Pellet Hormone Replacement FAQ

We know that Hormone Replacement Therapy is essential for managing severe menopause (or “manopause!”) symptoms, and hopefully there is an easy way to deliver it, right? Fortunately, there is! IntimMedicine offers an easy outpatient procedure to place a bioidentical hormone pellet under the skin. Outta sight, outta mind, and you get to start living your life again!

What is it?

Pellets are compounded bioidentical hormones for women (our team of experts will determine exactly what’s right for you – the right amount can help you regain your hormonal balance). Pellet therapy is actually FDA approved for men, as well. Pellets are typically naturally occurring hormones that are pressed into a solid, little insert, about the size of a grain of rice.

How does it work?

Your pellet will release a small amount of your hormonal regimen straight into your bloodstream, similar to what your ovaries or testes would normally have produced in your younger years. Research shows that pellets are able to deliver a consistent level of hormones to your body, unlike some creams, gels, or pills which are also compounded. Pellets also reduce the risk of blood clots (venous thrombosis) associated with oral hormone replacement therapy because the hormones released from pellets enter the bloodstream directly and do not cause changes in blood clotting factors made in the liver the way oral medications can. It’s a win-win!

How is it used?

Hormone Replacement Pellets are used like any other Hormone Replacement Therapy to help our bodies regain some of its hormonal balance, which will improve everything from the emotional roller coaster to hot flashes. The pellet is just a convenient delivery method! It’s not for everyone, but getting your hormones “just right” no matter the method is critical.

How long does the procedure take?

It is a quick and painless (with numbing medication) outpatient office procedure. We will insert the HRT pellet right into your hip, abdomen or buttock area, and you’ll be on your way and back to your life!

How long till I see results?

It will only take 7-10 days for you to notice your HRT Pellet working on your symptoms.

How long will my pellet last?

HRT Pellets typically last 3-6 months for men and women.

How can I make an appointment? Call us at 202.293.1000 or email us to set up a consultation appointment with one of our specialists here in Washington, DC. Don’t wait to get back to living your normal life – call us today!

man and woman in bed, separated, unhappy

Study Shows that Deep Dyspareunia can Improve with Interdisciplinary Treatment

There is good news for women who are suffering from Deep Dyspareunia! Dyspareunia is the fancy medical term for painful sex, and can be categorized two ways: superficial (affecting just the entrance of the vagina or vulva), or deep (pain during deep penetration).

In a recent study published in the Journal of Sexual Medicine, researchers had 278 women self-report pain scores related to their Dyspareunia symptoms on an 11-point scale. The women and their physicians decided which treatment options to pursue, including “minimally invasive surgery, hormone therapy, pain education, physiotherapy, or psychological therapy” (ISSM). This is what is considered an “interdisciplinary approach,” since treatments were not limited to one course of action.

After a year, researchers followed up with the women who participated in the study and found that the 28% of women who had reported absent or mild pain had increased to 45% of women, the 17% who rated their pain as moderate increased to 25%, and the 55% of women who said they were experiencing severe pain decreased to 30% of women. These are great results and should give hope to women who are still experiencing painful sex!

It should be noted that having depression and being at a younger age were considered predictors for having continuing deep dyspareunia after a year, because depression can also “affect the sexual response cycle, pelvic floor function, relationships with partners, and emotional aspects of pain” (ISSM). More research needs to be done about how depression can affect deep dyspareunia, but the authors of the study recommend treating your depression first and foremost should you be suffering from it, as your other symptoms can improve with that treatment.
Because the women and their doctors chose different plans of action to treat the symptoms, we can’t be sure exactly which treatments were most effective, but the bottom line is that after only a year your symptoms can improve if you are able to attack the problem holistically. That’s where we come in. IntimMedicine Specialists are well-known for our holistic, tailored approach towards treating our patients. If you are experiencing painful sex, give us a call, or e-mail us! Our experts here in Washington, DC would love to discuss which options to try with you to start treating your pain and improve your sex life and beyond!

Let's talk about IT - MonaLisa Touch

Let’s Talk About IT

Introducing MonaLisa Touch, a groundbreaking vaginal treatment for menopausal women.

“IT” is vaginal discomforts, including dryness, burning, itching, and painful sex, all which fall under the umbrella term, “vaginal atrophy.” Vaginal atrophy can occur after vaginal childbirth and/or during menopause. Around 40% of menopausal women suffer from vaginal atrophy, but these women rarely talk to their gynecologists about it. If you’re one of them, it is time to stop suffering in silence and get back to enjoying your sex life!

