You might not have heard of pessaries before, but they’ve been around in one form or another for centuries. These small, removable devices are inserted into the vagina to provide non-surgical relief for pelvic organ prolapse (POP). They are also far more common (and simple to use) than you may expect.

Pessaries and Pelvic Organ Prolapse (POP)

The muscles and tissues that support the pelvic organs (including the bladder, uterus, cervix, vagina, and rectum) hang together much like a hammock. “A prolapse happens,” the Office on Women’s Health explains, “when the pelvis muscles and tissues can no longer support these organs because [they] are weak or damaged.” As a result, one or more of these pelvic organs may drop from its standard position, or even press into or out of the vagina.

This type of pelvic floor disorder can involve:

  • Urinary incontinence (leaking of urine)
  • Fecal incontinence (leaking of stool)
  • Weakening of the muscles and tissues supporting the organs in the pelvis
  • Pain during intercourse
  • A feeling of heaviness or pressure in the vagina

According to the National Association for Continence, “In addition to childbirth, risk factors for the development of POP include a family history of POP, obesity, advancing age, prior hysterectomy, and conditions that chronically increase intra-abdominal pressure, such as asthma or constipation.”

Though some women opt for surgical solutions to POP, pessaries are less invasive—providing support for the prolapse, or filling gaps caused by it.

Besides providing symptom relief and improved quality of life, pessaries are also fairly easy to maintain. A study reported in the Journal of Obstetrics and Gynecology Canada concludes that any major complications were the result of cleaning and maintenance neglect, and any “Minor complications such as vaginal discharge, odor, and erosions can usually be successfully treated.”

Pessary History and Composition

POP is described in the Egyptian Kahun Gynaecological Papyrus — the oldest documented medical literature we know of. But it wasn’t until the end of the sixteenth century that pessaries became more widely and safely used. Early versions were composed of wax, wood, glass, metal, leather and even Bakelite.

The main difficulty surrounding the first pessaries was that they were made from materials that could decompose within the body. The first “incorruptible” pessary was developed in 1844, “when Charles Goodyear was granted U.S. patent no. 3,633 for the invention of vulcanized rubber,” as described in a 2012 article published by Hindawi.

Currently, there are three types of pessaries: the doughnut pessary, ring pessary with support, and Gelhorn pessary. Generally, these are made of silicone, and are easy to remove and replace for cleaning.

Which one is best for your body? The Global Library of Women’s Medicines advises that “The choice of pessary depends on a variety of factors including type and degree of prolapse . . . the type of pessary the clinician has available . . .  and whether the patient desires to manage her pessary at home, as some pessaries cannot be self-removed.” But consultation with your gynecologist can help determine the best solution.

If you’re concerned about POP symptoms, curious about a pessary fitting, or would like to discuss other options for POP relief including a routine for pelvic floor exercises, contact our team at (404) 352-2850 or schedule an appointment online for a consultation.

Short for loop electrosurgical excision procedure, LEEP is a process in which an electrically heated wire loop is used to remove tissue from a woman’s lower genital tract. The thin wire loop acts as a surgical knife, removing a small layer of the tissue with precision. After removing abnormal tissue from the cervix or vagina, practitioners can send the sample to the lab for testing. Here’s a closer look at what the process entails and why it’s performed.

Who might need a LEEP?

According to Johns Hopkins Medicine, LEEP is performed to:

  • Test for cervical or vaginal problems after abnormalities are detected during a pelvic exam or Pap test
  • Remove abnormal precancerous cells from the vagina or cervix to prevent cancer from developing
  • Diagnose or treat polyps, genital warts, or abnormal cells caused by exposure to diethylstilbestrol (DES) — a synthetic form of estrogen that was sometimes prescribed between 1940-1971 to pregnant women. (DES exposure is known to increase cancer risk in the daughters of women who used it during their pregnancies.)

How can you prepare for a LEEP?

