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In celebration of National Condom Week (4/14-4/21), a reminder about the importance of safe sex is due.   Last year, the CDC reported that rates of Syphilis, Chlamydia, and Gonorrhea in the U.S. had all increased for the fourth straight year.  Forty-five per cent of the new Chlamydia cases were found in young women—a particularly alarming statistic, as this infection can lead to infertility if unrecognized/untreated.  Genital herpes is estimated to have a prevalence of 1 in 6 Americans, with women far outnumbering men in new cases.  And the HPV virus, as we all know, can lead to cervical dysphasia and even cancer in infected women.   All of this points to the importance of awareness and preventive measures in limiting the spread of various sexually-transmitted infections.   First of all—know your/your partner’s risks. Higher-risk populations for contracting STIs include men who have sex with men (MSM), those with new or multiple sexual partners, those who live in an area of high STI prevalence, and those who exchange sex for drugs or money.   Second—consider preventive measures you/your partner can take before you become sexually active.  The HPV vaccine series has proven very effective in reducing infections with the viral strains that the vaccine is designed to prevent.   Hepatitis B infection can also be prevented though vaccination.  Individuals with genital herpes can reduce the likelihood of transmitting the virus to their partners by taking a daily suppressive medication.  And certain high-risk individuals can take pre-exposure antiretroviral prophylactic (PREP) medication regularly to ward off acquiring HIV from an infected partner.  If you do decide to become sexually active, using condoms consistently and getting tested regularly are paramount.  Condoms are not 100% effective at preventing STIs, so the importance of regular screening cannot be underestimated—be safe!



Certainly, if you have a cold or the flu, I would not recommend exercising.  Patients ask all the time, “can I still exercise, even though I am sick?”  Keep in mind, most infections are viral, and part of treating a viral infection includes rest.  Even if you have a bacterial infection, it is best to rest, because no matter what is causing the infection, you are always dehydrated and exercise is going to make this worse which makes your recovery harder.

Asthma is caused by your body reacting to outside elements or allergens.  Extreme weather is never good for exercising, but if you keep a few things in mind you may be able to exercise without causing an asthma flare.

In the winter the air is colder and drier typically.  When you are breathing in this heavier air you may notice that your lungs burn. Normally there is a small layer of mucus in your lungs that keeps things in check, but if you are breathing in the cold dry air, that small layer of moisture evaporates and in turn you experience that burning feeling.  Breathing in the cold dry air takes more of an effort for your body and it can trigger a histamine reaction, which is similar to what happens when your lungs are exposed to allergens.  The histamine reaction will cause your body to produce more mucus which in turn makes your airways smaller and makes it harder to move air. Increased mucus can also make you to be more susceptible to getting infections.

Keeping all of this in mind, it is recommended that you try to breathe through your nose as much as possible and try to make the air that you are taking in more moist by either wearing a mask or breathing through a scarf.  Breathing through your nose also helps your body combat infections, because you have little hairs in your nasal area that will kick out microbes to keep you healthy.  Make sure you are well hydrated at all times which also helps to keeps the germs to a minimum.  It is also helpful to use your rescue inhaler 15-30 minutes before you exercise.

Additional things to keep your asthma stable during the winter would include getting a flu shot, avoiding sick contacts if possible, washing your hands often, vacuuming/dusting frequently and washings sheets and blankets in hot water once a week. Asthmatics are more prone to asthma attacks when they get sick, so taking precautions to not get sick go a long way.  I am also a big proponent of 500 mg of Vitamin C in the winter to help avoid getting sick.  But remember, if you do get sick, give your body the rest it needs to recover quickly and avoid exercise.


06/Feb/2019

Rittenhouse Obstetrics and Gynecology is an exciting new option for obstetrical care in Philadelphia, the only one that offers primary care and obstetrics together. Our program was thoughtfully created from the ground up to offer women an alternative to large university practices.

We offer a unique experience, with longer appointment times, allowing a focus on educating and empowering our patients throughout their pregnancy. From the first intake visit, we provide our patients a resource packet from trusted sources to limit the need for searching online and possibly finding false or harmful information. Our providers incorporate complimentary, evidence-based options to improve the experience, such as using jelly beans for gestational diabetes screening rather than the sugar drink that so many women dread. We also are knowledgeable about support services, such as doulas, an underutilized but valuable resource for women during labor and the postpartum period.

