Gynecology

Well Woman Exam

The well woman exam is an important time to discuss your contraceptive needs, planning of a pregnancy, sexual concerns, sexually transmitted diseases, vaginal discharge or discomfort, menopausal symptoms, or other concerns.

The relationship between you and your doctor is an important one. To get the best care, be prepared for your health care visit, know your medical and surgical history, including an accurate medication list and communicate any concerns you have with your doctor. Do not be afraid to ask questions or speak up about your concerns. At Boston Ob-Gyn, we want you to feel comfortable with your doctor and feel comfortable with the care we provide.

History

Your doctor will ask you questions about your past medical problems. To understand your history, it is important to make sure your doctor is aware of all your medical problems, including non-gynecological issues. Your doctor will ask about medications, allergies, what surgeries you have undergone, any medical problems that run in your family, as well as ask questions about your occupation, relationship status, ethnicity, tobacco, alcohol and drug use. Your sexual habits are also an important part of properly taking care of your health that will be addressed during your visit. Please bring any past medical records, x-rays or test results that pertain to the reason for your visit.

Physical Exam

You will have a general physical exam during your well woman visit, including your weight and blood pressure. The physical exam often includes both a pelvic exam and a breast exam. We take the utmost care in making sure you are comfortable. The pelvic exam has three parts, looking at the vulva, looking at the vagina and cervix with a speculum and checking the internal organs with a gloved hand.

Tests

Routine pap smears are done every 3-5 years from ages 21-65. Ask your doctor if you want tests for sexually transmitted infections.

Contraception

We offer many forms of contraception including:

• Intrauterine contraceptive devices (IUDs: Paragard, Mirena, Liletta, Kyleena and Skyla)
• Contraceptive implants (Nexplanon)
• Injectable contraceptives (Depo-Provera)
• Birth control pill
• Vaginal ring (Nuvaring)
• Birth control patch
• Diaphragm

Other forms of contraception do not require a prescription or exam including condoms, spermicide, withdrawal, and rhythm or timed coitus.

Sexually Transmitted Infections

Ask your doctor if you want screening for sexually transmitted diseases.

• Genital Herpes
• Gonorrhea, Chlamydia and Syphilis
• HPV (Human Papilloma Virus)
• Pelvic Inflammatory Disease
• HIV
• Hepatitis B and C

Vaccines

We offer three vaccines including those for:

• HPV (Gardasil)
• Flu
• Pertussis or whooping cough (Tdap)

Colposcopy

A colposcopy allows your doctor to do an in depth exam of your cervix, vagina or vulva with a microscope. This is usually done because of an abnormal pap smear, Type 16 or 18 HPV, or a lesion noted during a routine exam.

Infertility

An infertility evaluation is recommended if you have not become pregnant after 1 year of regular sexual intercourse without using any form of contraception. If you are older than 35 years, an infertility evaluation may be performed after 6 months of trying to conceive.

During an infertility evaluation, both you and your partner may undergo tests to try to find the cause. The first visit usually involves a detailed medical history and physical exam. You will be asked questions about your periods, medications you are taking, medical problems and past surgeries, illnesses or birth defects in your families, past pregnancies and miscarriages, tobacco and drug use.

There are many causes of infertility and many treatments that can help couples get pregnant. Male factor infertility may be the only cause of infertility in about 10% of couples and female factors occur in about 35% of couples. Often, infertility occurs due to both female and male factors in another 35% of couples. Reasons for female factor infertility include ovulation difficulties or anatomic issues. Sometimes a cause of infertility is not found, this is called unexplained infertility. Up to 15-30% of couples who undergo an infertility evaluation do not find a reason for their difficulty getting pregnant. There are many treatments for the different causes of infertility.

Infertility evaluation for a woman

An assessment of whether you ovulate is done, usually by evaluating your menstrual cycle, basal body temperature assessment, ovulation predictor kits or progesterone levels. Various blood tests may be performed to assess thyroid disease, prolactin levels and ovarian reserve (the function of the eggs found in the ovaries), which can all disrupt ovulation. Tests of ovarian reserve must be done on the third day of your period. In addition, a hysterosalpingogram (special x-ray of the uterus) may be performed to assess the inside of your uterus and look at whether the fallopian tubes are blocked. Your doctor will discuss which tests you should have.

Infertility evaluation for a man

A semen analysis is a key part of the initial evalutation. This test is done to assess the amount and shape of sperm, and how well it moves. A semen sample is obtained by masturbation, usually at home. Your partner can then bring the sample in a sterile container (provided by your doctor) to an infertility specialist (by appointment only). Talk to your doctor about the specifics to have this test performed.

Treatment

The appropriate treatment for infertility depends on the cause. If a cause is not found, there are still many treatments. Often, your doctor may start with a medication that stimulates ovulation, called ovulation induction. Depending on your situation, your doctor may refer you to a reproductive endocrinologist or infertility specialist.

Menopause

Menopause is the time in your life when you naturally stop having menstrual periods because the ovaries stop making estrogen. The average age of menopause is about age 52. Perimenopause is what we call the years leading up to menopause when your estrogen is starting to decrease. Perimenopause usually starts in your 40s, for most women. During perimenopause, you may notice changes in your menstrual cycle. Periods may become irregular, heavier or lighter. You may also develop hot flashes, sleep difficulties, night sweats, vaginal dryness or pain with intercourse. Some women have many of these symptoms during perimenopause and some women do not. Some women require treatment for perimenopausal symptoms. Both hormonal and non-hormonal treatments are available. Please talk to your doctor if you are experiencing any symptoms that are bothering you, either at your routine gynecology visits or please call to make an appointment at any time.