LEEP generally requires neither prior fasting nor procedural sedation, but you may be advised to avoid tampons, douching, or having sex directly before the procedure. Oftentimes, the procedure is scheduled for a time when you won’t be on your period, as this allows for a better view of the cervix. You may be encouraged to take an over-the-counter pain reliever a half hour before the procedure.

What does the LEEP entail?

LEEP can be performed right in the doctor’s office in most cases. It should take no longer than a few minutes. You’ll be asked to place your legs in stirrups, and the doctor will insert a speculum (the same tool used during routine pelvic exams) into your vagina.

A local anesthetic will be administered to prevent any pain. While this may produce a slight, initial sting, any discomfort should be minimal thereafter.

The doctor will then insert the loop, remove the tissue, and apply a paste or use electrocautery to stop the bleeding. You may also be asked to sit and rest for 10 to 15 minutes after the procedure.

What is recovery like?

According to the experts at Memorial Sloan Kettering, it’s normal to experience brown discharge for one to two days following LEEP. You may have vaginal bleeding several days later, but use pads instead of tampons for absorption, as nothing should be inserted into the vagina for at least two weeks.

Be sure to call your doctor if you experience heavy vaginal bleeding or if you’re passing clots. While you can shower as usual, avoid baths unless your doctor directs you otherwise.

Physical activity such as aerobic exercise should be avoided for two weeks. You may also notice that your first period after the procedure is heavier or later than normal.

What are the next steps?

LEEP is effective in removing all abnormal cells most of the time. You’ll have follow-up visits with your doctor to be sure all targeted cells have been removed and that they have not returned. If all cells haven’t been removed, a subsequent LEEP or different treatments may be required.

Routine pap tests screen for abnormal cells and are important aspects of preventive women’s care. If you’re due for your annual exam, contact our team at (404) 352-2850 or schedule an appointment online. Our team also offers LEEP as an in-office procedure, as a quick and efficient way to remove abnormal cervical cells. Find out more about all of our office procedures.

Sure, it’s a complicated word to spell and pronounce. But a colposcopy is also a beneficial test your healthcare provider may employ to view your cervix—the opening to your uterus—and vagina more closely than is possible during a typical physical exam.

Why might you need this procedure? If problems or abnormal cells are found during a pelvic exam or Pap test, a colposcopy may help your doctor better assess what’s behind any abnormal blood vessels, tissue structure, color, and patterns.

According to Johns Hopkins Medicine, a colposcopy can assist in the treatment of:

  • Bleeding
  • Polyps (noncancerous growths)
  • Genital warts (which could suggest infection with human papillomavirus (HPV), a risk factor for developing cervical cancer)
  • Diethylstilbestrol (DES) exposure, which possibly raises the risk for cancer of the reproductive system in women whose mothers took DES during pregnancy

Your healthcare provider may also have other reasons to recommend this procedure, which you can and should discuss with them.

So, What Should You Expect?

A colposcopy is often carried out in a hospital clinic, but it can also be done in the office of your gynecologist or primary care doctor. It takes around 15 to 20 minutes, and there is no extra anticipated time for recovery.

Your healthcare provider may suggest you avoid vaginal sex, using tampons or other products that go into the vagina itself for 24 – 48 hours before the procedure.

Both the NHS.UK and Johns Hopkins Medicine help to further break down the colposcopy procedure in these ways:

  • You’ll be asked to undress from the waist down and lie down in a chair with padded supports for your legs
  • Empty your bladder before the procedure
  • A device called a speculum will be inserted into your vagina and gently opened to expose your cervix – similar to having a cervical screening test
  • The colposcope (a microscope with a light on the end) will be positioned to look at your cervix. It does not go into your vagina
  • If necessary, your health care provider may wash your cervix with a vinegar solution to highlight any abnormal areas. A Schiller test (involving an iodine solution) may also be conducted at this time. You may feel a mild tingling or burning sensation when either of these solutions are applied
  • If necessary, a small sample of tissue (a biopsy) may be removed for closer examination in a laboratory. This should not be particularly painful. You may feel a pinch or stinging sensation, which could also cause brief cramping afterward.

