Frequently Asked Questions

Obstetrics:

travel / have cold or allergy / perm or color hair / saunas, hot

tubs, and tanning booths / nausea and vomiting / exercise and

work / swelling / exposed to chicken pox / headaches /

constipation / gum swelling or bleeding / leg cramps / safe to

paint / continue intercourse / heartburn / hemorrhoids / yeast

infections / herbs and extra vitamins

Gynecology:

pap smears / birth control / yeast infection and vaginitis / gyn

exam /

When do I need to start getting pap smears?
Current recommendations according to the American Cancer Society (ACS) and the American College of OB?GYN (ACOG) recommend starting pap smears 3 years after the first time you have sex, or age 21years, you should still have a yearly pelvic exam and tests for infection like Chlamydia and Gonorrhea.

Back to Top

Do I need a pap smear if I've had a hysterectomy?
If you hysterectomy was done for "benign" reasons (i.w. fibroids, bleeding, pain, etc.) and you had previously normal pap smears before the hysterectomy, then NO, you do not need any more pap smears.

If you did not have regular pap smears before the hysterectomy, or had the hysterectomy for cervical cancer or dysplasia, then YES, you should have pap smears done afterwards - usually for a limited amount of time.

Even if you and your doctor decide you don't need pap smears, it is still important to get yearly breast and pelvic exams (feeling with the hand) as well as yearly mammograms.

Back to Top

Is there a certain age that I can stop getting pap smears?
While there is no absolute age that you no longer need pap smears, current recommendations suggest that after the age of 30 years, you may be able to only have pap smears every 2-3 years. After the age of 70 years, it may be reasonable to discontinue screening. This is an individualized decision that depends on the kind of pap smear testing your doctor does, as well as your own personal history. Please discuss this with your physician before you stop getting pap smears. Again, yearly breast exams, pelvic exams, and mammograms are still very important!

Back to Top

What are the different types of birth control ?

People have used birth control methods for thousands of years. Today, we have many safe and effective birth control methods available to us. 

All of us who need birth control want to find the method that is best for us. And each of us has different needs when choosing a method. If you are trying to choose, learning about each method may help you make your decision. Only you can decide what is best for you.

Below is a list of commonly used forms of birth control.

• Abstinence
• Birth Control Implant (Implanon)
• Birth Control Patch (Ortho Evra)
• Birth Control Pill
• Birth Control Vaginal Ring (NuvaRing)
• Birth Control Shot (Depo-Provera)
• Birth Control Sponge (Today Sponge)
• Breastfeeding
• Cervical Cap (FemCap)
• Condom
• Diaphragm
• Emergency Contraception (Morning After Pill)
• Female Condom
• Fertility Awareness-Based Methods (FAMs)
• IUD
• Outercourse
• Spermicide
• Sterilization for Women
• Vasectomy
• Withdrawal (Pull Out Method)

Back to Top

What Is Vaginitis?

Vaginitis is an irritation of the vulva or vagina. It is very common.

Many women think any irritation of the vagina or vulva is caused by a yeast infection. Yeast infection is one cause of vaginitis. But there are several other common causes of vaginitis.

Back to Top

What Else Besides Yeast Infection Can Cause Vaginitis?

Vaginitis is caused by

• yeast infection
• bacterial vaginosis
• trichomoniasis
• allergies and irritants
• lack of the hormone estrogen

Sometimes there is more than one cause.

Back to Top

What Are the Symptoms of Vaginitis?

If you have vaginitis, your vagina or vulva may be red, irritated, or uncomfortable. You may have vaginal fluid come out of your vagina that is different from your usual discharge. The discharge may have an unpleasant smell. You also may have itching or burning in or around your vagina. Vaginal intercourse may be uncomfortable. And you may feel as if you need to urinate (pee) more often than usual.

With a yeast infection, discharge is usually thick, white, and odorless. You may also have a white coating of your vagina if you have a yeast infection.

With bacterial vaginosis, you may not have any symptoms. Or you may have a heavy vaginal discharge. It is usually grayish and foamy and has an unpleasant, "fishy" odor.

Back to Top

Is There a Treatment for Vaginitis?