Women in pregnancy often experience non-pregnancy related problems that would be best addressed by a primary care doctor. We are the only obstetrical practice that has primary care doctors that work actively with our obstetrical team and feel comfortable addressing these concerns in a pregnant woman. The combination of providers allows for the most comprehensive and convenient medical care, all under the same roof.

Our practice is also unique in that all our providers and staff are female, which creates a safe, comforting atmosphere. Our providers are very experienced and most have children or are in the process of building their families, allowing us to relate to the challenges of pregnancy for a modern woman. We also have a strong focus on keeping up with current research and recommendations, and have weekly meetings to discuss best practices.

We chose to partner with Jefferson Health given their long-standing history of safe outcomes, including one of the lowest c-section rates in Philadelphia. Jefferson is on the forefront of research related to labor and delivery, and we trust their providers. Together, we have worked hard to coordinate genetics screening and transfers of care, to allow patients to take advantage of their specialists and smoothly transition to their program for delivery.

Our team is so excited that we get to continue to care for our patients during pregnancy and are working hard to give our patients the best experience we can.


03/Jan/2019

The thyroid is a small, butterfly shaped gland that sits at the base of your throat. Don’t be fooled by its diminutive size. The thyroid is actually the general that directs the function of many parts of your body, as well as your major organs.  The thyroid produces thyroid hormone, which it makes all on its own from the iodine consumed in your diet. Directions on when and how much hormone to release comes from the commander in chief: the pituitary gland. Making sure that your thyroid is able to produce the hormone and distribute it to your cells properly is more important than most people think.

Sometimes an illness, medications, damage to your thyroid, or even age can change the function of your thyroid. That’s why your doctor usually includes thyroid testing in your annual blood work. If you have too little hormone and it is not being sent out to your cells, it is called HYPOthyroidism. When this happens, everything slows down. You may feel tired, depressed, cold or even start to gain weight even though you have not changed your diet or exercise routine. It is not unusual for menopausal women to require thyroid medication to boost production and distribution of thyroid hormone. Synthroid (levothyroxine) is a safe medication with very few side effects that women can take daily with little concern.

When your thyroid is not producing enough hormone, it gets signals that it is under- producing and starts to work harder. Sometimes this can result in an enlarged gland that is called a goiter. This is much less common than it used to be because so many foods are iodine-enriched, making sure that a normal diet is adequate to provide needed amounts of iodine to produce thyroid hormone. Even so, it is very important to have your levels checked every year to prevent the stress on the thyroid. If you see or feel a bump near your thyroid, see your doctor for an evaluation.

The other side of the coin is HYPERthyroidism. This is when your thyroid is turbo-charged and produces way more hormone than you need. You may feel anxious, with a racing heart, have trouble sleeping and lose more weight than you’d like. The autoimmune disorder, Grave’s disease, is the most common cause of hyperthyroidism. With Graves, your own antibodies see the thyroid as foreign and attack it. This causes the thyroid to overproduce hormone. There are a number of medications that can help to slow things down. There are also treatments and finally, surgical removal of the thyroid. Only your doctor can tell you which is best for you.



Happy 2019!  As we run, walk, or maybe even crawl into the New Year, we often begin with a desire, if not a definitive plan to make lifestyle improvements.  Once and for all, we’re going to tackle that cluttered home, lose those extra pounds, or find the career where we’ll truly find fulfillment.  Despite our good intentions, we may quickly find ourselves overwhelmed and frustrated as we set lofty and often unrealistic goals.  Without a thorough assessment of our needs, wants, and resources, we can often fail to achieve our intended lifestyle improvements.  The New Year offers an excellent opportunity for a fresh start and a reexamination of our goals and choices.  As we begin 2019, I encourage you to look at your life with a critical eye and decide what you need to, want to, and are willing to try to work to improve.  Here are 19 suggestions for 2019 that can help.  Through these, you can improve your chances of lifestyle balance, goal achievement and of living the life you want and deserve.

