Hormonal Acne

Acne or clogged pores affect over 85% of teenagers will face acne on their face, neck, shoulders, chest, back, and/or upper arms mild to severe.

Causes of Acne:

  • Hormonal alteration at Puberty & Perimenopause
  • Excess androgens or imbalance of estrogen to androgen ratio
  • Triggers for hormonal imbalances:
  • Puberty & Perimenopause
  • Pregnancy
  • Change in Oral contraceptives
  • Causes that worsen acne:
  • Sweating & Humidity
  • Oily hair products
  • Facial cosmetics
  • Stress

Treating Acne:

  • Over the counter:
  • Salicylic acid
  • Glycolic acid
  • Azelaic acid
  • Lactic acid
  • Benzoyl peroxide
  • Prescription medications:
  • Antibiotics
  • Certain OCP
  • Retinoids
  • Steroids
  • Spironolactone
  • Isotretinoin (Accutane)

Female hair Loss

It’s normal to lose around 60-100 pieces of hair a day, but women can lose twice or even three times that number when the hair is washed.

Causes of Hair Loss:

  • Heredity
  • thyroid problems
  • Anemia & Iron deficiency
  • Polycystic Ovarian disorder
  • Excess of vitamin A
  • Dramatic weight loss
  • Stress
  • Some Antihypertensives & antidepressants
  • Psoriasis
  • Scalp infections​

Treatment options for Hair loss:

  • Spironolactone: An antiandrogenic medication that can reduce hair loss.
  • Rogaine (minoxidil): only about 10-15% report new hair growth.
  • Supplements: Biotin, Iron, and Zinc
  • Hair Replacement


Cervicitis is a quite common condition that is described as inflammation of the cervix.​

Sexually transmited Cervicitis Cause:

  • Chlamydia
  • Gonorrhea
  • Genital herpes
  • Mycoplasma and ureaplasma
  • Trichomoniasis​​

Other Cervicitis Causes:​

  • Injury
  • Chemical allergies, such as to latex condoms, spermicides, or douches
  • Low estrogen or high progesterone levels
  • Bacterial vaginosis​

Some cancers or treatments for cancer​

  • Cervicitis Symptoms
  • Abnormal bleeding (specially postcoital)
  • Painful intercourse
  • Pelvic pain
  • Gray or yellowish vaginal discharge
  • Frequent, difficult, or painful urination
  • Cervicitis Treatment
  • Antibiotic course
  • Antiviral treatment
  • Anti-fungal therapy​

Your partner needs screening and treatment with a two week recommended pelvic rest.

Vaginal Infections

Normal Vaginal Discharges:

Through the normal course of the menstrual cycle, women’s vaginas can produce a discharge. It is usually a clear or cloudy white discharge and is produced in order to clean itself.

Vaginal discharge concerns:

  • Changes in vaginal discharge
  • Pain during sex
  • Itching, burning, stinging, swelling, or tenderness in the vagina
  • Burning while urinating​


  • Bacterial Vaginosis
  • Yeast infections
  • Gonorrhea
  • Chlamydia
  • Trichomoniasis
  • Allergic reactions​

Bacterial Vaginosis vs. Yeast Infection

​These two conditions are due to an imbalance of normal microorganisms found in your vagina.

​Yeast infection: usually result in itching or burning and white discharge that resembles cottage cheese.
Bacterial vaginosis: causeS a fishy odor, and discharge that has the consistency of yogurt.

Pituitary gland tumors called adenomas can increasingly produce prolactin hormone in addition to the following conditions:

  • ​Pregnancy
  • Breastfeeding
  • Hypothyroidism
  • Certain medications​

Untreated Prolactinoma:

  • Osteoporosis
  • Hypopituitarism
  • Hypothyroidism
  • Visual changes
  • Persistent Headaches​

Diagnosing Prolactinoma:

  • MRI
  • Blood level testing
  • History​

Treating Prolactinoma:

  • Medication: Dopamine agonists: Cabergoline (Dostinex)
  • Surgery: Trans-sphenoidal

Pelvic organ prolapse

Pelvic organ prolapse occurs due to lack or reduced support and results in anatomical abnormalities of following organs:

  • Bladder
  • Rectum
  • Uterus
  • Vaginal Vault, following a hysterectomy
  • small intestines(enterocele)
  • Pelvic organ prolapse can range from mild to severe.

