Pediatric & Adolescent Gynecology
At Triangle Physicians for Women, we have the specialized training to address the gynecological needs of children and adolescents with possible underlying health problems. We place particular emphasis on wellness and prevention, in order to educate young women to care for and respect their bodies. When working with this age group, we are sensitive to the type of delicate care needed for:
– Counseling about the risks of sexual activity
– Prevention of sexually transmitted diseases
– Hormonal treatment options for skin disorders such as excessive hair growth and acne
In addition to wellness and prevention, our team of expert OB/Gyn physician and midwife practitioners provides evaluation and treatment of abdominopelvic pain and menstrual cycle abnormalities related to various conditions of the uterus, ovaries, vagina, and vulva. We do our very best to make the visit comfortable and reassuring as we assess the issues surrounding the reproductive health of growing girls and young women — medically, emotionally, and developmentally.
Triangle Physicians for Women’s providers are able to diagnose and treat conditions including:
–Congenital anomalies of the reproductive system that happen as the organs (internal and external) develop. These irregularities are present at birth (congenital) or present themselves later, such as during puberty.
-Skin conditions of the vulva that result in swelling, pain, itching or sores on the outside of their genitals. An infection, irritation or inflammatory disorder may trigger these symptoms, and we will work with you and your daughter to control and soothe these skin problems.
The flaps of skin (labia) around the outside of the vagina may grow together in places (labial adhesions) or be larger than normal, causing discomfort. Medicines like estrogen or steroid creams may be needed for conditions that affect the labia, and depending on severity, surgery (labiaplasty) may be recommended.
-Abnormal vaginal discharge
Fluid discharge is a normally occurring vaginal defense against infection, but any distinct changes to this discharge can signal an infection, skin irritation, allergy, or inflammation.
Vaginitis is an infection or inflammation of the vagina due to yeast infection, sexually transmitted infection or other infection. It can also happen because the skin is irritated by laundry soap or bath products.
Signs of puberty, such as developing breasts and menstrual periods, usually begin in the early teen years, but many factors can delay this phase. In cases where the delay is caused by medical problems, carefully supervised treatment with hormone medicines may be the answer.
Teens may have a range of problems with their menstrual periods — inconsistent, too heavy, painful, or absent altogether. Our goal is to determine what, if any, underlying conditions may be causing these issues, and work to correct them.
-Polycystic ovary syndrome (PCOS)
A hormonal imbalance within the ovaries can cause them to enlarge and develop many small, fluid-filled sacs (cysts). If your daughter has PCOS, she may grow excess hair on her body, have acne, and possibly skip periods. PCOS can be treated with medicines to balance hormones and control menstrual periods.
-Ovarian cysts and tumors
As the ovary is making a follicle each month, ovarian cysts can develop. These cysts can be painful, large or limit blood flow to the ovaries. In extreme cases, they may be tumors (though mostly benign), requiring minimally invasive surgery for removal, with the ultimate goal of preserving future fertility.
-Sexually transmitted infections (STIs)
STIs are infections that spread through close contact. Without treatment, they can cause lasting damage. Common STIs that we treat include chlamydia, genital herpes, and gonorrhea.
Come to us with questions you have about your daughter’s gynecological health, and know that we will offer the same sensitivity and TLC for her as you do. We will discuss all available treatment options, weighing the pros and cons of each, and determine what the best course of action is for her unique case. Our partnership in your women’s healthcare needs extends to the care of your growing daughter, working together to set her on a path to lifelong health.
Vaginal Atrophy …
… talk about a dreary phrase that just begs to be whispered behind closed doors. Vaginal atrophy is a pretty common aging process, but it doesn’t have to mean a permanent way of life as you age. Silence that whispering voice in your head, and speak up – we’ve got relief in the form of MonaLisa Touch, and it’s just a phone call away.
Symptoms, Not a Life Sentence
Most commonly, the symptoms of vaginal atrophy present themselves as:
– Vaginal dryness or itchiness
– Burning sensations and irritation of the vagina
– Fissuring of the opening of the vagina
– Pain during sexual intercourse (Dyspareunia)
– Vaginal pain
These symptoms occur as a result of the walls of the vagina becoming thinner, and a reduction in the natural elasticity and blood supply. The protective mucosa of the vagina loses its youthful hydration and thickness, which causes a loss of lubrication. The overall function and health of the vagina are affected by changes in the natural pH balance of the internal environment. All of these symptoms combined (or individually) can have a dramatic effect on a woman, both physically and emotionally, often affecting intimate relationships.
Who is Affected?
We all sit here thinking, “Oh, that won’t be me,” but the reality is that over 40% of menopausal and postmenopausal women experience symptoms in which some or all of the unpleasant side effects listed above are present. Younger women who have used the Pill for prolonged periods, breastfeeding mothers, and women who experienced traumatic delivery and severe perineal repair and scarring may be affected. And over 60% of women going through breast cancer treatment are affected by vaginal atrophy. Because Hormone Replacement Therapy is not recommended for this group of cancer patients, they are left with little to no effective treatment and relief for their symptoms.
