Comprehensive Gynecologic Care from Adolescence through Menopause

Your well woman visit includes a pelvic and breast exam, screen for diseases, assessment of your general lifestyle, and plans for reproduction or contraception. Well woman visits give you the opportunity to ask questions and to express and explore any concerns you may have about your reproductive health in general. When appropriate, perimenopause and menopause issues are addressed and treated at the well woman visit.

A Pap smear  determines whether there are abnormal cells on or in the cervix/vagina. This procedure can screen for precancerous or cancerous cells present in the cervix/vagina. It is also possible to test for the presence of HPV (Human Papilloma Virus) and STIs with a Pap smear.

A breast exam is a preventive physical exam used to asses the presence of lumps and other changes in the breasts. For additional screening or diagnosis, women may be referred for mammography.

Hormonal birth control is most frequently taken in the form of oral contraceptives, daily hormone pills that prevent pregnancy by preventing ovulation. Other methods of hormonal birth control include vaginal rings, implants, or patches.

Intrauterine devices are the most highly effective form of reversible birth control and just one can prevent pregnancy for 3 - 10 years. They are small devices that are inserted directly into the uterus. If pregnancy is desired, IUDs can safely and easily be removed with an office visit.

Tubal ligation is a surgical procedure in which the fallopian tubes are sealed off or clamped to prevent eggs from passing through the fallopian tubes. It is considered a permanent form of birth control.

The cervix is the small organ that forms the opening of the uterus. It is the organ through which a baby exits the uterus during childbirth and through which blood passes from the uterus during menstruation. Most conditions of the cervix are detected during gynecological exams using special tools to see the cervix.

• Abnormal Pap smears
• Cysts/polyps
• Cancer
• Fibroids/myomas
• Cervicitis
• HPV

The typical female body produces a mixture of hormones – including estrogen, progesterone, and androgens – to trigger puberty, to regulate ovulation and menstruation, and to prepare the body for pregnancy. However, an imbalance of hormones can cause unpleasant symptoms or even painful conditions. Hormonal conditions can cause unwanted facial hair, acne, fatigue, weight gain, or an overgrowth of ovarian cysts (Polycystic Ovarian Syndrome). Many of these conditions can be treated with hormonal birth control. There are many methods available, including birth control pills and intrauterine devices.

The ovaries are two small glands located on either side of the uterus. They are responsible for releasing hormones that trigger the various stages of the menstrual cycle. They also play a role in the preparation for pregnancy. The ovaries are also responsible for producing and releasing eggs. Some  common conditions that may affect the ovaries:

• PCOS 
• Ovarian cancer

All women will at some point go through the process of perimenopause, a natural decline in reproductive hormones that affects most women in middle age, but some younger and some older as well. Many women experience uncomfortable symptoms during the transition to menopause and during menopause itself, including (but not limited to) breast changes, vaginal dryness, mood changes, sleep disorders, fatigue, joint pain, painful intercourse, night sweats, and hot flashes. We can help you determine whether the symptoms you are experiencing around perimenopause are normal versus something to be concerned about. In addition, we offer various treatments to help assuage the uncomfortable symptoms of menopause.

We offer tests for all common Sexually Transmitted Infections, in addition to treatments. Some of the most common STIs - chlamydia, gonorrhea, and syphilis - can be treated and cured with antibiotics. Other STIs - genital herpes and genital warts - are caused by viruses and treatments are available to help manage uncomfortable symptoms. HIV testing is also available.

The uterus is the central unit of the female reproductive system. It functions primarily to hold a developing baby after conception until birth. The inside layer of the uterus is called the endometrium. A woman’s period is the result of this bloody tissue inside the uterus thickening and shedding in cycles. Some common conditions that may affect the uterus:

• Prolapse
• Adhesions
• Malformations
• Polyps
• Adenomyosis
• Fibroids
• Abnormal bleeding
• Endometriosis

The vagina is the canal that provides a path to and from a woman’s uterus. The external face of the vagina is referred to as the vulva. Some conditions that commonly affect the vagina and vulva:

• Infections
• Vaginismus
• Lesions
• Abnormal bleeding
• Cysts

Conization can be used either for diagnostic purposes or for therapeutic purposes to remove abnormal cells from the cervix. Conization refers generally to the process of excising a cone-shaped sample of tissue from the cervix. Common conization procedures include Cone Biopsy and Laser of Cervix.

Endometrial ablation is an outpatient procedure used to treat heavy menstrual bleeding. There are many different causes of excessive uterine bleeding which are addressed prior to an ablation. In this procedure, a special device is used to destroy the endometrium, resulting in substantially lighter periods.

A hysteroscopy is used to diagnose or treat conditions of the uterus. The procedure involves inserting a narrow lens through the cervix, to allow a view of the inside of the uterus.

A hysterectomy is the surgical removal of the uterus. Salpingo-oophorectomy refers to the surgical removal of the fallopian tubes and ovaries. These procedures are often performed alongside one another but can be performed separately if the condition warrants. These procedures are performed most frequently to treat conditions of the uterus, including abnormal bleeding, chronic pain, and cancer.

Laparoscopy refers to a surgical procedure in which an instrument called a laparoscope is inserted into the pelvis through a small incision. Laparoscopy can be used to treat various conditions of the pelvic region and can also be used diagnostically to determine the presence of a condition such as endometriosis, inflammatory disease, or cancer.

Dilation and curettage (D&C) is a surgical procedure in which the uterine lining is scraped either to remove tissue or to take a sample for testing. The procedure involves first dilating the cervix and then scraping the inside of the uterus with a surgical tool. It is used for a number of reasons including to diagnose and treat conditions such as abnormal bleeding and other uterine conditions.

Tubal ligation is a surgical procedure in which the fallopian tubes are sealed off or clamped to prevent eggs from passing through the fallopian tubes. It is considered a permanent form of birth control. 

An in-office urine test along with an exam, and sometimes ultrasound,  are performed to confirm pregnancy.

Miscarriage, or the loss of a pregnancy, is a relatively common occurrence. Most often the cause is unknown. If a miscarriage is suspected, an in-office physical exam, and possibly an ultrasound, are performed for confirmation. Often a miscarriage can pass naturally, but medications may be prescribed to help the tissue pass more easily. A surgical procedure may be necessary in some situations.

An ectopic pregnancy is a dangerous and potentially life-threatening condition in which a fertilized egg implants and begins growing somewhere outside the uterus, most often in the fallopian tube. An ectopic pregnancy is not a viable pregnancy. It can be managed with medical treatment or by surgical means. The greatest danger posed by an ectopic pregnancy is the growth of the zygote causing the fallopian tube to rupture, leading to severe internal bleeding.

Difficulties getting pregnant can sometimes be resolved with diagnosis and treatment of conditions that affect fertility, such as endometriosis, ovulation disruptions, or other factors affecting the reproductive organs or hormonal system. Dr. Wolanski treats many infertility conditions and when appropriate refers patients for Assisted Reproductive Care.