Gynecology exams and Pap tests begin at age 21. We are happy to see younger women to discuss contraception, screening for sexually transmitted infections, or any other gynecologic concerns or questions.
Please call our office for an appointment. Generally, same day appointments are available. Infections can have varying symptoms and it is important to be evaluated by your provider to ensure the correct diagnosis and treatment.
If you miss one pill, take it as soon as you remember. If you do not remember until the next day, take two pills at the same time. If you miss two days, take two pills for the next two days and use a back-up method of contraception such as condoms for the remainder of the pill pack. Be aware that taking two pills can sometimes cause nausea. Missing pills or taking pills late can sometimes result in very light vaginal bleeding and can also decrease the efficacy of your birth control. Try to take your pills at the same time every day so you are less likely to forget. Setting a daily reminder on your phone may help you remember. If you consistently have trouble remembering to take your pills on time, talk to your provider about alternative methods of contraception.
Intrauterine contraception is highly effective, long acting, and rapidly reversible. It is a safe option for most women. Ideal candidates are women who desire long-term contraception, are not planning pregnancy for at least a year, are in mutually monogamous long term sexual relationships, and desire non-estrogen methods. Paragard, Mirena, and Skyla IUDs are available in our office. They are inserted during your period, preferably on the heaviest day. If you recently had a baby and are breastfeeding, you will not be menstruating and can schedule the insertion on any day.
You can expect spotting or light bleeding for the first three to four months after starting hormonal contraception such as birth control pills, Nuvaring, Mirena, and Implanon/Nexplanon. This is a common side effect, not harmful, and should improve with time. It does not mean that your contraception is not working. Sometimes, women miss their period completely when using hormonal contraception. As long as you have been using it correctly, there is no concern about this either.
Emergency contraception, also called the morning after pill, helps prevent pregnancy after unprotected sex or birth control failure. It should be taken as soon as possible because the sooner you take it the better it works. It can be taken for up to five days after the incident, but it is more effective in the first 72 hours. It is available over the counter for women 17 years or older. A prescription is necessary if you are 16 or under. If you are already pregnant, emergency contraception will not affect or abort an existing pregnancy.
You can have a pap test when you have your period as long as the flow is not heavy. However, whenever possible, please try to schedule your pap test visit when you do not have your period.
HPV is a very common virus for women in their twenties and is usually only significant if a Pap test becomes abnormal or if HPV persists consistently after age thirty. Starting at age thirty, women should have a Pap test along with testing for HPV.
The HPV vaccine (Gardasil) is administered to females and males age 9-26 in three doses over a six month period. The Centers for Disease Control and the American College of Obstetricians and Gynecologists recommend routine HPV vaccination to girls at age 11 or 12. The vaccine is most effective when given before any exposure to HPV (i.e. before sexual activity) and produces higher antibody when given at this age compared to older ages. Girls and women age 13-26 can still receive the vaccine if they have not previously. The HPV vaccine is not recommended for pregnant women.
HPV can cause genital warts, precancerous lesions of the cervix & vagina, and cervical cancer. The HPV vaccine helps protect against diseases caused by HPV Types 6, 11, 16, and 18. These four types of HPV cause approximately 70% of cervical cancers and 90% of genital warts. However, because there are more than 100 types of HPV, the vaccine will not protect against all HPV types. The vaccine will also not protect against HPV types to which you have already been exposed. However, since exposure to all four HPV types prevented by the vaccine is unlikely, vaccination may still provide some benefit. Vaccination does not eliminate completely the chance of developing precancerous or cancerous lesions of the cervix, so it is still imperative that routine Pap testing continues.
The HPV vaccine is administered in three doses. The second dose is given two months after the first dose and the third dose is given six months after the first one. If the second or third doses are not given at those exact intervals, they can be given at any time and the earlier doses do not need to be repeated. Insurance companies will only pay for doses completed by the 27th birthday.