Vaginitis is usually easy to treat. The type of treatment depends on

• what type of vaginitis you have
• how severe your symptoms are
• whether you are pregnant

For vaginitis caused by bacterial vaginosis, yeast infection, or trich, your health care provider may prescribe creams, suppositories, vaginal tablets, or oral medicines. Some medicines for yeast infections are available without a prescription.

For vaginitis caused by an allergy or an irritant, the symptoms usually go away when you stop using the substance or object that is causing irritation. Sometimes you might need to use a cream to help clear up the problem. In rare, severe cases of allergic reactions, you may require emergency medical attention.

For vaginitis caused by low levels of estrogen, your health care provider may prescribe a cream with estrogen in it, or a vaginal ring that releases estrogen into your body.

Remember, vaginitis has little to do with how clean you are. Bathing or douching will not cure vaginitis. But good hygiene is an important part of being healthy. It includes washing your vulva daily with mild, perfume-free cleansers.

To make sure your treatment works

• Don't use anybody else's medicine. Even if your symptoms are like somebody else's, you may need different treatment.
• Don't use old medicine. It may not work anymore, and it may even make the infection worse.
• Use up your entire prescription — even if your symptoms have stopped. They may come back if you don't take all your medicine.
• Take your medicine even if you get your period. Some vaginitis infections can grow quickly in menstrual flow.
• Be sure to return for all your checkups.

Back to Top

Do I Need to See a Health Care Provider?

If you have had yeast infections in the past that have been diagnosed by a health care provider, and your symptoms are the same, you might try an over-the-counter medicine.

Otherwise, it is very important to see a health care provider if you think you have a yeast infection or another kind of vaginitis.

Vaginitis isn't often a major health problem. But sometimes it can be serious.

Pregnant women with bacterial vaginosis have a higher risk of miscarriage, especially in the first trimester. Bacterial vaginosis is associated with premature delivery, low birth weight, and pelvic inflammatory disease.

Vaginitis can also increase the risk for HIV infection. Other, more potentially dangerous infections like gonorrhea and chlamydia have symptoms just like vaginitis. Only a health care provider can find the cause and offer the right treatment.

You should see your health care provider whenever

• you have abnormal vaginal discharge and/or odor, irritation, bleeding, or pain
• your symptoms have not been diagnosed
• your treatment isn't working

Back to Top

Is Vaginitis Spread During Sex?

It depends on the cause of the vaginitis. "Trich" is easily passed between sex partners — same-sex as well as opposite-sex partners.

It is not yet clear if bacterial vaginosis and yeast infections are transmitted from one partner to another. All kinds of bacteria are exchanged during sex play. It may be that the bacteria exchanged between partners, especially new partners, may cause an overgrowth of the bacteria that cause bacterial vaginosis or yeast infections in the vagina.

Vaginitis caused by irritants, allergies, or lack of estrogen are not passed during sex.

Back to Top

How Can I Prevent Vaginitis?

Don't have vaginal intercourse or share sexual fluids if

• you or your partner is being treated for bacterial vaginosis, a yeast infection, or a sexually transmitted infection
• you think either of you is infected
• condoms or female condoms are not available

Vaginitis develops more quickly when the vulva is moist. Be sure to

• Keep the area around your vulva as dry as possible.
• Wash your vulva regularly with mild soap and water.
• Rinse well and dry thoroughly after washing.
• Let towels dry before you use them again.
• Only use your own towels — don't share them.
• Avoid sitting around in a wet bathing suit.

Avoid anything you have found to irritate your vagina or vulva. And don't douche unless your health care provider advises it.

Back to Top

What is a GYN exam?

A GYN (short for gynecological) exam typically includes a pelvic exam,  testing for many vaginal infections (including yeast infections and STIs), and may include a pap smear

The recommendation is that all women 21 years of age or older, and, regardless of age, all who are sexually active have a yearly (annual) GYN exam.

Several important things happen at a gyn exam:

• There is an opportunity to ask questions about a wide range of topics including (but not limited to):

• Sexuality
• Contraception (birth control)
• Vaginal infections
• Answers (e.g. "Is it normal for me to ....")

