Services / Procedures / Surgery

Woman’s Group of Meridian OB-GYN Services

Complete Gynecological Care

Gynecological Care encompasses everything from routine examinations and pap smears to contraceptive counseling and help with problematic issues, such as abnormal uterine bleeding. For your comfort and convenience, we often perform state-of-the-art procedures right in the office in order to evaluate and even treat certain conditions. Our services are designed to meet the obstetrical and gynecologic needs of our patients throughout their life span. With complementing teams of physicians, Women’s Health nurse practitioners and a nurse midwife, we provide Complete Care for Women.



Woman’s Group of Meridian offers prenatal and postnatal care that nurtures the well-being of both you and your child. Since your physical health directly affects your baby, your provider will continually assess your condition during your pregnancy. You'll be screened for disease, high-risk conditions, and other issues. Together, you and your doctor can make adjustments or take action as needed to ensure your health and the health of your baby.


Well Woman Examinations are a proactive way for you and your doctor to maintain your good health by identifying risk factors, discussing lifestyle choices, and catching potential problems before they become serious issues. You can expect to talk about contraception and sexual health, receive age- or circumstance-appropriate physical exams and tests, and talk with your physician about anything that concerns you. And you can be sure we use the most advanced assessment techniques to optimize the accuracy of your tests.


Midlife Health is a relatively new concept in health care, focusing on a growing population of women 40 years of age and over. Our staff specializes in all facets of midlife health. Your routine gynecological care will focus on cancer screening, breast disease, treatment for peri-menopausal symptoms, and more. Your doctor will assess and discuss with you the benefits and risks of hormone replacement therapy. You'll be counseled in preventive nutrition, if you wish, to mitigate risk factors for heart disease and osteoporosis. And you'll be screened and treated for troublesome midlife health issues such as urinary incontinence.

Birth Control

Oral Contraceptive Pills,

There are many different oral contraceptive brands. In some cases, different brands are identical except for packaging. In other cases, brands have different hormones in slightly differing amounts. When prescribing a pill, physicians may consider estrogen dose, progestin dose, type of progestin and relative potency as important factors. The risk of serious side effects is higher among women who take more than 50 mcg of estrogen. Thus, the ideal pill is the one with the lowest estrogen and progestin doses that will be effective in preventing pregnancy and minimize adverse effects.


IMPLANON® is a type of birth control for women. It is a flexible plastic rod the size of a matchstick that is put under the skin of your arm.

IMPLANON® contains a hormone called etonogestrel. You can use a single IMPLANON® rod for up to three years. Because IMPLANON® does not contain estrogen, your healthcare provider may recommend IMPLANON® even if you cannot use estrogen.


Mirena slowly releases very small amounts of the hormone levonorgestrel directly into your uterus. There is no single explanation for how Mirena works. Mirena may: Thicken cervical mucus to prevent sperm from entering your uterus, Inhibit sperm from reaching or fertilizing your egg, Make the lining of your uterus thin.The above actions work together to prevent pregnancy. Like other forms of birth control, Mirena is not 100% effective.

Mirena keeps hormone levels steadier and lower than the Pill.

Mirena is a tiny T-shaped piece of soft, flexible plastic that is placed in the uterus by your healthcare provider during an office visit. It's designed to be small and comfortable, so that you and your partner most likely won't even feel like it's there.

NuvaRing® is an easy-to-use birth control option that, when used as directed, is just as effective as the Pill. But with NuvaRing®, you don’t have to take it every day in order to get a full month of pregnancy protection. In a given 1-month period, NuvaRing® must be inserted into your vagina, removed after 3 weeks, and a new ring must be inserted no more than 7 days later. It’s a flexible ring about 2” in diameter that you insert vaginally once a month. Once inside, NuvaRing® releases a continuous low dose of hormones to prevent pregnancy. In a clinical trial, 9 out of 10 NuvaRing® users said they would recommend it to others.

Depo Provera,

Depo Provera is the brand name of the birth control shot, a hormonal injection that a woman gets every three months in order to prevent pregnancy. The shot contains progestin, a hormone that prevents ovulation and thickens a woman's cervical mucus. Depo Provera is very effective at preventing pregnancy. It may take a while for women to get pregnant after stopping Depo Provera, but the shot will have no long-term impact on fertility.

The ParaGard® - Intrauterine copper contraceptive A small T-shaped piece of soft flexible plastic wrapped with copper. Your healthcare provider places it in your uterus during an office visit. Paragard offers protection from pregnancy immediately after it is placed. It is believed to work primarily by preventing sperm from reaching and fertilizing the egg.1 It may also prevent the egg from attaching to the uterus. The contraceptive effectiveness of ParaGard® is enhanced by the continuous release of copper into the uterine cavity. ParaGard® is indicated for intrauterine contraception for 1, 5, even up to 10 years, but patients may have it removed anytime before then, depending on their needs and family circumstances. Paragard offers protection from pregnancy immediately after it is placed.

Preconceptual Planning

Prepregnancy is the ideal time to review your lifestyle, habits and health history. Getting healthy before pregnancy will help you cope with the stress of labor, delivery and recovery. And it will help your baby, especially in those critical early weeks of development.

Nutrition and vitamins are critical for you and your baby. Women who are planning a pregnancy should take prenatal vitamins, which contain folic acid. Folic acid supplementation can lower the incidence of neural tube defects (spina bifida). The spinal cord closes by 28 days of embryologic life, prior to when many women realize they are pregnant, making vitamins particularly important in the preconceptual period.

Before becoming pregnant, you should also decrease or eliminate caffeinated beverages. Heavy ingestion of caffeine may be associated with smaller, less healthy babies.

