It’s Important to Speak With Your Doctor
Every woman has been there….You’re sitting on the exam table and your gynecologist asks if you have questions or concerns. You do, but you’re also nervous and a little embarrassed about asking very personal questions.
Having advise with a gynecologist
“You should ask your questions – and anything else that’s on your mind – without feeling ashamed,” said Rachel Spieldoch, MD, a gynecologist and laparascopic surgeon in Scottsdale, AZ.
1. Does this look normal?
“This is one of the most common questions women ask,” said Dr. Spieldoch, “and the answer is almost always a resounding yes.” While today’s media can make it seem like women should only look one way, this just isn’t the case. Just as people come in lots of different shapes and sizes, body parts are subject to different interpretations.
However, there can be times where you do have something abnormal going on that needs to be checked out. Skin conditions such as psoriasis, warts, rashes and vitiligo (patches of skin that lose their color) can all affect your nether regions. Lesions, pain, abnormal discharge and any other change should be addressed by a gynecologist.
2. How much “self-love” is too much?
While this may seem like a myth, it is possible to “self-love” too much. This can cause desensitization over time or make it difficult to climax from intercourse with a partner. While it is a normal part of a healthy sex life, if it’s taking over your life or interfering with your relationship, it should be addressed.
3. How can I avoid embarrassment when exercising?
If you’re experiencing leaking when you’re exercising, it’s likely due to stress urinary incontinence. That’s defined as a loss of urine after some type of activity that puts pressure on the bladder, such as:
- Lifting weights
This occurs when the muscles regulating the bladder and urethra weaken. While you may think of this as an older woman’s problem, Dr. Spieldoch said that “around 20 percent of women in their 20s experience it, and a full 50 percent of women have leakage issues.” Contributing factors include:
- Chronic coughing
- Prior pelvic surgery
While stress urinary incontinence is common, you don’t have to live with it. If it’s causing you embarrassment or interfering with your relationships or quality of life, talk to your gynecologist. Nonsurgical treatments have a high rate of success and include a pessary (a device inserted into the vagina to provide support), bladder tampons (same concept), pelvic floor rehabilitation, vaginal laser procedures and Kegel exercises. Kegels can improve symptoms up to 75 percent if you do 40-60 a day. In severe cases, bladder sling surgery may be recommended; it has a success rate of about 85 percent.
4. Are private piercings safe?
Intimate piercings are becoming more common and less taboo thanks to social and cultural influencers. However, it’s normal to have some worries if you’re considering going under the needle. While clitoral piercings are usually considered safe as long as they’re done properly by a professional piercer, they can cause desensitization over time.
They can also increase your risk of sexually transmitted infections. It’s important to avoid intercourse completely while the piercing is healing – which can take four weeks to six months – and that you’re aware of your partner’s sexual history and practice safe sex afterward.
Nipple piercings have been around for hundreds of years and have a more thoroughly documented history. They’re considered to be safe when done by a professional, but they do carry a risk of infection or rejection of the piercing itself.
Rejections are more likely if there’s excessive tugging or pulling on the piercing, or if you have a metal allergy. “Breastfeeding with these piercings is a common concern, but it usually doesn’t negatively impact milk production,” said Dr. Spieldoch. “There are enough milk ducts in and around the nipple that even if a few are damaged from the piercing, it doesn’t affect anything.”
Developing an open, positive relationship with your doctor is an important part of your health. Remember that the gynecologist’s office is a safe, confidential space and nothing is off limits or taboo. It may be embarrassing to you, but it won’t be to your doctor. He or she really has heard and seen it all. Discuss your concerns to see if treatment could help or offer some peace of mind.
Time for a New Year and a Healthy You!
The time for New Year’s resolutions is upon us. For those looking to improve their well-being in 2018, McDowell Mountain Gynecology has a list of five resolutions you can make to address your gynecological health.
Schedule an annual well woman exam.
Annual exams, also known as well woman exams, provide an annual opportunity for you to check in with your gynecologist and get screened for preventable health conditions. Well Women Exams include a breast exam and Pap test, so the appointment should not be put off or ignored. Save time during your next appointment and learn how an annual exam can help prevent cervical and breast cancer.