Add it all up, and we’re looking at a very large population of women who are silently suffering through symptoms that affect their everyday quality of life and most important relationships — many of whom don’t know to speak up and ask for help. So, let’s put an end to that right here and now.
At Triangle Physicians for Women, you have a group of advocates who are great listeners, have successfully treated women with your exact symptoms for years, and can set your mind at ease about the far-reaching emotional effects you’re probably experiencing as a result of this physical aging process. It’s normal. It’s treatable. And it’s okay to talk about it.
Previously, therapeutic barrier creams and topical Hormone Replacement Therapy (HRT) vaginal estrogen creams, as well as lifestyle changes to improve vulval care, have been the go-to methods offering short-term relief. Once the patient stops using the cream or stops adhering to all treatment protocols, the benefits disappear.
Thankfully, there is a safe, new treatment option available that offers relief called MonaLisa Touch. This comfortable, non-hormonal, non-surgical course of treatment is a 5-minute procedure in our office. There is no downtime, and the only post-treatment advice is to abstain from sexual intercourse for 5 days.
MonaLisa Touch addresses a number of the issues causing vaginal atrophy, with one simple 5-minute treatment, repeated 2 times (6 weeks apart). A laser delicately delivers a precise amount of heat to the vaginal walls, which stimulates regeneration of the vaginal tissue, promoting proliferation of the cells and restoration of wall strength and blood supply.
The MonaLisa Touch procedure offers significant advantages over current treatment options, as it addresses the issues that cause vaginal atrophy, rather than temporarily quieting the symptoms. MonaLisa Touch creates longer-lasting relief as well as a new and effective option for patient groups who were previously not suitable for existing HRT treatments.
How MonaLisa Touch Works
The fields of dermatology and aesthetic medicine have given us valuable information about stimulating fibroblast cells in the skin to promote natural regeneration processes. This technique, in the MonaLisa Touch procedure, stimulates collagen formation underneath the vaginal skin, promotes proliferation of the cells and restoration of blood supply. In as little as 30 days after treatment, there is regeneration of new tissue in the vaginal walls and the protective mucosa recovers volume, hydration, and elasticity.
By restoring the natural pH balance of the vaginal mucosa, and targeting the causes of vaginal atrophy, many of the symptoms of vaginal dryness, irritation and fissuring are greatly reduced or disappear – all with virtually no side effects or discomfort.
Talk to us today to receive trusted guidance on your options. Suffering silently is never the answer, and we’re here to provide solutions that are sure to improve the aging process that we all go through.
At Triangle Physicians for Women, we continuously strive to stay abreast of new pregnancy, labor and delivery technologies and procedures, all with the thoughtful goal of improving your overall patient experience. One topic that has been gaining recognition and popularity lately is “gentle cesarean sections”.
Since most women enter the labor and delivery unit with specific hopes and expectations for their birth, the process of cesarean sections usually carries an undue sense of “disappointment”, “failure” or “missed opportunity” for the women whose birth plans had to be altered unexpectedly to include the operation. Gone (or need-to-be-gone) are the prenatal instructors who preach au natural, drug-free, vaginal births as the “best” or “only” way to to be “successful”.
With a 32% c-section rate for all births in the U.S., many hospitals and physicians have gone to great lengths to make c-section operations more similar to the experience of a vaginal birth, increasing the acceptance of these medically or surgically assisted births. New moms can embrace this gentle intervention (for any reason) as a full-fledged birth “success”, and enjoy the same maternal advantages of bonding and breastfeeding.
All cesareans involve the surgical removal of the baby through the mother’s abdomen, rather than through the vaginal birth canal, and typically take place behind a veiled blue curtain in a brightly lit, sterile environment. Most c-sections occur with a sense or urgency or emergency, such as fetal distress, non-progressing or obstructed labor (when the baby is positioned feet-down), maternal infection or diabetes.
Jenny Smith, a midwife and co-author of a study published in BJOG, An International Journal of Obstetrics & Gynaecology, was one of the early proponents of this refined technique in 2008. Unlike typical c-sections, this equally safe technique involves lowering the surgical drape so that both parents are able to see their baby’s birth, the partner can cut the umbilical cord, and whenever possible, customized birth plan requests such as music or lowered lights can be part of the process. The anesthetic is subtly dosed so that the woman’s upper body and arms can safely cradle the baby with skin-to-skin contact after the baby is slowly removed from the abdomen. Research has shown that these changes do not increase complications, and with just a few modifications to the hospital’s standard Caesarean procedures, mothers can still have that “birth moment” with their partner and infant, and feel more empowered during the process.