We at IntimMedicine Specialists are very happy to offer you a vaginal laser procedure called MonaLisa Touch from our office here in Washington, DC. MonaLisa Touch is a painless and minimally invasive therapy that requires 1-3 treatments over the course of a few months. We know you have questions – we have answers!

Who is MonaLisa Touch for?

MonaLisa Touch is for any woman who wants to prevent or treat vaginal symptoms related to a decrease in estrogen, which can occur during menopause, after childbirth during breast feeding, or after many different cancer treatments, especially following breast cancer. If you are looking for a treatment that does not require hormones or surgery, MonaLisa Touch might be your answer!

How does MonaLisa Touch work?

MonaLisa Touch is a laser treatment that reactivates the production of collagen and rebalances the conditions of the superficial vaginal tissues. It does this by gently acting on the vaginal walls. This is a safe and painless process that only takes a few minutes.

Does it hurt?

MonaLisa Touch is completely painless! Patients have reported feeling a slight vibration, and some say that it feels no different than getting a pap smear. For extremely sensitive patients, a form of “Novocaine” can be topically applied without injections to eliminate any discomfort of the procedure.

How long is the recovery, and how long does it take to start working?

We recommend refraining from vaginal intercourse for 3-4 days after each treatment, but you’ll start to notice a positive difference almost right away! More treatments may be recommended depending on the severity of symptoms, but typically 3 sessions are needed for best results.

How long does the treatment last?

Treatments can last for at least a year, depending on the severity of symptoms and your age and lifestyle. We can revisit the need for additional treatment sessions with you after a year or if symptoms recur.

We can help you restore your vivacity! If MonaLisa Touch vaginal therapy sounds right for you, give us a call at 202.293.1000 or email us to make an appointment for a consultation at IntimMedicine in Washington, DC.

Men have Pills for their Sexual Dysfunction, Why Can’t Women?

A Response to “How Addyi, the ‘Female Viagra,’ Can Do More Harm Than Good” By Dr. James A Simon

Earlier this month, Dr. Janet Brito, a sex therapist based in Hawaii, raising a few questions about the efficacy and wisdom in using Addyi, known as the “Female Viagra,” to treat sexual dysfunction in women. The article she wrote has been removed from that site that posted it due to the inaccuracy of the information the article contained. In spite of this, I felt that it was important to address her concerns, and to explain how Addyi is, in fact, an empowering tool that women who are suffering from hypoactive sexual desire (HSDD) or female sexual interest/arousal disorder (FSAD).

Efficacy and Use

Regarding the efficacy and use of Addyi, Dr. Brito makes several claims that are either blatantly false or not based in fact. She states that Addyi “needs to be taken every day for at least 8 to 16 weeks before it starts working.” According to the package insert itself (approved by the FDA), if Addyi isn’t working by 8 weeks, its use should be discontinued.

Brito brings up the fact that “according to the Addyi website, ‘it’s exact mechanism of action is not fully understood,’” without any other comment, perhaps implying that this is a reason it should not be used, but this fact is also true for all antidepressants, pain killers, appetite altering medications and most medicines generally.

“Initially, flibanserin was slated for the treatment of depression. After two rejections by the FDA, Addyi was approved in 2015 to treat low sexual desire in premenopausal women — despite trials showing only minimal results compared to a placebo,” states Dr. Brito. Addyi was originally developed to treat depression, but in people with major depressive disorder where Addyi didn’t work for depression, it increased sexual desire. That’s correct, it worked to increase sexual desire even in women that were clinically depressed.

Thus, the company behind Addyi pursued sexual dysfunction as an option to help women suffering from hypoactive sexual desire disorder or HSDD or female sexual arousal disorder or FSAD. The drug was rejected twice by the FDA, in my opinion, because the FDA kept changing their mind about what they wanted.

The company was trying to develop a first-in-class medication where the tools for assessing efficacy weren’t invented yet. For responders to the medication (excluding all the non-responders), they had 5.7 sexual events per month, which can’t be considered minimal, and which the responders themselves judged as a meaningful improvement.

“Their desire stats did change and show an increase when researchers measured it according to the Female Sexual Function Index — but if participants didn’t notice their own response, can it really be considered effective?” asks Dr. Brito. The Female Sexual Function Index is a validated questionare answered by the study participants, an approach agreed upon with the FDA. Participants reply to the FSFI based on how they, the participants, feel.

