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When do I need to take my teenage daughter to see a gynecologist?

November 3, 2011 by Dr. Tamar K. Gottfried Leave a Comment

Many concerned parents have questions about if and when their adolescent daughters need to visit a gynecologist. While there is no official subspecialty in pediatric and adolescent gynecology, there are many Ob/gyns that have an interest in taking care of younger patients and their obstetric and gynecologic needs. That said, most teenage girls do not need to have a gyn visit once they begin developing and having periods. Gyn visits are reserved for those girls that are having problems with their periods, having undiagnosed abdominal pain, problems with discharge or itching, or need counselling for birth control or sexually transmitted disease prevention.

Perhaps the most important gyn issue for the teenage patient is vaccination for the Human Papilloma Virus (HPV). HPV is the virus that causes abnormal paps, genital warts and cervical cancer. There are 2 vaccines on the market available for women and girls ages 11- 26. In order to prevent abnormal paps caused by HPV, it is important to vaccinate women before they are exposed to the HPV virus through sexual contact. That is why the vaccine is given to teenagers. It involves 3 injections over 6 months and can be given in a pediatric or gynecology office. While teenagers do not have to have actual Pap smears until age 21, HPV prevention is an issue even in the teenage years.

Other reasons to see the gynecologist as a teen are menstrual problems such as late onset of periods, irregular bleeding or heavy, long or painful periods. A young woman doesn’t have to suffer and miss school and activities because of bad periods. There are treatments that can help lighten periods.

Of course, some teenagers are thinking about becoming sexually active or already are. For these young women, it is extremely important to visit a gynecologist to learn about protecting themselves from pregnancy and from sexually transmitted diseases. These are real risks, even for teenagers, and are preventable with proper education.

In conclusion, even though routine gyn exam or Pap smears are not needed for teenage girls, there are many others reasons for a teenager to visit a gynecologist. We are happy to see teenage girls in a comfortable and confidential manner for their ob/gyn needs at our Mesa office.

Tamar Gottfried is a Board Certified Obstetrician/ gynecologist practicing general Ob/gyn in Mesa Arizona and affiliated with Banner Desert and Banner Gateway Medical Centers. She can be contacted at 480-545-0059. This is a general interest article only and is not intended to be medical advice. See a medical professional before making medical decisions

My family is complete and my husband won’t get a vasectomy. What is my permanent birth control solution?

October 23, 2011 by Dr. Tamar K. Gottfried Leave a Comment

There have been various options for female sterilization offered throughout the years for women desiring permanent birth control. Previously, women could only get their fallopian tubes tied, cut, burned or clipped through a procedure requiring anesthesia, abdominal incisions, and surgery in the abdominal cavity. This required time off from work and involved the risk of major surgery.

Now there is the option of a sterilization procedure that is easier for women than a vasectomy is for a man. For a vasectomy, an incision is made under local anesthesia into the scrotum and the vas deferens, the tube that transports sperm is cut. With the Essure procedure, women can have permanent sterilization in their Ob/Gyn office under a light anesthesia and without any “cutting’. Using a camera to look into the uterus, small metal devices are placed in the opening of each Fallopian tube. These will cause a natural scarring which will eventually block the tube and prevent pregnancy,. With this procedure, women avoid the hospital or surgicenter copayment, and can walk out of office, relatively pain free, minutes after the procedure.

Essure, like the older female sterilization procedures, is permanent and for women who are sure that they never ever want to get pregnant again. It doesn’t affect their periods or their hormones either. However, some women who use hormonal methods for birth control prior to sterilization notice that their “natural” periods are heavier when they go off of the pill, IUD or shot and lose that benefit. For women that don’t ever want to worry about birth control again, Essure is a wonderful option. A 10 minute office procedure provides permanent contraception and is incision- free.

Is there a down side to Essure? It does require being on a back up method of birth control for 3 months after the procedure, while the device is scarring into the Fallopian tubes and causing the permanent blockage that will prevent pregnancy. This is still less than the waiting period after a vasectomy.

If you are considering a permanent birth control solution to prevent pregnancy and tired of waiting for your husband to do the task, please contact my Mesa Ob/Gyn practice to schedule an appointment.

If a pregnancy is full term at 37 weeks, why can’t I be induced?

October 21, 2011 by Dr. Tamar K. Gottfried Leave a Comment

Although pregnancies are considered to be full term after 37 weeks, there are advantages to waiting until 39 weeks to deliver. Pregnancies are dated from the mom’s last menstrual period, not from the date of conception. Full term pregnancy is a range rather than a date, with 37-41 weeks considered to be full term.