Pregnancy is not a time to diet, so optimize your weight prior to conceiving. Obesity is associated with a higher incidence of gestational diabetes, high blood pressure and difficult labors. Ideal nutrition is achieved with your old-fashioned food pyramid, containing moderate servings from all five food groups. Fad diets are unbalanced; they could be harmful to you and your baby.

Discuss your medical history and any medications you take with your obstetrician prior to becoming pregnant. Some medications (including some antibiotics, antiseizure drugs and drugs used for psychiatric disorders) may harm your baby and should be stopped well before conception. If a type of medication is essential for your health, perhaps your doctor could minimize the dose or substitute an alternative, safer drug. Women with serious health problems (diabetes, lupus, hypertension) can have successful pregnancies, but they need to get special care before and during their pregnancies.

A moderate exercise program begun preconceptually is safe to continue in an uncomplicated pregnancy. High temperatures, contact sports and heavy lifting should be avoided. The key is to initiate the exercise program before you become pregnant, then to make remaining fit and active a part of your healthy pregnancy.

Finally, review your immunization status, family genetic history, work environment, and prior pregnancy history with your doctor before becoming pregnant. These are all important areas where early intervention will help you and your baby throughout your pregnancy. Becoming a parent is a major commitment; improving your health before pregnancy can help you to have a normal pregnancy and a healthy baby.

Urinary incontinence

More than 13 million people in the US suffer with urinary incontinence and 85% of them are women. Varying degrees of urinary incontinence may be the end result of "normal" life stresses such as pregnancy and childbirth over the years, but whatever the cause, it's unnecessary for anyone to be limited by this condition. Our office provides state of the art diagnostic equipment, including a urodynamic machine, used to diagnose the exact cause of incontinence. We use a multi-dynamic approach to the treatment of incontinence including drug management, physical therapy, and surgical repair.

There are two main kinds of chronic incontinence. Some women have both.

Stress incontinence occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladder. It is the most common type of bladder control problem in women. Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch the pelvic floor muscles. When these muscles cannot support your bladder properly, the bladder drops down and pushes against the vagina. You cannot tighten the muscles that close off the urethra. So urine may leak because of the extra pressure on the bladder when you cough, sneeze, laugh, exercise, or do other activities.

Treatment for stress incontinence includes: Doing Kegel exercises to strengthen the pelvic floor muscles. It is one of the best ways to improve stress incontinence. Using a removable device called a pessary (which is placed inside the vagina). It can help reduce stress incontinence by putting pressure on the urethra. Taking medicines, but they may have bothersome side effects. Having surgery to support the bladder or move it back to a normal position, if other treatment doesn't help.

Urge incontinence happens when you have a strong need to urinate but can't reach the toilet in time. This can happen even when your bladder is holding only a small amount of urine. Some women may have no warning before they accidentally leak urine. Other women may leak urine when they drink water or when they hear or touch running water. Overactive bladder is a kind of urge incontinence. But not everyone with overactive bladder leaks urine. For urge incontinence, your doctor may: Suggest behavior changes to fix the problem. For example, bladder training helps you to increase how long you can wait before you have to urinate. Prescribe medicine to treat urge bladder problems. If you have more than one kind of bladder control problem, first your doctor will treat the one that bothers you the most. Then he or she will treat the other cause, if needed.

Mixed incontinence is a combination of different types of bladder control problems, usually stress and urge incontinence. These problems often occur together in older women.

Urodynamic testing

Urodynamic testing provides a more advanced way to check bladder function. Urodynamic testing may be done if your health professional suspects that you have mixed incontinence with more than one cause. The actual tests done in urodynamic testing often vary. They may include:

Cystometry (cystometrography, uroflowmetry), which is a series of tests to measure bladder pressure at different levels of fullness. Cystometry tests include: Leak point pressure (LPP), which measures weakness in the muscle that holds back urine (sphincter). Maximum urethral closure pressure (MUCP), which measures the pressure keeping the urethra closed naturally.

Pap Smear

A Pap smear is a test of a sample of cells taken from a woman's cervix. The test is used to look for changes in the cells of the cervix that show cervical cancer or conditions that may develop into cancer.

It is the best tool to detect precancerous conditions and hidden, small tumors that may lead to cervical cancer. If detected early, cervical cancer can be cured.

The Pap smear is done during a pelvic exam. A doctor uses a device called a speculum to widen the opening of the vagina so that the cervix can be examined. A plastic spatula and small brush are used to collect cells from the cervix. After the cells are taken, they are placed into a solution. The solution is sent to a lab for testing. A Pap smear is not painful, but the pelvic exam may be a little uncomfortable.

A normal Pap smear means the cells from the cervix look normal.

An abnormal Pap smear means the cells do not look normal. Sometimes repeat Pap smears are needed. Different tests also may need to be done, such as a colposcopy (the use of a special microscope to examine the cervix and vagina). Pap smears can occasionally show signs of infection but cannot be relied on to screen for sexually transmitted diseases (STDs). Other tests are necessary to determine the presence of an STD. There are several things you can do to help make the Pap smear as accurate as possible. These include avoidance of sex, douching, and vaginal creams for 48 hours before the test.

An abnormal Pap smear does not necessarily mean that cancer cells were found during the examination. There are many causes for abnormal Pap smear results. Your doctor will evaluate the results to determine if further testing is necessary.

A repeat Pap smear may be necessary if you had an infection at the time of the test or if there were not enough cells collected during the test. If the results of the repeat Pap smear are still abnormal, your doctor may recommend that you have a colposcopy to further evaluate the problem.