Triangle Physicians for Women is pleased to offer this new patient-centered technique whenever possible, and welcomes your questions and requests for more information on the procedure. Our feeling remains: no matter how your baby arrives, birth is a miracle and joy that should be celebrated and supported.
State-of-the-Art 3D Breast Screenings + All-in-One Annual Visits
Triangle Physicians for Women’s new 3D Mammography suite has been an exciting state-of-the-art upgrade that we’re pleased to provide to our patients. As medicine advances, TP4W’s administrators strive to keep our practice updated with the newest women’s health resources and conveniences. It’s a promise and a commitment that can – literally – be life-changing for the patients we serve.
You’re in Good Hands
As part of the 3D mammography capabilities at TP4W, it’s important to mention the skilled technician behind the machine, Amanda Bruckner, R.T. (R) (M) ARRT. Those acronyms behind her name list the educational requirements, ethical standards, and certification/licensing exams that Amanda has completed in order to provide you with the very best in care.
Amanda was born in Raleigh, NC and received her Associates in Applied Science in Radiology from Johnston Community College in 2012, before becoming registered in Mammography in 2014. She is currently pursuing a Bachelor’s Degree of Radiologic Science through Adventist University of Health Sciences and plans to graduate in the summer of 2017.
Before joining the TP4W team, Amanda worked as a Registered Radiologic Technologist, Mammographer, and Employee Education Liaison at Johnston UNC Healthcare for 5 years.
Amanda’s long-term commitment towards “perfecting her ARRT” is another way that TP4W confidently claims the best of one-stop, annual well woman exams in the area, right here in our Cary office. Being able to complete your annual gynecological exam and breast screening in one visit offers many time-saving and scheduling conveniences, beyond just the health benefits!
So, what’s the difference between 2D and 3D imaging?
3D mammography is especially beneficial for women with dense breasts (40-50% of women aged 40-74 in the U.S.) Studies have found that women with high breast density have about a 4x-5x higher risk of breast cancer than women with low breast density. This makes breast density a stronger breast cancer risk factor than many other factors known to increase risk.
What is a 3D mammography breast exam?
A 3D mammography exam is very similar to having a traditional 2D mammogram, but far more accurate in earlier breast cancer detection than any other mammogram. Like a 2D mammogram, the technologist will position you, compress your breast and take images from different angles.
3D mammography works by capturing multiple slices (images) of the breast from several angles, creating a layered 3D breast image. Our radiologist is then able to review your breast, one thin slice at a time, almost like turning pages in a book, which helps them make a more accurate diagnosis. Unlike a 2D traditional mammography where doctors can only see the front cover of a book, thus viewing all of the complexities of your breast tissue in a flat image, 3D mammography allows for more detail to be seen.
Is there any additional compression?
There’s no additional compression required with 3D mammography, and it only takes a few seconds longer.
Why we recommend 3D mammography:
3D mammography is simply a better mammogram. This technology is clinically proven, and it’s the most accurate mammogram available. It is the biggest breakthrough in breast cancer detection in 30 years.
Facts about 3D mammography
- 3D mammography is clinically proven to be superior to a regular 2D mammogram.
- Several large studies have shown that 3D mammography detects 41% more invasive breast cancers and reduces the chance that you will need to be called back for additional views by up to 40%.
- 3D mammography is approved for all women who would be undergoing a standard mammogram, regardless of age or breast type – or whether you are coming in for a screening and/or diagnostic mammogram.
- Very little X-ray dose is used during the 3D mammography exam, just about the same amount as traditional film mammography, and well within the FDA safety standards for mammography.
Please call us today at 919-678-6900 to discuss your personal health risks, and let Amanda and our team answer any questions you may have about our 3D mammography services.
600 New Waverly Place, Suite 310
Cary, NC 27518
Let’s get to know … Dr. Vijay Sheshadri
Walking down the halls of TP4W, you’ll usually see Dr. Vijay Sheshadri multi-tasking — hustling to see patients, researching new medical procedures, and talking about ways to grow & improve everything in his path. Practicing since 1999, he moved to the Triangle with his wife, Bethany, in 1999 and founded Physicians for Women. Quite simply, this is one devoted OBGYN who strives to make every patient feel valued and cared for. It’s a level of personal commitment that just comes naturally after over 20 years of doing what he loves.
If you look around his office, you can’t help but notice he’s off the charts – ah – enthusiastic about his allegiance to THE Ohio State University, where he earned his undergraduate degree. As an Ohio native, naturally, he also looked in-state for his Doctor of Medicine degree, which he got from the Medical College of Ohio, then attended the University of Louisville for his medical training. In addition to his impressive schooling, he is a Fellow with the American Congress of Obstetrics and Gynecology and a Diplomat of the American Board of Obstetrics and Gynecology.
