What is an OB/Gyn?
Finding an OB/Gyn
Choosing an OB/Gyn is an important decision. Thus, our goal is to assist you in making that decision.
First of all, when selecting an OB/Gyn, you may want to begin your search several different ways:
- Ask a family physician. He or she is in constant contact with all kinds of health care professionals and will be able to point you in the right direction.
- Ask family, friends, neighbors and/or co-workers.
- Contact your local Chamber of Commerce or Better Business Bureau for reputable OB/Gyn’s.
- Contact your city, county or state medial agencies for names of qualified Obstetrician/Gynecologists. Contact and ask for referrals from medical associations. Many are listed in this publication.
You may want to consult your health care insurance provider for a list of OB/Gyn’s that are provided with your health coverage plan.We recommend an interview with the potential OB/Gyn. They are very busy but should provide you a ten to fifteen minute time frame for an interview. We suggest asking any questions that you feel important. It is very important that you feel comfortable with the doctor so you can discuss your most personal issues. Also, you may want to ask the following:Is your staff friendly and accommodating?
What are the procedures if we need a doctor in the middle of the night or on a weekend?
Do you have an associate that covers for you when you are not available?
Do you have more than one office, and if you do, how is your time divided between offices?
What kind of continuing education do you utilize?
How do you stay current on the latest drugs, prescriptions, and medical treatments available?
What type of insurance coverages do you accept?
Discuss your family medical history and particular problems you are concerned about.
After you have consulted a few OB/Gyn’s, you should have a good idea which one you felt most comfortable with and whom best answered your questions.
How OB/Gyn’s Were Selected
|Consumers’ Research Council of America has compiled a list of top Obstetricians and Gynecologists throughout the United States by utilizing a point value system. This method uses a point value for criteria that we deemed valuable in determining the top health care professionals.The criteria that was used and assessed a point value is as follows:
Simply put, Obstetrician/Gynecologists that have accumulated a certain amount of points qualified for the list. This does not mean that OB/Gyn’s that did not accumulate enough points are not good doctors; they merely did not qualify for this list because of the points needed for qualification.
Similar studies have been done with other professions using a survey system. This type of study would ask fellow professionals who they would recommend. We found this method to be more of a popularity contest. For instance, professionals who work in a large office have much more of a chance of being mentioned, as opposed to a professional who has a small private practice. In addition, many professionals have a financial arrangement for back-and-forth referrals. For these reasons, we developed the point value system.
Since this is a subjective call, there is no study that is 100% accurate. As with any profession, there will be some degree of variance in opinion. If you survey 100 patients from a particular physician on their satisfaction, you will undoubtedly hear that some are very satisfied, some moderately satisfied and some dissatisfied. This is really quite normal.
We feel that a point value system takes out the personal and emotional factor and deals with factual criteria. We have made certain assumptions. For example, we feel that more years in practice is better than less years in practice; more education is better than less education, being board certified is better than not being certified, etc.
The Top Obstetrician/Gynecologist list that we have compiled is current as of a certain date and other OB/Gyn’s may have qualified since that date. Nonetheless, we feel that the list of Top Obstetrician/Gynecologists is a good starting point for you to find a qualified health care specialist.
No fees, donations, sponsorships or advertising are accepted from any individuals, professionals, corporations or associations. This policy is strictly adhered to, ensuring an unbiased selection.
The Gynecologic Exam
|The standard Gynecologic exam begins with the subject’s medical history being disclosed through an interview between the patient and the Gynecologist or other healthcare professional to learn about her background. The exam is designed as a preventive measure to screen for cervical cancer and breast cancer, as well as other abnormalities such as cysts on the ovaries. The best time for an examination is one week after the menstrual cycle, while the worst time is one week prior.
The nurse will begin with taking the patient’s blood pressure, weight and pulse. She will ask when her last period was and ask if she is experiencing any problems or has any particular concerns. It is common for a urine sample to be taken to check for bladder infections, kidney disease and pregnancy.
The Gynecologist will listen to the patient’s heart and lungs and check her breasts for any lumps. Following the external exam the doctor performs a Pap smear. A Pap smear, also called a Pap test, screens for cervical cancer by detecting changes in cervical cells that the physician collects by using a small spatula and smearing it onto a slide. This is one of the most effective tests that can be performed to detect changes before they progress into cancer.