1) Spend some time alone.  Get to know yourself without the influence of others.  You might find you like your own company.

2) Learn and practice Mindfulness.  Work on being in the present rather than allowing yourself to dwell in the past or anticipate the future.

3) Set boundaries with others, be they family, friends or coworkers.  Do not accept disrespect.

4) Allow others to help you.  They’ll feel good and you may get some much needed relief.

5) Get up and move!  Take the stairs, go for a brisk walk, do some jumping jacks, practice yoga, ride your bike.  Find a way to move your body.  Simply moving briskly 20 minutes each day can help decrease anxiety, depression and relieve stress.

6) Don’t be so hard on yourself if you don’t accomplish everything you planned each day.  No one does.  Work on small, realistic, attainable daily goals.  Small achievements reinforce us, leading us to want to strive for more.

7) Help someone else.  You’ll feel good and they may get some much needed relief.

8) Surround yourself with supportive and loving people.  Make good choices about with whom you choose to share your world.

9) Work on clearing away physical clutter.  You’ll be amazed at how this can lead to increased productivity and decreased anxiety.

10) Decide what changes will make you the happiest in the coming year.  Prioritize those.

11) Give yourself a time out.  When you feel overwhelmed, take 10 minutes alone to regroup.  Close your eyes and breathe.

12) Stop comparing your life, body, career, children, house, relationship, etc., to others.  You are a unique individual and deserve to be treated as such.

13) Look for opportunities to enhance parts of your life you never considered.  Read more.  Learn an instrument.  Take a break from social media.  Volunteer.

14) Share your intentions to improve your life with someone.  You’re more likely to achieve goals when you tell someone else.

15) Take risks but don’t be careless.

16) Let go of regret and grudges.  These simply expend energy unnecessarily and increase stress.

17) Have high expectations of others, both personally and professionally.

18) Be honest about your present circumstances.  If you’re feeling anxious and depressed, seek help.

19) Finally, as the great Maya Angelou said, “My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor and some style.”  Let’s all seek to do the same in the New Year.

Best wishes for a wonderful 2019!



We all know that winter time can be joyful and cozy. However, this time of year can also be accompanied by frequent illnesses, extra stress, and overindulgences. To protect yourself this holiday season, we recommend the following:

1)  Wash your hands!!! Yes, it seems obvious, but it’s all too easy to forget. This simple action, when done right, can protect you against many respiratory and diarrheal infections. Wet your hands under running water, lather up with soap, and scrub your hands (including the backs, under nails, and between your fingers) for at least 20 seconds, or for the length of time that it takes you to hum/sing the “Happy Birthday” song twice. Wash your hands before and after you handle food, before eating, before and after you care for a sick individual, after using the bathroom or changing a diaper, after blowing your nose/coughing/sneezing, after touching garbage, and after handling pets/pet food/pet waste. If you are interested in the science behind handwashing, please check out the CDC’s website here: https://www.cdc.gov/handwashing/show-me-the-science-handwashing.html

2)  Get your flu shot. The science behind the flu shot is robust. Getting your yearly vaccination can help avoid flu-related hospitalizations, illnesses, and transmitting the flu to others who are unable to obtain the vaccine (infants under 6 months or those with severe, life-threatening reactions to the flu vaccine).

3)  Aim for a regular sleep schedule, and if possible for 7-8 hours of sleep every night.

4)  Stay well hydrated- ideally (unless you have other significant medical conditions such as heart failure) aiming for about 6-8 glasses of water a day.

5)  Make sure you are aiming for those 4-5 fruits and vegetables a day, even during special occasions. If you overindulge, don’t beat yourself up, but aim for healthier, well balanced meal options in general.

6)  Be cautious with alcohol intake. We recommend no more than 7 drinks per week in women, and specifically no more than 2-3 drinks per day.

7)  Avoid contact with individuals that are sick to the best of your ability, and as above- make sure you wash your hands frequently to avoid spreading germs.

8)  Take time out for yourself to decompress; this may mean yoga, meditation, therapy, reading a good book, watching your favorite TV show, exercising, etc. Self-care and mindfulness is important.