Family comes first for Dr. Sheshadri. He enjoys spending time with his wife and two daughters, and when he manages to find a few extra hours, you’ll find him focusing on his martial arts training. He also enjoys playing tennis and an occasional round of golf.
But one passion of Dr. Sheshadri’s came into his life unexpectedly: sarcoma. He and Bethany founded the Victory Over Sarcoma Foundation after being diagnosed with the disease himself. Let’s hear his story in his own words, and why this foundation is so important to him:
I was diagnosed with a very rare type of sarcoma in November of 2010. I was fortunate in many different ways. Despite it being a locally very aggressive tumor, there was no systemic spread. It was in a location that was very easy to remove with great margins. Despite the surgery being large and aggressive, I am lucky to suffer no long term disability. I was able to access some of the most brilliant physicians and staff because of my close proximity to Duke University. So, when I was given this very scary diagnosis, at every point, the ball rolled my way.
Unfortunately, most people with sarcoma are not so lucky. You see, sarcoma is a cancer of the connective tissue. Connective tissue is in every organ in the body. Simply stated, it can be anywhere in the body. This type of cancer has largely been ignored in the research and pharmaceutical world because it affects a small number of people. Unfortunately, the outcomes can be very devastating. Because of the lack of research, the treatment tends to be very aggressive surgical therapy, limited chemotherapy, and radiation. The prognosis is often grim and the attention to cure leaves the survivors often debilitated. Because of its relative obscurity in the eyes of the common medical world, the experts in this field tend to be few and far between. There is a clear need for help. That is why the Victory Over Sarcoma Foundation was founded by my wife, Bethany. You see, while we were in our darkest days, she had made a promise to give back once our family had recovered and triumphed over this disease.
First of all, there are too many people out there that do not have the resources to obtain the best in medical care. Around the time of my diagnosis, we learned about a boy, roughly the age of our daughter, who lived in Tennessee. He had the same diagnosis as mine. They were trying desperately to get him to Duke to be treated. Unfortunately, it was not economically possible for him to do so. He ultimately died 6 months later. It is critical that people be able to access these tertiary care centers for treatment. Something this small can make the difference between life and death. Because the surgery has to be so aggressive, survivors are often left to deal with life changing disabilities. Houses and cars are not built by standards to accommodate these special needs. Once again, there needs to be a way to make these adaptations affordable. This is where we would like to help. Through our foundation and the generosity of our donors and supporters, we would first, like to help those not as fortunate as us to gain access to the best doctors with the greatest knowledge about sarcoma. Then, our goal is the help these survivors live their lives to its fullest.
To learn more about the Victory Over Sarcoma Foundation, or how you can help in Dr. Sheshadri’s mission, please visit the website for information.
Incorporated in Cary, North Carolina in 1999, the Hope for Haiti Foundation is a cause near & dear to our Dr. Grana. First dreamt up by Jean Elade Eloi, who grew up in a small Haitian village called Zorangé, the Foundation began with the goal of empowering young leaders to spark change, beginning in their own homes.
Hope for Haiti staff, team members and volunteers, like Dr. Grana, dedicate their time, talents, resources, and hearts to helping the people of Haiti, to secure a better future for Haiti by spreading hope and support in five important areas:
Community – advancing growth and vitality to create a foundation of change in Haiti
Education – offering supplies and instruction to the underprivileged children throughout the remote villages and towns of Haiti
Environment – delivering education, tools, and resources for Haitian farmers and citizens
Medical – ensuring care for communities without clinics, hospitals, medical doctors, or nurses
Spiritual – providing development for churches and pastors who need support and encouragement
As a physician, Dr. Grana’s devotion to the organization can be seen through her surgical and medical work in the clinic in Bainet, where she helps equip and support the Haitian staff there. She and the Foundation partners believe that health is the cornerstone of a productive and thriving society, and work to empower the Haitians to take action and affect change in their own nation. With new nurses, ministers, and teachers already in place, the Hope for Haiti Foundation’s efforts are already quite evident. Dr. Grana is also very excited about the new birth center that is being built in Zorangé through the Foundation.
Most recently in February 2017, Dr. Grana visited the region and chronicled her journey and photos with us.
We’re pleased to share them with you here:
We literally bring an operating room in suitcases to a clinic that does not have running water.
The people come from all over Haiti and line up and wait in hopes of being seen and possibly having surgery.
The website also has blogs with one written by our post op nurse about being in the operating room with us for her first time.
Rural communities in Haiti lack access to any form of medical care, causing malnutrition, chronic illness, and death
from preventable diseases. To combat this, HFHF focuses its energy on training Haitian medical professionals
who can serve rural communities in Haiti and by supporting Haitian-run medical initiatives.
Rural Primary Care Clinics
HFHF runs two primary clinics in the rural villages of Zorangé and Gandou, each serving a population of about 10,000.