Vocalize any symptoms or health concerns ASAP
If you experience changes to your period, such as irregularity or change in flow, changes to your breasts or any other symptoms, it’s very important to contact your provider and see if they advise visiting the office for an appointment. Unpleasant symptoms like painful periods and heavy menstrual bleeding aren’t something you should have to put up with, and treatments are available at McDowell Mountain gynecology. Strange symptoms may indicate an underlying but undiagnosed health condition, so it’s still important to visit us.
STD and STI Prevention
Practicing safe sex to prevent an STD (sexually transmitted disease) or STI (sexually transmitted infection) comes down to the decisions every woman makes with her partner. Disease and infections that are transmitted from sexual contact can come from oral and anal sex as well, so it’s incredibly important that you take the appropriate steps to protect yourself. If you have any questions regarding STD screening, treatment or prevention, please call our office to make an appointment.
Family Planning Goals
Perhaps your plans to start a family won’t start taking shape for another couple of years, but if you do wish to start trying for a pregnancy in the next few months, McDowell Mountain Gynecology recommends considering preconception counseling. Preconception counseling walks you through the steps that are important prior to becoming pregnant, including how to evaluate peak fertility times during your ovulation cycle.
McDowell Mountain Gynecology offers the HPV vaccine, Gardisil to help prevent against the spread of HPV (Human Papilloma Virus), which is linked to cervical cancer. The vaccine is recommended by the CDC to young women and men starting as young as 12 – you do not need to be sexually active to receive the vaccine. HPV is spread through intercourse, but even a condom cannot fully protect a person from getting the virus.
The start of a new year is the perfect time to reassess all of your goals, including ones related to healthcare. McDowell Mountain Gynecology is here to help whenever you are ready to reach out. Call us for an appointment at 480.483.9011
Happy New Year! We look forward to taking care of you for a Happy, Healthy 2018!
Breast Cancer Screening
Breast cancer is the most commonly diagnosed cancer in women in the U.S. and the second leading cause of cancer death in American women. It accounts for 30% of all new cases of cancer diagnosed in women. A woman’s lifetime risk of developing breast cancer is 12% (1:8). Breast cancer mortality (death) rates have decreased significantly in the past 50 years. This is attributed to early detection and improvements in breast cancer treatment. Regular screening mammography starting at age 40 y/o reduces breast cancer mortality in average-risk women.
While screening provides improved health outcomes, there can also be adverse consequences. Screening can be harmful through false-positive test results and over-diagnosis of benign lesions. Additionally, cost of testing, anxiety, discomfort/pain, inconvenience, overdiagnosis and overtreatment are potential risks. Many women are concerned about the risk of radiation exposure from routine screening. The risk of radiation induced cancer is 2 per 100,000 women. The potential mortality benefit from early detection is 60 fold the risk of radiation exposure. In other words, the benefit of detecting breast cancer far outweighs any risk from radiation exposure. Balancing the benefits and risks of screening has led to controversy of opinion about uniform guidelines for breast cancer screening.
Breast cancer risk assessment is particularly important for identifying women who may benefit from more intensive breast cancer surveillance. Risk assessment and identification of women at high risk for breast cancer in the office setting allows for adequate referral to health care providers with expertise in cancer genetics and counseling, testing for germline DNA mutations (i.e. BRCA), discussion of risk reduction options, and the opportunity to identify other family members at increased risk.
The main risk factors for breast cancer are female sex and advancing age. Other factors have been found to be associated with increased risk, but most women diagnosed do not have identifiable risk factors. Other risk factors include family history of breast cancer, known gene mutation, prior breast pathology showing atypical hyperplasia or lobular carcinoma in situ, early menarche, late menopause, nulliparity, estrogen and progesterone hormone therapy, ethnicity (i.e. Ashkenazi), obesity, alcohol consumption, smoking, and dense breasts.
Currently self breast exams are no longer considered beneficial. Instead, breast self-awareness is recommended. This is defined as a woman’s awareness of the normal appearance and feel of her breasts. It means that a woman should be attuned to noticing a change or potential problem with her breasts. Additionally, women should be educated about signs and symptoms of breast cancer and advised to notify their health care provider if they notice a change. It is recommended that a practitioner performs a breast exam in intervals of every 1-3 years for women 25-39 y/o and yearly for women 40 y/o and older. A clinical breast exam by a practitioner will detect 2-6% more cases of invasive cancer than mammography alone.
