

SIMEDHealth Women’s Health has taken a step forward with the acquisition of a device called the EndoSee. This new technology makes the hysteroscopy procedure quicker, easier, and more effective. A hysteroscopy is an assessment of the inside cavity of the uterus, according to Dr. Osorio of SIMEDHealth Women’s Health. The EndoSee is a handheld device that lets doctors see the inside of the uterine cavity quicker and easier than ever before. According to Endosee.com, this device allows doctors to complete a hysteroscopy “in an average of 3 minutes.” Anesthesia was normally necessary for hysteroscopy before but, now with the EndoSee, no anesthesia is needed.

Prior to the EndoSee, patients normally were given a sedative and anesthesia. The procedure could have lasted anywhere between 5 minutes to an hour and required more time after to recover from the sedatives, anesthesia, and procedure itself.  

 

 

Other available services at SIMEDHealth Women’s Health include:

  • wellness exams
  • pap smears
  • annual exams
  • urinary incontinence
  • hematuria
  • UTI testing
  • urodynamics
  • pre and post-menopausal natural hormone therapy
  • birth control comprehensive evaluations of pelvic pain
  • endometriosis and endometrial biopsy
  • pelvic organ prolapse
  • colposcopy/abnormal pap smears
  • abnormal uterine bleeding
  • osteoporosis evaluation and management
  • pelvic pain
  • mass and inflammatory disease
Click here for more information about our women’s health doctors and locations!

Cervical Cancer Screening Guide

Women laughing with information about pap smear and cervical cancer screening

January is Cervical Health Awareness Month. Cervical cancer was once one of the most common causes of cancer death for American women, but now it can be easily prevented with vaccinations and regular screenings.

Learn more about cervical cancer and cervical health with SIMED Ocala Women’s Health Physician, Dr. Oscar Osorio.

1. What exactly is cervical cancer?

Cancer is an abnormal growth of cells on any tissue. The growth is invasive and spreads to adjacent and distant organs, causing damage to tissues. Cervical cancer is cancer of the “tip” or distal area of the uterus.

2. What part of the body is the cervix?

The cervix is the lower, neck-part of the uterus that leads to the vagina. It is where the menstrual flow exits the uterus. The cervix is accessible and seen in the vagina during a gynecologic exam.

3. Who is cervical cancer common in?

Cervical cancer is caused by the HPV virus. The HPV virus is a sexually acquired organism that infects the cervical cells, potentially causing cancer. Although the virus is most common in younger women, teenagers, and women in their early 20s, cervical cancer itself is more common in women older than 30. Women who smoke are at increased risk, as are women with immune deficiencies and those with HIV infection.

4. What is a cervical screening? How does it work?

Infographic showing that HPV and cervical cancer are common in women of certain age groups

A cervical screening is a test designed to identify HPV infections on the cervix in early stages, and thus, avoid progression of the disease to cancer. If cervical cancer is identified, the patient will receive treatment and will be put under surveillance as needed.  You can get tested for cervical cancer with a Pap smear.

5. How often should people get a cervical screening?

Screenings with pap smear should start at age 21, and current recommendations state a pap smear should be performed at least every 3 years.

6. How else can people avoid cervical cancer?

Other than getting a pap smear as recommended, because HPV is a sexually acquired disease, using condoms could potentially decrease risk. Additionally, refraining from smoking could also reduce the risk. Because cervical cancer is linked to HPV, you should also get vaccinated against HPV. The Centers for Disease Control and Prevention recommend vaccination at ages 11-12, but women can be vaccinated up to age 26.

7. Aside from a screening, what symptoms might indicate someone has cervical cancer?

Early cervical cancer is mostly free of symptoms. One of the most common symptoms, though, is abnormal vaginal bleeding, especially after or during intercourse.

Have you gotten screened for cervical cancer? You can get a screening at the SIMED Women’s Health clinics in Gainesville, Ocala, Lake City, Chiefland, or Lady Lake.

To schedule an appointment, call:
Gainesville, Lake City, Chiefland: (352) 331-1000
Ocala, Lady Lake: (352) 391-6464
Or you can request an appointment online.