‘Tis the season for lots of cookies, cakes, creamy drinks, hearty meals and overall indulgence!  This is the time of year when you are faced with more temptation than ever. Let’s take a few moments to think about how you can maintain your health while still enjoying the season:

1. Remember that balance is everything! 
Follow the 80/20 rule. This means that 80% of the time you will eat as healthily as usual and 20% of the time you will let yourself enjoy a treat without guilt. Here is some math: There are 40 days and 120 meals between Thanksgiving and New Years. If you follow the 80/20 rule you can have a treat at 24 of those meals. Choose wisely and consider tracking on your calendar. You may find that you can’t resist indulging at one event but you have no problem at another. Skip the donuts and leftover pies at work and save your 24 for a dinner or a party!

2. “Indulge” with these healthy but tasty treats:
A) Dip your vegetables in something creamy…. Make a savory dip with plain Greek yogurt!  For a thicker consistency, strain the yogurt overnight over a cheesecloth to remove liquid, then mix the thickened yogurt with your favorite savory seasoning and top with fresh chives or scallions. (Tip: you can use Greek yogurt as a substitute for many recipes that call for cream or sour cream).

B) Fill your house with the warm smell of baked apples and cinnamon: Slice apples in half or in to bite sized pieces. Coat with a small amount of coconut oil and cinnamon to taste. Optional: Sprinkle with almond slivers. Bake in the oven at 350F 20-30 minutes.

C) Try making “cookie dough” balls with chickpeas! Blend together chickpeas, nut butter and a small amount of honey. Your goal is a cookie dough consistency. Toss in some chocolate chips and roll the “dough” in to bite sized balls. You can eat this raw or you can bake it to get the melted chocolate effect!

3. Ask yourself, is this making me healthy? Is it making me happy?
If the answer is neither, why are you eating it? When was the last time somebody offered you a cookie and you took one bite and thought “this isn’t very good” but kept eating it anyway? This season challenge yourself to put the not-so-tasty cookie down! Save your 24 for something worthwhile!

4. Choose this not that:
A) Choose an apple crumble instead of an apple pie
B) Choose grilled, braised or roasted instead of stuffed, smothered, or rich
C) Instead of randomly grazing at a party, choose one item you can’t resist and then fill the rest of your plate with protein and produce



A game-changing new treatment is giving women back control of their bodies as well as their sexual desire.

What would say if we told you there was a shot which you could get directly into your clitoris, which would increase your sexual desire, give you mind-blowing orgasms and even treat urinal incontinence… and all of this could be achieved on your lunch break with zero downtime? You’d probably believe us more readily if we told you we’d commuted to work this morning on a purple unicorn. But the truth is that this procedure, known as the O-Shot, does exist and is about to become mainstream. In fact, you may have already heard of it in another guise – the vampire facial (made famous by Kim Kardashian, if you happened to catch that particular episode of Kim and Kourtney Take Miami). The vampire facial is the brainchild of Dr Charles Runels, who saw that PRP (Plasma Rich Platelets) medical technology was revolutionising medicine by helping to heal musculoskeletal injuries, and that it could also be applied to the the face to encourage skin rejuvenation.

As part of the treatment, a blood sample is taken from the patient and using a centrifuge, platelet rich plasma (PRP) is isolated. This PRP’s is full of growth factors, which are injected into the affected area to activate stem cells the stem cells there. In 2010, it struck Dr Runels that this technology could be used not only in facials, but in another unlikely way. “One day a patient of mine was undergoing a facial, and asked if this procedure could, in theory, be used on her vagina. And of course I said that it could, so the idea for the O-Shot was born from this.”

