Routine Well-Woman Care

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Every woman should see a gynecologist annually; the best in Michigan practice at the Detroit Medical Center. Our specialty services are offered by leading, board-certified physicians and nurse clinicians with a focus on minimally invasive techniques.

From your first annual gynecologic exam to post-menopause, quality gynecologic care is a very important part of a long, happy and healthy life. DMC Women and Infant Services provides comprehensive gynecologic services, from well woman care and routine examinations and screenings, to contraceptive management, menopause-related care, urogynecology, incontinence related care and much more.

Our gynecology experts provide for the following:

Adhesions

Adhesions are fibrous tissue that connects things, often in the form of scar tissue. In some cases, adhesions can connect parts of your body that aren’t supposed to be connected. In women, pelvic adhesions can cause pain and fertility problems, depending on where the adhesions are. Our expert surgeons offer multiple options to remove these adhesions, including minimally invasive procedures to remove adhesions and correct damage.

Adolescent Gynecology

DMC Hutzel Women’s Service physicians work together with the Children’s Hospital of Michigan to bring your child the best possible care. Whether she is an infant, child or teen, we offer comprehensive services that are tailored to her specific needs. Our services include a complete evaluation and development of a treatment plan addressing congenital (inherited) abnormalities, menstrual and puberty problems, polycystic ovary syndrome (PCOS) and more.

Annual Physical Exams

Annual physical exams are vital to maintaining your good health. That is why DMC Women and Infant Services focuses on providing you with expert preventive care, including cervical exams, pap tests and more.

Chronic Pelvic Pain

Defined as pain in your lower abdominal (pelvic) region that lasts for six months or longer, your chronic pelvic pain may be due to a variety of underlying conditions. It can be difficult to diagnose the cause of your pelvic pain, but our experts are here to help. A thorough examination, and possibly other blood or diagnostic tests will be needed to diagnose and develop an appropriate treatment plan.

Endometriosis & Endometrial Ablation

Endometriosis occurs when tissue from inside your uterus also grows outside of your uterus. This can cause pain, since the tissue continues to break down as it would during your menstrual cycle, except there is no place for the broken down tissue to go.

Symptoms

• Pain in the lower abdomen, especially during your period or sexual intercourse
• Infertility
• Excessive bleeding during periods

Treatment

Medication is often prescribed, specifically pain medicine and hormone pills or oral contraceptives. Surgery is an option, especially for women trying to become pregnant, and there are different types of surgical procedures designed to reduce or end your endometriosis. Conservative surgery aims to remove as much excess tissue as possible without changing your fertility. If you no longer wish to become pregnant, a hysterectomy or endometrial ablation can be performed. Both of these options will result in infertility as a hysterectomy removes your uterus and endometrial ablation permanently destroys the lining of your uterus.

Human Papilloma Virus (HPV) and Cervical Cancer

Celibate nuns never get cervical cancer. This might seem like an odd bit of trivia, but it helped researchers understand the cause of this deadly cancer.

Humanpapilloma virus (HPV) causes cervical cancer and is a very common infection that can be spread from person to person. Some types of HPV are spread through sexual contact. For the sexually active female population, cervical cancer is a tremendous public health problem.

Studies suggest that at least three out of four people will get an HPV infection during their lifetime. Sexually transmitted HPV can be spread through vaginal, anal, or oral sex. Some 100 types of HPV have been identified and more than 30 types can infect the genital areas of women and men. Like many sexually transmitted diseases, there often are no signs of genital HPV. Some types will cause visible warts, while other types are known to be a major cause of cancer of the cervix. HPV also has been linked to cancer of the anus, vulva, vagina, and penis.

A simple test, the Papanicolaou (Pap) smear, has contributed greatly to the early detection of cervical cancer and has been credited with reducing its mortality (death) rates. Cervical cancer mortality has decreased by more than 70 percent since the introduction of the test. Still, approximately 13,000 new cases of cervical cancer and around 4,500 deaths occur each year in the United States.

Treatment

HPV itself is never treated, but symptoms and signs of the virus are. Minor Pap test abnormalities do not need treatment because most will go away on their own. Other abnormalities may be treated with freezing, burning, or cutting away the abnormal tissue. Self-administered cream may be used for genital warts.