• A complete medical and family history is taken and a general physical exam is performed.  This can help identify any general health problems.
• A breast exam is performed and self breast exam techniques are taught.  This is important as 1 in 9 women will eventually develop breast cancer.
• A pelvic exam (including STI testing and possibly a pap smear to check for any pre-cancerous lesions on the cervix) is performed.
• Contraception may be discussed, with the pros and cons of each method described.  If you wish, and there are no medical reasons why you should not have it, a prescription for the birth control pill or other contraceptive may be written.

Back to Top

May I travel during pregnancy?

Most women can travel safely until close to their due date. For most women, the most comfortable time to travel is in the middle of pregnancy. Problems are least likely to happen during this time. During pregnancy, many women have concerns about seat belts. There is no question that you are much better off wearing your seat belt during pregnancy. The baby is very well protected in the uterus from trauma, but car accidents are the most common source of trauma during pregnancy. The most common reason for fetal death is maternal death, and maternal death is much less likely in mothers who wear seat belts. Both lap and shoulder belts should be worn at all times. The lap belt should be worn low on the hips, not over the uterus. Also remember that after delivery, an approved car seat must be in you car in order to take your baby home from the hospital. We recommend you not sit with your legs crossed and that you get out to walk every two hours.

People also have concerns about flying during pregnancy. In general, there does not seem to be an increased risk for women who fly during pregnancy. Any woman who sits for long periods of time without getting up for a walk is at risk for developing a blood clot in her legs. For this reason, on flights over two hours, you should get up, stretch your legs, and take a walk up and down the aisle. Because of this, an aisle seat is usually advisable.

Our office recommends that patients do not travel at all in their ninth month, and restrict travel to within two to three hours from home during their eighth month.

Back to Top

What can I do for cold and allergy symptoms?

Colds are miserable things, even at the best of times, but there are increased concerns during pregnancy. Many things can relieve symptoms at home, sometimes eliminating the need for an office visit.

• Use a cool mist vaporizer/humidifier at night. This moistens the air you breathe to keep secretions flowing.
• Saline gargles (one teaspoon of salt in ½ cup warm water) every four hours while awake will cut the mucus in the back of the throat and relieves mild soreness.
• Any brand of saline nose drops (NOT regular Afrin or Neo-Synephrine) at bedtime and on arising in the morning will help moisten secretions.
• Tylenol (plain) two tablets every four hours if necessary for aches (maximum of six tablets in 24 hours.) Preferably not during the first trimester and not at all for one week before your triple test.
• Take your temperature, orally, twice daily – call us if your temperature is greater that 100.4 Fahrenheit.
• Coughing can be relieved with one teaspoon of honey and 2-3 drops of lemon juice. Hold this in your mouth until the honey thins and then swallow. If coughing interrupts sleep or causes vomiting, call your doctor. You may try Robitussin DM, an over-the-counter cough medication, after the first trimester.
• Increase fluids (especially water) to two quarts a day.
• Get extra rest, if possible.
• Actifed or Sudafed may also be use for symptom of congestion when taken as directed on the package. It is preferable that you not take this in your first trimester of pregnancy.

Back to Top

May I color or perm my hair during pregnancy?

Often pregnant women have concerns about the safety of hair dyes and permanents during pregnancy. There is no scientific data on this question, but it seems unlikely that these types of exposures are harmful.

Back to Top

Are saunas, hot tubs, and tanning booths safe during pregnancy?

The use of saunas, hot tubs, and tanning booths is not recommended in pregnancy. The extreme temperature could potentially damage the developing baby. Extremely hot baths are not recommended during pregnancy. Bath temperatures should be below 100 ° Fahrenheit.

Back to Top

What can I do for nausea and vomiting during pregnancy?

The following suggestions may be useful in relieving nausea and vomiting:

• Remember, "any calorie is a good calorie" so eat what stays down for you.
• These foods may not be well tolerated:
  • Greasy or fried foods, as they take longer to leave the stomach
  • Very sweet foods
  • Spicy hot foods
  • Foods with strong odors
• Eat smaller, more frequent meals, that is six small meals and snacks.
• Drink fluids between meals, not with meals.
• Eat foods that are at room temperature or cooler. Hot foods may trigger nausea.
• Drink beverages chilled or cold. Decaffeinated soda is often well tolerated. Don't opt for diet soda, you need the calories right now.
• Eat slowly and rest after meals. It is best to rest sitting in an upright position for about one hour after eating.
• Dry toast, soda crackers, or dry pre-sweetened cereals may relieve periods of nausea.
• Keep track of when you feel nausea and what causes it.
• If continued vomiting occurs, do not eat or drink anything until the vomiting has stopped. As you feel better, try some small amounts of clear liquids (broth, Jell, apple, grape, or cranberry juice, and/or popsicles.)
• Tart or salty foods such as lemons or pickles may help decrease nausea.
• Avoid mixing hot and cold foods at a meal, as it may stimulate nausea.
• Ask your doctor about medicine to control nausea.
• Avoid eating in a room that is stuffy, too warm, or has cooking smells/odors that may disagree with you.
• Wear loose fitting clothing.
• To avoid the sight/smell of foods, eat meals out or have others bring prepared food to you.
• These are signs that you need to call your doctor:
  • Unable to keep anything down for more than two days
  • Fainting
  • Vomiting blood
  • Rib pain
  • Jaundice (skin is greenish or yellow)
  • Your weight drops more than five pounds within a week

Back to Top

Is it safe to exercise and continue work during pregnancy?

Exercise can help strengthen muscles used in labor and delivery and lessen some of the discomforts of pregnancy. It may give you more energy and make you feel better. The type of exercise you can do during pregnancy depends on your health and how active you were before you became pregnant. This is not a good time to take up a new, hard sport. If you were active before, you can continue to be within reason. If, for example, you play tennis, you can still play unless you have special problems or feel very tired. A good "rule of thumb" is to limit exertion to about 2/3 of what you could do before pregnancy.

Most of the time, a healthy woman with no complications in her pregnancy can keep working until the end of her pregnancy. Some may need to make some changes. If you are experiencing problems that you feel may be related to your job, please discuss this at one of your office appointments. Your family should be able to help you at home as fatigue increases at the end of your pregnancy.

Back to Top

Is it normal for swelling to occur?

A certain amount of swelling (called edema) is normal during pregnancy. It occurs most often in the legs. Elevating the legs usually makes the swelling less by the next morning. Swelling can begin during the last few months of pregnancy, and it may occur more often in the summer. Let your doctor or nurse know if you have swelling in your hands or face, because this may be a sign of another problem. A clue that your hands are swollen is that your rings are too tight. Never take medications (water pills) for swelling unless they have been prescribed for you.

• Elevate you legs when possible
• Rest in bed on your side
• Lie down with your legs raised on a small footstool or several pillows
• Do not wear stockings or socks that have a tight band of elastic around the legs.
• If you must sit a lot on the job, stand up and move around from time to time.
• Try not to stand still for long periods of time.

Back to Top

If I am pregnant and a family member has or has BEEN EXPOSED to CHICKENPOX, what should I do?

Most adults are immune to chicken pox, either from having the disease or by forming immunity from a mild exposure. If you have had chicken pox in the past, you and your baby are protected. If you are not sure, ask your doctor to check your immunity with a blood test. If this shows positive immunity, you are both protected. If it shows no immunity, an injection of a medicine called Varicella Immune Globulin (VZIG) may be given to prevent chicken pox. In order to be effective, this injection must be given within 72 hours of exposure.

Back to Top

What can I do for headaches during pregnancy?

Headaches are common during pregnancy. Usually headaches do not signal a serious problem. How often they occur and how bad they are may vary. It is important to discuss with your health care team which medications you can use for the headache. You should contact your doctor if your headache does not go away, returns very often, is very severe, causes blurry vision or spots in front of your eyes, or is accompanied by nausea. You may use Tylenol (acetaminophen) two regular tablets or one extra-strength tablet for headaches.

Back to Top

What can I do to relieve constipation?

At least half of all pregnant women seem to have problems with constipation. One reason for this may be changes in hormones that slow the movement of food through the digestive tract. Sometimes iron supplements may also cause constipation. During the last part of pregnancy, pressure on your rectum from your uterus may add to the problem. Here are some suggestions that may help:

• Drink plenty of liquids – at least 6-8 glasses of water each day, including 1-2 glasses of fruit juice such as prune juice. Liquids (such as coffee, tea and cola) which make you go to the bathroom should not be drunk. They will tend to create a negative water balance in your body and thus make your stools harder and more difficult to pass. li> Eat food high in fiber, such as raw fruits and vegetables and bran cereals.
• Exercise daily – walking is a good form of exercise.