Little Understanding

Patients come to Dr Runels seeking the O shot for a myriad of reasons, from female sexual disorder (difficulty getting aroused) and female orgasmic disorder (difficulty climaxing) both of which statistics* say that one in 20 women suffer from, to hypoactive sexual desire disorder (low desire), which around 10 per cent of women suffer from. There are also physical reasons such as urinal incontinence and dyspareunia (pain during sex), both of which can be caused by child birth, menopause, or just as part of the natural ageing process. Sadly research shows that only 14 per cent of women ever talk to their doctor about sex, even though approximately 48 per cent of women are concerned about their sexual function. “Part of the reason that doctors and patients don’t really get into discussions about these kinds of disorders is that there isn’t really a proven solution, other than hormone therapies, or psychotherapy, which may not be what the woman even needs,” says Dr Runels. “Whereas on the other hand men have drugs available to them such as Viagra.” Another problem which women have revealed to him is that they don’t get much sympathy from their partner or friends, in a similar way to if she were suffering from a psychological disorder. “If a woman has pneumonia or breaks her arm, sympathy is given in abundance, but a woman with depression or severe anxiety, can be slower to share her problems and friends can be even slower to understand,” says Dr Runels. “It’s the same with a sexual disorder.”

Feeling Good

Loss of sexual function can cause a downward spiral for women.“When a women has a positive sexual experience, she is more likely to initiate sex,” says Dr Runels. “If a woman has a negative experience – difficulty with arousal or pain – it’s more difficult for her to get aroused the next time. Her responses become less powerful, so it’s a vicious downward spiral. However after the shot, she has a positive experience, so there’s a positive spiral upwards. The effect is twofold – physical and psychological – because in addition to the tissue becoming healthier, she is also more open to future encounters.” The first O-Shot goes into the patient’s clitoris, and for those of you who didn’t get the anatomy class in school it’s worth noting that most of the clitoris is inside a woman’s body, the part that is visible is actually only the tip. When the O-Shot is injected the whole clitoris can be stimulated rather than just the tip because the nerves become more responsive. This is also how it helps with urinal incontinence because the same nerves help to control the urge to urinate, so women are better able to feel and control the musculature there. The second shot goes into the skene’s glands in the vagina, which is similar to the prostate gland in a man. After the O-Shot some women even become ejaculatory for the first time in their lives when they orgasm.

Sexual energy is a very big part of the creative process – it energises us whether that’s in the bedroom or the boardroom.

Release the Energy

According to Dr Runels, the majority of his patients have tried all the conventional methods of improving the quality of their sex lives, from sex therapy and sex aids to self-help books, and he acknowledges that while getting to know your body better is always a good thing, there is little point if your body is not working effectively because of hormonal changes or after a procedure like an episiotomy. “I compare this to being told to read a book on how to drive a car when your engine has broken down,” says Dr Runels. “I had a patient in her twenties who delivered a large baby, and had to have an episiotomy. She hadn’t been able to have sex with her husband since because she was in so much pain, and it was really affecting their once very loving, attentive relationship.” The fact that Dr Runels can offer women an option means women begin to feel they are taking back control of their bodies and their sex lives, and this is hugely transformative. “I can see that they feel like they are getting their spark back. The ancient Chinese believed that we could transmute sexual energy into genius and creativity, and without it people become like a castrated animal. I am a big believer that sexual energy is a very big part of the creative process, and it energises us whether that’s in the bedroom or the boardroom. Even women who do not have a partner and do not want a partner, but may just want to have sexual experiences alone benefit from this resurgence in sexual energy.”

Coming Soon

On this side of the Atlantic, currently Dr Sherif Elwakil, is the only doctor offering the treatment in Europe at his cosmetic clinics in Harley Street and Baker Street, London (Royalskinclinic.com). “I have patients who come specifically for this treatment from all over Europe and I expected it to be successful, but I had no idea it would be this successful. So far I’ve had four patients come to me from Ireland, who have even come to me in the morning and flown home that evening.” But why is this treatment not available more widely if it’s going to revolutionise how we treat sexual disorders for women? “I think old-school medical practitioners in Europe are slow to get on board with new treatments like this from the States. But the feedback is so good that more and more people will begin asking for it. I think women’s sexuality has been underestimated for too long. I have actually trained with Charles Runels in the US in how to teach other doctors how to administer this treatment and I’m going to start holding training sessions around Europe from January, so I expect next year that this treatment will really take off.”