The doctor then uses a medical examining instrument called a speculum. This instrument is inserted into the vagina and will hold the vaginal walls open, allowing the doctor to view the internal vaginal area and cervix, and to collect a Pap smear sample. A long Q-Tip is inserted and brushed against the cervix to obtain cervical cells for examination by a pathologist.
Mammograms are known as “the picture that can save your life”. Breast cancer is the second most common cancer in women and the leading cause of cancer-related deaths in women aged 40 to 55. Breast cancer facts are startling:
No matter what their ages, all women need to take care of their breasts. As a person gets older the chances of getting breast cancer increase. Cancer can appear at any time, so it is important to be checked each year. If any kind of lump is detected or any other type of change in the breasts are noticed, it is recommended that a doctor be seen right away.
Mammograms are a relatively simple procedure. A patient stands in front of a machine while the technician places a single breast between two plastic plates. The plates press against the breast and make it flat. Better image quality is possible when the breast is flat, although it may cause a few minutes of discomfort.
The Mammogram consists of two low-dose x-rays. One x-ray is taken from the top of the breast and the other from the side. It only takes a few seconds for this important test, and it is crucial to have one done by the age of 40 since doctors need to establish a “baseline”, or record of the breast’s normal appearance.
Mammograms are performed at many locations. Many hospitals, clinics, imaging x-ray centers, and mobile van units offer Mammograms. A doctor can recommend a location if one cannot be found.
3D / 4D Ultrasound
3D stands for “Three-Dimensional”. A 3D Ultrasound exam will create a three dimensional image. 4D presumably stands for “four-dimensional”. 4D is similar to 3D, with the exception that the fourth dimension, representing time, gives live-action images of the unborn child. 3D and 4D Ultrasound use sound waves to create images. This technology is safe for the mother as well as the unborn fetus.
The 3D/4D method works similarly to radar; Ultrasound uses sound waves to look inside the body. When the device is placed upon the body it projects sound waves and the returning echo generates an image. This is a safe and non-invasive procedure that does not require any exam preparation. The procedure lasts approximately 30 to 60 minutes; the time variance is due to many factors including the position of the baby in the womb.
Expectant mothers have Ultrasounds performed at various times throughout their pregnancy. At around 16 to 25 weeks the ability exists to see more of the baby at once, and view the amazing development that has already taken place. From 25 to 36 weeks, babies tend to build more fat, resulting in the ability to see more facial features. Image quality varies, depending on the baby’s position, size and movement.
Without birth control, vaginal intercourse results in an 85% chance of pregnancy within the first year. For couples that determine both abstinence and pregnancy to be unwanted, birth control has provided many methods for family planning. Each method is designed to meet the unique finances, reversibility, and safety of the couple involved.
Barrier methods, the most common form of birth control, involve a physical barrier designed to block sperm from fertilizing an egg. Condoms consist of a protective film made of latex, polyurethane, or natural skin that covers the partner’s sexual organ during intercourse. Condoms have been designed for both the male and the female and have a failure rate of between 3 – 5%. Spermicides are gelatinous substances that contain a sperm-killing chemical, having a failure rate of 6%. Diaphragms are small rubber coverings that protect any sperm from entering the cervix, with a failure rate of 6%. Condoms, spermicides, and diaphragms can be combined for increased protection.
Hormonal contraceptives are taken by females to interfere with ovulation. Hormonal implants, or Norplant, involve six flexible tubes implanted into an arm for contraception with a failure rate of .05% for up to five years. Contraceptive injections, or Depo-Provera, are injected into the muscles or an arm every three months for a failure rate of .3%. Of all hormonal contraceptives, birth control pills, with a failure rate of between .1% and .5%, are most common. Each hormonal contraceptive is highly effective in preventing pregnancy, although side effects include weight gain, menstrual irregularities, headaches, depression, blood clotting disorders, hot flashes, decreased sexual desire, breast pain, and acne.
Surgical sterilization is an irreversible form of birth control with an extremely low failure rate. For males, a Vasectomy involves the removal of ducts that carry sperm from the testes to the penis. For females, a tubal ligation involves the barricading or removal of the fallopian tubes for prevention of passage of eggs that descend from the ovaries.