Post-Biopsy and Post Procedure

“If a biopsy taken during your colposcopy shows that you have precancerous tissue, the tissue may need to be removed to keep cancer from developing,” explains the experts at Cancer.net. They, like us, encourage open communication with your doctor about alternate tests available for a more specific cancer diagnosis, and, if necessary, the different tissue removal methods that may be right for you.

Aside from these potentially scary and challenging conversations around possible biopsy results, in general, there are no direct side effects from the colposcopy itself. For a day or two afterward, you might experience a dark vaginal discharge if a biopsy proves necessary, but that comes from the solution used to reduce bleeding during the biopsy process.

Other possible mild, post-biopsy symptoms include bleeding, cramping, or soreness. We encourage you to reach out to your doctor right away if these symptoms worsen or don’t go away, and especially if you have extremely heavy bleeding, fever after the examination, or severe pain in your lower abdomen or pelvis.

Event tests that are simple to pronounce can be difficult to discuss, but the experts at Avant Gynecology are here for you. If you have further questions about the colposcopy process (or anything else), reach out to the experts at Avant Gynecology or by giving us a call at 404-352-2850.

Congratulations to Dr. Lynley Durrett and Dr. Obiamaka Mora for receiving Top Doctors honors in Atlanta magazine’s July issue!

Dr. Durrett has been practicing obstetrics and gynecology for more than 20 years and has been annually recognized as a Top Doctor in the publication since 2010.

Dr. Mora joined McDaniel and Durrett Gynecology in 2012 and oversaw the transition to Avant Gynecology in 2018. She has been recognized as an Atlanta Top Doctor in the publication for two years.

Both Dr. Durrett and Dr. Mora are currently seeing and accepting new patients at the Buckhead office located on the Piedmont Hospital campus.

Atlanta magazine works with Castle Connolly Medical Ltd., a healthcare research company based in New York, to assist in its annual effort. Doctors are nominated for consideration through both a nationwide survey and a peer nomination process. Castle Connolly’s physician-led team of researchers then select the Top Doctors through a rigorous screening process that includes an evaluation of educational and professional experience. This year the publication honors physicians representing the following counties: DeKalb, Fulton, Cobb, Clayton, Gwinnett, Carroll, Cherokee, Coweta, Douglas, Fayette, Forsyth, Hall, Henry, and Rockdale.

“Receiving this type of recognition from my physician peers means so much to me,” says Dr. Durrett. “My ultimate goal is to be the best gynecologist I can be for the sake of my patients. I’m grateful for the honor, but more importantly, thankful for the privilege to serve.”

Dr. Mora echoes those sentiments. “Women’s health is my passion,” she says, “and I wouldn’t be able to accept an acknowledgment such as this without a patient population willing to trust me with their health and well-being.”

Drs. Durrett and Mora’s professional expertise include minimally invasive and robotic techniques with interests in vaginal prolapse treatment, pelvic reconstructive surgery, bio-identical hormone replacement therapy, symptomatic fibroid management, and endometriosis management. They are also both members of the American College of Obstetricians and Gynecologists (ACOG) and the American Medical Association (AMA).

Make an appointment with Atlanta’s Top Doctors at Avant Gynecology on our website or by giving us a call at 404-352-2850.

A hysterectomy is the surgical removal of the uterus — one of the most commonly performed surgeries in women. In fact, it’s estimated that one in nine women will undergo this procedure, which is performed to treat conditions such as:

  • Fibroids
  • Endometriosis that isn’t cured my medication or less invasive surgeries
  • Uterine prolapse
  • Persistent vaginal bleeding
  • Chronic pelvic pain
  • Cancer

There are several ways surgeons can perform a hysterectomy, and the type of procedure used will depend on each patient’s specific circumstances. Traditionally, an abdominal hysterectomy has been the most common practice. During this procedure, a large incision is made in the lower abdomen, and the uterus is extracted through it.