HPV Vaccine

We offer Gardasil®, the only cervical cancer vaccine that helps protect against four types of HPV, including the two types that cause 70% of cervical cancer cases and two more types that cause 90% of genital warts. Gardasil is only for girls and young women ages 9 to 26 because the clinical trials for the drug only included females within this age group. Many women who have HPV are first exposed to it in their teens and 20s.

It’s important to understand that the HPV vaccine does not take the place of Pap tests. You should always follow your doctor’s advice on when to get Pap tests. Only you and your doctor can decide if the HPV vaccine is right for you.

Hysterectomy and Alternatives

A hysterectomy is a procedure that removes your uterus. In the past, this has been a common treatment for excessive bleeding and other symptoms during your menstrual cycle. Hysterectomies can be performed using multiple procedures, including minimally invasive and nonsurgical options, such as a laparoscopic supracervical hysterectomy or a total laparoscopic hysterectomy (TLH), among others.

For women who do not have a cancerous condition, a minimally invasive alternative to hysterectomy can be an option, and physicians at DMC Women and Infant Services are pioneering minimally invasive alternatives.

You might want to talk with your doctor about alternatives to hysterectomy if you have a non-cancerous condition, have uterine fibroids or you are done having children but are years away from menopause.

Alternatives to hysterectomy include:

• Hot Water Endometrial Ablation — a minimally invasive procedure to control abnormal uterine bleeding performed in an outpatient procedure.
• Uterine Balloon Therapy — designed for women who do not have cancer, a balloon is inserted through the vagina and used to remove the endometrial lining of the uterus.
• Myomectomy — a surgical procedure that removes fibroids but leaves the uterus intact.
• Uterine Fibroid Embolization (UFE) — a minimally invasive, interventional radiology treatment for benign tumors. For many women, it is an excellent alternative to a hysterectomy or open abdominal surgery.

Interstitial Cystitis (IC)

The pain can be unbearable, many times worse than a urinary tract infection. One woman described it as a knife twisting inside her bladder. As if that weren’t bad enough, women often visit eight or nine doctors before it’s accurately diagnosed. The condition is Interstitial Cystitis (IC) and DMC Women and Infant Services physicians are skilled in diagnosing and treating the condition, a chronic, inflammatory condition of the bladder wall. For some reason, the protective layer of the bladder is not present in women with IC. Without this protective layer, the chemical content of urine is very irritating to the bladder and the muscles and nerves that surround the bladder.

IC is often misdiagnosed as endometriosis, urinary tract infection or irritable bowel syndrome. In some cases, IC is closely associated with these other conditions.

Before diagnosing Interstitial Cystitis, a number of other diseases must be ruled out, including bladder infection, bladder cancer, sexually transmitted diseases, neurological disorders, kidney disease, and vaginal infections. After ruling out other causes, the two main diagnostic tools are a potassium sensitivity test and cystoscopy.

Symptoms

• Severe pain
• Frequent urge to urinate

Treatment

Primary treatments include dietary modification and a solution of medications instilled directly into the bladder to replace the protective layer of mucus. Other treatment options include oral medications, stress reduction techniques and bladder hydrodistention (slowly stretching the bladder with fluid).

Menopause

Menopause isn’t a disease; it’s a normal, healthy part of life. Not long ago, many women looked at menopause as the beginning of the end — the start of old age. But today, women often live half their adult lives after menopause. Physicians at DMC Women and Infant Services are nationally recognized authorities on menopause — working with women to minimize menopause symptoms while conducting groundbreaking research.

Menopause usually begins between the ages of 45 and 55, though some women reach natural menopause in their thirties (“premature menopause”). Other women may experience menopause as late as their sixties. Smoking can speed up menopause by one or two years.

Common symptoms of menopause include hot flashes, sleep problems, mood swings and decreased sexual desire. Until recently, most women going through menopause were prescribed hormone therapy to minimize symptoms. That changed in July 2002, thanks in part to research conducted at DMC Hutzel Women’s Hospital, where research showed that hormone therapy increased the risk of many deadly diseases and dementia.

While hormone therapy is still used to treat the most severe symptoms of menopause, it is not routinely prescribed as it once was. Instead, our physicians usually advise women to try healthy lifestyle changes which can minimize symptoms. Then, if the symptoms are still too severe, they might consider low-dose hormone therapy for a short period of time.