​Symptoms of prolapse are:

  • Pressure And pain
  • Difficult urination or bowel movements
  • Pain or discomfort during sex
  • Palpable protrusion of tissue through the vagina

Pelvic Prolapse Treatment:

  • Pessary: A pessary is a small, doughnut-shaped device made out of plastic or rubber that can be inserted into the vagina.
  • Kegel exercises: Perform 20 repetitions of this exercise 3-5 times per day.
  • Weight loss
  • Surgery:Obliterative surgery or Reconstructive
  • Sacrospinous ligament fixation
  • Colporrhaphy, anterior & posterior
  • Sacrocolpopexy
  • Vaginal mesh
  • Recovery from Reconstructive Surgery
  • 4-6 weeks

What is a colposcopy procedure?
Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light into the vagina and onto the cervix. A colposcope can greatly enlarge the normal view. This exam allows the health care provider to find problems that cannot be seen by the eye alone.

Why is colposcopy done?
Colposcopy is done when results of cervical cancer screening tests show abnormal changes in the cells of the cervix. Colposcopy provides more information about the abnormal cells.

A colposcopy can help your doctor diagnose the following:

  • Cervical cancer
  • Vulvar cancer
  • Vaginal cancer
  • Precancerous changes of the cervix, vulva, or vagina
  • Cervicitis (inflammation of the cervix)
  • Genital warts​

Preparation for Your Colposcopy

  • Take an over-the-counter pain reliever (Panadol, Voltaren or Profen) about 30 minutes prior to your procedure.
  • Preferably schedule your procedure between cycle day 5-7 of your menustral calendar.
  • Avoid sex for 48 hours prior to procedure
  • Avoid Tampons prior and after the procedure
  • Bring along an iPad/Laptop or music device to ease anxiety while we prepare the equipment for procedure​

Risks of Colposcopy

  • Usually very safe and rarely with any complications while done with experienced physician, some specific risks may be:
  • Bleeding
  • Infection
  • Pelvic pain
  • Post Procedure expectations:
  • Abnormal discharge
  • Spotting
  • Avoid Tampons, intercourse and swimming for ten days and contact your physician with any concerns or excessive bleeding.

Urinary Tract Infections

Women are fairly prone to urinary tract infections because of the shortness of their urethra and the close proximity of the urethra to the vagina and anus. Bacteria that live in this moist environment can spread to the urinary tract during sex or with the use of certain vaginal birth control methods. If the bacteria reach the bladder, the woman may develop a bladder infection, also known as cystitis. A kidney infection is known as pyelonephritis and can be a serious medical condition.​

Symptoms of a Urinary Tract Infection:

  • Urge to urinate.
  • Pain with urination.
  • Frequent urination.
  • Cloudy urine or color changes
  • Fever, chills
  • Nausea or vomiting
  • Back pains
  • Risk factors:
  • Multiple vaginal births
  • Diabetics
  • History of UTIs
  • Obesity
  • Post-menopause
  • Kidney stones​

Diagnosing a Urinary Tract Infection:

  • Urinalysis
  • Urine culture
  • History taking
  • Treatment options;
  • Outpatient antibiotics specific to culture sensitivity
  • increased fluid intake
  • Frequent voiding
  • Voiding prior & after intercourse
  • Inpatient therapy in severe Pyelonephritis
  • Prophylaxis for recurrent infections
  • Cranberry juice or cranberry pills may aid in preventing UTIs, but the effect is not well understood.
  • Estrogen therapy can help prevent UTIs in women who are going through menopause.


  • Pyelonephritis is a serious and more aggressive version of a UTI affecting upper urinary tract and Kidneys.
  • Many times outpatient therapy is inadequate and during pregnancy, if ignored may lead to adult respiratory distress and become fatal.
  • Urinary tract infection, plus these additional symptoms, may indicate pyelonephritis:
  • Fever, chills, nausea, and/or vomiting
  • Back pain or pain in the sides
  • Disorientation or confusion
  • Urine color changes
  • Pyelonephritis Risk increased with:
  • Diabetes
  • Use of steroids
  • Immunosuppression like pregnant state or HIV
  • renal or ureteral stones
  • Urinalysis, Urine culture, WBC and CRP infection markers plus ultrasounds are diagnostic tools.

A fluid-filled benign cyst that develops near the adnexa or tubular end.

Risks of Paratubal Cysts:

  • Hemorrhaging (bleeding)
  • Rupture of the fallopian tube
  • Ovarian torsion
  • Diagnosing Paratubal Cysts
  • Pelvic Ultrasound
  • MRI
  • Incidentally during operations

Surgery for Paratubular cyst depends on:​

  • Your age
  • Your symptoms
  • Size greater than 7 cm

Infertility Testing & treatment

Infertility affects about 15% of all couples. Primary infertility is defined as the inability to conceive after 12 months. It can be a male factor or female factor related but a mixed issue is often encountered.