The clinics provide first aid and primary care services, including parasite treatment, hypertension, fevers (Typhoid, Malaria),
women’s health, eye care, a pharmacy, and diagnostic Laboratory.
Additional Medical Projects
Health education through Radio Bigot and community health workers
Water filter distribution
Training traditional birth attendants (matrons)
But the most amazing thing this year is that this “surgery in a suitcase” is becoming routine for our team at Hope for Haiti Foundation. Although the challenges of performing medical procedures in a remote community with limited infrastructure remain, the team’s sheer determination to provide this desperately needed medical service serves as a catalyst to overcome any challenge.
We proudly support Dr. Grana and the Hope for Haiti mission,
and look forward to sharing more stories with you about their amazing work.
How about you? Have any questions you’d like to ask Dr. Grana? Want to share a similar story of hope you’ve experienced?
We’d love to hear from you.
February 2017 – As I moved from downward dog to warrior to the tree pose at a yoga class recently, the twinges and pulls in my left upper arm again reminded me what I have been through over the last ten months.
Nothing prepares you to hear the words, “You have cancer.” That was confirmation of my fears after a mammogram, ultrasound and biopsies revealed I had “abnormal” findings. In other words, the “Big C.” It all started last April when I felt a lump in my armpit while showering. I thought (and prayed) it was just an infected bump from razor burn. One call to Triangle Physicians for Women, and they had me in the office within 24 hours to see Dr. Lisa Grana. I was due to have my mammogram within the next few weeks anyway, but Dr. Grana expedited everything on my behalf.
The result? Invasive ductal carcinoma, and it had already spread to my lymph nodes. That’s what the lump was in my armpit. How could this have happened? I never missed a mammogram since turning 40. But, as I now know, it wasn’t enough.
Like 40% – 50% of women in the United States, I have dense breasts. That can make it tricky to see growths in mammograms. Fortunately, we live in a region where we have access to some of the best medical and technological advances available today. Enter 3D mammograms, now available at Triangle Physicians for Women. 3D mammography, also known as tomosynthesis, is the biggest breakthrough in breast cancer detection in 30 years. With an increased cancer detection rate, it is superior to conventional 2D mammography with hardly any difference in the screening process. While the 2D mammogram takes x-ray images from the side, the 3D takes multiple images of the breast in slices, allowing the radiologist to examine the breast layer by layer. Because more of the breast can be reviewed, it reduces the risk for call backs.
I was stunned when seeing my 2D mammogram side by side with the 3D mammogram. I had three malignant tumors in my left breast, one nearly an inch wide. In the 2D image, you couldn’t see them at all because my breast tissue is so dense. But in the 3D image, they lit up like a Christmas tree. The 3D mammogram saved my life.
I underwent 5 months of chemotherapy, a double mastectomy and two months of daily radiation. I’m now getting ready to begin a 13-month clinical trial testing a chemotherapy drug that I hope will deter my breast cancer from returning. I often wonder if I had a 3D mammogram the year before, if the tumors could have been spotted sooner and I wouldn’t have to undergo such intense treatments.
So, here’s your chance to be be the CEO of your health. Please take action and make sure you are doing the following things:
- Do monthly breast self exams. For how-to’s, click here.
- See your OBGYN for your annual exam.
- Ask your OBGYN if you have dense breasts.
- Ask about getting a 3D mammogram.
- Remind your friends, sisters, moms and the men in your life to do the same.
Getting a mammogram just got a lot easier, too, now that Triangle Physicians for Women has its own mammography suite, located inside Triangle Physicians for Women’s facility. It features the highest quality mammography available with state-of-the-art equipment, which can detect 41% more invasive breast cancers.
At Triangle Physicians for Women, being a one stop shop for women’s health means you can spend less time away from your family or work. You can add your screening mammogram appointment to your annual well-woman exam appointment. And if you need to schedule these appointments separately? No problem; they can do that too. Plus, it’s never a hassle to get your previous mammogram films/records. Simply sign an authorization to release medical records form, and they will take care of the rest.
Do you feel empowered? Get on it! Be the CEO of your health today.
By Sharon Delaney McCloud
Triangle Physicians for Women Patient
Breast cancer survivor, mom, wife and business owner
Triangle Physicians for Women Now Offering 3D Mammography
Together, we can beat breast cancer. Triangle Physicians for Women is committed to women’s health and encourages women to take preventative measures against breast cancer. For the ease and convenience of our patients, we are proud to offer our in-house 3D mammography suite.
Breast cancer continues to be the second leading cause of cancer deaths in women. Four out of five women agree that yearly screenings are important, but only 60% are taking advantage of these potentially life-saving exams. With the most advanced technology on the market, Triangle Physicians for Women is dedicated to providing our patients with state-of-the-art mammography to prevent and fight breast cancer.