If you would like to schedule an appointment specifically with Dr. Osorio in Lady Lake or Ocala, call (352) 391-6464 or request an appointment online.

Women's Health Physical Therapy Available Today

Flyer for SIMED Women's Health Physical Therapy in Gainesville, Ocala, and Lady Lake

Did you know SIMED offers Women's Health Physical Therapy? Reclaim control of your body.

SIMED offers women's health physical therapy at our Gainesville, Ocala, and Lady Lake locations. 

You can get treatment for: 
- Muscle Weakness
  - Bladder and Bowel Dysfunction
  - Frequency and Urgency Issues
  - Incontinence - Bowel and Bladder Leakage
- Pelvic and Perineal Pain
- Low Back Pain
- Post Prostate Procedures
- Cystocele and Rectocele

Gainesville: 352-373-6565
Ocala: 352-351-5019
Lady Lake: 352-259-0842

Filamae Garnica, SIMED's Women's Health Physical Therapist in Gainesville, Ocala, and Lady Lake

 

Meet the SIMED Women's Health Physical Therapist:

Filamae Garnica will be working with patients for the Women's Health Physical Therapy.

She is knowledgable and trained to treat conditions specific to women.

She can recognize and help patients with a variety of problems and help them restore control over their bodies.

Don't wait to change your life! Talk to your doctor or call your SIMED Physical Therapy location today.

Learn about our other physical therapies.

 

 

Breast Cancer Prevention Guide

photo of a mammography machine saying you should get a mammography when you turn 40

For Breast Cancer Awareness Month, SIMED gynecologist Dr. Prethi Vaddadi compiled the best information from the American Congress of Obstetricians and Gynecologists (ACOG) on breast cancer screenings, mammographies and breast cancer to equip our patients with everything they need to protect their breasts.

Why Breast Cancer Screenings Are Important

In the United States, 1 in 8 women will develop breast cancer by age 75. Regular breast cancer screenings can help find cancer at an early and more curable stage. Screenings can also find breast problems that are not cancer, according to the ACOG.

Screening for breast cancer is done using a mammography. A mammography uses X-ray technology to view the breasts. The images are called a mammogram.

A mammography is done:

1. As a screening test to check for breast cancer in women who do not have signs or symptoms of the disease
2. As a diagnostic test to check lumps or other symptoms that you have found yourself or that have been found by an OBGYN or other healthcare provider.

When You Should Start Having Mammography Screenings

If you have average risk of breast cancer, screening mammography is recommended beginning at 40 years old. If you have not started screening in your 40s, you should start having a screening done no later than 50 years old. Screenings should continue until you are at least 75, the ACOG said.

How to Prepare for a Mammography

The day of your test, make sure not to wear powders, lotions, or deodorants as they can show up on the X-ray and make your mammogram more difficult to interpret. For your mammogram, you will need to undress from the waist up and put on a gown, according to the ACOG.

If you still have periods, you may want to wait until a week after one of your periods to have the test done as breasts are often less tender after a period.

What to Expect

You will be asked to stand in front of an X-Ray machine, and your breasts will be placed between two flat plastic plates. You will feel pressure as the plates will flatten your breasts as much as possible so the most tissue can be viewed. Sometimes mammograms can cause the breasts to ache, but only briefly, the ACOG said.

What Your Screening Score Means

After your mammogram, your results will be given as a score ranging from 0 to 5.

0 – More information is needed. You may need another mammogram
1 – Nothing abnormal is seen. Keep having routine screenings.
2 – Benign conditions, such as cysts (a noncancerous sac-like structure), are seen. Continue having normal screenings.
3 – Something is seen that is probably not cancer. A repeat mammogram should be done within 6 months.
4 - Something is seen that is suspicious for cancer. You may need a biopsy (a sample of tissue taken from the body to be examined).
5 – Something is seen that is highly suggestive of cancer. You will need a biopsy.

If the biopsy indicates breast cancer, the patient will be referred to a surgeon and oncologist for further evalauation and management, according to the ACOG.