What to Expect

There will be a nurse present with the doctor throughout the procedure, which takes about 35 to 40 minutes in all and will set you back £1,000. First the doctor or nurse applies a numbing cream to the vagina and the arm. Blood is drawn from the arm in the same was as with any blood test. While the PRP is being prepared, which takes about ten minutes, the doctor can talk to you and answer any last minute questions you might have. Then, using a very thin needle, the PRP is injected the clitoris and into the upper vagina into an area most important for the sexual response. Because these areas have been numbed with the anesthetic cream, you feel little or no pain and the actual injections themselves takes no more than five minutes. “The best this about this treatment is that you’re using the growth factors you have in your own body to stimulate vaginal and clitoral rejuvenation, so it’s a completely natural treatment, with no downtime afterwards,” says Dr Elwakil. “Some of my patients have even had sexual intercourse the same day after treatment.”

It Doesn’t End There

When it comes to PRP medical technology both Dr Runels and Dr Elwakil emphasise that we are only seeing the tip of the iceberg as regards its potential. “Stem cell research is in its infancy, which is why a lot of the money I make from the O-Shot I put back into research for its other potential uses,” says Dr Runels. “Imagine a keychain which holds the key to every room in the body – bone, hair, collagen – this keychain is the PRP and science hasn’t unlocked this stem cell technology fully yet. There are many doors still to be opened.” Another condition which has responded well to treatment with PRP has been lichen sclerosus, which is a long-term skin condition which can affect the genital and anal areas. “I am currently talking to the Lichen Sclerosus and Vulval Health, Association here in the UK,” says Dr Elwakil. “I have personally injected five patients with lichen sclerosus who have reported that it has improved the condition. I have also had patients come to me, who haven’t lost sexual function and don’t suffer from



Hormonal contraceptives offer women of all age’s protection against unintended pregnancies through suppression of ovulation, thinning of the uterine endometrium, and/or inhibition of sperm motility and decreased sperm dispersion through the cervical canal and into the ovum. Many reliable, effective, and safe contraceptives are available for women, including long-acting reversible contraception (LARC) for women who are not candidates for estrogen-containing birth control or who prefer continuous protection for extended intervals.

Hormonal IUCs release progestin, a synthetic version of the hormone progesterone. The levonorgestrel impregnated IUC releases progestin into the uterine cavity, thickening cervical mucous, and causing thinning of the lining of the endometrium. There are four approved devices in the U.S., to include the Mirena, Kyleena, Skyla and Liletta. These are small, plastic, T-shaped contraceptives, that are placed inside the uterus and prevent pregnancy more than 99% of the time. The progestin IUCs start working about seven days after insertion and may be left in place, depending on the type, from three to seven years. All are inserted by a trained healthcare professional and can easily be removed at any time. At RWWC, we currently have both the Liletta and the Kyleena.

Liletta slowly releases 52 mg of a progestin hormone called levonorgestrel. This is the same kind of hormone that is often used in birth control pills. Only a small amount of levonorgestrel enters your bloodstream. Neither the Liletta nor the Kyleena contain estrogen. Approved for use in the U.S. in 2015, it measures 32 mm x 32 mm. Kyleena, approved in 2016, contains 19.5 mg of levonorgestrel and measures 28 mm x 30 mm. It works the same way as the other progestin containing IUCs, slowly releasing levonorgestrel over time. Both are effective against unintended pregnancies for up to five years.

The Copper-T 380A IUD (intrauterine device) was introduced into the United States in the late 1980’s. It is a small, (36mm vertically x 32mm horizontally) plastic “T” shaped contraceptive placed in the uterus by a trained health care professional. The approved duration for use of the Copper IUC is twelve years. Otherwise known by the brand name Paragard, this IUC is the only nonhormonal IUC approved for use in the U.S. Paragard does not contain hormones, instead using the copper that surrounds it to halt sperm from getting to the egg as well as possibly creating an immune response within the reproductive tract that interferes with fertility before an egg reaches the uterus. IUCs prevent fertilization but are not abortifacients, which had been a common myth. The Paragard IUC works as soon as it is placed inside the uterus and can be used for emergency contraception if inserted within five days after unprotected intercourse. The Paragard is easily removed whenever you want and is safe to use while breastfeeding. Common side effects after placement include heavier periods and cramping for several months, both alleviated with over the counter non-steroidal anti-inflammatories (NSAIDs) like ibuprofen. We do offer the Paragard IUC at RWWC.