Social Oppression and Relationships

Dr. Brito spends a great deal of the article drawing a connection between a pill to treat sexual dysfunction for women and a long history of societal oppression of women. I fail to see the connection, as Addyi is only prescribed to patients who wanted to increase their sexual desire for one reason or another, not because their partners or society had problems with their libidos as Brito suggests.

Brito’s other accusation that those who prescribe Addyi are not taking into account any of the other factors that might contribute to low sexual desire, is not based in fact. Study participants were excluded from entering the research studies if they had any other reason for their loss of sexual desire, any reason. Such reasons would have included: depression or other medical conditions, medications known to affect sexual function, and any relationship problems, just for examples. Erectile Dysfunction has many causes and factors, and yet men are prescribed Viagra without a second thought. Shouldn’t women have equal access to a pill that can help them with their sexual function, too?

Like those who are prescribed a pill for depression, Addyi can help women start living their lives again, and get back to their old selves.

Brito also writes, “…sometimes the issue is about the relationship you have with yourself, not others.” On this point, I totally agree. But women with relationship problems with themselves or their partners were excluded from the clinical development of Addyi as noted above. Addyi is there for women who have been diagnosed with HSDD or FSAD, who are in a healthy relationship with their partners, and who want to get back to enjoying their partners sexually.

Dr. Brito concludes the article with this line, “Instead, ask yourself, honestly, if any of the aforementioned factors are impacting your life. And, if so, what lifestyle changes to embark on to start to feel better on your terms.” Addyi, Viagra, anti-depressants, and a slew of other medications may not be the best choice for every patient, but the patient does have a choice.

Why a sex therapist (who cannot even prescribe Addyi or medication generally) is ruling out a drug that is effective, readily available, and which delivers on the promise to increase “sexual desire and satisfying sexual events,” is beyond me.

To discuss if Addyi might help you or determine if you might be suffering from HSDD or FSAD, give us a call at 202.293.1000 or e-mail us to make an appointment at our office in Washington, D.C.

woman holding a baby in her lap
Postpartum

Treating Postpartum Vaginal Laxity

If you’ve given birth, you know all the physical and emotional distress associated with the process! And if you’ve given birth vaginally, you know it can be difficult to bounce back to normal “down there,” which can have a major effect on your sex life.

Vaginal Laxity, or “looseness” as it relates to vaginal childbirth occurs when the muscles in the walls of the vagina are over-stretched as you push that bowling-ball sized baby’s head through it. The vagina naturally relaxes in response to sexual arousal, but regular sexual activity will not contribute to the vagina “loosening” because the vaginal will naturally re-tighten itself afterwards. The relaxing of the vaginal wall also naturally occurs during childbirth, but there are limits to its elasticity. You can stretch out a waistband or a sock in the same way – over-stretch it, and it will never be the same… or will it?

Sometimes Vaginal Laxity sorts itself out along with a host of other post-partum body complaints that new moms have once their babies have transitioned over to solid food and stopped breast feeding. But, Vaginal Laxity can also persist, and can contribute to sexual dysfunction. Not everyone who experiences Vaginal Laxity has complaints about their sex life, but it can reduce pleasurable sensation during intercourse and result in less sexual satisfaction for you and your partner, which of course contributes to less sexual intimacy. Add Vaginal Laxity to the list of other life-altering changes that baby brings and it can seem like your love life is over!

The good news is, you do not have to live with Vaginal Laxity! There are many ways to treat it. Talk to your OB/GYN about it at your next appointment, try pelvic floor physical therapy, and keep up with your Kegel exercises, but your vaginal walls might still need a little extra help. That’s where we come in! IntimMedicine Specialists is host to several ongoing clinical trials, and we are excited to offer a free treatment in a study on a new technology to help with vaginal tightening! If you’ve given birth vaginally at least six months ago and are experiencing sexual dysfunction related to vaginal laxity, you may qualify. Medical insurance is not required for study participation and compensation for time and travel is provided.

If Vaginal Looseness is keeping you from enjoying sex, it’s time to treat it! Space is limited, so call to schedule your appointment with Laura Barbee at 703-242-6362.

gloved hands holding breast implants

A healthy body image leads to better sexual health, but are breast implants worth the confidence boost?