What Breast Density on Your Report Means

infographic on breast cancer including facts and testing and risk factors

Breast density means the breasts have more fibrous tissue and less fat which is normal, but may make it harder for a radiologist to see cancer. If your report says you have dense breasts, you may need to discuss other screening tests in addition to the mammography with your gynecologist or health care professional, the ACOG said.

What the Risk Factors for Breast Cancer Are

Risk factors include family history of breast cancer, ovarian cancer, or other inherited types of cancer, chest radiation at a young age, a history of high-risk breast biopsy results, and obesity. Women without these factors have average risk.

What a Breast Exam Entails

In a clinical breast exam done by your ob-gyn or other health care professional, your doctor will examine your breasts. The exafdm may be done while you are lying down or sitting up. Your breasts will be checked for any changes in size or shape, puckers, dimples, or redness of the skin. Your doctor may feel for changes in each breast and under each arm. A breast exam should be done at least annually and more often if an abnormality is found, according to the ACOG.

Why Self-Breast Exams Are Important

Breast cancer is most often found by the woman herself. In almost half of all cases of breast cancer in women 50 and older, breast cancer is found by the woman herself. In woman younger than 50, more than 70% of cases of breast cancer are found by the woman herself.

How to Perform a Self-Breast Exam

Average risk women should become familiar with and aware of the normal appearance and feel of their breasts. If they recognize a change, they should contact their gynecologist or other health care provider, according to the ACOG.

For women of greater than average risk, a breast self-examination involves examining the breasts in a systematic way. For instruction, consult with your gynecologist.

What a Benign Breast Condition Is

A benign breast condition is one that is not cancerous. These conditions usually go away on their own and are easily treated. Because a few benign conditions can increase your risk of breast cancer, you should get follow-up tests with your gynecologist, the ACOG said.

Different Types of Benign Breast Conditions Include 

Benign breast problems include pain, lumps or masses, infections, nipple discharge, and skin changes.

What Causes Benign Breast Pain

There are two types of breast pain:

1. Cyclic breast pain – It occurs in response to changes in hormone levels. Your breasts may feel swollen, more sensitive, or painful before your menstrual period. Similar symptoms may also be presented if you use combined hormonal contraceptives.
2. Noncyclic breast pain – It is not related to your menstrual cycle and usually occurs in one breast in one specific location. Many things can cause the pain including infection, i njury, and medication. In rare cases, the pain can be caused by breast cancer. 

What the Different Types of Benign Breast Lumps or Masses Are

In general there are three main types of benign breast masses, according to the ACOG.

1. Nonproliferative – This type of mass has normal cells. An example is a cyst. Cysts are usually small and go away by themselves or can be drained with a needle.  Another example is a simple fibroadenoma which usually shrinks or goes away on its own. If it is larger or keeps growing, it may need to be surgically removed.
2. Proliferative without atypia – In this breast mass type, the cells are increasing in number but otherwise remain normal. Having this type of lump slightly increases risk of breast cancer in the long term. They are usually surgically removed, but sometimes can just be watched to ensure they are not growing.
3. Atypical hyperplasia – The cells increase in number, but also do not look normal under a microscope. This type greatly increases the risk of developing future breast cancer. Surgery is recommended, along with close follow-ups.

woman with breast cancer ribbon pointing to the ribbonWhat Nipple Discharge to Watch Out For

Benign discharge usually occurs in both breasts and only when the breast or nipple is squeezed. It is usually milky white or greenish in color. Bloody or clear discharge is more concerning and is a common benign breast symptom. During pregnancy, discharge is normal as breasts prepare to produce milk, but in women who are not pregnant, it can be caused by hormonal changes and some medications. It should be checked by your gynecologist or other health care professional, the ACOG said.

What Skin Changes Can Affect the Breast

Psoriasis and eczema can affect the breast. Yeast infection of the skin folds under the breast is also common, especially among women with larger breasts. Some skin conditions can increase concern of breast cancer. These include dimpling of the skin, redness, warmth, and ulcers (small, red, painful blisters). Nipple changes like crusting, scaling, or changing shape can also raise concern. If you notice any of these symptoms, talk with your gynecologist.