Pap testing begins at age 21. Between ages 21 and 30, Pap tests are performed approximately every two to three years. Beginning at age 30, Paps with testing for human papilloma virus are performed every three years. Based on an individual patient's history, these intervals may change. Please discuss your recommended interval with your practitioner. Pap tests are not performed after age 65 except under unusual circumstances. Even though you may not need a Pap test annually, you may still schedule a yearly gynecologic exam. A breast and pelvic exam will be performed, prescriptions refilled, referrals provided as needed, as well as any other concerns addressed.
Call our office for an appointment. Early treatment helps to minimize long-term effects of STIs. Avoid sexual contact until you are treated. Some STIs may have mild or no symptoms at all so intermittent screening can be beneficial.
No, not necessarily. Many sexually transmitted infections may have mild or no symptoms and can be transmitted without knowing. The only way to know for sure is to get tested.
If you are sexually active and could be pregnant, take a home pregnancy test or call us for an appointment. If you are using hormonal contraception, skipping periods may be a side effect of your contraceptive method. If you are not on any medication and have not had a period for three months, please call our office for an appointment.
The American Cancer Society and the American College of Obstetricians and Gynecologists recommend annual mammograms starting at age 40. The United States Preventive Services Task Force recommends biennial screening mammography starting age 50. If you are at high risk of developing breast cancer due to personal or family history, mammograms before age 40 may be indicated, as well as other enhanced screening such as breast MRIs. Mammogram screening ends at age 75. Please discuss with your provider when you should have a mammogram.
Downtown Women has experienced providers with special interest in the treatment of menopause, including lifestyle strategies, the use of bioidentical hormones, and conventional hormone replacement therapy (HRT). Please call our office to schedule a consultation if you would like more information.
Congratulations! Please schedule a visit with one of our obstetricians to confirm how far along you are in your pregnancy. This initial visit is usually scheduled about eight to ten weeks after your last menstrual period began. The next visit will be with either of our midwives, Nancy Kraus or Emory Ship. Thereafter, your prenatal visits will be monthly until the third trimester when they will increase in frequency. During the last month of your pregnancy, you will be coming in weekly.
One of our six obstetricians will deliver your baby. Please refer to our provider list. Whoever is on call when you go into labor will take care of you at the hospital. Typically, we have patients rotate their prenatal visits with each of the OB providers. This will allow you to meet with and get to know well all of the doctors who may assist you during labor and delivery.
While there are very few studies of hair dye use in human pregnancy, animal studies have shown no adverse effects. Many women have dyed their hair during pregnancy with no reported harmful outcomes. Only a minimal amount of hair dye is absorbed through the scalp after application and this small amount is unlikely to harm your baby. If you dye your hair with a single process and you’d like to be especially cautious, wait until after the first trimester to dye your hair. Highlights should be fine at any time since hair dye is not applied directly to the scalp. For more information: http://www.otispregnancy.org/files/hairtreatments.pdf.
It is advisable for most women to continue a regular exercise program during pregnancy. However, you should not start a training program for a major event or add anything more strenuous. Hydrate well. You do not have to monitor your heart rate, but you should exercise at a pace that allows you to converse while exercising. Avoid activities with a risk of falling or injury such as skiing or contact sports. Do not exercise in excessively hot conditions such as Bikram yoga.
Air travel (on pressurized aircraft only) is considered safe for most women with healthy pregnancies prior to 36 weeks. Restricting travel if you are at risk for preterm labor or if you are over 36 weeks gestation is recommended. While flying, drink plenty of fluids. Promote circulation by walking up and down the aisle and while seated periodically flex and extend your ankles and legs. If you are planning a cruise, please be aware that most cruise lines will not accept pregnant passengers after 24 weeks gestation.
Due to risk of contamination with listeria, mercury, and toxoplasmosis, certain foods should be avoided during pregnancy.
Listeria: Do not eat unpasteurized soft cheeses such as brie, feta, blue, goat, or camembert. Avoid hot dogs and deli meats. Listeria can be inactivated by high temperatures, however, so any of these foods should be safe if heated until steaming hot. Do not eat smoked or raw fish.