There has been a lot of press lately about the ideal time to electively deliver a baby. Recent recommendations from the March of Dimes and the American College of Obstetrics and Gynecology take into account the fact that babies are healthier if they are born after 39 weeks. Babies born from 35-38 weeks, considered near- term, have more problems with feeding, maintaining their temperature and other factors than babies born after 39 weeks. They are also more likely to spend time in the Neonatal Intensive Care Unit and not go home from the hospital with their mothers.

Banner Health Care, based in Arizona and including Banner Desert Medical Center in Mesa Arizona, has been leading the way in the movement to only electively deliver babies after 39 weeks. This new policy only applies to elective (non medical) deliveries- not to medically indicated ones. For example, if a mother has high blood pressure, or if the fluid around the baby is low, or if her water breaks and her labor needs to be induced or if she’s in labor, she will be delivered even if she is not 39 weeks along. On the other hand, if a mom is planning a repeat cesarean delivery, or wants to deliver on a specific day, or is simply tired of being pregnant, that will have to wait until she is 39 weeks. This policy ensures that that babies are born at the safest time for them and their mothers.

Tamar Gottfried is a Board Certified Obstetrician/ gynecologist practicing general Ob/gyn in Mesa Arizona and affiliated with Banner Desert and Banner Gateway Medical Centers. She can be contacted at 480-545-0059 . This is a general interest article only and is not intended to be medical advice. See a medical professional before making medical decisions

When is vaginal discharge abnormal?

October 20, 2011 by Dr. Tamar K. Gottfried Leave a Comment

For many women, vaginal discharge is a common occurrence. It can be difficult to know which discharge is normal and which needs medical attention. Many women try to diagnose themselves, based either on their prior experience or on over the counter tests. However, more than half of women who self diagnose a yeast infection are incorrect in their diagnosis. Additionally, the otc tests, which rely on the pH or acid/base balance of the vagina can be difficult to read and interpret. Results can be confused by other factors as well.

A general rule with vaginal discharge is that it should not be smelly or cause itching or irritation. A discharge that has an unpleasant or fishy odor, and/or is bubbly or frothy could be Bacterial Vaginosis, an upset in the chemical balance of the vagina, which requires prescription antibiotics to treat. An extremely bad smelling discharge can also be a sexually transmitted infection such as Trichomonas, Chlamydia or Gonorrhea. If a discharge causes itching or burning, it could be any of the above. It could also be yeast or even an allergic reaction. While many yeast infections have the typical curdy white thick discharge, some present with other symptoms and can be more challenging to diagnose.

In an Ob Gyn office, the diagnosis of vaginal infection is made not only by examining the discharge, but usually by doing a confirmatory lab test that can detect even low levels of bacteria or fungus. These tests take at least 24 hours for the result to come in and then, if positive for infection, a prescription can be called in to the pharmacy if needed.

Sometimes a vaginal discharge is examined and the tests do not confirm an infection. A mucousy/ slimy clear discharge can actually be normal since the vagina cleanses itself by producing discharge. Some people produce more discharge than others do due to factors such as medications, the use of an IUD (intrauterine device) or changes in the menstrual cycle.

In conclusion, there are a wide variety of vaginal discharges, some normal and some not. The best way to distinguish which is which is a trip to the Gynecologist for an exam and testing. While over the counter tests and creams can seem to be time savers, their use sometimes delays making the correct diagnosis and getting the correct treatment for a vaginal infection.

1520 S Dobson Rd
Suite 316
Mesa, Arizona 85202

When do I take a pregnancy test?

October 15, 2011 by tamargottfried Leave a Comment

Urine pregnancy tests check for the presence of a chemical in urine that is produced in larger and larger amounts during the first months of pregnancy. They can be positive as early as a few days before a period is missed and stay positive throughout a pregnancy. A woman should take a pregnancy test if her period is late or if it is lighter than usual and there is a chance she could be pregnant. Pregnancy tests are more likely to be positive if the urine is concentrated- that is why the first urination of the morning is often recommended, especially if it is very early in the pregnancy. If the urine is very dilute, very watery, the test may still be positive around the time of the missed period, but the positive sign may be lighter. If a urine pregnancy test is negative, it may be too early, or the urine may be too dilute. If the period doesn’t come, or if there are other signs of pregnancy, the urine pregnancy test should be repeated in a few days or at a time when the urine is more concentrated.

Why do a pregnancy test at a doctor’s office? At our Mesa obgyn office, the urine pregnancy tests work similarly to the ones at home. Many people are unsure if they’ve done the test right, or if they can trust their home test, so they come in to do it at an Ob office and this is fine! At our office, if your test is positive, we can start you out with some vitamin samples and schedule your first Ob visit. If the test is negative and we want more precise information, we can order and draw a blood pregnancy test. Coming in to do a pregnancy test in an Ob office can give you peace of mind and it is free and doesn’t cost a cent!

Tamar K. Gottfried, MD
1520 S. Dobson Road, suite 316
Mesa, AZ 85202