Back to Top

Is it normal for my gums to bleed during pregnancy?

During pregnancy, the extra hormones in your body may cause your gums to swell and bleed. Floss and brush regularly, using a soft toothbrush, to keep your teeth in good shape. Having a dental checkup early in pregnancy is a good idea to be sure your mouth is healthy. Local anesthesia, if needed, does not pose a risk during pregnancy. Dental x-rays should only be done if necessary and with your abdomen shielded.

Back to Top

ARE LEG CRAMPS NORMAL?

In the last three months of pregnancy, you may find that you have more leg cramps. Get plenty of calcium (three glasses of milk or supplement) and potassium (oranges or bananas.) Stretching you legs before going to bed can help relieve cramps. Avoid pointing your toes when stretching or exercising.

Back to Top

Is it SAFE to paint during pregnancy?

Latex paints manufactured before 1991 used small amounts of mercury as a preservative. There was some concern that this mercury could present a health hazard, so mercury is no longer used in latex paints. The fumes from latex paints are not felt to be a specific risk to a developing baby, but it is always wise to paint in a well-ventilated area. The fumes from oil-based paints, turpentine, paint thinner, etc., are best avoided by pregnant women. Also, remember when painting to avoid use of a ladder to reduce the risk of injuries due to a fall.

Back to Top

Is it safe to continue to have SEXUAL INTERCOURSE during pregnancy?

Some people worry about having intercourse during pregnancy. They may be afraid it will cause a miscarriage. For a healthy woman with a normal pregnancy, intercourse is safe into the last weeks of pregnancy. For your comfort, you and your partner may want to try different positions. Your doctor or midwife may advise you to limit or avoid sex if there are signs of problems in your pregnancy.

Back to Top

What can YOU do to reduce or prevent heartburn?

Indigestion is commonly called heartburn, but it does not mean that anything is wrong with your heart. It is a burning feeling that starts in the stomach and seems to rise into the throat. It occurs when digested food from your stomach, which contains acid, is pushed up into your esophagus (the tube leading from the throat to the stomach.) Liquids that you drink also take up space in your stomach, so they may also add to the problem.

Changes that take place in your body during pregnancy may worsen indigestion. Changes in your hormone levels slow digestion and relax the muscle that normally prevents the digested food and acids in your stomach from entering the esophagus. In addition, your growing uterus presses up on your stomach.

To help relieve heartburn, try the following:

• Eat five or six small meals a day instead of two or three large ones. (A glass of fluid may be equal in volume to a small meal, so avoid drinking large amounts of fluids with meals.)
• Avoid foods that cause gas, such as spicy or greasy foods.
• Do not eat or drink several hours before bedtime.
• Wait two hours after eating before exercising.
• Antacids may be helpful, such as Maalox, Tums, or Gaviscon. Liquid will be more effective than tablets. If the problem is frequent and only briefly relieved by antacids, speak with your doctor or midwife.

ARE hemorrhoids common during pregnancy?

Very often pregnant women who are constipated also have hemorrhoids. Hemorrhoids are varicose (or swollen) veins of the rectum. They are often painful. Straining during bowel movements and having very hard stools may make hemorrhoids worse and can sometimes cause them to protrude from the rectum.

Do not take drugstore cures while you are pregnant without first checking with your doctor or nurse. Hemorrhoids usually improve after the baby is born. Several things can help give relief or avoid the problem in the first place:

• Avoid getting constipated.
• Eat a high-fiber diet.
• Drink plenty of liquids.

Are yeast infections common during pregnancy?

It is not uncommon to develop a yeast infection during pregnancy. If such an infection does occur, it is safe for you to use over-the-counter products, such as Monistat. These are readily available at stores.

However, if you are early in your pregnancy, before 12 weeks, it is important that the cream be used externally only. After 12 weeks, it is safe to gently use the applicator internally.

Back to Top

Are herbs and extra vitamins safe during pregnancy?

No, your prenatal vitamins should be the only supplement used during pregnancy unless your provider specifically directs you to use an additional product.

Back to Top