Natural methods of birth control involve self-discipline and control among couples that are sexually active. Withdrawal is the removal of the penis from the vagina just before ejaculation. While having a failure rate of 4%, this has proven highly unreliable for distinguishing the total chance for pregnancy. The Calendar and Sympto-Thermal methods involve abstaining from sex during the eight most fertile days of the menstrual cycle. Each involves keeping track of days and symptoms, with the rise of body temperature associated with ovulation playing a role in the Sympto-Thermal method. These methods result in a failure rate of between 2% and 9%. Abstinence is the avoidance of any sexual activity, with a failure rate of 0%. All natural methods except abstinence are highly unreliable.
|Infertility is best defined as the inability to conceive a child after one full year of trying. Over five million Americans are affected by infertility. There are many different causes of infertility and it can be due to male problems as well as female.Infertility in men is primarily caused by the number and quality of sperm cells. There are various reasons for poor quality and low sperm count. Alcohol, drugs, smoking, environmental toxins and certain medications can temporarily reduce sperm. There are many factors involved in long-term or permanent sperm production abnormalities. These include side-effects from illnesses like Mumps, STDs, tumors, Diabetes and even surgery on the prostate gland.
Infertility in women is primarily caused by ovulation disorders. Without ovulation, eggs are not available for fertilization. Ovulation problems are signaled by irregular, or lack of, menstrual periods. Ovulation problems can be caused by stress, diet and even intense athletic training. Other problems that can lead to female infertility include blockage of the fallopian tubes, resulting in the inability of eggs to pass through into the uterus. These blockages can result from an Ectopic pregnancy, Endometriosis or Pelvic Inflammatory Disease.
There are many different type of tests to determine whether the fertility problem is with the male or the female. The first step with the male is to check the sperm quality and count. With the female the first test determines if she is ovulating each month. This can be done by charting changes in body temperature throughout the day. There are even FDA- approved home ovulation test kits.
Depending on the results of the initial testing, your doctor may then proceed with further testing to determine the cause of the infertility. The results of the tests will help the doctor recommend the proper treatment. Eighty to ninety percent of infertility cases can be treated with drugs or surgery.
|Menopause is an important tuning point in a woman’s life. The word “menopause” is a medical term for the end of a women’s menstrual periods. Menopause is a combination of two Greek words meaning “month” and “terminate”. This occurrence is a natural part of aging in women . Menopause begins when the ovaries stop making hormones, called estrogen. When the estrogen levels drop it leads to the end of the monthly menstrual periods. Menopause can occur anytime between the ages of 44 and 60, with the average age being 51.
Hormonal Replacement Therapy
Hormonal replacement therapies utilize patches, pills, creams and implants as methods of administering hormones. It is common for these types of therapies to include estrogen and/or progesterone.
Other types of non-hormonal therapies are available, and we recommend that before you come to a decision regarding any of the above that you consult your physician.
|A hysterectomy, the surgical removal of the uterus, effectively eliminates a woman’s fertility. It has become the most common form of female surgery in the United States, as approximately 33% of American women over the age of 60 have undergone such a surgery.To provide for limitless medical situations involving potential pre-operative pain, it is performed utilizing the methods described below. The most common method is a total abdominal hysterectomy. This involves the complete removal of the uterus through an incision in the abdomen. A vaginal hysterectomy, on the other hand, involves the removal of the uterus through the vaginal opening, and becomes feasible if the size of the uterus allows it.
At the same time of surgery, the ovaries and cervix are sometimes removed for medical reasons related to the individual. In addition to the cessation of menstrual bleeding, removal of the ovaries results in decreased production of sex hormones, vaginal dryness, pain or discomfort during sexual intercourse, and hot flashes.
Sexually Transmitted Diseases
|Sexually Transmitted Diseases, or STD’s, are infectious diseases that spread through sexual contact. Recent data from the Centers for Disease Control states that there are over 15 million cases of sexually transmitted diseases reported annually. Adolescents, ages fifteen to twenty four, are at the highest risk for acquiring an STD. The epidemic nature of STD’s makes this an ongoing problem, difficult to remedy.Many sexually transmitted diseases are treatable. The first-line treatment for STD’s is antibiotics. Penicillin has been effective against Syphilis and Gonorrhea but many new Gonorrhea organisms are more resistant to these older more traditional antibiotics.
When men contract Gonorrhea it can cause a burning sensation when urinating and a yellow discharge from the penis. Often women have no sign of infection but some experience a yellow discharge, low abdominal pain and irregular menstrual bleeding.