Women at average risk of breast cancer should be offered screening mammography at 40 y/o. If they have not initiated screening in their 40s, they should begin screening mammography no later than 50y/o. Screening should be performed every 1-2 years based on patient health and risk factors. Biennial (every 2 years) screening mammography may be a reasonable option for women after 55 y/o. Women should continue screening mammography until at least age 75y/o. Age alone should not be the basis to continue or discontinue screening. Women should continue screening mammography as long as their overall health is good and they have a life expectancy of at least 10 years.
If you have concerns or questions regarding your breast health, please call today to schedule an appointment with Dr. Rachel Spieldoch or a provider at McDowell Mountain Gynecology at 480-483-9011.
Mcdowell Mountain Gynecology is now offering vaginal laser with Selene Touch!
SeleneTouch offers women a minimally-invasive, pain-free, fast, safe and effective solution for many feminine health conditions.
SeleneTouch is an in-office solution requiring no down-time, no anesthesia and minimal sexual interruption.
50% of post-menopausal women, after childbirth, hormonal changes and medications, experience a diverse range of symptoms and side effects including: dryness, itching, and painful intercourse, which affect Quality of Life.
The SeleneTouch micro-ablative laser energy is dispensed in a controlled and uniform distribution into the vaginal wall tissue. The superior design allows the SeleneTouch laser to ablate small micro spots of tissue, while leaving the adjacent tissue intact, thus promoting faster tissue regeneration. This natural tissue regeneration process promotes the restoration of pre-menopausal metabolic activity including new collagen, elastin, and vascularization of the vaginal mucosa.
Increased collagen production, thicker vaginal mucosa and natural restoration of the ablated vaginal tissue allow post-menopausal women to return to their normal lifestyle with comfort, confidence and improved Quality of Life.
The design allows the laser to ablate small micro spots of tissue, while leaving the adjacent tissue intact, thus promoting faster regeneration.
To learn more about this revolutionary procedure contact McDowell Mountain Gynecology for your consultation today! 480-483-9011.
Lichen Sclerosus is a chronic dermatologic condition that involves thinning and inflammation of the skin. It can be found anywhere on the body. However, in women it most commonly affects the vulva. Lichen sclerosus is most often seen among post-menopausal women. The cause of this disorder is unknown. People with lichen sclerosus often have a personal or family history of autoimmune disorders. The usual presentation is vulvular itching. It can also cause vulvular burning and painful intercourse. Some women are asymptomatic and the condition is found incidentally during a regular visit.
On examination, the vulvular skin appears thin and white. It is typically found on the labia minora and labia majora. With progression of the disorder, there can be fusing of the skin involving the labia with loss of the clitoral hood. Thinning of the skin can make the area sensitive and bleeding with intercourse can occur. The intense itching can lead to scratching which in turn can cause trauma to the skin of the vulva. Where there is trauma, inflammation can occur which can lead to thickening of the skin, fissures and even infection. The thickened areas of skin have been found to be a risk for developing vulvar cancer. Therefore, routine examination is recommended to monitor for changes in skin thickness.
The goal of treatment for lichen scelrosus is to control the symptoms of vulvar itching and burning. Corticosteroid ointments or creams are most commonly prescribed for lichen sclerosus. A medium to high potency steroid ointment is typically used to control symptoms. The most common steroid medication prescribed is Clobetasol ointment. If the skin is unresponsive to ointment then steroid injections can be used. Other treatments include vaginal estrogen to help keep skin healthy and tacrolimus cream to modulate the immune system and decrease inflammation.
If thickened areas are seen on exam, a biopsy may be recommended to exclude vulvar cancer and for correct diagnosis. The use of hypoallergenic agents to moisturize the skin can help prevent trauma to the underlying compromised skin. For example, Vaseline is often used to maintain moisture.