There are several options on the market for breast implants these days; silicone or saline, textured or smooth, even fat injections are an option. But which of these are the safest to use?

According to Michael S. Kluska, D.O., smooth, round silicone breast implants made of a highly cohesive gel are the safest and most popular option. He says textured implants and contoured implants (which are usually textured) could lead to a rare type of breast cancer called anaplastic large cell lymphoma, or ALCL. He also mentions that textured implants have a higher likelihood of getting “stuck” in place and healing, resulting in lop-sidedness.

Saline vs. silicone is another thing to consider for breast implants. Saline implants have a slightly higher risk of rupturing compared to silicone, and that they tend to ripple more than silicone implants. Saline implants are a three-part system, which Dr. Kluska cites as the reason for more frequent ruptures. “Usually, failures of saline implants occur at the port where we fill the implant,” says Dr. Kluska.

Breast augmentation using fat injections is also an option, but according to Dr. Kluska, fat can be unpredictable, and often requires several appointments where fat grafts are taken from the patient and transferred into their breasts to achieve the desired size. A woman who is young, healthy, non-smoking and not obese is an ideal candidate for fat grafting.

So, why take the risk of breast cancer, a ruptured implant, or go through the trouble of fat grafting? Well, self-image is an important part of overall health and well-being, and particularly for women who have had mastectomies, breast implants are an obvious solution to help them feel sexy and beautiful. And when getting breast implants, bigger isn’t always better. “We know now that bigger implants can potentiate bigger problems. Sizing the implant to make the patient have better anatomical proportions is always in the patient’s best interest,” says Dr. Kluska. Self-acceptance is still an important part of your well-being and your sexual health, and it will still be part of your journey if you choose to get breast implants.

The long and short of it is, breast augmentation can be a way to help you achieve greater self-confidence in your daily life, and in the bedroom. Always be sure to talk to a doctor you trust, and if you are in the Washington, DC area, we are always here to listen and talk you through what options are best for YOU. Call us at 202.293.1000 or e-mail info@intimmedicine.com to make an appointment!

woman, thoughtful

  New research published this month on the JAMA Network Open indicates that 7.0% of women and 10.3% of men have what is now classified as compulsive sexual behavior disorder (CSBD). CSBD is defined as “failing to control one’s sexual feelings and behaviors in a way that causes substantial distress and/or impairment in functioning.” There are a few things we can glean from this data, but it might tell us a whole lot more about our society than it does about human sexuality.

  First off, the results are self-reported and based on perceptions of one’s own behavior. Negative stigma about sexual urges or thoughts within certain cultures and sub-cultures in the United States could result in what researchers are now calling a disorder, but might actually be healthy urges interpreted through an unhealthy social lens. Psychologists have argued about what constitutes “healthy” sexual behavior since the dawn of the field, and the discussion is nowhere near a conclusion. Unfortunately, using a self-reporting survey does not allow researchers to be able to distinguish between participants feeling distressed about compulsive and intrusive sexual impulses, and participants feeling distressed about their sexual urges because of moralistic pressures within their sub-cultures.

  Secondly, the close percentage of men and women who are now diagnosed with CSBD could be telling, or it could not be. The long unspoken “rules” about male and female sexuality in the US could be at play here. Men have been told that their sexual urges cannot be repressed and that it is unhealthy to do so, while women have held the role as “sexual gatekeepers.” Those societal factors and gender roles may have led to fewer men and more women reporting distress due to their sexual urges and behaviors. On the other hand, it could be interpreted that men and women actually have similar sex drives and sexual habits. With interpretations of sexuality in America in such a complicated place, it is difficult to make a determination about this.

  The bottom line is this: if your sexual behaviors or urges are causing you distress or impairment in functioning, whatever that means to you, it is worth talking about! It is our goal to help you feel whole and healthy, and we believe sexual health and wellness is a huge factor in achieving that goal. Give us a call at 202.293.1000 or email info@intimmedicine.com to make an appointment with one of our specialists today. We are here to help.

 

Congratulations to the New ISSWSH President

The International Society for the Study of Women’s Sexual Health (ISSWSH.org), the preeminent organization focusing on the biopsychosocial aspects of women’s sexuality, welcomes Dr. James A. Simon, M.D., Clinical Professor of Obstetrics and Gynecology at The George Washington University School of Medicine in Washington D.C., as its new president.