With medical advancements, the less invasive vaginal hysterectomy is now widely practiced. The difference in this procedure is that a small incision is made in the vagina instead of the abdomen, and the uterus is removed that way.

Benefits of Vaginal Hysterectomies

According to the American College of Obstetricians and Gynecologists (ACOG), vaginal hysterectomies are associated with better outcomes compared to other approaches. Because the process is less invasive, vaginal hysterectomies often have a faster surgical time and shorter hospital stays. This could also mean a reduced risk of complications.

The ACOG also notes that the time span for overall healing and recovery from this type of hysterectomy is often shorter, which means a quicker return to normal activity.

Candidates for Vaginal Hysterectomies

While this may sound like an obviously easier procedure, it’s not ideal for everyone.

A vaginal hysterectomy may not be appropriate, for example, if you have an enlarged uterus or scarring from previous surgeries. Those with cancer or suspected cancer in a reproductive organ, or large uterine fibroids, or endometriosis may also be advised to undergo an alternate method.

Vaginal Hysterectomy Recovery

You may experience several changes after a hysterectomy, including loss of periods. But if your ovaries remain intact, you shouldn’t encounter any other related hormonal fluctuations.

In some instances, the ovaries may be removed during a hysterectomy, to reduce the risk of ovarian cancer. If this is so, your body will undergo menopause shortly after the surgery. This may include symptoms such as hot flashes, vaginal dryness, mood changes, and changes in the libido. If your symptoms interfere with your daily life, talk to your doctor about options for managing them.

During recovery, give yourself plenty of time to rest so your body can heal. You may experience bloody vaginal discharge for several days or weeks, and your doctor may advise you to use sanitary napkins. You can also discuss pain management options with your health specialist, to reduce any discomfort during the recovery period.

While a little physical activity each day may be beneficial, avoid lifting anything heavier than ten pounds for at least four weeks. Your doctor may have more specific recovery instructions, so be sure to follow them precisely.

If you’re experiencing any of the health issues discusses above and you want to discuss the option of a hysterectomy, schedule an appointment with one of our providers by calling (404)-352-2850. You can also learn more about our surgical services online.

On Sunday, May 23, 2021, Avant Gynecology’s Dr. Lynley Durrett and Dr. Obiamaka Mora were featured guests on The Weekly Check-Up on News/Talk WSB Radio.

During the show, Drs. Durrett and Mora discussed women’s health topics with host Ashley Frasca. Topics included uterine fibroid treatment, hormone replacement therapy, mammography, robotic-assisted surgeries, IUDs, COVID-19 vaccinations, and the importance of annual healthcare visits. They also took several questions from callers.

You can listen to the full show below.

Tune into The Weekly Check-Up every Sunday from 3 to 5 p.m. on AM 750 and NOW 95.5 FM News/Talk WSB, or stream online at WSBRadio.com.

Laparoscopic surgery is a procedure that uses a small, lighted camera known as a laparoscope to give surgeons access to the abdominal or pelvic area. The procedure is also known as keyhole surgery, due to the size of the incisions made: typically, these cuts are no more than a half-inch in length. As a form of minimally invasive surgery, this approach has several benefits for patients and can be used for a range of diagnostic applications and treatments.

What Types of Procedures Can Be Done Laparoscopically?

A laparoscopy is an important tool for a variety of specialists, including gynecologists, as it allows doctors to diagnose and treat conditions within your reproductive system.

While blood work and imaging services can reveal many insights into a potential reproductive condition, images retrieved by a laparoscope provide doctors with a much more detailed look into the affected area.