Lichen scelrosus is a skin disorder that can cause emotional and physical discomfort. With prop[er care, symptoms can be controlled with simple treatment. Regular exams to monitor for skin changes are recommended. If you think you may be suffering from symptoms if lichen sclerosus or other vulvar conditions, please schedule and appointment at McDowell Mountain Gynecology with Dr. Kimberly Hartzfeld at 480-483-9011.
We look forward to seeing you!
What’s All The Hype About Human Papillomavirus?
Human Papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Nearly 90% of sexually active men and women are exposed to HPV at some point in their lifetime. HPV encompasses a group of over 200 related viruses. They are categorized into high risk HPV and low risk HPV. While there is no treatment for the virus, most HPV infections will resolve within 1-2 years. If left untreated, persistent high risk HPV infection can lead to cervical cancer. Low risk HPV can cause genital warts which are benign cauliflower-like lesions on the skin.
HPV is sexually transmitted by skin-to-skin contact. The virus can be transmitted even when there are no signs or symptoms. In some cases symptoms do not appear for years after exposure to HPV. This can make it difficult to pinpoint the source for infection.
High risk HPV can cause cancer of the vulva, vagina, cervix, penis, anus, and throat. The highest HPV related cancer risk for women is cervical cancer. There are approximately 11,000 new cases of cervical cancer each year. HPV strains type 16 and 18 are most aggressive and cause up to 75% of all cervical cancers.
There are a few ways to decrease your risk of HPV infection. These include proper use of condoms (although this does not provide full protection), getting vaccinated, and engaging in a monogamous relationship. There are 3 FDA approved vaccines for HPV. In a person who has never been sexually active or exposed to HPV, the vaccine can decrease your risk of getting the most common HPV strains that cause cervical cancer and genital warts. HPV types that cause cervical cancer are not the same as those that cause genital warts. Most women with HPV do not have visible lesions and don’t realize they have been infected.
To screen for cervical cancer, a PAP smear is performed. Current recommendations state that women 30 years of age and older should routinely be tested for HPV with a PAP smear. If a PAP test shows abnormal cervical cells or high risk HPV, then additional testing is needed. This test is called a colposcopy. During colposcopy, a microscope is used to view the cervix after the application of vinegar. Any abnormal areas are biopsied and sent to a lab. If the changes are mild, then the abnormalities may resolve on their own and follow-up PAP smears are recommended. If moderate to severe changes are noted, then further treatment with cryotherapy (freezing of the cervix), loop electrical excision procedure (LEEP), conization of the cervix, or laser is recommended. With appropriate follow-up, the risk of progression to cervical cancer is low. This is why it is very important to follow up with your gynecologist.
Low risk HPV can cause genital warts which are seen visually on exam. They are generally described as cauliflower-like skin lesions. Genital warts (condyloma) are most often found on the vulva, vagina, cervix and anus. Treatment for genital warts consists of topical medication/creams, cryotherapy, excision of the lesions, and laser removal.
At McDowell Mountain Gynecology you will receive up-to-date screening and most current treatment options for HPV and HPV related lesions. Call our office today and schedule your appointment with one of our excellent providers!
Kimberly Hartzfeld, D.O., FACOG
Polycystic Ovarian Syndrome (PCOS)
What’s in the know about PCOS?
PCOS is the most common hormonal disorder among women of reproductive age with signs and symptoms beginning soon after a woman first starts having periods (menarche). In some cases PCOS develops later during the reproductive years, for instance, in response to substantial weight gain. It occurs when a woman’s levels of estrogen, androgens, and progesterone are out of balance which leads to the growth of ovarian cysts and a multitude of symptoms.
PCOS has many signs and symptoms which include irregular periods, unwanted hair growth, weight gain, and infertility. All of these can worsen with obesity. Every woman with PCOS may be affected a little differently, and the range of symptoms can vary.
PCOS has been linked to an increased risk for developing other medical conditions such as insulin resistance, type 2 diabetes, high cholesterol, high blood pressure and heart disease.
*10% of women of childbearing age are estimated to have PCOS
*50% of women are undiagnosed
*50% will develop type 2 diabetes or pre-diabetes before the age of 40
*The risk from developing endometrial cancer is increased by 3x
*PCOS is responsible for 70% of infertility issues in women who have difficulty ovulating
What are risk factors for PCOS?