HIV (Human Immunodeficiency Virus)
All About UTIs
|A UTI, or Urinary Tract Infection, begins in the urinary system. UTIs can be painful, and they can also become a serious health problem if the infection spreads to the kidneys.
The urinary system is composed of the kidneys, ureters, bladder, and urethra. All play a role in removing waste from the body. The kidneys filter waste from the blood. Tubes called ureters carry urine from the kidneys to the bladder, where it is stored until it exits the body through the urethra. All of these parts of the urinary system can become infected, but most infections involve the lower tract—the urethra and the bladder.
Normally, urine is sterile. It is usually free of bacteria, viruses, and fungi, but it does contain fluids, salts, and waste products. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. Most infections arise from one type of bacteria, Escherichia coli (E. coli).
In many cases, bacteria first travel to the urethra. When bacteria multiply, an infection can occur. An infection limited to the urethra is called urethritis. If bacteria move to the bladder and multiply, a bladder infection called Cystitis results. If the infection is not treated promptly, bacteria may then travel further up the ureters to multiply and infect the kidneys. A kidney infection is called Pyelonephritis.
UTIs are rarely serious when they occur in otherwise healthy adults. However, they have the potential to cause permanent kidney damage or life-threatening infection if they are not treated promptly, especially in people who have medical conditions that may complicate the infection.
Some people are more prone to getting a UTI than others. Any abnormality of the urinary tract that obstructs the flow of urine—a kidney stone, for example—sets the stage for an infection. An enlarged prostate gland also can slow the flow of urine, raising the risk of infection. People with diabetes have a higher risk of a UTI because of changes in the immune system. Any other disorder that suppresses the immune system raises the risk of a urinary infection. Women are more likely to have UTI than men. Many women suffer from frequent UTIs. Nearly 20 percent of women who have a UTI will have another, and 30 percent of those will have yet another.
You may have a UTI if you have any of the following symptoms:
Oral antibiotics can treat most UTIs successfully. The length of treatment may depend on the location of the infection, your sex and age, and whether you have complicating conditions such as pregnancy, diabetes, or prostate problems.
Preventing Cervical Cancer
|Cervical cancer is the rapid, uncontrolled growth of abnormal cells on the cervix, the lower part of the uterus that opens into the vagina. Fortunately, when detected at an early stage, cervical cancer is highly curable. Pap test screening, when done regularly, is the single most important tool for preventing cervical cancer because it can detect abnormal cervical cell changes before they become cancerous, when treatment is most effective.
Abnormal cervical cell changes are often the result of high-risk sexual behaviors years earlier. These behaviors include having unprotected sex, having multiple sex partners, or having a partner who has had multiple partners. These behaviors increase your risk of infections and sexually transmitted diseases. The most common cause of cervical cancer is infection with a high-risk type of the human papillomavirus (HPV). A past HPV infection in you or your partner can cause abnormal cervical cell changes later since the virus may remain in the body for life. Low-risk types of HPV cause genital warts, but other types may not cause any symptoms so you may not know you have had it.
Smoking or having an impaired immune system may also increase your risk for cervical cell changes. The use of birth control pills for more than 5 years may be a risk factor related to infection with HPV.
So, the best ways to prevent cervical cancer is to:
Some of the risk factors for cancer can be avoided, but many cannot. For example, although you can choose to quit smoking, you cannot choose which genes you have inherited from your parents. Both smoking and inheriting specific genes could be considered risk factors for certain kinds of cancer, but only smoking can be avoided. Prevention means avoiding the risk factors and increasing the protective factors that can be controlled so that the chance of developing cancer decreases.
Although many risk factors can be avoided, it is important to keep in mind that avoiding risk factors does not guarantee that you will not get cancer. Also, most people with a particular risk factor for cancer do not actually get the disease. Some people are more sensitive than others are to factors that can cause cancer.
Disorders of the Ovaries
The ovaries are a pair of female reproductive organs which are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries have two functions: they produce eggs and female hormones.
Each month, during the menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a fallopian tube to the uterus. The ovaries are the main source of female hormones. These hormones control the development of female body characteristics, such as the breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy.
