We can perform genetic testing if you have a strong family history of Breast/ Ovarian/ Uterine or Colon Cancer. However, we strongly recommend you filling out the family history questionnaire and assessing your risk by utilizing the tool below. You will need to schedule a separate genetic testing appointment and a follow up appointment to discuss the results. Please note that the results of genetic tests will not be discussed over the phone/ email or portal.

Family History Tool.

Thank you.

Wishing you a healthy future

Walk IN GYN Care team.

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Human Papilloma virus (HPV) is a widely prevalent virus that is passed from person to person through skin-to-skin contact. Although these strains are spread through sexual contact, sexual intercourse is not necessary to spread HPV.  It may be spread through any sexual contact.  It has been suggested that about three out of four sexually active people may have a genital HPV infection  at some point in their lives.

How can we test for HPV?

There are over 120 known strains of HPV at present and only about 15 of those strains are linked to cervical cancer, and approximately 12 strains may cause genital warts.  For women over 30, a pap smear checks for any abnormal cells as well as detectable strains of high risk HPV.  In women under 30, high risk HPV is tested only if the pap smear reveals any abnormal cells.  This is because cervical cancer is very rare under the age of 30 and most women with HPV are able to clear the virus on their own.  Adolescents have an almost 80% clearance rate for high risk HPV.

What is an abnormal pap test and how do you proceed if you have an abnormal pap?

Abnormal pap results may be reported as “Abnormal cells of unknown significance (ASCUS)” , low grade intra-epithelial lesion (LGSIL) or high grade squamous intra-epithelial lesion ( HGSIL).  The next steps in care are decided depending on the results of the pap smear.  If you are positive for HR HPV ( high risk human papilloma virus) and don’t have any abnormal cells, you may just need to be watched closely for any cell changes.  You will be advised to have a test called colposcopy which includes examination of cervix under magnification and a cervical biopsy ( sampling). Depending on the results, you may need 6 monthly follow up or removal of abnormal cells by a small procedure called LEEP or cryo-freezing. It is important to remember that testing positive for HPV does not mean that you have cervical cancer.

Does HPV affect men? How can we test men?

HPV affects men as well as women.  HPV testing is currently not widely prevalent for males. Therefore, it may be hard to go back and figure out who the high risk HPV infection was contracted from. HPV can survive and lay dormant (asleep) inside the cervical cells for many years before detection.  Condoms may help prevent HPV transmission, but HPV can also infect areas that are not covered by a condom, therefore they may not prevent complete transmission. Here is some more information for HPV infection and testing in men. https://www.cdc.gov/std/hpv/stdfact-hpv-and-men.htm

How can we prevent HPV infection?

The current recommendations for prevention against high risk HPV infection include HPV vaccination. There are two such vaccines available. GARDASIL 9 is a vaccine indicated in females and males 9 through 45 years of age for the prevention of cervical, vulvar, vaginal, and anal cancers caused by human papilloma virus (HPV) Types 16, 18, 31, 33, 45, 52, and 58; precancerous or dysplastic lesions caused by HPV Types 6, 11, 16, 18, 31, 33, 45, 52, and 58; and genital warts. The injection is given in a 3 shot series over 6 months. The vaccine has  minimal, if any, side effects.  Most insurances cover the vaccination series. The vaccination can be offered or prescribed by your gynecologist or pediatrician.

For spanish and chinese translation- click here.

For any additional questions or to schedule the Gardasil vaccination, please feel free to walk in or call us as Walk IN GYN Care (www.walkingyn.com).

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https://www.mdlinx.com/article/6-immune-boosting-nutrients-for-cold-and-flu-season/fbsqk39D5NwXckpTfSV82

The post This whirlwind weather driving your sinuses crazy? appeared first on Walk In GYN Care.

Our panel for STD testing in the sexually active age group women includes the following

From the Pap 

1. Pap without HPV High Risk (Age below 30 years)
2. Pap with HPV ( Age above 30 yrs)
3. Gonorrhea
4. Chlamydia
5. Trichomonas

From Blood Work

1. HIV
2. Genital herpes type 2
3. Hepatitis B
4. Hepatitis C
5. Syphilis

The post STD testing appeared first on Walk In GYN Care.