Vaginitis is a term used to describe an entire range of disorders characterized by inflammation of a woman’s vagina. The majority of women are affected by vaginitis regardless of age, state in life, or degree of sexual activity. The vagina has normal discharge that is clear or cloudy and whitish. A healthy vagina keeps a balance of many organisms such a bacteria and yeast. The most common types of vaginitis are Candidiasis (yeast), Bacterial Vaginosis (Bacteria), and Trichomonas (Parasite). Vaginitis usually reflects the woman’s overall health status. The severity of symptoms of vaginitis varies in all women. The causes of vaginitis and vulvovaginitis can range from poor health such as diabetes, use of antibiotics, a change in normal body’s hormones such as pregnancy or menopause, STDs, spermicides, douching, or poor nutritional habits. It is important that the treatment prescribed for the infection is very specific for the vaginitis and is followed for the entire prescribed length of time. Sometimes vaginal and cervical inflammation from the vaginitis can affect the results of a pap smear. It is best to get the infection treated before your pap appointment.

It is important for a woman to learn how to prevent vaginal infections by being aware of the symptoms, causes, and different types of vaginitis that may affect her overall well being, sexual health, and possibly her sexual partner.

Abnormal Uterine Bleeding (AUB)

Abnormal uterine bleeding, or menorrhagia, refers to menstrual periods that are abnormally heavy, prolonged or both or may refer to bleeding between periods. In general, AUB is diagnosed when abnormal bleeding interferes with daily activities and there is no evidence of a physical cause (like cancer or endometriosis). Abnormal uterine bleeding is a common problem for women between age 40 and 50 when hormone levels begin to change in the five to seven years before menopause -- when menstrual periods end forever.

Ovarian Cyst

A functional ovarian cyst is a sac that forms on the surface of a woman’s ovary during ovulation. It holds a maturing egg. Usually the sac goes away after the egg is released. If an egg is not released, or if the sac closes up after the egg is released, the sac can swell up with fluid.

Functional ovarian cysts are different than ovarian growths caused by other problems, such as cancer. Most of these cysts are harmless. They do not cause symptoms, and they go away without treatment. But if a cyst becomes large, it can twist, rupture, or bleed and can be very painful.

Most functional ovarian cysts do not cause symptoms. The larger the cyst is, the more likely it is to cause symptoms. Symptoms can include: Pain or aching in your lower belly, usually when you are in the middle of your menstrual cycle. A delay in the start of your menstrual period. Vaginal bleeding when you are not having your period.

Some functional ovarian cysts can twist or break open (rupture) and bleed. Symptoms include: Sudden, severe pain, often with nausea and vomiting (possible sign of a twisted cyst). Pain during or after sex (possible sign of a ruptured cyst).

Your doctor may find an ovarian cyst during a routine pelvic exam. He or she may then use a pelvic ultrasound to make sure that the cyst is filled with fluid. In a few months, after you have been through 2 or 3 menstrual cycles, your doctor will recheck you. The cyst is likely to go away on its own during this time.

If you see your doctor for pelvic pain or bleeding, you'll be checked for problems that may be causing your symptoms. Your doctor will ask you about your symptoms and menstrual periods. He or she will do a pelvic exam and may do a pelvic ultrasound.


Noncancerous balls of muscular tissue, fibroids can grow inside the uterus, on the surface of the uterus or in the muscular wall of the uterus. They can range in size from less than an inch in diameter to the size of a grapefruit. They don't always produce symptoms. However, even small fibroids can cause heavy menstrual bleeding. Plus, fibroids may affect fertility by interfering with an embryo's ability to attach to the uterus. Large fibroids might cause frequent urges to urinate; they can also cause heaviness and discomfort in the pelvic region. If fibroids aren't causing any problems, however, you don't need treatment. Plus, because fibroids tend to shrink after menopause, women in their late 40s or early 50s with fibroid-related symptoms may opt to wait to see if symptoms go away with menopause

Sexually Transmitted Diseases

Sexually transmitted diseases, commonly called STDs, are diseases that are spread by having sex with someone who has an STD. You can get a sexually transmitted disease from sexual activity that involves the mouth, anus, vagina, or penis.

According to the American Social Health Organization, one out of four teens in the United States becomes infected with an STD each year and by the age of 25, half of all sexually active young adults will get an STD.

STDs are serious illnesses that require treatment. Some STDs, like AIDS, cannot be cured and are deadly. By learning more about STDs, you can find out ways to protect yourself from the following STDs.

Common STDs have a variety of symptoms (if symptoms develop at all) and many different complications, including death.

  • Chlamydia
    • Most common of all STDs caused by bacteria
    • No symptoms in 80% of women and 50% of men
    • Discharge from the vagina or the penis, burning or pain during urination
    • Transmitted through vaginal, oral, or anal sexual contact
    • Ectopic pregnancy and infertility for women are among the most serious complications
    • Treatable with antibiotics
  • Genital herpes: One type of herpes typically causes cold sores in the mouth, and another type causes genital sores; however, each type can cause either type of infection.
    • Recurring outbreaks of blister like sores on the genitals
    • Can be transmitted from a mother to her baby during birth
    • Reduction in frequency and severity of blister outbreaks with treatment but not complete elimination of infection.
  • Hepatitis (A, B, C, D)
    • Hepatitis B most often associated with sexual contact
    • Yellowish skin and eyes, fever, achy, tired, might feel like the flu
    • Severe complications, including cirrhosis and liver cancer
    • No cure available, remission possible with some aggressive medications
    • Immunizations available to prevent hepatitis A and B
  • Gonorrhea
    • Discharge from the vagina or the penis
    • Painful urination
    • Ectopic pregnancy and infertility for women most serious complications
    • Treatable with antibiotics
  • Syphilis
    • Mild symptoms, often goes undetected initially
    • Starts with painless genital ulcer that goes away on its own
    • Rash, fever, headache, achy joints
    • Treatable with antibiotics
    • More serious complications associated with later stages of disease if undetected and untreated
  • HIV
    • Spread primarily by sexual contact and from sharing IV needles
    • Can be transmitted at the time a person becomes infected with other STDs
    • Fatigue, night sweats, chills or fever lasting several weeks, headaches, cough
    • No current cure; medications available to slow disease progression
  • Genital warts
    • Caused by a virus related to skin warts
    • Small, painless bumps in the genital or anal areas (sometimes in clusters that look like cauliflower)
    • Various treatments available (for example, freezing or painting the warts with medication)
  • Pubic lice
    • Very tiny insects living in pubic hair
    • Can be picked up from clothing or bedding
    • First notice itching in the pubic area
    • Treatable with creams, anti-lice agents, and combing
  • Scabies
    • Skin infection caused by a tiny mite
    • Highly contagious
    • Spread primarily by sexual contact or from contact with skin, infested sheets, towels, or furniture
    • Treatment with creams