Cancer occurs when cells become abnormal and keep dividing and forming more cells without control. Like every other organ in the body, the ovaries are made up of many types of cells. Normally, cells divide to produce more cells only when the body needs them. This orderly process helps keep us healthy. If cells keep dividing when new cells are not needed, a mass of tissue forms. This mass of extra tissue, called a growth, or tumor, can be benign or malignant.
Malignant tumors are cancerous. Cancer cells can invade and damage tissues and organs near the tumor. Cancer cells can also break away from a malignant tumor in the ovary and spread to other organs in the abdomen and form new tumors. Ovarian cancer spreads most often to the colon, the stomach, and the diaphragm. The cancer cells can also enter the lymphatic system or the bloodstream and spread to other parts of the body. The spread of cancer is called metastasis.There are several types of ovarian cancer; most ovarian cancers are epithelial carcinomas, which begin in the lining of the ovary. Other types of ovarian cancer are rare.
The cause of ovarian cancer is unknown. In 10 to 20 percent of women with ovarian cancer, a family history of the disease is found. Other risk factors for developing ovarian cancer include infertility and long-term ovulation that is not interrupted by pregnancy or suppressed with hormonal birth control methods. Older women are at highest risk: More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age, and approximately one quarter of ovarian cancer deaths occur in women between 35 and 54 years of age.
Ovarian cancer does not cause many symptoms in its early stages—which is why 75 to 80 percent of cases are not diagnosed until the cancer has reached an advanced stage. The most common symptoms that cause women to seek evaluation include ongoing abdominal discomfort, cramping pain, intestinal gas, or a change in bowel or bladder habits.
Surgery is the preferred treatment and is frequently necessary for diagnosis. Surgery performed by a specialist in Gynecologic Oncology results in a higher rate of cure. Chemotherapy is used as after surgery to treat any residual disease. Chemotherapy can also be used to treat women who have a recurrence. Radiation therapy is rarely used in ovarian cancer in the United States.
Ovarian cancer is rarely diagnosed in its early stages. It is usually quite advanced by the time diagnosis is made. The outcome is often poor. The five-year survival rate for all stages is only 35 percent to 38 percent. If, however, diagnosis is made early in the disease, five-year survival rates can reach 90 percent to 98 percent
An ovarian cyst is a round, thin-walled, clear fluid-filled sac that develops in the ovary as part of normal egg development. When on the ovary’s surface, an ovarian cyst looks something like a skin blister. A normal ovarian cyst can grow as large as 1.5 inches as it prepares to release an egg into the abdomen.
When an ovarian cyst does not release its egg, it continues to grow, becoming larger than normal—known as a Functional Ovarian Cyst. These may also form after an egg is released. In this case, the ovarian cyst reseals itself and swells with fluid, which is called a Luteal Cyst. Functional ovarian cysts are the most common type of ovarian growth in women of childbearing age.
Like most types of ovarian cysts, functional cysts usually don’t cause symptoms and are first noticed during a general pelvic exam. However, a larger ovarian cyst can twist, rupture, or bleed and be very painful. If your health professional has found that you have a functional ovarian cyst, you have no reason to worry about it being cancerous—functional cysts do not lead to cancer. Most functional ovarian cysts are harmless and disappear on their own within a few months.
Treatment depends on your age, the type and size of your cyst, and your symptoms. Your doctor may suggest:
Wait and See
You can wait and be re-examined in one to three months if you are in your reproductive years, you have no symptoms and an ultrasound shows you have a simple, fluid-filled cyst. Your doctor will likely recommend that you get follow-up pelvic ultrasounds at periodic intervals to see if your cyst has changed in size. Watchful waiting, including regular monitoring with ultrasound, is also a common treatment option recommended for postmenopausal women if a cyst is filled with fluid and less than 2 inches in diameter.
Birth control pills
Your doctor may recommend birth control pills to reduce the chance of new cysts developing in future menstrual cycles. Oral contraceptives offer the added benefit of significantly reducing your risk of ovarian cancer—the risk decreases over time as you take birth control pills.
Your doctor may suggest removal of a cyst if it is large, doesn’t look like a functional cyst, is growing or persists through two or three menstrual cycles. Cysts that cause pain or other symptoms may be removed. Some cysts can be removed without removing the ovary in a procedure known as a Cystectomy. Your doctor may also suggest removal of the one affected ovary and leaving the other intact in a procedure known as Oophorectomy. Both procedures may allow you to maintain your fertility if you’re still in your childbearing years.