Consult your OB/GYN if:

  • You are over the age of 35
  • Your periods are irregular or absent
  • You have endometriosis
  • pelvic inflammatory disease
  • You have had more than one miscarriage in the past​

Male Infertility:

  • Low sperm count or abnormal sperm
  • Problems with sperm transference and blockage
  • Damage due to cancer treatment
  • Abusing substances such as tobacco, alcohol, marijuana,
  • steroids use​

Female Infertility:

  • Endometriosis
  • Ovulation abnormalities
  • PCOS
  • Stress-related anovulation
  • Rapid weight gain or loss
  • Tubal factors
  • Uterine cavity abnormalities

A Bartholin's cyst, or Bartholin's duct cyst, occurs when the duct of the Bartholin's gland is blocked, resulting in the development of a fluid-filled cyst.

It may sometimes be caused by an infection, but a Bartholin's cyst is not an infection.

The Bartholin glands are situated between the vagina and the vulva (the external part of the female genitals) and produce a fluid that helps reduce friction during sex. They are not normally visible to the naked eye.

Thomas Bartholin (1616-1680), a Danish physician, mathematician, and theologian, was the first person to describe these glands, hence their name. He was best known for his work in the discovery of the lymphatic system in humans.

Fast facts on Bartholin's cyst

  • Bartholin's cysts can cause pain or discomfort, but they are not life-threatening.
  • Not all Bartholin's cysts require treatment.
  • Bartholin's cysts are commonly small and have no presentable symptoms, meaning diagnosis can be delayed until medical examination.Causes

Bartholin's glands, also known as the major vestibular glands, are a pair of glands between the vagina and the vulva that produce lubrication when stimulated.

Along with the lesser vestibular glands, they aid in sexual intercourse by reducing friction.

The lubricating fluid goes from the Bartholin's glands down tiny tubes (ducts) which are about 0.8 inches (2cm) long into the lower part of the entrance to the vagina.

If there is a blockage in these ducts, the lubricant builds up. The ducts expand and a cyst is formed. This is a Bartholin's cyst. When the cyst is formed, there is a risk of infection in the area, and a subsequent abscess.​

A woman is more likely to have a Bartholin gland cyst when she is:

  • young and sexually active
  • has not yet become pregnant
  • has just had one pregnancy​

Cysts can range in size from that of a lentil to a golf ball. Although Bartholin's cysts are not sexually transmitted, gonorrhea (a sexually transmitted disease) is a common cause.

A cyst is a closed sac-like structure full of liquid, which can be semisolid or include gas.

A bacterial infection may cause the blockage and subsequent cyst.

Examples include:

  • gonococcus, which causes gonorrhea
  • Chlamydia trachomatis, which causes chlamydia
  • Escherichia coli, which can affect water supply and cause hemorrhagic colitis
  • Streptococcus pneumonia, which can cause pneumonia and middle ear infections
  • Haemophilus influenzae (HIB), which can cause ear infections, and respiratory infections

Anxiety disorder is a serious feeling of being overwhelmed with routine day to day activities.

Types of Anxiety Disorders:

  • General Anxiety Disorder even without a trigger.
  • Social Anxiety Disorder: extraordinarily anxious during routine social interactions.
  • Panic Disorder: sudden, repeated episodes of panic attacks described below.
  • Phobia: an unreasonable and intense fear of some object, person, or situation.

Anxiety Disorders Symptomatology:

  • Insomnia
  • Rapid heartbeat
  • Sweating
  • Shortness of breath
  • Chest pain
  • Rapid breathing
  • Fear
  • Nausea
  • Dizziness​


  • ​Depression is one of the most common mental illnesses.
  • It is a recognized illness that can be treated effectively with medical intervention and affects both males and females.

Causes of Depression:

  • Genetic
  • Physical
  • Psychological
  • Social
  • Environmental​

Types of Depression:

1. Persistent Depressive Disorder: Patients who have been feeling depressed for at least two years may be diagnosed with persistent depressive disorder.
2. Major Depression: They may be unable to sleep, work, eat, or even play like normal.
3. Seasonal Affective Disorder (SAD): This is a disorder in which feelings of depression tend to manifest in the winter months and disappear in the spring and summer.
4. Psychotic Depression: Depression plus one or more psychotic symptoms(hallucinations, delusions).
5. Bipolar Disorder: cycles of very intense highs and lows, lasting days, weeks, or months. Along with periods of extremely severe depression, patients with bipolar disorder also experience periods of extreme agitation, activity, and energy known as “mania.”
6. Postpartum Depression: manifests after a woman delivers and is not just the “baby blues”; a chemical imbalance that develops as a result of the hormonal and physical changes a woman’s body. Around 10-15% of mothers may experience postpartum depression.

Please contact our office if you feel any of the above symptoms.