Did you know that women may spend more years in menopause than in their reproductive years? Thankfully, there's a lot you and your doctor can do to promote a long, healthy, and happy life. Troublesome symptoms such as hot flashes and night sweats can be improved in a variety of ways. Heart disease and osteoporosis risks can be assessed and addressed. Preventive nutrition is actively promoted. And a personalized evaluation of the benefits and risks of hormone replacement therapy will help you and your physician make well-informed decisions about what's best for you.

Menopause is a normal condition that all women experience as they age. The term "menopause" is commonly used to describe any of the changes a woman experiences either just before or after she stops menstruating, marking the end of her reproductive period. Menopause occurs when the ovaries no longer produce an egg every month and menstruation stops.

Menopause, when it occurs after the age of 40, is considered "natural" and is a normal part of aging. But, some women can experience menopause early, either as a result of surgery, such as hysterectomy, or damage to the ovaries, such as from chemotherapy. Menopause that occurs before the age of 40, regardless of the cause, is called premature menopause.

Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For women undergoing natural menopause, the process is gradual and is described in three stages:

  • Perimenopause . Perimenopause typically begins several years before menopause, when the ovaries gradually produce less estrogen. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, the decrease in estrogen accelerates. At this stage, many women experience menopause symptoms
  • Menopause. Menopause is the point when it's been a year since a woman has her last menstrual period. At this stage, the ovaries have stopped releasing eggs and producing most of their estrogen.
  • Postmenopause. These are the years after menopause. During this stage, menopausal symptoms, such as hot flashes ease for most women. However, health risks related to the loss of estrogen increase as the woman ages.

Pelvic Pain

Female pelvic pain is pain below a woman’s belly button. It is considered chronic, which means long-lasting, if you have had it for at least 6 months. The type of pain varies from woman to woman. In some women, it is a mild ache that comes and goes. In others, the pain is so steady and severe that it’s hard to sleep, work, or enjoy life.

If your doctor can find what’s causing the pain, treating the cause may make the pain go away. Some common causes include:

  • Problems of the reproductive system, such as endometriosis, adenomyosis, and uterine fibroids.
  • Scar tissue (adhesions) in the pelvic area after a pelvic infection or surgery.
  • Diseases of the urinary tract or bowel, such as irritable bowel syndrome or chronic bladder irritation.
  • Physical or sexual abuse. Experts are not sure why this is so, but about half of women with chronic pelvic pain have a history of abuse.1

Doctors don't really understand all the things that can cause chronic pelvic pain. So sometimes, even with a lot of testing, the cause remains a mystery. This doesn't mean that there isn't a cause or that your pain isn't real.

Sometimes, after a disease has been treated or an injury has healed, the affected nerves keep sending pain signals. This is called neuropathic pain. It may help explain why it can be so hard to find the cause of chronic pelvic pain.

The type of pain can vary widely. Chronic pelvic pain can include:

  • Pain that ranges from mild to severe.
  • Pain that ranges from dull to sharp.
  • Severe cramping during periods.
  • Pain during sex.
  • Pain when you urinate or have a bowel movement.

Pelvic Prolapse

Pelvic prolapse (a term that describes when the uterus drops into the vaginal canal) occurs when the ligaments that support the pelvic organs fail. This weakening can occur with age, estrogen deficiency, obesity or after multiple births. Once this pelvic support weakens, pelvic organs, including the uterus, bladder and rectum, may sag, resulting in pressure, rectal discomfort and problems with bladder and bowel control.

Losing weight, stopping smoking and avoiding constipation by getting plenty of liquids and fiber in your diet can sometimes help. Additionally, you can strengthen your pelvic muscles with Kegel exercises. To do these exercises, tighten and relax the muscles used to stop the flow of urine. This strengthens the vaginal canal and pelvic floor muscles, helping control urine flow and enhancing orgasm.

You may also be fitted with a pessary, a device placed in the vagina that holds the organs in place.

Surgery can be an option when organs have prolapsed. Surgery may involve creating a sling for the bladder or using specialized surgical tape to keep the bladder or uterus in place, or removing the uterus, via hysterectomy.

Breast Disorders

Breast lumps or changes are a common health worry for most women. Women may have many kinds of breast lumps and other breast changes throughout their lives, including changes that occur with menstrual periods, pregnancy, and aging. Most breast lumps and breast changes are normal.

Common, noncancerous (benign) breast changes include:

  • Sacs filled with fluids (cysts).
  • Generalized breast lumpiness.
  • Painless, movable, and firm round lumps (fibroadenomas).
  • Damaged fatty tissue (fat necrosis).
  • Growths inside the ducts (intraductal papillomas).
  • Enlargement of lymph nodes in the breast.
  • Breast pain (mastalgia).
  • Breast infections (mastitis) or abscesses.
  • Nipple discharge.
  • Inflamed blood vessels (thrombophlebitis).

Breast development is the first sign of puberty in young girls. Usually, breasts begin as small, tender bumps under one or both nipples that will get bigger over the next few years. It is not unusual for one breast to be larger than the other or for one side to develop before the other. A girl may worry that a lump under the nipple is abnormal or a sign of a serious medical problem when it is a part of normal breast development.