Summary of Updated Guidance:

• Antibody testing for Zika virus is now recommended for all pregnant women who have traveled to an affected area regardless of the presence of clinical illness.
• Antibody testing for Zika virus is now recommended for all pregnant women living in an affected area regardless of the presence of clinical illness
• Health care providers should discuss reproductive life plans, including pregnancy intention and timing, with women of reproductive age in the context of the potential risks associated with Zika virus infection.
• Women of reproductive age with current or previous laboratory-confirmed Zika virus infection should be counseled that there currently is no evidence that prior Zika virus infection poses a risk of birth defects in future pregnancies.

CDC issued updated practice advisory which reiterates the prevention strategies to minimize exposure to Zika and summarizes the current guidance for management of pregnant women who have been exposed. Click here to access updated Interim Guidelines.

Feel free to reach out to our office if you have further questions/ concerns….. Be Safe.

Walk In GYN team

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As per CDC data, the initial visits to physician’s office for genital herpes has increased from 57,000 in 1980 to 306,000 in 2013.

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You have decided to proceed with an IUD for birth control. This is how to prepare for your visit prior to the insertion.

At the office visit prior:

• Pap/ STD testing up to-date.
• Sonogram to check uterine cavity done.
• Paper work signed.

You will get a call from us to inform that we have the IUD.

If you don’t hear from us in 2 weeks, please call us or email us.

For IUD insertion visit:

• Call on Day 1 of period to schedule IUD insertion. Needs to be done towards the end of the period.
• Please eat something at least 1-2 hours before appt.
• Take 600 mg Ibuprofen (if not allergic) after food 1 hour before appt. OR Tylenol (1000mg) if allergic to Ibuprofen.
• Follow up appt. in 1 month for sonogram to check IUD placement.
• Expect cramping for 2-3 days after procedure and next few periods.
• Can take Ibuprofen (600mg) or Tylenol (650mg) every 6-8 hrs for that pain.
• Check IUD by Ultrasound once a year.

IUDs – HOW TO MAKE THAT CHOICE?

What is an intrauterine device (IUD)?

The intrauterine device (IUD) is used to prevent pregnancy. It’s a small, plastic, T-shaped device. Your doctor places the IUD in your uterus.

You have a choice between a hormonal IUD and a copper IUD.

The hormonal IUD prevents pregnancy by damaging or killing sperm. It also releases a type of the hormone progestin. Progestin prevents pregnancy in these ways: It thickens the mucus in the cervix. This makes it hard for sperm to travel into the uterus. It also thins the lining of the uterus, which makes it harder for a fertilized egg to attach to the uterus. Progestin can sometimes stop the ovaries from releasing an egg each month (ovulation).

There are two hormonal IUDs. One prevents pregnancy for 5 years, and the other prevents pregnancy for 3 years. Once you have it, you don’t have to do anything else to prevent pregnancy.

The copper IUD is wrapped in copper wire. Copper IUDs prevent pregnancy by making the uterus and fallopian tubes produce a fluid that kills sperm.

The copper IUD prevents pregnancy for 10 years. Once you have it, you don’t have to do anything else to prevent pregnancy.

A string tied to the end of the IUD hangs down through the opening of the uterus (called the cervix) into the vagina. You can check that the IUD is in place by feeling for the string. The IUD usually stays in the uterus until your doctor removes it.

How well does it work?

In the first year of use:

• When the hormonal IUD is used exactly as directed, fewer than 1 woman out of 100 has an unplanned pregnancy.
• When the copper IUD is used exactly as directed, fewer than 1 woman out of 100 has an unplanned pregnancy.

Be sure to tell your doctor about any health problems you have or medicines you take. He or she can help you choose the birth control method that is right for you.

What are the advantages of an IUD?

• An IUD is one of the most effective methods of birth control.
• It prevents pregnancy for 3 to 10 years, depending on the type. You don’t have to worry about birth control during this time.
• It’s safe to use while breast-feeding.
• IUDs don’t contain estrogen. So you can use an IUD if you don’t want to take estrogen or can’t take estrogen because you have certain health problems or concerns.
• An IUD is convenient. It is always providing birth control. You don’t need to remember to take a pill or get a shot. You don’t have to interrupt sex to protect against pregnancy.
• A hormonal IUD may reduce heavy bleeding and cramping.

What are the disadvantages of an IUD?

