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.
Teens and Sexuality
Jill Antell, WHNP
According to the Centers for Disease Control (CDC), there are about 20 million new sexually transmitted infections every year, and about half of these occur in young people between the ages of 15 and 24. Most sexually transmitted infections will not cause great harm; however, if left untreated, some will lead to serious conditions. Chlamydia, a common sexually transmitted infection, can lead to infertility in both men and women. In Arizona, there were over 30,000 reported cases of Chlamydia in 2012. It is recommended that all sexually active females 25 and younger have a yearly screening test for Chlamydia and Gonorrhea.
Approximately, 75 to 80 percent of sexually active people in the United States will have Human Papilloma Virus (HPV), the most common sexually transmitted infection, in their lifetime. HPV usually resolves without serious consequences but in some cases could lead to genital warts, cervical cancer, or other cancers.
McDowell Mountain Gynecology offers yearly health screenings for sexually active women of ALL ages. Yes that includes teens! Even if a young person is not yet sexually active, we offer prevention services such as HPV vaccinations, prevention counseling for sexually transmitted infections, contraception counseling, and more. We see NON- sexually active teens for issues such as irregular menstruation, painful periods, and birth control for the treatment of acne. We are sensitive and supportive of the relationships that parents have with their daughters. We encourage healthy communication between teens and their parents; we try to address health issues compassionately and professionally. Call us today for an appointment!
Dr. Spieldoch Featured in Scottsdale Republic
Dr. Spieldoch was featured in today’s edition of the Scottsdale Republic. Check it out!
Womens – Spieldoch QA – Scottsdale Republic 3-19-14
Congratulations to Dr. Spieldoch!
Rachel Spieldoch, MD and Scottsdale Healthcare have earned the AAGL Center of Excellence in Minimally Invasive Gynecology (COEMIG) designation in July 2013.
The COEMIG program is focused on improving the safety and quality of gynecology patient care and lowering overall costs associated with successful treatment. The program is designed to expand patient awareness of – and access to – minimally invasive gynecologic procedures performed by surgeons and facilities that have demonstrated excellence in these advanced techniques. To earn the COEMIG designation, surgeons and hospitals must partner together and demonstrate a cross-organizational commitment to minimally invasive gynecologic surgical care.
The COEMIG program recognizes surgeons and facilities that demonstrate an unparalleled commitment and ability to consistently deliver safe, effective, evidence-based care.
Earning the Center of Excellence designation signifies our ability to consistently deliver the safest, highest-quality of care to minimally invasive gynecology surgery patients
-Rachel Spieldoch, MD
But most importantly, Dr. Spieldoch believes that her commitment to excellence along with Scottsdale Healthcare improves the health and well-being of our patients.
AAGL Center of Excellence in Minimally Invasive Gynecology, COEMIG™ and the COEMIG™ seal are trademarks of the AAGL. All rights reserved.
Great News About Bioidentical Hormone Pellets
Time released bioidentical hormone pellets have become a popular and successful option for many women suffering from menopausal symptoms such as hot flashes, sleeplessness, vaginal dryness, fatigue and low libido. Not only are bioidentical pellets extremely convenient to the patient, but they offer a slow release of hormones to the body for sustained hormonal benefits. Additionally, many women who have not responded optimally to conventional hormone treatments will feel a sense of renewed vitality from the bioidentical hormone pellets.
However, the cost burden of hormone pellets has been a frustration for many patients who would otherwise benefit from hormone pellets. In an effort to accommodate to patient financial concerns and alleviate some of the cost burdens of hormone pellets, Dr. Spieldoch at McDowell Mountain Gynecology will be billing the insurance company for the costs of the insertion. The patient will remain responsible for the material costs of the hormone pellets.
Ultimately, this means significantly less cost to the patient!
Please ask if you have further questions. I sincerely hope that this helps our patients with their hormonal needs and makes hormone pellets more affordable.