Many women with breast pain or breast lumps worry about breast cancer.

The earlier breast cancer is detected, the more easily and successfully it can be treated.

There are 2 methods of early detection:

  • Clinical breast examination (CBE). During your routine physical examination, your doctor may do a clinical breast examination. During a CBE, your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes.
  • Mammogram. A mammogram is an X-ray of the breast that can often find tumors that are too small for you or your doctor to feel. Experts differ in their recommendations about when or how often women should have mammograms. Some recommend you begin screening at age 40 and some recommend you begin screening at age 50. Your doctor may suggest that you have a screening mammogram at a younger age if you have any risk factors for breast cancer.

Breast self-examination (BSE) involves checking your breasts for lumps or changes while standing and lying in different positions and while looking at your breasts in a mirror. Once you know what your breasts normally look and feel like, any new lump or change in appearance should be evaluated by a doctor. Most breast problems or changes are not caused by cancer. But BSE should not be used in place of clinical breast examination and mammography. Studies have not shown that BSE alone reduces the number of deaths from breast cancer.

Early breast cancer is often seen on a mammogram before there are any symptoms. The most common symptom of breast cancer is a painless lump. However, sometimes painful lumps are cancerous. Other symptoms of breast cancer include:

  • A lump or thickening in the breast or armpit that is new or unusual.
  • A change in the size or shape of the breast.
  • Skin changes, such as a dimple or pucker in the skin of the breast.
  • Discharge or bleeding from the nipple that comes out without squeezing the nipple (spontaneous discharge).
  • A change in the nipple.
  • Scaling or crusting of the nipple.
  • A change in the color or feel of the skin of the breast or the darker area around the nipple (areola).

Treatment of a breast problem depends on the cause of the problem.

In Office Laboratory

At Woman’s Group of Meridian, we perform blood tests and other routine laboratory procedures right in our office, eliminating the hassle of visiting a separate testing lab before or after your appointment. We hope that our patients can benefit from the convenience of this service.

Procedures in the Office

Colposcopy: A way of looking at the cervix through a special magnifying device to look for abnormalities. This is done when you have abnormal cells noted on a pap smear, to determine to what degree of abnormality cells are to proceed with the correct treatment.

Cryotherapy: Application of extreme cold to destroy abnormal tissue. When the pap smear or pathology is abnormal.

IUD: A type of birth control that is a small plastic device that is inserted and left inside the uterus to prevent pregnancy. Mirena is a five year treatment and Paragard is a ten year treatment.

Endometrial biopsy: A small sample is extracted from the lining of the uterus. This procedure is for heavy bleeding/abnormal bleeding and abnormal ultrasound.

Implanon: A birth control device that is placed in the upper arm and this treatment lasts for three years.

LEEP: A thin wire loop that cuts like a scalpel to remove a piece of the cervix due to abnormal cells.

Vulvar Biopsy: A small sample (usually less than 5 millimeters) taken from the external genitalia for evaluation of abnormal color, inflammation or concern of cancer.

Procedures in the Hospital

Cone biopsy

A cone biopsy is an extensive form of a cervical biopsy. It is called a cone biopsy because a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope. A cone biopsy removes abnormal tissue that is high in the cervical canal. A small amount of normal tissue around the cone-shaped wedge of abnormal tissue is also removed so that a margin free of abnormal cells is left in the cervix.

A cone biopsy can: Remove a thin or a thick cone of tissue from the cervix, depending on how much tissue needs to be examined. Be used to diagnose and sometimes to treat abnormal cervical tissue. The abnormal tissue is removed and sent to a lab to be examined.

D&C: Dilation and Curettage Procedure

A D&C involves two main steps:

  • Dilation involves widening the opening of the lower part of the uterus (the cervix) to allow insertion of an instrument. The doctor may insert a slender rod (laminaria) into the opening to gradually cause it to widen. Or medication may soften the cervix to help it widen.
  • Curettage involves scraping the lining and removing uterine contents with a long, spoon-shaped instrument (a curette). The doctor may also use a cannula to suction any remaining contents from the uterus. This can cause some cramping. In many cases, a tissue sample goes to a lab for examination.


A hysteroscopy is a way for your doctor to look at the lining of your uterus. He or she uses a thin viewing tool called a hysteroscope. The tip of the hysteroscope is put into your vagina and gently moved through the cervix into the uterus. The hysteroscope has a light and camera hooked to it so your doctor can see the lining (endometrium) on a video screen.

A hysteroscopy may be done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause. It also may be done to see if a problem in your uterus is preventing you from becoming pregnant (infertility). A hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps.

Your doctor may take a small sample of tissue (biopsy). The sample is looked at under a microscope for problems.


Laparoscopy is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs. Laparoscopy is used to find problems such as cysts, adhesions, fibroids, and infection. Tissue samples can be taken for biopsy through the tube (laparoscope).

In many cases laparoscopy can be done instead of laparotomy surgery that uses a larger incision in the belly. Laparoscopy can be less stressful and may have less problems and lower costs than laparotomy for minor surgeries. It can often be done without needing to stay overnight in the hospital.

Sling Procedure (TOT)

A sling procedure is used to treat urinary incontinence (loss of urine). It is used to treat incontinence associated with laughing, coughing or exercising (referred to as stress incontinence). It is not used to treat urge incontinence (overactive bladder) as usually medication is used. A TOT is a synthetic sling that is fitted under a women’s urethra that improves continence by providing a firm platform for the urethra. We use what is called a transobturator approach to place the supportive mesh. Typically sling procedures utilize either a transobdurator or retropubic approach. Each approach works well for stress incontinence.