How Benign Breast Conditions Are Evaluated

If you show symptoms, let your gynecologist or other health professional know. You will most likely have a breast exam, but might also have an imaging test like a mammography, ultrasound exam, or MRI, according to the ACOG.

Follow-Up Needed for a Benign Breast Condition

Most conditions don’t increase risk of cancer, but some, like breast lumps, do. If you have a condition that increases risk of cancer, more frequent clinical breast exams and imaging tests over the next 1 -2 years may be recommended based on your age, health risks, and test results, the ACOG said.

Dr. Vaddadi practices in SIMED’s Gainesville and Lake City offices. To review any of these topics, to get tested or examined for breast cancer, or just for general woman’s health issues, schedule an appointment with Dr. Vaddadi by calling 352-331-1000 or requesting an appointment online.

If you show symptoms, need a breast cancer exam, or have not had your annual gynecology visit, you can schedule an appointment with SIMED Women’s Health in Gainesville, Ocala, Lady Lake, Lake City, or Chiefland.

Gainesville: 352-331-1000
Ocala: 352-391-6464
Lake City: 352-331-1000
Chiefland: 352-331-1000
Lady Lake: 352-391-6464

You can also schedule your appointment online. Don’t wait; call or click today.

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View our article on why women in their 20s visit the gynecologist.
View our article on why women in their 30s visit the gynecologist.

 

Reasons Women in their 30s Visit the Gynecologist

Woman standing with a background behind her and information about polycystic ovarian syndrome or PCOD
As part of our women’s health series, we are highlighting common reasons women in their 30s visit the gynecologist. 
We spoke with Dr. Prethi Vaddadi, of SIMED Women’s Health, about why women go to the gynecologist, how their common problems are treated and what to look for in common gynecological issues.

Vaginitis:

Vaginitis is an inflammation of the vagina. As many as one third of all women will experience symptoms of vaginitis during their lives. Vaginitis is most common during the reproductive years.
A change in the balance of the yeast and bacteria that normally live in the vagina or a shift in a woman’s hormone levels can result in vaginitis. Symptoms associated with vaginitis include: change in color, odor or amount of vaginal discharge, itching or irritation, pain during intercourse, spotting or light vaginal bleeding, and/or painful urination.
Factors that can change the normal balance of the vagina include:
1. Use of antibiotics
2. Changes in hormone levels due to pregnancy, breastfeeding, or menopause
3. Douching,
4. Spermicides
5. Sexual intercourse
6. Infection.
To diagnose vaginitis, your health care provider will take a detailed history, examine the area and take a swab of the discharge from your vagina.

Common causes of vaginitis:

1. Yeast infection (candidiasis) 
Yeast infection is a common cause of vaginitis.  The yeast infection is usually caused by a fungus called Candida. It is found in small numbers in the normal vagina. However, when the balance of bacteria and yeast in the vagina is altered, the yeast may overgrow and cause symptoms.  
Symptoms may include
1. Itching and burning of the area outside the vagina called the vulva
2. Red and swollen vagina 
3. White, lumpy, odorless vaginal discharge
Yeast infections can be treated either by placing anti-fungal medication into the vagina or by taking a pill.
2. Bacterial Vaginosis:
Bacterial vaginosis is caused by a shift in the quantity of a particular bacteria normally occurring in the vagina.
Symptoms:
The discharge is usually thin and dark or dull gray, but may have a greenish color. Itching is uncommon, but may be present if there is a lot of discharge. The discharge odor is described as fishy, but may only be noticeable after sexual intercourse.
Treatment:
Several different antibiotics can be used to treat bacterial vaginosis, but the two that are most commonly used are metronidazole and clindamycin. They can be prescribed to be taken by mouth or via insertion into the vagina as a cream or gel.
3. Atrophic Vaginitis:
This condition is not caused by an infection, but may occur any time when female hormone levels are low, such as during breastfeeding and after menopause. 
Symptoms:
Atrophic vaginitis results in vaginal irritation, such as dryness, itching, burning, changes in urination, change in vaginal discharge, and/or painful vaginal intercourse. 
Treatment:
Atrophic vaginitis is treated with estrogen, which can be applied as a vaginal cream, ring, or tablet. A water-soluble lubricant also may be helpful during intercourse.

