Office Procedures

Annual Exams

Annual exams focus on preventive health assessments including a PAP test (depending upon a patient’s age and risk factors), pelvic exam, breast exam and any necessary laboratory testing, STD testing and medication management. Our providers will use this time to review the recommended preventive health measures based on your age and presence of risk factors.
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Hormone Pellets

Pellets provide an alternative method of receiving hormones, particularly estradiol and/or testosterone. Hormone pellet therapy is usually suggested for you after traditional methods for hormone replacement have failed. Pellets are made by a compounding pharmacy and contain either bioidentical estradiol or bioidentical testosterone hormone.

The pellets are about the size of a grain of rice and are inserted into the hip or buttocks in a simple, relatively painless procedure following the injection of a local anesthetic. The pellets slowly release hormones over the next several months, relieving many of the most common symptoms associated with menopause and hormone imbalance.

The advantage of hormone pellets over more traditional forms of Hormone Replacement Therapy (HRT) is that pellets are hassle-free and provide a consistent, more physiologic release of hormones. Usually, it only takes 1-3 days to obtain relief of menopausal symptoms after pellet insertion, and the positive effects can last from 3-6 months.
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A colposcopy may be indicated if you have been diagnosed with an abnormal pap test. The Pap test is a screening measure and not diagnostic of cervical dysplasia (abnormal or pre-cancerous cells). The colposcopy is needed to take a small biopsy of the cervix, so the tissue can be evaluated by a pathologist.

A colposcopy is performed in the office and takes approximately 15 minutes. The provider performing the colposcopy will place a speculum in your vagina and view your cervix through a colposcope. A colposcope is an instrument much like a microscope that allows the provider to see minor changes of the cervix that is not visible to the naked eye. Very small biopsies will then be taken, so the tissue can be examined by a pathologist.

If cervical dysplasia is found on colposcopy, your provider will likely suggest some form of intervention depending upon the severity of dysplasia. This may include repeating the pap test, a LEEP, cryotherapy or TCA treatment.


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Cryotherapy is a treatment for cervical dysplasia (pre-cancerous cells) and genital warts. This procedure involves freezing of the abnormal tissue with a small, metal probe that cools to sub-zero temperatures using liquid nitrogen. The abnormal cells are destroyed during this process, and your body will shed these cells in a watery discharge over the next few weeks.

Cryotherapy is performed in the office without any need for anesthesia. You may experience some cramping and a cold or hot sensation during the procedure.


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Loop Electrosurgical Excision (LEEP)

A LEEP is a well-tolerated office procedure that removes abnormal cells from the cervix and minimizes the risk of developing cervical cancer. Prior to the LEEP, the cervix will be numbed with a local anesthetic. A thin-wire loop transmits electric energy and cuts away a thin layer of surface cells from the cervix. This procedure is about 90-95% effective in treating cervical dysplasia.

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Endometrial Biopsy

Endometrial biopsies are useful in determining the cause of abnormal uterine bleeding and post-menopausal bleeding. The biopsy results may indicate if endometrial hyperplasia, atypical or cancer cells are present.

This procedure is most often performed in the office. A small, plastic tube with a “mascara-like” brush is gently passed through the cervix and into the uterine cavity. The brush collects a sample of the uterine lining, and the specimen is sent to pathology for evaluation.

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Endometrial Ablation

Endometrial ablation is indicated for the treatment of heavy, abnormal uterine bleeding of benign cause in pre-menopausal women who do not desire future fertility. In the appropriate patients, endometrial ablation is a safe and effective alternative to hormonal treatments for heavy bleeding and often prevents the need for future hysterectomy.

The procedure is relatively quick (15-20 minutes), free of incisions and results in little to no pain following the procedure. Endometrial ablations are performed in the office with local anesthesia or in an out-patient facility. Return to regular activities can occur in just 1-2 days after the procedure.

The vast majority of women report lighter periods after an endometrial ablation, and many women stop having periods all together. This procedure will not affect your hormones in any way and will not resolve any hormonal symptoms you may be experiencing. It is important to use an effective method of contraception following an endometrial ablation, as you should avoid pregnancy after having this procedure.

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Dilatation and Curettage (D&C)

Dilatation and curettage (D&C) is a common procedure most often performed when irregular, heavy, and/or post-menopausal bleeding is present. It can also be indicated after an incomplete miscarriage or if abnormalities are seen on imaging within the uterine lining, such as endometrial polyps or small fibroids. This procedure involves dilating the cervix and using a curette to remove endometrial (uterine lining) tissue for examination by a pathologist.

This procedure can be performed in the office with local anesthesia or in the outpatient setting. Recovery is very quick and you should be back to regular activities in a day or two.