Hot flashes

These sudden feelings of heat, usually in the upper body, are most likely in the first year or two before and after a woman’s period stops. Hot flashes usually last from 30 seconds to five minutes. To manage hot flashes try dressing in layers, sleeping in a cool room, identify and avoid any hot flash triggers, reduce your caffeine intake, exercise and practice paced breathing and relaxation exercises.

Mood swings

Mood swings are a normal part of the menopause years. Natural hormone changes are a primary cause, but moodiness is also caused by your reaction to hot flashes and a lack of sleep. You can manage these normal mood swings by minimizing stress in your life and telling those around you that you are experiencing mood swings and ask for their understanding, as well as taking a deep breath to relax before you react in anger.

Trouble sleeping

It’s common for women to have sleep problems during menopause. Hot flashes, night sweats and anxiety make sleeping difficult. A few things you can do to improve sleep during menopause include exercising in the morning or early afternoon, try a hot shower or bath before bed, avoid alcohol, caffeine and large meals before bed, drink herbal tea or warm milk before bed, keep your bedroom cool, avoid napping during the day, keep your bedroom dark or wear a sleep mask and close doors and windows to block sound.

Memory problems

While many women complain of memory problems and trouble concentrating during menopause, there is no evidence to suggest that menopause causes memory problems. For most women, the memory and concentration problems associated with menopause are caused by stress and interrupted sleep. It’s important for women to manage their stress levels during menopause. A few of the best ways include getting enough sleep, exercising regularly, maintaining a healthy diet and taking a yoga or meditation class to reduce stress.

Ovarian Cysts

An ovarian cyst is a growth on or in an ovary which can be solid or filled with fluid.

Symptoms

• None, no symptoms may be present
• Irregular periods
• Pain during sexual intercourse

Treatment

It is common for cysts to go away on their own, but when they don’t physicians often recommend oral medications or surgery in more extreme cases.

Pap Test

The Pap test is a simple, painless test where a speculum is placed in the vagina and a small sample of cells are removed from the cervix with a scraper and a swab. The sample is sent to the lab to look for abnormal cells, including cells that may lead to cancer.

If a Pap test shows certain abnormal cells, further HPV testing may be suggested. For patients younger than 30, HPV infections are common but most of these infections require no treatment. Patients over 30 may want both the Pap and HPV test at the same time. If the results of both tests are negative, annual testing may not be necessary. According to the American College of Obstetricians and Gynecologists, women should follow a few simple screening guidelines:

• First Screening — screening of cervical cells should begin by approximately three years after the first sexual intercourse or by age 21, whichever comes first.
• Women up to 30 — women up to 30 should have an annual Pap smear. Women under 30 have a higher likelihood of acquiring high-risk types of HPV that can cause premalignant cervical disease, which should be ruled out before extending the screening intervals.
• Women 30 and Older — according to the American College of Obstetricians and Gynecologists, there are two acceptable screening options for women in this age group. With either option, women in this age group may not need annual screening.

Prolapse

Pelvic organ prolapse is a medical condition that occurs when the normal support of the vagina is lost, dropping the bladder, urethra, cervix and rectum. As the prolapse of the vagina and uterus progresses, women can feel bulging tissue protruding through the opening of the vagina.

Loss of pelvic support can occur when any part of the pelvic floor is injured during vaginal delivery, surgery, pelvic radiation or back and pelvic fractures during falls or motor vehicle accidents. Hysterectomy and other can be associated with future development of prolapse. Other conditions that promote prolapse include constipation and chronic straining, smoking, chronic coughing, heavy lifting and obesity.

There are different types of prolapse, depending on the organ affected:

• Anterior Vaginal Prolapse – also known as cystocele, this type of prolapse occurs when the wall between the vagina and the bladder stretches or detaches from the pelvic bones.
• Posterior Vaginal Prolapse – also known as rectocele, it is the weakening and stretching of the back wall of the vagina, allowing the rectum to bulge into and out of the vagina. This is often due to a damaged back wall of the vagina from vaginal childbirth, although not everyone who has delivered a child vaginally will develop a rectocele.
• Uterine Prolapse – supporting ligaments and muscles of the pelvic floor are damaged, causing the cervix and uterus to descend into and eventually out of the vagina. Often, uterine prolapse is associated with loss of vaginal wall support (cystocele, rectocele). When the cervix protrudes outside the vagina, it can develop ulcers from rubbing on underwear or protective pads.
• Vaginal Prolapse after Hysterectomy – if a woman has had a hysterectomy, the very top of the vagina, where the uterus used to be, can become detached from its supporting ligaments, resulting in the tube of the vagina turning inside out. The condition is also known as vaginal “vault” prolapse. One or several pelvic organs (such as the bladder, small and large bowel) may prolapse into the protruding bulge.
• Rectal Prolapse – known as the rectum, the last 6 inches of the colon can come loose from the rectal wall, resulting in the rectum prolapsing through the anus. It looks like red, often donut shaped, soft tissue coming through the anus. In early stages, it can be confused with a large hemorrhoid.