One of the main reasons women do not have their mammogram is due to time constraints and busy lives. Now, you can get your well woman exam and your mammogram during the same visit. Call us today to schedule your appointment: 919-678-6900.
What is a mammogram?
A mammogram is an X-ray picture of the breasts. Because mammograms can detect tumors before they are seen or felt, they are the most effective way of detecting breast cancer at its most treatable stage. There are two types of mammograms: 2D (conventional) and more recently 3D.
What is 3D mammography?
The 2D mammogram only takes x-ray pictures of the front and side of the breast. With the 3D mammography, multiple x-rays are taken of the breast in layers, creating a 3-dimensional image. More of the breast can be examined by a radiologist, who reviews the image and can make an informed assessment.
Triangle Physicians for Women’s 3D mammography is the best and newest technology on the market, finding 41% more invasive breast cancer than conventional mammography. It is the most accurate mammogram available for women with dense breasts.
The process is very similar to 2D mammography. It takes only a few seconds longer than a conventional mammogram and comes with no additional discomfort, radiation or compression.
When should I start getting annual mammograms?
Factors such as family history can affect the age recommended to start getting yearly mammograms. Some women with extensive family history of breast and ovarian cancer start at age 35. Typically, women begin having mammograms at age 40. Talk to your provider about when you should start.
How should I prepare for my appointment?
For the most accurate test results (and lower the chances for a call back), do not wear lotion, perfume, deodorant or jewelry during your visit.
4 Questions Your Daughter Has Before Her First Gyno Appointment
A first visit to the gynecologist can make a young woman feel nervous, embarrassed, scared or all of the above. Our physicians and midwives make it a priority to make our patients feel as comfortable as possible, but explaining to your daughter what to expect before she even gets to the practice will reduce anxiety about a first exam. Here are some questions we hear often to address before a first visit:
The American College of Obstetrics and Gynecology recommends that young women schedule their first exam with an OB/GYN between the ages of 13 to 15. This visit will include an external exam and graduate to an internal exam when your daughter turns 21. If there is any instance of irregularities or vaginal bleeding, an internal exam of the reproductive organs may be necessary sooner.
2. What do I expect?
The provider will do a breast exam, while checking for lumps or cysts. Your daughter will be asked to spread her legs apart and put her feet in stirrups, and the provider will do an external exam, looking for swelling or sores. An internal exam checks normality of the uterus and ovaries, where a speculum (instrument that opens the vaginal walls) is used. This can be intimidating for the first time, so encourage her to take deep breaths to decrease discomfort. Depending on her age, she may need a Pap smear.
3. What is a Pap smear?
Women start getting Pap smears at age 21. This is to check for abnormal cells and cervical cancer. A small spatula will scrape cells from the cervix to be sent to a lab. Although uncomfortable, this process does not hurt. Again, deep breaths are key!
4. How do I prepare for my first visit?
Tell your daughter to think about questions to ask your provider beforehand – about contraception, sexual activity, period irregularities, anything. Any questions and/or concerns you have should be addressed and your provider can answer. Assure her that it is okay to feel a little embarrassed since it is the first visit, but remember there are no stupid questions, and nothing that hasn’t been heard before.
There are also questions she should prepared to answer:
- When was your last period?
- Are you having any problems with your period?
- Are you (or have you ever been) sexually active?
- Is there any possibility you could be pregnant?
- Do you have any discomfort in the vaginal area?
Did you know our midwives take gynecology appointments? All of our midwives hold the title Certified Nurse Midwife, so they are full-spectrum and are licensed to provide care to women of all ages and stages of life, not just during pregnancy.
Any other questions? Talk to us! Schedule your daughter’s annual appointment over Christmas break! We still have some spots open! Call us at 919-678-6900. To learn more about Triangle Physicians gynecology, click here.
Best Travel Pregnancy Hacks with Triangle Physicians for Women
‘Tis the season of traveling! With the holidays fast approaching, it’s hard to avoid a road trip. The best time to travel is during the second trimester, between 14 and 28 weeks. In many cases, this is past morning sickness in the first trimester and before third trimester fatigue. Triangle Physicians for Women has some tips on how to travel most effectively, safely, and comfortably during your pregnancy:
According to the National Highway Traffic Safety Administration, everyone must wear a seatbelt, although there is a common myth that seatbelts and airbags are unsafe for pregnant women. The seatbelt should be over the collarbone and under the abdomen, and tightly fastened (see below). Safety belts should never be above or across the belly. This ensures the best possible protection for mom and baby.
Despite another common myth, airbags should never be disabled. A study by the University of Washington found that out of 3,000 accidents involving pregnant women, there was no higher risk found of fetal distress, placental separation, or cesarean section in those whose airbags deployed. The safety component outweighs the potential risk of not using an airbag for both mom and baby.
