Gynecology

A Lifetime of Care

We understand women’s health issues and pride ourselves in the continuity of care we provide our patients. Our special bond with our patients often begins with a young woman’s first well-woman visit, through childbearing years, and into menopause and beyond. At Dominion Women’s Health, our gynecologists care for various conditions including endometriosis, fibroids, incontinence, heavy/painful periods, hormone replacement therapy and other women’s issues. Annual exams for prevention of serious health concerns are also performed in office as well as other procedures.

Your Annual Visit

General Exam and Medical History

Each visit begins with an update of your medical history and a general exam. During the general exam, we measure your height and weight, check your blood pressure, pulse rate, and listen to your heart. This gives us a “baseline” and an ongoing way to measure changes in your unique health from visit to visit. A general exam also alerts us to other potential health problems you may not know about. We’ll also talk with you about how you feel overall, any concerns you have, and issues you want to discuss, like maybe you’re thinking of starting a family, or want to try a different contraceptive. We’re here for you so please don’t hesitate to talk with us.

Breast Exam

Your gynecologist performs a physical exam of your breasts by pressing gently on each breast, moving them, feeling for lumps, and inspecting their appearance. A physical exam of the breasts is one of the best ways to detect abnormalities. Many women naturally have “lumps” and marks. This physical exam allows us to find out what’s normal for you and where those “lumps and bumps” are located, helping to make it easier to notice changes. We will perform a physical breast exam each time at your annual exam, regardless of your age, even if you’re getting routine mammograms.

Whatever your age or stage in life, please perform a monthly self-exam of your breasts. If you have any questions about how to do it the right way and what to feel for, please don’t hesitate to ask. Breast self-exams are one of the easiest yet most important things you can do for yourself. And, remember to contact us if you find something that concerns you.

Gynecological Exam & Prevention

First, your gynecologist will perform perform a pelvic exam by looking and feeling inside the pelvis. A Pap test, also called a Pap smear, is taken which is a painless swab from the cervix and vagina to detect changes. The cells are examined in a lab to see if there are abnormal cells (called dysplasia) which could lead to cervical cancer.

Generally, a Pap test is recommended for women starting at age 25. How often you need a Pap test depends on many things including your age and medical history. Previously the standard was for all women to have an annual Pap test but this was recently amended. We’ll talk with you about your situation and together, we’ll decide what’s best for your health and the frequency of your tests.

Your screening may also include a test for HPV (human papillomavirus) which should begin once you become sexually active. HPV is the name of a group of viruses; some of them are linked to problems such as genital warts, pre-cancerous lesions, and cancers of the cervix, vagina, and other areas. If something is found during your exam that needs more examination, we’ll contact you and talk about the next steps. You may need diagnostic tests depending on what we find.

Dominion Women’s Health offers Gardasil®, a vaccine that helps prevent certain diseases caused by HPV. Gardasil® is recommended for girls and women from ages 13 through 26. It’s a series of 3 injections: the first is followed by the second injection 2 months later; the third injection is given 4 months after the second.

Contraceptives

There are many types of safe, effective contraceptives available. We offer the full range of methods from barrier methods, to pills, patches, and reversible implants. We’re glad to discuss all types of contraceptives, including non-prescription methods. Not every method works well for every woman. There are pros and cons to each, potential side effects, and personal preferences to consider. Together, we’ll find what’s right for you and your stage in life. It’s not uncommon for a woman to try different methods throughout her productive years.

The following are methods we offer, all require a prescription after discussing with your doctor or nurse practitioner.

Birth control pills We provide prescriptions for the full range of options:

21-day pills (1 pill daily, same time of day for 21 days with 7 days off, then start a new 21 day dose)
28-day pills (1 pill daily, same time for 28 days, the pill’s estrogen and progestin levels change during the 28 days)
90-day pills (1 pill daily, same time for 90 days, with your period every 3 months)
365-day pills (1 taken daily, same time, year-round, your period may become lighter or might even stop).

Intrauterine device (IUD) A small device inserted into your uterus by your doctor to prevent pregnancy. Your physician must remove it when you plan to become pregnant or when the time is right. IUDs can stay in for years depending on the type, and can be removed at any time by their doctor. Each must be removed at some point by their doctor since they may loose their effectiveness over time. There are many brand including: Mirena, Liletta, & ParaGard. Some release hormones while others don’t.

Implant Using a needle inserted into your arm, a small thin flexible tube is placed. This releases hormones to prevent pregnancy for up to 3 years. Learn more about Nexplanon & talk to your gynecologist to see if this is right for you.

Vaginal ring A flexible, lightweight ring that you insert vaginally. It slowly releases hormones that are absorbed through vaginal tissue. It’s generally worn for 21 days, removed for 7 (you’ll get your period), then you insert a new ring.

Skin patch A small, adhesive patch you apply to a selected area of skin. The patch releases hormones that are absorbed through the skin. You change the patch weekly for 3 weeks with one week off.

Permanent contraception Permanent procedures such as a tubal ligation surgery should be done with very careful consideration and not made under stress or pressure. They may be performed through laparoscopy at an outpatient facility or as an in-office procedure using the Essure® procedure, a permanent, non-surgical birth control method.

Essure procedure Your physician places a soft flexible insert into each fallopian tube. Over several months, these inserts work with your body to form a natural barrier that blocks sperm from entering the tubes. After 3 months, your physician performs tests to ensure your tubes are blocked. Until your physician confirms the tubes are blocked, you use another form of contraception.

If you’re interested in permanent contraception, we’re glad to discuss these procedures with you so you can make a thoughtful, informed decision. Please note that hysterectomies are performed for medical necessity.

Treatment and Management of Problems and Conditions

We specialize in treating and managing conditions from the most complex to the most common, like painful cramping. The following are among the most common:

Premenstrual Mood Disorder

Many women have physical and emotional problems in the days leading up to their periods. Premenstrual mood disorder is when these problems are severe and happen every month. It may require treatment when it negatively affects your relationships or ability to work. PMD can mimic other serious problems like depression. Diagnostics

An excellent way to help us find out what’s going on is for you to keep a record of your symptoms and how you feel. Record them daily for at least 2-3 months and share that record with us.

Endometriosis Evaluation and Management

Endometriosis is a condition where tissue that forms in the lining of the uterus is found outside the uterus. It can also be found in the ovaries, fallopian tubes, bladder, and other areas. This tissue can swell, become inflamed and irritated, and cause scar tissue. It can be painful and is also linked to infertility. To learn more about endometriosis, watch the video below to hear Dr.Danny Shaban discuss this condition.

Pelvic exam is usually done first to determine if endometriosis is the cause of your problems.
Next, we need to visualize the endometriosis. A procedure called a laparoscopy confirms the condition which typically is not painful.

Treatments

Medication such as non-steroidal anti-inflammatory drugs (NSAIDs) are usually tried first if pain the main problem.
Hormone medications can help slow the growth of endometrial tissue and may prevent new tissue from forming. This will not get get rid of the problem but may prevent or slow the growth of new tissue.
Birth control pills.
Surgery, including removal of the tissue or a hysterectomy, may be a last resort.