Symptoms

• None – in early stages, pelvic organ prolapse has few noticeable symptoms.
• Inability to keep a tampon inside the vagina
• Dampness in underwear
• Discomfort during sexual intercourse, usually due to dryness
• Pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements
• Feeling like you are “sitting on a ball”
• Pushing stool out of the rectum by placing your fingers into the vagina during a bowel movement
• Difficulty urinating or a weak or spraying stream of urine
• Urine leakage with sexual intercourse
• Frequent urge to urinate or the sensation that your bladder is not emptying
• Lifting up the bulging vagina or uterus to start urination

Treatment

Pessary devices can cause some relief. Pelvic floor reconstruction is the surgery usually necessary to correct the prolapse and relieve symptoms.

Sexual Dysfunction

Sexual dysfunction can be caused by a variety of underlying conditions, but no matter what causes it, the never ending pain, discomfort and lack of response or sexual desire can be frustrating. Women can experience sexual dysfunction during all stages of life, and DMC Women and Infant Services physicians have the expertise to diagnose and treat your sexual dysfunction.

There are physical and psychological causes of sexual dysfunction that your physician will evaluate. Physical causes can include underlying health issues, such as heart disease or diabetes, side effects of medications, or can even be caused by chronic diseases like alcoholism. Psychological causes can include anxiety or past sexual trauma and more. Treatment is decided by the cause of your dysfunction, so an open discussion with your physician will help determine which course of treatment will most benefit your situation.

Sexually Transmitted Diseases (STD)

Also known as sexually transmitted infections (STI), STDs are diseases/infections spread through sexual contact. Some STDs are completely curable, but others are not curable and only symptoms are treated. It is important to see a doctor if you think you have a STD, some STDs can cause other health issues if not treated, such as infertility or organ damage.

Pregnant women can get and share infections like women who are not pregnant. One difference is that pregnant women can spread the infection to their child. Talk to your OB if you are pregnant and concerned about STDs.

Common STDs/STIs include:

• Chlamydia – very common in women, chlamydia can cause serious issues when untreated. It can also make it easier to become infected with HIV.
• Genital herpes – caused by herpes simplex virus, genital herpes can also be spread orally. It is not curable and can make it easier to become infected with HIV.
• Gonorrhea – a common STD, it is getting harder to treat due to antibiotic resistance. If gone untreated it can cause serious health issues. It can also make it easier to become infected with HIV.
• Hepatitis B – also known as HBV, it is caused by a virus that attacks your liver and causes serious health issues. It is not curable, but quick treatment can reduce the impact of infection.
• HIV/AIDS – human immunodeficiency virus (HIV) is the cause of autoimmune disease (AIDS) and can greatly impact your body’s immune system. It is not curable but treatment to slow the progression of the disease is available.
• HPV – human papilloma virus (HPV) is a cause of cervical cancer and genital warts that often goes away on its own, despite no available cure.
• Pubic Lice – also known as “crabs”, pubic lice can be cured through prescription or over the counter treatments.
• Syphilis – can lead to major health issues, including death. It can be treated with antibiotics and infection can make it easier to become infected with HIV.
• Trichomoniasis – also known as “trich”, trichomoniasis is caused by a parasite and is treatable with antibiotics.

Vulvar Disorders

Affecting your vulva, vulvar disorders can be caused by multiple things. Your vulva refers to the parts of your genitalia that are outside of the body, such as the vaginal lips. Common causes of vulvar disorders include a fungal infection, bacterial infection, skin allergy and cancer. Treatment is prescribed based on your symptoms and follow a physical examination by one of our DMC Women and Infant Services expert physicians.