To ensure you feel your best during the roadtrip, keep extra water bottles in a cooler in the car and continue to drink the recommended 8 oz. per day. Take frequent stops about every two hours to use the bathroom, stretch and take short walks to keep blood flowing and prevent swelling. To avoid fast food, pack a plethora of healthy (and fiber-rich) snacks to eat on the way – trail mix, fruits and vegetables in a cooler, energy, etc.
Wearing layers is essential – a cotton t-shirt, lightweight wool sweaters, and leggings is the perfect outfit for a road trip with frequent stops. Wear comfortable shoes for the car and bring a supportive pair for bathroom breaks.
With these tips, you can maintain your healthy habits while you are on the road and ensure your trip is safe and comfortable for you and you baby. As always, please remember every woman should talk with her physician no matter what stage pregnancy before traveling. Happy travels!
How MonaLisa Touch Can Help Change Lives, Including Help for Breast Cancer Survivors
The providers at Triangle Physicians for Women are excited to introduce MonaLisa Touch!
The MonaLisa Touch is a revolutionary laser treatment for vaginal dryness, vaginal burning and other vaginal symptoms of menopause.
How Does it Work?
The MonaLisa Touch treatment utilizes a laser to deliver controlled energy to the vaginal tissue stimulating cells to produce more collagen. Increased collagen production increases lubrication and sensation in the vagina.
There are three treatments over the course of 12 weeks. Each treatment takes less than five minutes in our office with no anesthesia and little to no downtime.
“We have been using the MonaLisa Touch laser for over a year now and have made a huge impact on many of our patient’s lives with this treatment,” said Triangle Phyicians for Women physician Dr. Lisa Grana.
Most patients see improvement after the first treatment. There are minimal side effects and a rapid recovery rate. Thousands of women have been treated and reported significant improvement of their symptoms.
Breast Cancer Survivors
We are excited to offer the MonaLisa Touch Treatment to breast cancer survivors as a safe and innovative treatment option. Physicians are calling it revolutionary and patients are calling it life changing.
Out of 2.8 million breast cancer survivors, 50% experience changes in their gynecological health.
Women who have undergone breast cancer treatment such as chemotherapy, hormone therapy, and ovarian removal may experience what is known as medical menopause. This can be temporary or permanent, depending on the individual. Symptoms for medical menopause are much like those of natural menopause, include vaginal dryness, vaginal burning, pain during sex, and frequent urination.
While many suffer from these issues, only 25% seek medical assistance.
“MonaLisa Touch has offered a great new option for breast cancer survivors to find relief from symptoms of menopausal atrophic vaginitis,” said Dr. Vulgaropulos. “The significance of this is remarkable considering the obstacles these women have overcome.”
Estrogen replacement therapy is one of the most common treatments for symptoms of menopause. However, this may not be a safe treatment for women who have had breast cancer.
Have questions about MonaLisa Touch? Consult your doctor or visit our MonaLisa FAQ page.
Tips for Ovarian Cancer Prevention
Ovarian cancer is the #1 cause of gynecological cancer deaths, and 1 in 75 women will develop it at some point during their lifetime. The American Cancer Society predicts that there will be over 22,000 new cases of ovarian cancer this year. September is Ovarian Cancer Awareness Month, so now is a better time than any to talk about prevention, risk factors, and symptoms.
An estimated 15% of all ovarian cancer diagnoses are linked to hereditary factors. A woman’s risk of developing ovarian cancer is increased if her mother, sister, or daughter has had ovarian, breast, or colorectal cancer. These cancers can be caused by an inherited mutation in certain genes that increase risks. There is also an increased risk if there has been cases of ovarian cancer on the father’s side.
Pregnancy and Birth Control
Women who carried their baby before the age of 26 have a lower risk of developing ovarian cancer. Every pregnancy after that decreases the risk even further. Breastfeeding has also been proven to decrease the risk.
Oral contraceptives have been proven to reduce the risk by 30 – 60% for women who have used them for over three years. The decrease in risk can last up to 30 years after women stop taking the pill.
Being active and eating right are ways to reduce the risk of cancer. Obese women (those with a body mass index of 30 or higher) are at a higher risk of developed ovarian cancer.
Tubal ligation (tubes tied) reduces the risk by two-thirds and a hysterectomy (removal of the uterus) reduces the risk by ⅓. A new procedure, called total laparoscopic hysterectomy, can be done through cameras and is very low-risk.
“Because the incisions on the abdomen are very small in a laparoscopic hysterectomy are able to return to a normal life in 1-2 weeks,” said Triangle Physicians for Women physician Dr. Vijay Seshadri.
For women with a high risk of ovarian cancer, a bilateral salpingo-oophorectomy (removal of fallopian tubes and ovaries) may be recommended.