Dr. Simon’s goals for his two-year term presidency include doubling the ISSWSH membership by expanding the knowledge of physicians (gynecologists, urologists, internists, and other primary care givers), advanced practice nurses (nurse practitioners, midwives, etc.), physician assistants, mental health providers (e.g., psychiatrists, psychologists, psychiatric social workers, certified sexual health counselors and educators), and pelvic floor physical therapists in the oft-neglected field of sexual medicine, a discipline with similar quality of life impact as arthritis, chronic obstructive pulmonary disease, asthma, and irritable bowel syndrome. Further, Dr. Simon vows to pressure the FDA into removing sexually discriminatory barriers to the development of new medications focused on improving women’s sexual health.

Dr. Simon served most recently as the president-elect of ISSWSH. He is also a past president of the North American Menopause Society, and The Washington Gynecological Society.

Dr. Simon is a prolific clinical researcher, holding distinctions for his involvement in reproductive endocrinology and infertility, the earliest advancements of in vitro fertilization, menopause, osteoporosis, and sexual medicine. Dr. Simon’s research has been supported by more than 360 research grants and scholarships from a wide range of sponsors, including the National Institutes of Health, The American Heart Association, The Heinz Foundation and the pharmaceutical industry. He is an author or a co-author of more than 550 peer-reviewed articles, chapters, textbooks, abstracts, and other publications, including several prize-winning papers. Dr. Simon is coauthor of the paperback book “Restore Yourself: A Woman’s Guide to Reviving Her Sexual Desire and Passion for Life.” A short list of his other honors and achievements includes being selected to “Top Washington Physicians,” “America’s Top Obstetricians and Gynecologists,” and “The Best Doctors in America.” Dr. Simon and his care team continue to treat patients from all around the world in his private practice in Washington, D.C.

Have questions regarding medical or women’s sexual health issues? Contact his office at (202) 293-1000.


 
 

For media/speaking inquiries, contact:
Nancy Rose Senich
Rose4Results.com (Agency)
Phone/Text: 1-202-262-6996
Email: nancy@rose4results.com

 

Hot Flashes

For women going through the menopausal transition, there’s no better discovery than a safe, natural, nonhormonal treatment for hot flashes that really works.

So a study just presented at the annual scientific meeting of the American College of Obstetricians and Gynecologists caught our eye. It focused on an over-the-counter botanical extract derived from pollen. Could such a simple remedy really improve symptoms and quality of life?

To learn more, we spoke with the study’s author, James A. Simon, MD, an ob-gyn in private practice in Washington, DC, and professor at The George Washington University School of Medicine and former president of the North American Menopause Society.

Relizen, the brand name in the US of the botanical extract, was developed after an accidental discovery—a Swedish beekeeper noticed that when bees feasted on the pollen of a particular flower, they seemed more energetic. So he wondered if giving that pollen to men and women would make them more energetic, too.

“It didn’t work,” said Dr. Simon. “But menopausal women who took it said that their hot flashes were better.” So the extract was developed using just the cytoplasm (material inside the cell) of the pollen—according to the manufacturer, that removes the pollen allergens. It’s actually been available in Europe under different names for about 15 years, and it is backed up by peer-reviewed research. In a 2005 double-blind placebo-controlled study of 64 menopausal women, 65% of those who took it had fewer hot flashes—compared with 38% of those who took a placebo. It’s been used by more than a million women in Europe.

In the new study, 324 women going through the menopausal transition took Relizen daily for three months. To get into the study, the women had to be having hot flashes—and be bothered by them.

Results: 86% had fewer hot flashes, and for 91%, their hot flashes were less severe. What the new study adds is an emphasis on self-assessed quality of life—fatigue, irritability, sleep quality. These all got better, says Dr. Simon, who has no financial stake in the company that makes Relizen. “Their sense of well-being improved,” he said. The mechanism—how this extract works—isn’t well understood. Side effects, such as stomach upset, were rare and tended to go away after a week or two.

AN ADDITIONAL BENEFIT FOR BREAST CANCER SURVIVORS

Because research has confirmed that it doesn’t affect hormones, Relizen may have a particular role to play for women who have survived breast cancer who have been told that hormonal treatments aren’t safe for them. Currently, the only nonhormonal FDA-approved prescription for relief of menopausal symptoms such as hot flashes is the antidepressant paroxetine (Brisdelle, which has the same active ingredient as the antidepressant Paxil). But this antidepressant not only has side effects such as headaches, nausea, weight changes, reduced sex drive and interference with the ability to have an orgasm—it may also interfere with the action of Tamoxifen, the drug that is often prescribed after breast cancer treatment to prevent recurrence. Relizen, according to a recent study in Menopause, doesn’t affect the action of Tamoxifen.