• An IUD doesn’t protect against sexually transmitted infections (STIs), such as herpes or HIV/AIDS. If you aren’t sure if your sex partner might have an STI, use a condom to protect against disease.
• A copper IUD may cause periods with more bleeding and cramping.
• You have to see a doctor to have an IUD inserted and removed.
• You have to check to see if the string is in place.

How to prepare for an IUD insertion?

• It can be a daunting idea to go for an IUD insertion. We recommend taking Advil or Ibuprofen 600 mg about 30 min before the insertion. If you are allergic to Ibuprofen, you can take 2 tablets for regular Acetaminophen (Tylenol) before coming in.
• The insertion should be planned towards the end of your menstrual cycle. Please call the office to schedule insertion when you are on your first day of the period.
• Do not plan any extensive physical activity the day of insertion, right after the procedure.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• You may experience some mild cramping and light bleeding (spotting) for 1 or 2 days. Use a hot water bottle or a heating pad set on low on your belly for pain.
• Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve) if needed. Read and follow all instructions on the label.
• Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Check the string of your IUD after every period. To do this, insert a finger into your vagina and feel for the cervix, which is at the top of the vagina and feels harder than the rest of your vagina. You should be able to feel the thin, plastic string coming out of the opening of your cervix. If you cannot feel the string, use another form of birth control and make an appointment with your doctor to have the string checked.
• If the IUD comes out, save it and call your doctor. Be sure to use another form of birth control while the IUD is out.
• Use latex condoms to protect against sexually transmitted infections (STIs), such as gonorrhea and chlamydia. An IUD does not protect you from STIs. Having one sex partner (who does not have STIs and does not have sex with anyone else) is a good way to avoid STIs.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have sudden, severe pain in your belly or pelvis.

Call your doctor now or seek immediate medical care if:

• You have new belly or pelvic pain.
• You have severe vaginal bleeding. This means that you are soaking through your usual pads or tampons each hour for 2 or more hours.
• You are dizzy or lightheaded, or you feel like you may faint.
• You have a fever and pelvic pain or vaginal discharge.
• You have pelvic pain that is getting worse.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You cannot feel the string, or the IUD comes out.
• You feel sick to your stomach, or you vomit.
• You think you may be pregnant.

See full video here

Be safe, be strong and be prepared.

Walk In GYN Team

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Colposcopy lets a doctor look at your vulva, vagina, and cervix. If the doctor sees a possible problem, he or she can take a small sample of tissue. Then another doctor studies the tissue under a microscope. This is called a biopsy.
Most women have this procedure after they have abnormal results from a Pap test.

How is the test performed?
During the test, your doctor puts a lubricated tool into your vagina. This is called a speculum. It gently spreads apart the sides of your vagina. This allows your doctor to see inside your vagina and the cervix. The doctor also uses a magnifying device to help him or her see better. This device does not go inside your vagina.
The doctor may put diluted vinegar or iodine on your cervix. This can help the doctor to see any areas that are not normal. Sometimes the doctor also takes photos or videos.
When the speculum goes in, it can feel a little uncomfortable. If the doctor does a biopsy, you may feel a pinch and have some cramping.

How should I follow up?
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.
What happens before the procedure?
Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.
Preparing for the procedure
• Tell your doctor if:
o You are having your menstrual period. This test usually is not done during your period. This is because blood makes it harder to see your cervix.
o You are or might be pregnant. A blood or urine test may be done to see if you are pregnant. Colposcopy is safe during pregnancy. The chance of miscarriage is very small. But you may have some bleeding from a biopsy.
o You take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
• Do not douche, use tampons, have sexual intercourse, or use vaginal medicines for 24 hours before the test.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctors ALL the medicines, vitamins, supplements, or herbal remedies you take. Some of these can increase the risk of bleeding.
• Your doctor will tell you which medicines to take or stop before your procedure. You may need to stop taking certain medicines a week or more before the procedure. So talk to your doctor as soon as you can.
What happens on the day of the procedure?
• You may want to take a pain reliever 30 to 60 minutes before the test. This can help reduce any cramping pain from a biopsy. Ibuprofen (Advil or Motrin) is a good choice.
• Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
At the doctor’s office
• Bring a picture ID.
• The procedure will take about 15 to 30 minutes.
Going home
• You will be given more specific instructions about recovering from your procedure.
When should you call your doctor?
• You have questions or concerns.
• You don’t understand how to prepare for your procedure.
• You become ill before the procedure (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the procedure.
Care instructions adapted under license by Adeeti Gupta Physician PC. This care instruction is for use with your licensed healthcare professional. If you have questions about a medical condition or this instruction, always ask your healthcare professional.