Most patients are continent following the procedure and can resume normal, non-strenuous activities within a few days. The suburethral sling offers several benefits:

  • Patients generally recover quickly, most with immediate improved bladder function
  • Typically day-surgery
  • Minimally invasive and suitable for a wide variety of patients: – hx of obesity, previous abdominal surgeries, complicated medical history
  • Incisions in the groin area are small
  • May be combined with other surgeries such as endometrial ablation, tubal ligation, hysterectomy or hysteroscopy

Talk with your provider about any incontinence symptoms you may have, even if you just experience frequency and/or urgency. The specialty of incontinence and female prolapse is expanding rapidly and many options are available to women of all ages.

Endometrial ablation

This minimally invasive surgery uses electrical energy, heat, a balloon or freezing to destroy the endometrium, or uterine lining. It can minimize or stop heavy bleeding. Success rates of endometrial ablation vary depending on the specific procedure used and the patient, but success rates for the following three to five years are generally quite high (up to 80 to 90 percent). Risks of endometrial ablation are very rare. They include: perforation of the uterus. injury to other pelvic organs bleeding, infection, accumulation of blood within the uterus because of scarring.


This procedure is one of the best options for treating fibroids if you want to preserve your fertility. During a myomectomy, fibroids are cut out of the uterus and removed through an incision in the abdomen. If fibroids are located in the uterine cavity, they may be removed through the vagina without an abdominal incision in a procedure called hysteroscopic myomectomy. The technique involves the use of an instrument called a hysteroscopic resectoscope and is primarily useful for women with bleeding or pregnancy-related problems. They may also be removed laparoscopically, using a small telescope called a laparoscope. During this procedure, a few small cuts are made in your abdomen or pelvis, which allow the laparoscope and other small instruments to be slipped inside, thus enabling the surgeon to remove the fibroids without having to make a large incision The benefit of a myomectomy is that it preserves the uterus and cervix so pregnancy is still possible.


A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:

  • Uterine fibroids that cause pain, bleeding, or other problems
  • Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
  • Cancer of the uterus, cervix, or ovaries
  • Endometriosis
  • Abnormal vaginal bleeding
  • Chronic pelvic pain
  • Adenomyosis, or a thickening of the uterus

Hysterectomy is usually considered only after all other treatment approaches have been tried without success.

Types of Hysterectomy

Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. Patients and health care providers sometimes use these terms inexactly, so it is important to clarify if the cervix and/or ovaries are removed:

  • In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping the cervix in place.
  • A total hysterectomy removes the whole uterus and cervix.
  • In a radical hysterectomy, a surgeon removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present.

The ovaries may also be removed -- a procedure called oopherectomy -- or may be left in place.

Surgical Techniques for Hysterectomy

An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting for about 70% of all procedures.To perform an abdominal hysterectomy, a surgeon makes a 5 to 7 inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision.

On average, a woman spends more than three days in the hospital following an abdominal hysterectomy. There is also, after healing, a visible scar at the location of the incision.

Minimally Invasive Hysterectomy

There are several approaches that can be used for a minimally invasive hysterectomy:

  • Vaginal hysterectomy: The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.
  • Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.
  • Laparoscopic-assisted vaginal hysterectomy: Using laparoscopic surgical tools, a surgeon removes the uterus through an incision in the vagina.

Total Laparoscopic Hysterectomy:

This procedure involves disconnecting the uterus, and other structures as needed, by operating only through the laparoscopes in the abdomen, starting at the top of the uterus. The entire uterus is disconnected from its attachments using long thin instruments through the "ports." Then all tissue to be removed is passed through the vagina or through the tiny half-inch abdominal incisions. A massive ovarian cyst can be removed without rupturing it inside the abdominal cavity by placing it in a sturdy surgical-grade pouch and passing the pouch out the vagina or, after collapsing the cyst inside the pouch, passing it out through the "port" incision. If the uterus is massively enlarged it can be disconnected from its attachments, then cut into tiny pieces and passed down the vagina. If a cancer is present, it can be removed with the staging procedures such as lymph node sampling, appendectomy, and omentectomy done safely. Abdominal scars consist of two to four tiny one-half inch incisions, one inside the belly-button, one in the top portion of the pubic hair just above the pubic bone, and one each just to the middle side of the front of the hip bone. Two days in the hospital and two weeks away from work are usual. Because there is no operating through the vagina (though tiny pieces of tissue can be passed down through it), there is no requirement for a wide vagina or loose ligaments. TLH can thus be performed on women who have never had children, women with narrow or long vaginas, women with previous surgeries, women with cancer, and women with massive organs. This technique is the least painful and least debilitating route of surgery for women who need hysterectomy but do not qualify to have a vaginal hysterectomy.

Tubal ligation

Tubal ligation, often referred to as "having your tubes tied," is a surgical procedure in which a woman's fallopian tubes are blocked, tied, or cutEither procedure stops eggs from traveling from the ovaries into the fallopian tubes, where the egg is normally fertilized by a sperm.

Tubal ligation is considered to be a permanent methods of birth control for women

Tubal ligation method

There are several different ways of closing the fallopian tubes, including clipping or banding them shut or cutting and stitching or burning them closed. Your surgeon will probably prefer one of the following methods. A tubal ligation can be done in the following ways:

  • Laparoscopy involves inserting a viewing instrument and surgical tools through small incisions made in the abdomen.
  • Postpartum tubal ligation is usually done as a mini-laparotomy after childbirth. The fallopian tubes are higher in the abdomen right after pregnancy, so the incision is made below the belly button (navel). The procedure is often done within 24 to 36 hours after the baby is delivered.