Sexually Transmitted Infections:

A person with an STI (Sexually transmitted infection) can pass it to others by contact with skin, genitals, mouth, rectum, or body fluids. Anyone who has sexual contact—vaginal, anal, or oral sex—with another person may get an STI. STIs may not cause symptoms. Even if there are no symptoms, your health can be affected.
STIs are caused by bacterial or viral infections. STIs caused by bacteria are treated with antibiotics. Those caused by viruses cannot be cured, but symptoms can be treated.
Common STIs: Chlamydia, Gonorrhea, Genital Herpes, HIV, HPV, Syphilis, Trichomoniasis, Hepatitis B
How can you reduce the risk of getting an STI?
Know your sexual partners and limit their numbers.  The more partners you have or your partners have had, the higher your risk of getting an STI.
Using a latex condom every time you have vaginal, oral, or anal sex decreases the chances of infection. Condoms lubricated with spermicides do not offer protection against STIs, and in fact, frequent use of some spermicides can increase the risk of HIV.
Sexual acts that tear or break the skin carry a higher risk of STIs. Even small cuts that do not bleed let germs pass back and forth. Anal sex poses a high risk because tissue in the rectum tears easily. Body fluids also can carry STIs. Having any unprotected sexual contact with an infected person poses a high risk of getting an STI.
Vaccines are available to greatly reduce the risk of Hepatitis B and HPV infections and should be received by anyone at moderate to high risk. 

Contraception:infographic about contraception for women including injection, oral contraception, implant, IUD

1. Long Acting Contraceptives
Long-acting reversible contraception (LARC) methods include the intrauterine device (IUD) and the birth control implant. Both methods are highly effective in preventing pregnancy, last for several years, and are easy to use. Both are reversible—if you want to become pregnant or if you want to stop using them, you can have them removed at any time.
The IUD and the implant are the most effective forms of reversible birth control available. During the first year of typical use, fewer than 1 in 100 women using an IUD or an implant will become pregnant. This rate is in the same range as that for sterilization.
Over the long term, LARC methods are 20 times more effective than birth control pills, the patch, or the ring.
IUD:
The IUD is a small, T-shaped, plastic device that is inserted into and left inside the uterus. There are two types of IUDs:
1. The hormonal IUD releases progestin. Different brands of hormonal IUDs are approved for use for up to 5 years and for up to 3 years.
2. The copper IUD does not contain hormones. It is approved for use for up to 10 years.
Both types of IUDs work mainly by preventing fertilization of the egg by the sperm. The hormonal IUDs also thicken cervical mucus, which makes it harder for sperm to enter the uterus and fertilize the egg, and keep the lining of the uterus thin, which makes it less likely that a fertilized egg will attach to it.
Implant:
The birth control implant is a single flexible rod about the size of a matchstick that is inserted under the skin in the upper arm. It releases progestin into the body. It protects against pregnancy for up to 3 years.
The progestin in the implant prevents pregnancy mainly by stopping ovulation. In addition, the progestin in the implant thickens cervical mucus, which makes it harder for sperm to enter the uterus and fertilize the egg. Progestin also keeps the lining of the uterus thin, making it less likely that a fertilized egg will attach to it.
2. Combined Birth Control Methods:
Birth control pills, the birth control patch, and the vaginal birth control ring are combined hormonal birth control methods. They contain two hormones: estrogen and progestin.
These hormones prevent pregnancy mainly by stopping ovulation (the release of an egg from one of the ovaries). They also cause other changes in the body that help prevent pregnancy. The mucus in the cervix thickens, making it hard for sperm to enter the uterus. The lining of the uterus thins, making it less likely that a fertilized egg can attach to it.
With perfect use—meaning that the method is used consistently and correctly each time—fewer than 1 woman out of 100 will become pregnant during the first year, according to the American Congress of Obstetricians and Gynecologists.
Vaginal Ring:
The vaginal ring is a flexible, plastic ring that is placed in the upper vagina. It releases estrogen and progestin that are absorbed through the vaginal tissues into the body.
You fold the ring and insert it into the vagina. It stays there for 21 days. You then remove it and wait 7 days before inserting a new ring. During the week the ring is not used, you will have your period. 
3. Progestin only contraception methods:
Progestin is a form of progesterone, a hormone that plays a role in the menstrual cycle and pregnancy. Progestin-only pills and the injection have about the same effectiveness as combination estrogen and progestin pills, rings, and patches.
 