To view this in Spanish and Chinese, click here.

Be safe, be strong and be prepared.

Your friendly Walk In GYN Care team!

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Rising STD rates in the United States

In the United States alone, there are nearly 20 million cases of new sexually transmitted infections yearly, from just eight viruses and bacteria, according to data from the Centers for Disease Control and Prevention (CDC).

The eight most common STDs in the U.S. are chlamydia, gonorrhea, hepatitis B virus (HBV), genital herpes, HIV, human papillomavirus (HPV), syphilis and trichomoniasis. About 50.5 million of these current infections are in men, and 59.5 million are in women, according to the CDC’s 2013 report, in which the researchers looked at 2008 data.

Each year, new cases of STDs cost nearly $16 billion in direct medical costs. Fifty percent of these new infections occur in young people, ages 15-24, even though this age group represents only a quarter of people who have had sex.

1. How can Chlamydia be detected?

Chlamydia can be easily detected by a vaginal swab or culture during a routine pap smear. Chlamydia can also be tested in the urine if you are uncomfortable with a pelvic exam. Chlamydia is the most commonly reported STD in the United States. But most people with chlamydial infections may not show any symptoms, and so the number of actual infections is much higher than the number of those reported, which was 1.4 million in 2012, or a rate of 457 cases per 100,000 people.

2. How is Chlamydia cured?

It is easy to cure chlamydia – it is a bacterial infection treated with antibiotics.

3. What if Chlamydia is not cured?

If left untreated, the infection can make it difficult for a woman to get pregnant. An untreated chlamydial infection can cause pelvic inflammatory disease (an infection of the reproductive organs), in about 10 to 15 percent of infected women, and lead to infertility.

4. How can you make sure Chlamydia has been treated?

You need to visit your gynecologist 3 months after the treatment to make sure it is out of your system.

5. Does your partner need to be treated?

Yes, your current and prior partners need to be traced and treated to avoid spread of Chlamydia in the community. Male partners may not have any symptoms, thereby making detection hard. The antibiotics are recommended for all partners, who should also be tested subsequently for “test of cure”. Protection should be used until test of cure culture has been confirmed negative.

Stay tuned for more….

Adeeti Gupta MD, FACOG

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1. All Vaginal discharge are not infectious.  Recurrent and persistent mixed vaginal infections can now be accurately diagnosed by a vaginal culture which can be performed through the Pap smear test at the same time.

2. Mixed infections with Candida (Yeast) and BV (Bacterial Vaginosis) are more common than you think. 70% of episodes of vaginitis are caused by BV and Yeast.

3. For most women, Vaginitis resolves without any difficulty.

4. Feminine hygiene products, panty liners and douches need to be retired and sent to the land far far away.

5. BV is not an STD! However, partner treatment may help reduce recurrent infections. Long term (6 months) weekly courses of vaginal metronidazole gel after an initial 1 week treatment with oral metronidazole or Tinidazole may be needed if you have recurrent bacterial infections.

6. Your daily chores after a work-out can wait. Excessive sweating, swimming in the pool, hanging out at the beach, wearing tight clothing for long durations can cause vaginal pH imbalance. One needs to hit the shower as soon as possible after a work-out to avoid that irritating BV or Yeast from haunting us.

7. Using mild soaps with no fragrances or irritants is the key. Look for the “water-based” on the label if you use vaginal lubricants!

8. Barrier creams like A&D cream, Aquaphor or the baby diaper rash creams go a long way in preventing chafing and irritation down there.

9. Oral Probiotics supplementation (50 billion CFU daily) in the right amounts daily is the key in healing and preventing recurrent infections.

10. Recurrent Yeast infections may need long term weekly courses of Fluconazole tablets (Need to be prescribed by your OBGYN with caution). Vaginal Boric acid suppositories (compounded by a pharmacist) may help in those persistent infections caused by the resistant yeast.

For more detailed discussion, check out our video series at That’svagenius.

Be safe, be strong and be prepared.

Your friends at Walk In GYN Care

#justwalkin

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