An open tubal ligation (laparotomy) is done through a larger incision in the abdomen. It may be recommended if you need abdominal surgery for other reasons (such as a cesarean section) or have had pelvic inflammatory disease (PID), endometriosis, or previous abdominal or pelvic surgery. These conditions often cause scarring or sticking together (adhesion) of tissue and organs in the abdomen. Scarring or adhesions can make one of the other types of tubal ligation more difficult and risky.

Laparoscopy is usually done with a general anesthetic. Laparotomy or mini-laparotomy can be done using general anesthesia or a regional anesthetic, also known as an epidural.

Cystocele Repair

A cystocele is the protrusion or prolapse of the bladder into the vagina. A number of surgical interventions are available to treat cystoceles.

A prolapse occurs when an organ falls out of its normal anatomical position. The pelvic organs normally have tissue (muscle, ligaments, etc.) holding them in place. Certain factors, however, may cause those tissues to weaken, leading to prolapse of the organs. A cystocele may be the result of a central or lateral (side) defect. A central defect occurs when the bladder protrudes into the center of the anterior (front) wall of the vagina due to a defect in the pubocervical fascia (fibrous tissue that separates the bladder and vagina). The pubocervical fascia is also attached on each side to tough connective tissue called the arcus tendineus; if a defect occurs close to this attachment, it is called a lateral or paravaginal defect. A central and lateral defect may be present simultaneously. The location of the defect determines what surgical procedure is performed.

Factors that are linked to cystocele development include age, repeated childbirth, hormone deficiency, menopause, constipation, ongoing physical activity, heavy lifting, and prior hysterectomy. Symptoms of bladder prolapse include stress incontinence (inadvertent leakage of urine with physical activity), urinary frequency, difficult urination, a vaginal bulge, vaginal pressure or pain, painful sexual intercourse, and lower back pain. Urinary incontinence is the most common symptom of a cystocele.

A staging system is used to grade the severity of a cystocele. A stage I, II, or III prolapse descends to progressively lower areas of the vagina. A stage IV prolapse descends to or protrudes through the vaginal opening. Surgery is generally reserved for stage III and IV cystoceles.

Rectocele repair

Rectal prolapse repair surgery treats a condition in which the rectum falls, or prolapses, from its normal anatomical position because of a weakening in the surrounding supporting tissues.

A prolapse occurs when an organ falls or sinks out of its normal anatomical place. The pelvic organs normally have tissue (muscle, ligaments, etc.) holding them in place. Certain factors, however, may cause those tissues to weaken, leading to prolapse of the organs. The rectum is the last out of six divisions of the large intestine; the anus is the opening from the rectum through which stool exits the body. A complete rectal prolapse occurs when the rectum protrudes through the anus. If rectal prolapse is present, but the rectum does not protrude through the anus, it is called occult rectal prolapse, or rectal intussusception. In females, a rectocele occurs when the rectum protrudes into the posterior (back) wall of the vagina.

Factors that are linked to the development of rectal prolapse include age, repeated childbirth, constipation, ongoing physical activity, heavy lifting, prolapse of other pelvic organs, and prior hysterectomy. Symptoms of rectal prolapse include protrusion of the rectum during and after defecation, fecal incontinence (inadvertent leakage of feces with physical activity), constipation, and rectal bleeding. Women may experience a vaginal bulge, vaginal pressure or pain, painful sexual intercourse, and lower back pain.


Boys are born with a hood of skin, called the foreskin, covering the head (also called the glans) of the penis. In circumcision, the foreskin is surgically removed, exposing the end of the penis. Routine circumcision is usually performed during the first 10 days. The doctor should prepare you by telling you about the procedure he or she will use and the possible risks. Circumcision after the newborn period can be a more complicated procedure and usually requires general anesthesia.

Gestational Diabetes

Pregnant women who have never had diabetes before but who have high blood sugar (glucose) levels during pregnancy are said to have gestational diabetes. Gestational diabetes affects about 4% of all pregnant women - about 135,000 cases of gestational diabetes in the United States each year.

We don't know what causes gestational diabetes, but we have some clues. The placenta supports the baby as it grows. Hormones from the placenta help the baby develop. But these hormones also block the action of the mother's insulin in her body. This problem is called insulin resistance. Insulin resistance makes it hard for the mother's body to use insulin. She may need up to three times as much insulin.

Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy. Without enough insulin, glucose cannot leave the blood and be changed to energy. Glucose builds up in the blood to high levels. This is called hyperglycemia. You may also be interested in our book,

How gestational diabetes can affect your baby

Gestational diabetes affects the mother in late pregnancy, after the baby's body has been formed, but while the baby is busy growing. Because of this, gestational diabetes does not cause the kinds of birth defects sometimes seen in babies whose mothers had diabetes before pregnancy.

However, untreated or poorly controlled gestational diabetes can hurt your baby. When you have gestational diabetes, your pancreas works overtime to produce insulin, but the insulin does not lower your blood glucose levels. Although insulin does not cross the placenta, glucose and other nutrients do. So extra blood glucose goes through the placenta, giving the baby high blood glucose levels. This causes the baby's pancreas to make extra insulin to get rid of the blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat.

This can lead to macrosomia, or a "fat" baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.


It's a fact: women who receive early and regular prenatal care are more likely to have healthier babies. If your doctor identifies yours as a high-risk pregnancy, it's even more critical that you get regular, specialized care. In addition to careful monitoring to catch issues before they become problems, your doctor may recommend counseling in nutrition, exercise, stress management and other topics. And if after the birth you or your baby requires specialized care, your physician will help you learn to attend to your own needs while you attend to the needs of your newborn.

Prenatal Care

Prenatal care is the health care you get while you are pregnant. Take care of yourself and your baby by:

  • Getting early prenatal care. If you know you're pregnant, or think you might be, call your doctor to schedule a visit.
  • Getting regular prenatal care. Your doctor will schedule you for many checkups over the course of your pregnancy. Don't miss any — they are all important.
  • Following your doctor's advice.