SHOULD YOU TRY IT?

If you want relief from hot flashes and night sweats, Relizen is one of many options, said Dr. Simon. Hormone therapy, such as estrogen, is certainly the most effective for symptomatic relief, but many women want to avoid taking systemic hormones based on safety concerns. (We’ll revisit this controversial issue in an upcoming article.)

Plant-based supplements that have estrogenic effects can help, and Dr. Simon occasionally recommends Remifemin, an over-the-counter product that contains the estrogenic herb black cohosh. “I double the dose on the package insert to achieve the best results,” he said. Purified soy phytoestrogens also work for some patients, he notes. If you decide to pursue either option, he recommends that you work with a health-care professional, as there are safety questions for some women in taking estrogenic compounds, especially women with or at high risk of developing breast cancer.

Among nondrug approaches, he’s seen success with hypnosis. Even acupuncture, which hasn’t been shown in studies to be effective for hot flashes, appears to work for some people, said Dr. Simon.

What he likes about Relizen is that it’s so safe—for any woman, including those with a history of hormone-sensitive breast cancer—that it’s fine to try on your own. “A patient can acquire it by herself and see if it’s beneficial—before seeing her practitioner,” said Dr. Simon. “If it doesn’t work after two or three months, she can see her health-care professional for other options.” (Note: Relizen is currently available through the manufacturer’s website.)

Sources: Study titled “Nonhormonal Treatment of Perimenopausal and Menopausal Climacteric Symptoms” by James A. Simon, MD, CCD, NCMP, clinical professor of obstetrics and gynecology, The George Washington University School of Medicine, and René Druckman, MD, presented at the American College of Obstetricians and Gynecologists Annual Scientific and Clinical Meeting 2016. Dr. Simon is a Washington, DC–based physician who provides patient-focused care for women across the reproductive life cycle, from adolescence to childbirth, and through the menopausal transition.

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Despite Recent Report, You Still Need an Annual Pelvic Exam

Recently, the U.S. Preventive Services Task Force (USPSTF) concluded that, “the current evidence is ‘insufficient’ to determine the balance of benefits and harms of the pelvic exam.” The USPSTF then made the recommendation to discontinue routine pelvic exams for women who are healthy and not pregnant. The broader media jumped on this as if it were fact, and an accepted change in practice. But does this lack of evidence mean there is no benefit to routine pelvic exams? Absolutely not.

The absence of evidence does not indicate the evidence of absence- If there is an absence of or limited evidence for the benefits of routine pelvic exams that does NOT mean there is adequate evidence to recommend against them.

The conclusion to discontinue the routine pelvic exam runs counter to the goals of improving women’s health through preventive care- Being asymptomatic is not the same as being healthy or not having a problem. The recommendation to perform pelvic exams only if women complain of problems will lead to missed opportunities to diagnose potentially fatal pelvic conditions. I understand that women do not like pelvic exams as they are intrusive, invasive and sometimes painful, but here is a fact I think most people are forgetting: they save lives. If you never check a temperature you’ll never find a fever.

Many others are also refuting the elimination of routine pelvic exams. As Dr. Maureen Phipps told the New York Times,This is not a recommendation against doing the exam. This is a recommendation to call for more research to figure out the benefits and harms associated with screening pelvic exams. That’s the big message here.” She is the chairwoman of obstetrics and gynecology at Brown University’s Warren Alpert Medical School and was on the USPSTF task force. The American College of Obstetrics and Gynecology (ACOG) and other organizations are still recommending yearly pelvic exams for women over the age of 21.

So, at the risk of being redundant, I strongly disagree with the conclusion of the USPSTF draft evidence review, but particularly as it applies to postmenopausal women. There is a lot more that goes into the routine gynecological visit, including the pelvic exam. Women 18 years and older or anyone with risk factors like multiple partners, history of HPV, chronic infection or fertility issues should be seeking routine pelvic exams and pap smears. Contact our office to see if you should come in for a screening.

Sincerely,

Dr. James A. Simon, MD, CCD, NCMP, IF, FACOG

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