*Increased insulin levels (increased insulin levels stimulate increased male hormone production)
*Obesity, especially if it began before puberty.
What are the signs and symptoms?
*Irregular / no periods This is the most common characteristic. Examples include menstrual intervals longer than 35 days; fewer than 8 menstrual cycles a year; failure to menstruate for 4 months or longer and prolonged periods that may be scant or heavy.
*Excess facial and/or body hair: Elevated levels of male hormones (androgens) may result in physical signs, such as excess facial and body hair (hirsutism), adult acne or severe adolescent acne and male-pattern baldness(androgenic alopecia)
*Severe acne: Because women with PCOS have a hormonal imbalance that causes an over production of male hormones, acne and oily skin are typical symptoms.
*Multiple cysts on the ovaries: Polycystic Ovaries become enlarged and contain numerous small fluid filled sacs which surround the eggs
*Weight gain or obesity: Because the weight gain is triggered by male hormones, it is typically in the abdomen, where men tend to carry weight. Often, women with PCOS will have an apple shape rather than a pear shape.
Insulin Resistance: Insulin is a hormone produced in the pancreas that allows cells to use sugar (glucose) — your body’s primary energy supply. If you have insulin resistance, your ability to use insulin effectively is impaired, and your pancreas has to secrete more insulin to make glucose available to cells. Excess insulin can also affect the ovaries by increasing androgen production. Too many androgens in our body can interfere with the ovaries’ ability to ovulate.
*Anxiety / depression: PCOS can have an emotional impact on women and can affect mood, stress and body image.
HOW is PCOS diagnosed?
According to the American Society for Reproductive Medicine there must be 2 of the 3 following signs and symptoms:
- Irregular ovulation or no ovulation
- Signs of increased androgen (male hormone) levels
- Multiple small cysts on the ovaries (this alone cannot diagnose PCOS)
How is PCOS treated?
There is no cure for PCOS and the main focus in treatment is to control symptoms so that the effects of PCOS on the body are minimized.
Measures include: improving insulin sensitivity, restoring normal ovulation and decreasing androgen levels.
The key lifestyle factors in improving these measures boil down to diet – low glycemic index diet, exercise – increasing physical activity and emotional well-being.
With PCOS, correcting abnormal hormone levels, losing weight and managing cosmetic concerns are key for those not planning on pregnancy. If pregnancy is desired, losing weight and promoting ovulation is key! Medications are often used to regulate periods, control hair loss and acne, as well as improve insulin resistance. Medications can also help decrease long term risks such as high cholesterol and heart disease.
PCOS is very complex and not always easy to understand but with a little help it can be well managed!
If you think you might be experiencing these symptoms, please schedule an appointment with one of our providers at McDowell Mountain Gynecology for further evaluation at 480-483-9011.
Jacqueline Johnstone CNM, MSN, BSN
Simply the Facts About the Intrauterine Device (IUD)
There are 2 different types of IUDs available to women
Which one is right for you?
The Paragard IUD is good for individuals who desire long term contraception. The Paragard can stay in the uterus for 10 years. The copper in the Paragard works by affecting the sperm’s ability to move around and by possibly preventing fertilization.
The Paragard is good for those who:
- Want to continue to get their period
- Do not want to use or who cannot use a form of birth control that contains hormones
- Do not experience heavy, painful periods
Hormonal IUD: Mirena, Skyla and Liletta
The Mirena IUD is good for individuals who desire contraception and lighter, less crampy periods. The Mirena IUD contains Levonorgestrel which is a type of hormone and it can stay in place for 5 years. Many women are under the impression that the hormones in the IUD will affect them the same way that the hormones in pills or the Nuva Ring would but that is not the case. The hormones in this type of IUD are localized to the uterus and any of the hormones that does become systemic is a very low dose.
The Mirena IUD is good for those who:
- Have heavy, crampy periods
- Do not want to or cannot use a form of birth control that contains estrogen
The Skyla IUD is the sister to the Mirena IUD. The Skyla IUD is similar to the Mirena but it is smaller and contains less progesterone. It is often considered ideal for a smaller uterus or younger patient population. The Skyla is approved for 3 year use.