Prenatal care can help keep you and your baby healthy. Babies of mothers who do not get prenatal care are three times more likely to have a low birth weight and five times more likely to die than those born to mothers who do get care.

Doctors can spot health problems early when they see mothers regularly. This allows doctors to treat them early. Early treatment can cure many problems and prevent others. Doctors also can talk to pregnant women about things they can do to give their unborn babies a healthy start to life.

Postnatal Care

Many women get sidetracked with the arrival of their baby. They tend to ignore the fundamentals of postnatal care and shift the entire focus on the newborn. Without a doubt caring for a new baby is a demanding task. But equally important is postnatal care or taking care of yourself after you have had your baby. Adequate rest, eating well and doing gentle exercises to regain and maintain your strength are all a vital part of staying healthy. In order to do it right you must protect your own health by attending to postnatal care with some amount of dedication.

Complications of Pregnancy

Although the majority of pregnancies are uneventful, sometimes complications do occur. The following are some of the more common pregnancy complications:

  • amniotic fluid complications
    Too much or too little amniotic fluid in the membranes surrounding the fetus may indicate a problem with the pregnancy. Too much fluid can put excessive pressure on the mother's uterus, leading to preterm labor, or can cause pressure on the mother's diaphragm leading to breathing difficulties. Fluids tend to build up in cases of uncontrolled diabetes, multiple pregnancy, incompatible blood types, or birth defects. Too little fluid may indicate birth defects, growth retardation, or stillbirth.
  • bleeding
    Bleeding in late pregnancy may be a sign of placental complications or a vaginal or cervical infection. Women who bleed in late pregnancy may be at greater risk of losing the fetus and hemorrhaging (bleeding excessively). Bleeding at any time during the pregnancy should be reported to your physician immediately.
  • ectopic pregnancy
    An ectopic pregnancy is the development of the fetus outside of the uterus. An ectopic pregnancy can occur in the fallopian tubes, cervical canal, or the pelvic or abdominal cavity. The cause of an ectopic pregnancy is usually a blocked fallopian tube.

    Ectopic pregnancies occur in one out of 40 to 100 pregnancies and can be very dangerous to the mother. Symptoms may include spotting and cramping. The longer an ectopic pregnancy continues, the greater the likelihood that a fallopian tube will rupture. An ultrasound may confirm the diagnosis. Treatment of an ectopic pregnancy may include medication or surgical removal of the fetus, resulting in an early termination of the pregnancy.
  • miscarriage/fetal loss
    A miscarriage is the loss of the fetus up to 12 weeks of pregnancy. Most miscarriages occur in the first 12 weeks of pregnancy and are usually due to fetal abnormalities.

    Miscarriages are usually preceded by spotting and intense cramping. To confirm that a miscarriage has occurred, an ultrasound may be performed. The fetus and contents of the uterus are often naturally expelled. If this process does not occur, a procedure called a dilatation and curettage (D&C) may be necessary. This procedure uses special instruments to remove the abnormal pregnancy.

    Fetal loss in the second trimester may occur when the cervix is weak and opens too early, called incompetent cervix. In some cases of incompetent cervix, a physician can help prevent pregnancy loss by suturing the cervix closed until delivery.
  • placental complications
    Under normal circumstances, the placenta attaches itself firmly to the top of the inner uterine wall. However, two placental complications may occur, including:
    • placental abruption
      Sometimes the placenta becomes detached from the uterine wall prematurely (placental abruption) leading to bleeding and a reduction of oxygen and nutrients to the fetus. The detachment may be complete or partial, and the cause of placental abruption is often unknown. Placental abruption occurs in about one in every 120 live births.

      Placental abruption is more common in women who smoke, have high blood pressure, have a multiple pregnancy, and/or in women who have had previous children or a history of placental abruption.

      Symptoms and treatment of placental abruption depend upon the degree of detachment. Symptoms may include bleeding, cramping, and abdominal tenderness. Diagnosis is usually confirmed by performing a complete physical examination and an ultrasound. Women are usually hospitalized for this condition and may have to deliver the baby prematurely.
    • placenta previa
      Normally, the placenta is located in the upper part of the uterus. However, placenta previa is a condition in which the placenta is attached close to or covering the cervix (opening into the uterus).

      This type of placental complication occurs in one in every 200 deliveries and occurs more often in women who have scarring of the uterine wall from previous pregnancies, in women who have fibroids or other abnormalities in the uterus, or in women who have had previous uterine surgeries.

      Symptoms may include vaginal bleeding that is bright red and not associated with abdominal tenderness or pain. Diagnosis is confirmed by performing a physical examination and an ultrasound. Depending upon the severity of the condition and the stage of pregnancy, modification of activities or bedrest may be ordered. The baby usually has to be delivered by cesarean section, to prevent the placenta from detaching early and depriving the baby of oxygen during delivery.
  • preeclampsia/eclampsia
    Preeclampsia, also called toxemia, is a condition characterized by pregnancy-induced high blood pressure, protein in the urine, and swelling due to fluid retention. Eclampsia is the more severe form of this condition, which can lead to seizures, coma, or death.

    The cause of preeclampsia is unknown, but it is more common in first pregnancies. It affects about seven to ten percent of all pregnant women. Other risk factors for preeclampsia include the following:
    • a woman carrying multiple fetuses
    • a teenage mother
    • a woman older than 40
    • a woman with pre-existing high blood pressure, diabetes, and/or kidney disease
    Symptoms may include severe swelling of the hands and face, high blood pressure, headache, dizziness, irritability, decreased urine output, abdominal pain, and blurred vision. Treatment will vary according to the severity of the condition and the stage of the pregnancy. Treatment may include hospitalization, bedrest, medication to lower the blood pressure, and close monitoring of both the fetus and the mother.