Gynecology

Well Woman Examinations
Abnormal Pap Smears
Polycystic Ovarian Syndrome
Gynecological Sonography
Recurrent Pregnancy Loss
Urinary Incontinence

Well Woman Examinations

Alliance Ob/Gyn PC offers well woman examinations to women of all age groups.

We utilize Thin-Prep Pap smear technology with concurrent screening for sexually transmitted diseases and / or HPV when appropriate.

The Gardasil vaccine for HPV is available in our office.

Labs are drawn in office for your convenience.

Abnormal Pap Smears

Pap smear abnormalities are very common.  The most common abnormality is termed ASCUS, which stands for Atypical Squamous Cells of Undetermined Significance.  Over  90% of these are actually false positives, and there is no abnormality.  The most direct way to evaluate this abnormality is with a procedure called colposcopy.  This is a simple office procedure that obtains microscopic views of the cervix and vagina.

Other Pap smear abnormalities include low grade and high grade dysplasias.  Dysplasia is an abnormal cell.  With a low grade dysplasia your body's immune system will usually sense that something is wrong and get rid of the abnormal cells and you don't need any treatment except careful monitoring.  A high grade dysplasia is best thought as a pre-cancerous condition.  Left untreated 10-15% of these high grade dysplasias will eventually become cervical cancer.  These high grade dysplasias can conservatively treated with a LEEP procedure.

These abnormalities are generally caused by HPV, or Human Papilloma Virus.  HPV infections are essentially ubiquitous.   Almost everyone has had a transient infection with HPV.  There are over one hundred different types of HPV.  Although some types are linked to genital warts and cervical cancer, other can cause plantar warts or no symptoms at all.  HPV testing can aid in the diagnosis of certain Pap smear abnormalities.

A highly effective vaccine for HPV, Gardasil, is recommended for women age 9-26.

Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is a sign and symptom complex characterized by irregular menses, anovulation, hirsuitism (hair growth), weight gain, and infertility.

The word "syndrome" simply refers to the various signs and symptoms.  It does not refer to underlying cause of the disease.  Various disease processes can mimic PCOS such as hypothyroidism, late onset congenital adrenal hyperplasia, and various adrenal or testosterone secreting tumors.

Insulin resistance has been found to be a leading cause of PCOS.   To understand insulin resistance one has to understand how insulin functions normally.   Insulin is a hormone that is secreted by an abdominal organ called the pancreas.   The pancreas normally secretes approximately 20 units of insulin a day to maintain a normal blood glucose level; however, the pancreas has the ability to secrete a lot more insulin if needed.  Insulin allows blood sugar to enter the body's cells.  Insulin preferentially allows sugars into fat cells.  I have found that the following analogy is the best way to explain insulin resistance.
Imagine my job is to drive a truck around I-285 every day and that it takes 20 gallons of gas to drive around I-285, but I have a 50-gallon gas tank.  Just as the pancreas's job is to keep blood sugar normal and it normally takes 20 units of insulin to perform its job.  Imagine that the pancreas can produce up to 50 units a day.  If something is wrong with my truck, it has some dirt in the engine, it's not running well, it will use more gas to do its job, say, 30 gallons to drive around I-285.  Just as if you have insulin resistance your body is making more insulin, but it is still doing its job to keep your blood glucose normal, thus you don't have diabetes.  Now imagine that I had a couple of bales of pine straw in the back of my truck, it weighs more.  It will take more gas to get around I-285, say 40 gallons.  Just as if you gain weight your body must produce more insulin to service the rest of the body, but you still are keeping your blood sugars normal.  If I have a little more dirt in my engine or I'm carrying more bales of pine straw it may take 60 gallons of gas to get around I-285.  I only have a 50-gallon tank, thus my truck stops on I-20.  I don't do my job, just as insulin resistance is a spectrum of disease that can be mild or be overt diabetes.

How does this cause PCOS?  Higher levels insulin directly inhibits the release of eggs from the ovary.  Thus it causes infertility and irregular menses.  This also causes the ovary to secrete higher levels of androgens (male type hormones) and thus unwanted hair growth.  Remember insulin also preferentially stores sugars into fat cells, thus someone who has high levels of insulin and a high carbohydrate diet will become obese. 

Insulin resistance can be inherited or acquired.  The inherited form is a defect in the insulin receptor or other mechanism of insulin metabolism.  The acquired form occurs with obesity.  The common scenario is someone who was slowly gaining weight, 3-5 pounds per year, and then suddenly gains weight rapidly.  There obesity has pushed them into insulin resistance and they start preferentially storing carbohydrates into fat.
The treatment is to reverse this process with insulin sensitizing drugs such as metformin and a low carbohydrate diet.

Gynecological Sonography

The physician staff of Alliance Ob/Gyn PC will perform a vaginal sonogram at the time of your visit if it is indicated.  You will not have to come back for a second appointment to have the sonogram performed by an ultrasound technician.  Indications include:

1. Pelvic Pain
2. Pelvic Masses
3. Painful Periods
4. Heavy Periods
5. Irregular Bleeding

A vaginal sonogram is a painless procedure.  Whenever a sonogram is performed, you want the sonogram transducer to be as close as possible to the organs to be evaluated.   The tip of the vaginal probe is covered with a lubricated sheath and gently inserted into the vagina and used to palpate the pelvic organs.

The morphological (size and shape) features of the uterus and ovaries are evaluated, but also the remainder of the pelvis is including bowel and bladder is checked for abnormalities and tenderness.

At times a sonohysterogram may be performed.  It is usually done between days 7-10 of your menstrual cycle, but should be done after your cycle has resolved.  A small catheter is placed in the cervix and sterile saline is instilled into the cervix while a three dimensional image is obtained.  This allows us to evaluate uterine polyps, submucosal fibroids, and the lining of the uterus.