Hormonal contraception also offers many health benefits besides prevention of an unintended pregnancy. The hormonal intrauterine contraceptive (IUC) may reduce the risk of some cancers, including cancer of the endometrium (the lining of the uterus), cervical, ovarian, and even colon cancer. Many women benefit from menstrual regulation and decreased cramping, while others have a lighter period-or no period at all. Both the hormonal and non-hormonal IUCs are over 99 percent effective, cost-effective, long-lasting, and decrease the possibility of user error that comes with taking a pill every day or using condoms.

There are a few risks involved with the IUCs, as well as contraindications, that should be discussed with your healthcare provider prior to insertion. Please schedule a consult beforehand, if you have not already discussed the appropriateness of IUCs at your annual gynecologic visit. Problems can be managed, and most women are happy with their choice. Continuation rates for intrauterine contraceptives are generally higher vs. other forms of contraception for women.­

We also offer Nexplanon. The Nexplanon is considered a contraceptive implant – it is a very small rod inserted under the skin of a woman’s upper arm to provide birth control. It’s invisible and prevents pregnancy for up to 4 years.



If you don’t have endometriosis, you’ve probably heard of it – it affects about one in ten women of reproductive age. Although the condition’s two main symptoms are pelvic pain and infertility, both are treatable, and women with endometriosis often go on to have healthy pregnancies.

If you are having pelvic pain or trouble getting pregnant then you should schedule an appointment with your practitioner and we can refer you, if necessary, to a specialist.

What is endometriosis?

Endometriosis is a condition where cells from the endometrial lining implant and grow outside of the uterus (including on the ovaries, the pelvic cavity and the fallopian tubes), causing inflammation and scar tissue that can lead to pelvic pain and infertility.

What are the causes of endometriosis?

There are several potential causes, including:

  • Retrograde menstruation: During menstruation, while most of the blood and tissue flows out of the vagina, a small amount of blood and tissue travels up backwards through the uterus and fallopian tubes and into the pelvic cavity. In most women, the immune system gets rid of that blood and tissue. By contrast, the immune system of women with endometriosis is unable to fully eliminate the backflow. Therefore, tissue from the uterine cavity is able to stick to and invade areas outside of the uterus. This is the most common cause of endometriosis.
  • Blood or lymphatic system spread: endometrial cells can spread to other parts of the body (the pelvic cavity in particular) through blood.
  • Coelomic Metaplasia: in this case, cells in other parts of the body unrelated to the uterus turn into endometrial cells.

What are the symptoms?

Pelvic masses, pelvic pain and infertility are the main symptoms of endometriosis. All of them can be treated, but not necessarily at the same time. In some cases, women with endometriosis have no symptoms at all and are diagnosed only after they seek a reproductive endocrinologist’s help in getting pregnant.

How is the condition diagnosed?

While checking for symptoms and performing a physical exam is an important first step, the only real way to diagnose endometriosis is through a biopsy obtained during surgery. There is no blood test for endometriosis.

How is endometriosis treated?

When treating endometriosis, it is important to first identify whether a patient is mainly concerned with addressing her pain or treating infertility. It is not always possible to simultaneously relieve a patient’s pain and also help her to become pregnant. If a woman is not looking to conceive and just wants to alleviate her pain, over the counter pain killers like Advil or Motrin, as well as hormonal treatments like birth control pills or the Mirena IUD, can help.

Patients whose main concern is pregnancy will likely require treatment with fertility medications and either artificial insemination or in vitro fertilization (IVF). IVF is the most effective treatment for infertility in patients with endometriosis because it bypasses pelvic scar tissue and enables the sperm and egg to meet in a controlled environment. However, even in IVF, women with endometriosis have slightly lower pregnancy rates than other individuals with infertility.

So I can get pregnant if I have endometriosis?

Yes, you read that right! You might need a little help through IVF, but you can get pregnant.


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1632 Pine Street
Philadelphia, PA 19103
Phone: 215-735-7992
Fax: 215-735-7991
Email: info@rwwc.com

Hours

Monday – Thursday:  8am – 8pm

Friday: 8am – 4pm for the summer

Saturday: Closed for summer

Sunday: Closed

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