Abnormal Uterine Bleeding:

The normal length of the menstrual cycle is typically between 24 days and 38 days. The vaginal bleeding in a cycle is usually 4 to 6 days, but can last up to 8 days.
Bleeding in any of the following situations is considered abnormal uterine bleeding:
1. Bleeding or spotting between periods
2. Bleeding or spotting after sex
3. Heavy bleeding during your period
4. Menstrual cycles that are longer than 38 days or shorter than 24 days
5. “Irregular” periods in which cycle length varies by more than 7–9 days 
6. Bleeding after menopause.
Some of the causes of abnormal bleeding include: 
1. Problems with ovulation
2. Fibroids and polyps
3. Adenomyosis, a condition in which the endometrium (or inner lining of the uterus) grows into the wall of the uterus
4. Bleeding disorders
5. Problems linked to some birth control methods, such as an intrauterine device (IUD) or birth control pills
6. Miscarriage
7. Ectopic pregnancy (fertilized egg implants outside the uterus)
8. Certain types of cancer, such as cancer of the uterus and cervix.
Abnormal uterine bleeding is diagnosed by obtaining a detailed health history of you and your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar. You also can use a smartphone app designed to track menstrual cycles. Blood tests may be done to rule out other diseases.
Treatment of Abnormal Uterine Bleeding:
Medications often are tried first to treat irregular or heavy menstrual bleeding.
If medication does not reduce your bleeding, a surgical procedure may be needed. There are different types of surgery depending on your condition, your age, and whether you want to have more children.

Abnormal Cervical Screening (Pap Smears):

Cervical cancer screening is used to find abnormal changes in the cells of the cervix that could lead to cancer. The cervix is the portion of your uterus that extends down into the vagina. Screening includes the Pap test and, for some women, testing for a virus called HPV.
The main cause of cervical cancer is infection with HPV. If you have an abnormal cervical cancer screening test result, you may need further testing. 
Treatment:
In general, there are two ways to treat abnormal cervical cells: 1) “excisional” treatment and 2) “ablative” treatment. With excisional treatments, tissue is removed from the cervix and is sent to a laboratory to be studied. The results will determine the severity of abnormal cells.  With ablative treatment, abnormal cervical tissue is destroyed, and there is no tissue to send to a laboratory for study.

Polycystic Ovary Syndrome (PCOS):

Common PCOS signs and symptoms include the following:
• Irregular menstrual periods
• Infertility
• Obesity
• Excess hair growth on the face, chest, abdomen, or upper thighs
• Severe acne or acne that occurs after adolescence and does not respond to usual treatments
• Oily skin
• Patches of thickened, velvety, darkened skin called acanthosis nigricans
• Multiple small fluid-filled sacs in the ovaries
Although the cause of PCOS is not known, it appears that PCOS may be related to many different factors working together. These factors include insulin resistance, increased levels of hormone called androgens, and an irregular menstrual cycle.
PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences.
Treatment:
A variety of treatments are available to address the problems of PCOS. Treatment is tailored to each woman according to symptoms, other health problems, and whether she wants to become pregnant.
Combined hormonal birth control pills can be used for long-term treatment in women with PCOS who do not wish to become pregnant. For overweight women, weight loss alone often regulates the menstrual cycle. Even a loss of 10–15 pounds can be helpful in making menstrual periods more regular. Insulin-sensitizing drugs used to treat diabetes frequently are used in the treatment of PCOS. 