For more information: http://www.otispregnancy.org/files/listeriosis.pdf
Mercury: Do not eat Shark, Swordfish, King Mackerel, or Tilefish as they contain high levels of mercury. Eat up to 12 ounces (2 average meals) a week of lower mercury fish and shellfish.
For more information: http://www.otispregnancy.org/files/methylmercury.pdf
Toxoplasmosis: Do not eat raw or undercooked meat. (Also, avoid changing the cat litter and wear gloves when gardening or handling soil.)
For more information: http://www.otispregnancy.org/files/toxoplasmosis.pdf
Low to moderate caffeine consumption during pregnancy is considered safe. Pregnant women should limit their caffeine intake to less than 200 mg/day (roughly one to two cups of coffee). Although research results have been conflicting, a few studies have suggested an increased risk of miscarriage with high caffeine intake (more than 200-300 mg/day). For more information: http://www.otispregnancy.org/files/caffeine.pdf.
If you are taking prescription medications, please discuss with your provider. Click here
Please call our office. Your provider may order a blood test to check to see if you are already immune to Parvovirus B19. Approximately 50% of adults are immune from past infection. If you are not immune and are found to be infected, ultrasounds can help monitor the pregnancy for signs of infection. The vast majority of women who become infected with Parvovirus B19 during pregnancy deliver healthy, unaffected babies. For more information: http://www.otispregnancy.org/files/fifthdisease.pdf.
It is highly unlikely that exposure to paint fumes will harm a developing fetus. As a precaution, ventilate well by opening any windows or doors. Avoid prolonged exposure, especially in the first trimester. After the room has been well ventilated, it’s ok if you can still smell the paint fumes as long as you’re not feeling ill from the odor.
The Centers for Disease Control and the American College of Obstetricians and Gynecologists recommend influenza vaccine for all women who will be pregnant through influenza season (October-May). Vaccination is important because pregnant women are at increased risk for severe illness due to influenza. Administration early in the flu season is optimal and vaccination is safe in any trimester. Flu vaccine FAQs
Pertussis (also called whooping cough) is a highly contagious disease that causes severe coughing. In newborns, pertussis can be a life-threatening illness and can be prevented with a vaccine called Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis). If you have never received a Tdap vaccine before, you should receive it late in your second trimester (after 20 weeks gestation) or during your third trimester. It can also be safely administered to breastfeeding mothers if it was not given during pregnancy. Getting your Tdap vaccine is an effective and safe way to protect yourself and your newborn from whooping cough. Tdap FAQs
Thimerosol, a mercury-containing preservative found in multi-dose vaccination vials, has not been shown to be harmful to pregnant women or their unborn babies and it does not cause autism. Although it is not considered harmful, we do not routinely use any vaccines with thimerosol in pregnancy.
If you typically sleep on your back, it’s safe to continue doing so in your first and second trimesters. In your third trimester, it’s best to avoid lying on your back for prolonged periods of time. When you lie on your back, your enlarged uterus may press on the vena cava, the major vein that returns blood to the heart from your lower body. Sleeping tilted to one side or another will help maximize blood flow to both you and your baby. Try placing a pillow between your legs, under your hip, or behind your back to make your sleep position more comfortable. But don’t be alarmed if you go to sleep on your side and wake up flat on your back. Spending moderate amounts of time on your back does not have an adverse effect on your baby’s health.
We do not perform routine episiotomy. We prefer to avoid episiotomy whenever possible, although in certain circumstances it may be necessary.
Yes. Our practice is very supportive of natural childbirth. If you choose to labor without pain medication, we recommend obtaining a labor support doula for added care and comfort during your birth.
Yes. Attempting a vaginal birth after cesarean section (VBAC) is a safe and suitable choice for many women who have had a prior cesarean delivery. If you are interested in VBAC, please consult with one of our obstetricians, as certain factors may increase or decrease your chances of success.