Laparoscopy can also be used to treat specific conditions. Some examples of gynecological laparoscopic surgeries include:

  • Removal of fibroids in or around the uterus, or cysts that may develop on the ovaries
  • Treatment of endometriosis — a condition of abnormal tissue growth outside the uterus
  • Hysterectomy (removal of the uterus, conducted to treat abnormal bleeding, cancer, and other conditions)
  • Tubal ligation to prevent pregnancy
  • Treatment of pelvic prolapse
  • Treatment of incontinence

What Are the Benefits of Laparoscopic Surgery?

Laparoscopic procedures have several benefits over traditional surgeries. In general, patients experience:

  • Smaller external scars and less internal scarring
  • Reduced pain and quicker healing
  • Quicker return to normal activities
  • Shorter hospital stays

What Can You Expect From Laparoscopic Surgery?

Laparoscopic surgeries are typically performed under general anesthesia, in which the patient is unconscious and experiences no pain. The anesthetic medication can either be inhaled through a mask or delivered intravenously.

Once you’re unconscious, the surgeon will make a small incision — usually through the belly button. The laparoscope is then inserted through this space. If any other surgical instruments are required to perform the procedure, these will be inserted through other separate, small incisions also made in the abdomen. (One common example of this is a gas inserted via tube, which provides the surgeon with ample space within which to work and view the area.)

After performing the necessary procedure, any gas used will be released, and the minor incisions will be closed up with Steri-strips to aid with healing. You’ll then be transferred to a recovery area, where you may stay for about an hour, for recuperation and monitoring. Since the anesthesia can cause drowsiness, you should avoid driving for 24 hours following the procedure. Make sure to have a friend or family member to get you home.

While recovery may depend on the exact nature of the procedure, most patients can remove their Steri-strips two to three days after surgery. (Be sure to follow your doctor’s instructions on this.) You’ll likely be able to return to work three days after the procedure.

It’s possible you may experience some discomfort in the neck, chest, and shoulder areas, caused by the gas. Moving around, taking a warm shower, and using a heating pad can help relieve this symptom. If you experience nausea, consider eating something light — such as soup and crackers —in the evening after the procedure.

If you think you might be a good candidate for laparoscopic surgery, or want to discuss the process further, turn to Avant Gynecology. Find out more about our hospital procedures by reaching out to the experts at Avant Gynecology or giving us a call at (404) 352-2850 to schedule an appointment.

It can be a frightening experience hearing your gynecologist say that your Pap smear test results came back abnormal. While it can be tempting to jump to negative conclusions about what your results mean, it’s important to not worry quite yet. Abnormal Pap smears do not always indicate issues as serious as cervical cancer. The experts at Avant Gynecology break down what these results mean.

What Does an Abnormal Pap Smear Result Mean?

An abnormal Pap smear can have several different meanings and causes, but often indicate changes in the cervical cells. Some other causes for an abnormal result are:

  • Inflammation
  • Herpes
  • Trichomaniasis
  • Human Papillomavirus (HPV)
  • Vaginal Infection
  • Cervical Dysplasia (abnormal cells that can be pre-cancerous)

While some of these may bring concern, there are several harmless reasons as to why a Pap smear can come back abnormal such as recent sexual activity, menstruation, using tampons, or taking a bath before your test. Additionally, it’s relatively common for most women to experience an abnormal result at some point in their lifetime.

More Testing to Discover Results

While a Pap smear can indicate when abnormal cells are present, it does not give a full examination of the cervix. Often, more testing is needed. That’s what a colposcopy is for! This minor procedure allows an OB-GYN physician to use a low-powered microscope to study the abnormal areas in the cervix, vagina, and vulva to detect any signs of disease. During this procedure, the following happens:

  • A similar tool as the one used in your Pap smear will be placed into the vagina.
  • Several different solutions will be used to highlight the area.
    • A vinegar solution: This removes the mucus in the area.
    • An iodine solution: This identifies the abnormal areas that appeared in the Pap smear.