Endometriosis:

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus.
Endometriosis occurs in about one in ten women of reproductive age. It is most often diagnosed in women in their 30s and 40s.
Almost 40% of women with infertility have endometriosis. Inflammation from endometriosis may damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissue.
Symptoms:
The most common symptom of endometriosis is chronic (long-term) pelvic pain, especially just before and during the menstrual period. Pain also may occur during sex. If endometriosis is present on the bowel, pain during bowel movements can occur. If it affects the bladder, you may feel pain during urination. Heavy menstrual bleeding is another symptom of endometriosis. Many women with endometriosis have no symptoms.
Diagnosis:
The only way to tell for sure that you have endometriosis is through a surgical procedure called laparoscopy. Sometimes a small amount of tissue is removed during the procedure. This is called a biopsy.
Treatment:
Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.

Ovarian Cysts:

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms in or on an ovary. Ovarian cysts are very common. They can occur during the childbearing years or after menopause. Most ovarian cysts are benign (not cancer) and go away on their own without treatment. Rarely, a cyst may be malignant (cancer).
In most cases, cysts do not cause symptoms. Many are found during a routine pelvic exam or imaging test done for another reason. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause twisting of the ovary. This twisting usually causes pain on one side that comes and goes or can start suddenly. Cysts that bleed or burst also may cause sudden, severe pain.
If your obstetrician–gynecologist (ob-gyn)or other health care professional thinks that you may have a cyst, ultrasound, blood tests and physical exams may be done.
Treatment:
There are several treatment options for cysts. Choosing an option depends on the type of cyst and other factors. Treatment options include watchful waiting and, if the cyst is large or causing symptoms, surgery.
 
Dr. Vaddadi practices in SIMED’s Gainesville and Lake City offices. To review any of these topics or just for general woman’s health issues, schedule an appointment with Dr. Vaddadi by calling 352-331-1000 or requesting an appointment online.
Gainesville: 352-331-1000
Lake City: 352-331-1000
Chiefland: 352-331-1000
Lady Lake: 352-391-6464
You can also schedule your appointment online. Don’t wait; call or click today.
 
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Common Reasons Women In Their 20s Should See a Gynecologist

young woman in pain with hands on her abdomen
Dealing with your 20s can be hard enough without throwing women’s health issues into the mix. That’s why we’ve asked Dr. Meera Nair, a SIMED Women’s Health physician in Gainesville and Chiefland, about the common health issues she treats for women starting in their teens and how you can avoid them.
But first, Dr. Nair notes that its important women get yearly exams beginning when they reach puberty.
 

1. Birth control 

While contraceptives aren’t necessarily an issue themselves, they help treat many other issues, and even healthy young women will go to the doctor to get the one that fits them best.
The most common birth control method is the pill. In recent years, more women have been turning to longer acting contraceptive methods like IUDs and implants. 
 
Advantages of Using Birth Control

infographic common reasons women in their 20s see a gynecologist

1. Helps with acne
2. Regulates periods
3. Makes periods less painful
4. Prevents pregnancy
If you’re interested in learning more, visit the SIMED women’s health center.

2. Sexually Transmitted Diseases

STD screening can be done whenever women get their pap smears (test for cervical cancer).
When women are diagnosed with an STD, they receive treatment and are counseled about the treatment and how to prevent the STD from coming back. 
 
Chlamydia 
Chlamydia is the most common STD, and about 1.5 million people in the United States have been diagnosed with it. The number of people both undiagnosed and diagnosed together can be about 3 million.
That’s because Chlamydia usually has no symptoms. 
If Chlamydia symptoms are present, they include:
1. Irregular bleeding
2. Pelvic pain
3. Discharge similar to a UTI
If there’s any risk, like if someone has been sexually active with a new partner, had unprotected sex in the past, it’s recommended they see a women’s health doctor to get tested. 
If untreated, Chlamydia can lead to serious pelvic infections and even infertility. 
 
Herpes
Herpes is a common viral STD. 
Herpes presents itself as painful sores in the genital area. Tthe symptoms can be confused with yeast infection. 
Herpes can be treated with antiviral antibiotics.
If you have herpes, the virus stays in your system so you could pass it onto your partner.
 