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Vulvar Surgery

A labiaplasty is a surgical reduction of the inner labia to enhance comfort and improve cosmetic appearance. This procedure will result in smaller and more symmetrical labia. Labiaplasty can be performed in the office with local anesthesia and takes approximately 30 minutes.

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Pessary Fittings

A pessary is a plastic device that fits into the vagina and provides support to the uterus, vaginal walls, bladder and/or rectum if pelvic organ prolapse is present. When symptoms related to pelvic organ prolapse become bothersome, surgery is often indicated. However, a pessary can be a good option if it is desirable to delay surgery or avoid surgery. If the right pessary is fit properly, it can help reduce symptoms of pelvic organ prolapse, including urinary incontinence and vaginal pressure and bulging.

A pessary fitting can be performed during a regular office visit. Our providers will select a type and size pessary with consideration of your vaginal anatomy and the particular problems you are experiencing. Pessary fittings can be a trial and error process, and it may take a few tries to find the right fit.
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IUD Insertions

An IUD (intrauterine device) is a convenient, long-term, and reversible type of birth control option that is more than 99% effective in preventing pregnancy. There are two general types of IUDs available in the U.S., hormonal and non-hormonal. Hormonal IUDs contain progesterone and available brands include Mirena®, Kyleena®, Liletta® and Skyla®. The hormone-free IUD is called ParaGard®. Depending on the IUD selected, it can provide pregnancy protection for 3-10 years. Hormonal IUDs can also make your periods better by cutting down on cramps and lightening the menstrual flow. Some women stop getting periods at all with certain IUDs.

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Nexplanon® is a small, thin and flexible arm implant that provides up to 3 years of continuous birth control. It’s placed directly under the skin of your inner, upper arm with a quick and relatively painless procedure. It’s also reversible and can be removed by your health care provider at any time during the 3-year period.

Nexplanon® is more than 99% effective in preventing pregnancy. Common side effects include a change in your normal menstrual bleeding pattern. You may have longer or shorter bleeding during your cycle, spotting between periods and varied amounts of time between your periods.

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Sacral nerve stimulation with InterStim® therapy is indicated to reduce symptoms of overactive bladder, urge incontinence and urinary retention in patients who have failed or are unable to tolerate treatment with medications. InterStim® enhances the communication between the sacral nerves and the bladder with mild electrical pulses that are delivered by a small device placed under the skin of the upper buttock.

First, we recommend evaluation of your bladder condition with a urodynamic study. If sacral nerve stimulation is indicated, we will schedule an InterStim® trial where a temporary wire will be placed near the tailbone and a small stimulator device will be worn on the outside, like a paging device. If you experience a significant reduction in symptoms during the evaluation period of 3 to 7 days, a long-term neurostimulator can be placed under the skin during a minimally-invasive, outpatient procedure.

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Urgent PC®

Urgent PC® is a non-drug, non-surgical option for overactive bladder and associated symptoms of urinary urgency, urinary frequency and urge incontinence. This is an effective in-office treatment that delivers a specific type of neuromodulation that stimulate nerves along the leg and into the pelvis to regulate bladder function. During treatment, a small, slim needle electrode is inserted near your ankle. The needle electrode is connected to a battery-powered stimulator and mild impulses are sent through the electrode, along your leg to the nerves in your pelvis that control bladder function.

Urgent PC® treatment sessions typically last 30 minutes. It is recommended to have an initial series of 12 treatments scheduled about one week apart. If you have a good response with the initial treatment, you will likely need follow-up treatments every 1-2 months to maintain results.

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ThermiVa® is a non-surgical treatment that rejuvenates vaginal tissues and increases natural moisture production for improved appearance, function and intimacy. Using radiofrequency technology, ThermiVa® tightens vaginal tissues by stimulating your body’s natural production of collagen and elastin. This leads to a noticeable improvement in vaginal tightness and elasticity, reduction in labial sagging, enhanced orgasm quality, reduction in vaginal dryness and less urinary incontinence.

These pain-free treatments are performed in the office and results are immediate. There is no downtime or recovery period. Treatments typically last 30-45 minutes each, and a series of three treatments spaced one month apart is typically recommended.

ThermiVa® may be right for you if you experience vaginal dryness, urinary incontinence, vaginal laxity, vulvar sagging, mild vaginal prolapse, pain during intercourse, loss of sexual confidence, or lack of orgasm.
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Botox® Cosmetic is one of the most extensively studies medical aesthetic treatments and is the only approved treatment to temporarily improve the appearance of both frown lines between the brows and crow’s feet lines in adults.

Botox® works beneath the skin’s surface and targets the underlying muscle activity that causes lines to occur. It is administered using a tiny needle in a quick procedure with minimal pain. You will notice results take effect in 2-7 days with results lasting up to 4 months.
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