Liletta is a newer IUD that is similar to the Mirena IUD and can also be used for 3 years.
So Why Choose an IUD?
- It can be placed in a single office visit
- Close to 100% effective at preventing pregnancy
- One of the most cost effective forms of birth control
- Periods diminish or disappear altogether – with the Mirena
- Long term / reversible form of birth control
- Cannot be seen or felt
- Alleviates having to remember a pill every day
- Can be used at any age before menopause
It is important to remember that neither type of IUD prevents against sexually transmitted infections (STI) or HIV/AIDS. Therefore, it is important to use appropriate protection.
It is a myth that you must give birth to children prior to getting an IUD for contraceptive protection. The IUD does not cause permanent infertility and is completely reversible once removed.
It is true that the IUD is the most effective form of birth control and Paragard is FDA approved for emergency contraception.
If you are interested in discussing the IUD in more detail, please schedule an appointment at McDowell Mountain Gynecology 480-483-9011. I look forward to seeing you!
-Jacqueline Johnstone, CNM, Advanced Practitioner
Single Site Surgery is Here!
Imagine having your hysterectomy or other gynecologic surgery through ONE tiny incision! This incision is almost invisible after healing. It is truly amazing! Dr. Spieldoch is expertly trained to perform Robotically Assisted Laparoscopic Single Site Surgery. If you are facing Gynecologic problems that need surgical treatment, ask Dr. Spieldoch if you are a candidate for Robotically Assisted Single Site Surgery.
Please refer to the DaVinci Website at www.davincisurgery.com if you wish to read more on this incredible technology.
CALL DR. SPIELDOCH TO SCHEDULE AN APPOINTMENT: 480-483-9011
What Everyone Needs to Know about Vitamin D
Rachel Spieldoch, MD
We all know Vitamin D is important for ongoing bone health. However, most of us are unaware of the many benefits vitamin D has in our bodies. And many of us are frustrated trying to figure out exactly how much vitamin D is enough and how much is too much.
Vitamin D is produced by the skin in the form of vitamin D3. It can also be ingested in the form of vitamin D3 or vitamin D2. This is further metabolized by the liver into the biologically active form 25-OH vitamin D which can be measured with a simple blood test.
Severe vitamin D deficiency can result in calcium malabsorption, hyperparathyroidism, bone loss, and increased risk for fracture. Muscle pain and bone pain can also occur with severe deficiencies. Interestingly, obesity and women of color are risk factors for vitamin D deficiency. Other risk factors include decreased sun exposure, regular use of sunscreen, low dietary intake of vitamin D, liver disease, anti-seizure medications, and osteoporosis or osteopenia. It is important that women with specific risk factors or a previously low level of vitamin D have their levels tested by a physician. Additionally, blood testing of parathyroid hormone as well as calcium may be helpful in select patients.
Current studies show that at least 30% of U.S. adults age 20 or older have vitamin D deficiency. Additionally, vitamin D supplementation of at least 400 IU /day has been associated with a decreased risk for vertebral, nonvertebral and hip fractures.
Observational studies show that vitamin D deficiency may be linked to cardiovascular disease, cancer, diabetes and autoimmune disorders. Additionally, smaller studies suggest that vitamin D deficiency may be linked to breast cancer and melanoma.
Is it possible to get too much Vitamin D? The answer to this is yes. Surprisingly, too much vitamin D has been associated with a higher risk of fracture! Additionally, observational studies suggest that elevated vitamin D levels may be associated with pancreatic cancer and cardiovascular disease.
According to the Institute of Medicine report from 2010, the recommended dose of vitamin D supplementation for healthy adult women up to age 70 y/o is 600 IU/day. After the age of 70, the recommended dose increases to 800- 1000 IU/day. This is the recommended dose for women not receiving any direct sun exposure. If your vitamin D level is low or you have other risk factors, the medical recommendation may differ.
Achieving optimal benefits from vitamin D involves maintaining a balance. It is important to be mindful that too much vitamin D can carry health risks. However, appropriate supplementation and blood levels appear to have profound impacts on preventing disease and maintaining healthy bones.