Like all cancer, early detection is key. Yearly women’s tests may detect other reproductive cancers early on, but ovarian cancer is usually too small in the early stages to be found during a Pap test or pelvic exam. This is why it is important be aware of family history as well as symptoms. The more common symptoms are bloating, pelvic and abdominal pain, and urinary symptoms (such as urgency and frequency). Other less frequent symptoms include fatigue, back pain, menstrual irregularities, pain after sex, constipation, and difficulty eating.
Many of these symptoms occur often for women and can perceived as normal. It is recommended that if any occur for more than a few weeks to contact their primary care provider.
Only 20% of ovarian cancer is caught in the early stages. About 14,240 women will die from ovarian cancer this year. This month, help Triangle Physicians for Women raise awareness for ovarian cancer and encourage preventative care.
Prenatal Yoga Classes at Cary Practice – Triangle Physicians for Women
Yoga is a well-known exercise regimen that keeps the mind and body healthy, and it’s proven that exercising while pregnant is beneficial for both Mom and baby! Prenatal yoga is specifically designed for women during any trimester of pregnancy, and is more beneficial than traditional yoga classes. Here are some reasons why you should sign up for Prenatal Yoga classes at Triangle Physicians for Women:
Relieves Anxiety & Stress
Normal pregnancy comes with its own unique anxiety and stressors! By practicing mindfulness, routine breathing exercises, and learning to feel in tune with your ever-changing pregnant body, we find that women who practice prenatal yoga are more likely to be less stressed than those who don’t. The exercises performed during prenatal yoga classes are proven to regulate heart rate and blood pressure while naturally increasing endorphins which serve to create mood stability and increase energy levels.
“So much of prenatal yoga is allowing women’s bodies to rest because so much of being pregnant is exhausting,” says Holly Healy, who teaches the bi-weekly prenatal yoga class at Triangle Physicians for Women. “My class is more about restoring women’s bodies.”
Relieves Common Pregnancy Pains
There are normal “discomforts of pregnancy” which occur throughout the pregnancy. Whether it is nausea during the first trimester, back pain in the second, or shortness of breath in the third, prenatal yoga exercises and poses help to alleviate the naturally occurring “normal miseries of pregnancy”. The stretching movements that typically start off a prenatal yoga class work to increase circulation, which in turn reduces swelling and body aches.
Holly starts her class off by asking the group (usually of about 2 to 4) if anyone is experiencing specific discomforts, and then tailors her class to relieve the pain in that area. Most of the pain comes from the body compensating for the baby’s growth that helps relieve tension.
Prepares for Labor
Research shows that those women who practice prenatal yoga during pregnancy will spend less time in labor than those who do not have an exercise regimen in place. Prenatal yogis also experience less pain during and after giving birth. Increasing the strength and flexibility in muscles during pregnancy, prepares women for childbirth, often making them feel more in control and confident during labor and delivery.
Deep breathing is also a big part of the class, contributing to the preparation of labor and delivery. “In prenatal yoga, there’s a heavy focus on breathing, and figuring out which breathing pattern works best for each person,” Holly says. “Allowing them to focus on it in class can prepare them for breathing practices during labor and delivery.”
Meet Like-Minded Moms
In addition to all the mental and physical benefits for both Mom and baby, prenatal yoga classes allow women to meet like-minded moms-to-be, creating a bond between them. A prenatal yoga class makes for a supportive group, and a memorable experience that women can enjoy along with their pregnancy.
Prenatal yoga with Holly is offered on the 1st and 3rd Friday of each month at 7:00pm at Triangle Physicians for Women,600 New Waverly Place, Suite 310. Bring $10 cash, your yoga mat, and written clearance from your OB doctor in order to participate. Register with Holly via email: email@example.com.
Join us for Mommy & Me Yoga!
Where: Triangle Physician’s for Women
600 New Waverly Place, Suite 310
When: 2nd & 4th Friday of each month
6:15 – 7:15pm
Taught by Holly Healy, FNP IBCLC and AAAI, Pre/Post Natal, & Kids Yoga Certified.
Register by emailing Holly at firstname.lastname@example.org.
Bring your yoga mat and a blanket for your baby! Babies 6 weeks – 12 months welcome!
Postpatum Education and Support NC
Postpartum and Education Support is an organization dedicated to the emotional wellness of mothers. We offer support for mothers and their families, provide resources for health care providers, and heighten public awareness of perinatal mood disorders.
We also offer Moms Supporting Moms (MSM) is a peer-led, judgment-free support group for women struggling with issues related to pregnancy, delivery and early motherhood. Our weekly support group meetings provide a confidential and safe environment for sharing stories, discussing problems and seeking solutions. We meet 7:00 – 8:30pm every Thursday Mid-Carolina Ob-Gyn offices, Medical Plaza of Rex Hospital 4414 Lake Boone Trail, Suite 300; Raleigh, NC 27607. Click here to learn more.