Once the colposcopy test results are in, your physician will go over the results with a pathologist. Together, the two will determine the next steps for uncovering the issue and potential treatment plans.

While Pap smears are not always comfortable, they are essential. The American College of Obstetrics and Gynecologists (ACOG) recommends that:

  • Women ages 21 to 29 should get a Pap test every three years.
  • Women ages 30 to 65 should have a Pap test combined with an HPV test every five years.
  • Some women with certain conditions may need more frequent testing, including women with a history of cervical cancer, HIV/AIDS, or a weekend immune system.

Be proactive about your health; schedule a Pap smear with your OB-GYN today. If you have any further questions about the next steps after receiving abnormal Pap smear results, reach out to the experts at Avant Gynecology or give us a call at 404-352-2850.

The pelvic muscles support the bladder, bowel, and uterus; playing an important role in sexual function and childbirth, according to Healthline.

Pelvic floor exercises are an excellent solution for strengthening these muscles. They can also help improve conditions like urinary incontinence and pelvic organ prolapse.

Want to learn more? The experts at Avant Gynecology explain the benefits of pelvic floor exercises.

The Benefits of Pelvic Floor Exercises

Here are some of the primary benefits of performing pelvic floor exercises:

  • Increases pleasure and reduces pain during sex
  • Makes the child birthing process easier and decreases chances of incontinence after childbirth
  • Makes passing urine and feces through the body easier
  • Prevents pelvic floor prolapse
  • Help treat urinary incontinence
  • Strengthens support for your baby while pregnant

Why Do These Exercises?

For women experiencing urinary incontinence or pain during sex, pelvic floor exercises are often recommended by medical experts to help resolve these issues. Research also suggests that these exercises reduce the frequency and severity of symptoms of pelvic floor prolapse.

Even if you are not experiencing any of the conditions mentioned above, pelvic floor exercises are still beneficial for your overall health and should be an integral part of your daily exercise.

Types of Pelvic Floor Exercises

Below are three of the most common exercises that can help strengthen your pelvic floor muscles:

Kegel: The most popular form of exercise for the pelvic floor muscles are Kegels. To do these, you will need to contract the pelvic floor muscles, hold for five seconds, then release for five seconds. Repeat this exercise at least 3 times a day in sets of 10.

Squats: Besides strengthening your quads and hamstrings, squats also strengthen pelvic floor muscles. To do a squat, stand upright with your feet shoulder-width apart, bend your knees like you’re about to sit down in a chair, and push yourself back up. Repeat this exercise 3 times a day in sets of 10.

Bridge: Bridges are primarily performed to strengthen the buttocks, but can also help the pelvic floor muscles. To do a bridge, lie down on the floor with your knees bent at a 90-degree angle. Push your hips off the ground by squeezing your glutes and your pelvic floor muscles. Hold this for at least three seconds, then slowly release it back to the ground. Repeat this exercise at least 3 times a day in sets of 10.

If you have any questions or want to learn more about pelvic floor exercises, reach out to the experts at Avant Gynecology on our website or by calling us at 404-352-2850.

On Sunday, February 7, 2021, Avant Gynecology’s Dr. Lynley Durrett and Dr. Obiamaka Mora—both honorees of the 2020 Castle Connolly and Atlanta magazine “Top Docs” list — returned as guests on The Weekly Check-Up on News/Talk WSB Radio.

During the show, Dr. Durrett and Dr. Mora discussed women’s health topics with host, Ashley Frasca, including hormone replacement therapy, contraception, vaginal rejuvenation, uterine fibroids, and took several questions from callers.

Drs. Durrett and Mora were also joined by Dr. Jessica Shepherd, M.D., MBA, an OB/GYN and women’s health expert, to discuss Acessa — a minimally invasive procedure available for the treatment of fibroids—now available at Avant Gynecology.

You can listen to the full show below.