Prevention of Recurring STDs
After you’ve been treated, it’s important to get tested again to make sure the treatment worked. 
If you have STDs, the best way to prevent them from recurring is to treat your partner as well.
Always practice safe sex.

3. Polycystic ovarian disease (PCOD)

PCOD is not a structural disorder, but a hormonal or metabolic disorder.
People with PCOD will have irregular periods, meaning they may not get their period every month or ovulate every month. This can cause infertility which can make it difficult for women to get pregnant.
People with PCOD usually have a higher risk of diabetes when they get pregnant or when they’re order. Their chances of getting uterine cancer also increase as they age.
A majority of people who have PCOD are overweight and insulin resistant with abnormal cholesterol and triglycerides.
If you have PCOD, you have a greater risk of becoming diabetic.
 
PCOD Treatment
The most important treatment is to lose weight which will correct most of the hormonal and metabolic imbalances. Losing weight can also help prevent diabetes which is associated with PCOD. 
You should increase your exercise to help prevent diabetes and lose weight. Losing weight is the key to returning to a normal ovulation schedule and will usually lead to regular periods and greater fertility chances.
Birth control pills also help regulate hormone imbalances and will reduce the risk of future uterine cancer. They’ll help with hair growth.
“Birth controls pills are basically the wonder drug for PCOD.” – Dr. Nair

4. Abnormal Pap Smear

Cervical cancer can be picked up at an early stage using a pap smear. Pap smears allow gynecologists to identify the precancerous conditions years before they turn into cancer and prevent the cancer. 
Dr. Nair recommends women begin getting pap smears starting at 21 years old.
To prevent the precancerous conditions from worsening, get treatment and monitoring. Some of the abnormality will clear within 24 months. During that time, checkups are recommended every six months. 

5. Pelvic Pain

 
Pelvic pain is common in the younger age groups. When people come into the doctor with pelvic pain, it could be a fibroid (a benign tumor usually in the wall of the uterus), an ovarian cyst or endometriosis. 
 
Endometriosis
Endometriosis is a chronic benign condition where the uterine lining appears outside the uterus. While the uterine lining is supposed to appear in the uterus and get shed during periods, sometimes those cells appear outside women’s uterus inside the abdomen. 
During the woman’s periods, the cells will bleed causing severe pain. 
Because an ultrasound might not pick up endometriosis, sometimes a surgery called a laparoscopy is done when the person is put under anesthesia and a camera is put inside their abdomen and through their belly buttondiagnose and treat endometriosis.
If endometriosis worsens and becomes chronic, women may need a hysterectomy to prevent it from coming back. Women can also wait until menopause.
 
The best way to avoid issues is to see your doctor every year.
Each year, a women’s health appointment includes a  discussion about her sexual health, contraceptives, an STD screening and even discussion about emotional issues. It may include a pap smear too.
During a visit, women can get vaccines and a whole physical examination. The visit can even include talk about psychological issues like depression or bullying at school. The physical exam will include a full pelvic examination and breast examination.
While pap smears begin at 21, Dr. Nair recommends that physician visits start whenever a child reaches puberty or gets her period.  A teenager might feel more confident with her physician than with her parents, and the physician would be able to ask questions and discuss concerns.
When a woman becomes sexually active, she’ll need STD screenings and counseling. Domestic violence counseling can be part of a gynecological exam, adding to its importance.
 
To schedule an appointment with Dr. Nair in Gainesville or Chiefland, call 352-331-1000 or request an appointment online.
If you need an annual checkup or have one of the problems listed above, you can see a SIMED gynecologist in Lake City, Gainesville, Ocala, Chiefland and Lady Lake.
For a Gainesville gynecologist: 352-331-1000
For an Ocala gynecologist: 352-391-6464
For a Lake City gynecologist: 386-775-3001
For a Chiefland gynecologist: 352-331-1000
For a Lady Lake gynecologist: 352-391-6464
You can also schedule your appointment online. Don’t wait; call today.