This is a common question and while bleeding after sex can oftentimes be explained, it can never be assumed to be normal. Common causes of bleeding with or after sex include infection, dry vaginal tissue, lesions on the cervix/vagina/vulva, or abnormalities associated with the uterus. All of these things can be easily evaluated for by an OB/GYN in the office. Patients commonly describe pain as well with sex. This symptom also is not normal and should be evaluated. It is so important to not be embarrassed about this. Pain with intercourse (also known as dyspareunia) is very common and truly can be a huge quality of life issue. Many causes exist and the importance of providing a good history to a doctor cannot be underestimated. Patients typically describe pain with insertion, deep vaginal pain or generalized pelvic pain. The good news is that while there are many causes of dyspareunia, many treatment options are available.

Breast cancer is the most commonly diagnosed cancer in women in the United States and the second most common cause of cancer-related death. For these reasons, screening is important and should be emphasized in all women. Depending on a woman’s age, the recommendations for screening vary. One question that needs to be addressed is whether a clinical breast exam by your health care provider is important. Also, if a woman is doing routine mammograms, does she also need a clinical breast exam? The American College of Obstetrician gynecologists currently recommend that women between the ages of 20-39 have a clinical breast exam every one to three years. Women age 40 and over require an annual breast exam as well as a mammogram. Studies show that having a clinical breast exam does improve breast cancer detection and in some cases can detect a cancer that was missed on a mammogram. The good news is this exam can be incorporated into your yearly exam. If you have any questions or concerns, this should be addressed before your annual visit.

The short answer is ,"it depends." First, it is important to know that fibroids, also known as leiomyomas, are benign tumors most often of the uterus. Approximately 80% of women develop fibroids in their lifetime. Watchful waiting is an option for patients without symptoms. Typically a follow up ultrasound or pelvic exam is done to assess if fibroid(s) are growing. Rapidly growing fibroids most often associated with heavy bleeding can be a sign of uterine sarcoma- an uncommon but very serious uterine cancer. If a patient has symptomatic fibroids like pain, bleeding, pelvic pressure or infertility then evaluation and treatment are needed. A baseline ultrasound to assess size and location of fibroids is very helpful for guiding treatment options along with a hemoglobin blood level. Fortunately many treatment options exist for fibroid treatment ranging from medical to surgical. Some of these options include hormonal therapy, levonorgestrel IUD, uterine artery embolization to block fibroid blood supply, fibroid removal through laparoscopy or hysteroscopy , and hysterectomy.

Yes, regardless of your bone health status, it is recommended that everyone has adequate intake of calcium and vitamin D. From age 9-18, 1300 mg of calcium is needed daily. From age 19-50, 1000 mg of calcium is needed daily and 51 and older, 1200 mg. Vitamin D is also important for bone health and everyone should receive the recommended daily dose of 600 IU per day until the age of 71, when recommendations increase to 800 IU. The Institute of Medicine recommends achieving these levels of calcium and Vitamin D through diet and supplements if you are not receiving enough. It is important to determine how much calcium and vitamin D is in your diet so you know how much is needed from supplements. You receive approximately 300 mg of calcium per serving of dairy products. Other foods that are rich in calcium include dark green vegetables, soy products and some breads and cereals. Vitamin D is found in many fortified foods, such as dairy products. It is important that the elderly, those who avoid sunlight, or live in Northern Minnesota during the winter, get enough vitamin D.

As we age, the nerves and muscles that control the bladder may no longer work as well as we want, causing leakage. Fortunately, there is a proven treatment option for people who have not had success with medications and behavioral therapy. InterStim is a neuro-modulation therapy that targets the communication problem between the brain and the nerves that control the bladder. It involves the permanent placement of a nerve- stimulating device, called InterStim, which stimulates and quiets the nerves of the bladder. The InterStim procedure has several benefits, including freedom from the embarrassment of leaks and reducing the need to interrupt sleep to urinate. Patients who have had this procedure have used the term life-changing. It allows them to have less urgency and more control of their bladder. The patients who’ve recently received the implant at CRMC have been “thrilled” with the improvement they’ve experienced and said the procedure has given them back their lives. They can once again go places and do things they’ve not been able to do for a long time and no longer need to constantly search for the nearest restroom. Some are now pad-free for the first time in years. InterStim is very effective for people with overactive bladder leakage and in helping women with urinary retention and fecal incontinence.

An International Board Certified Lactation Consultant (IBCLC) is an allied health professional who specializes in the clinical management of breastfeeding. IBCLCs’ main objectives are to provide support to mothers and babies so that they can reach their breastfeeding goals, provide education to the community about the benefits of breastfeeding, and work towards the establishment of protocols and laws that support breastfeeding as the norm. CRMC has an IBCLC and two nurse Certified Lactation Counselors available to help mothers prepare for and succeed at breastfeeding. They can assist with a wide variety of issues including poor latching, tongue or lip ties, flat or inverted nipples, milk supply problems, or even struggles with confidence. They observe mothers nursing prior to discharge and offer suggestions and tips. They are also available at the 72 hour check when baby comes back for a weight check or private consultations. CRMC is committed to helping mothers succeed at breastfeeding.

Much like pregnancy and maternity care, newborn care is most often routine and consists of observation. A baby is given an APGAR score at 1 and 5 minutes after birth which consists of five factors used to evaluate the baby’s condition, (Appearance, Pulse, Grimace, Activity, Respiration), two for each, with a maximum score of 10. Intervention is performed as needed to establish optimal airway and circulation. Other screening tests during the first 24 hours after birth include: Newborn Hearing Screen to identify congenital hearing deficit; Congenital Heart Defect Screen to identify any structural heart defect; Trascutaneous bilirubin to identify presence and risk for jaundice; and Newborn metabolic screen to identify many rare, but serious metabolic disorders and deficiencies. One of the most reassuring ways to know baby is thriving and doing well is simply to observe the infant’s feeding, voiding and stooling patterns. Since patients are often discharged at 24-48 hours, CRMC has a 72 hour follow up visit to assure these patterns are normal. A breast fed infant will often lose 8-12 ounces in the first 3 days, and then start regaining when the milk supply is optimal. This is completely normal and the baby is then expected to return to his/her birth weight by 2 weeks of age. Any interruption in this normal course of events would trigger appropriate support and consultation with the newborn’s physician or CRMC’s lactation team.

Perhaps one reason is that she can get not only her pregnancy related questions answered but also take care of general health concerns for herself and the whole family. Bring along the toddler for a well child check up, teenager for an athletic physical, injury or sore throat and make back to back appointments. Another big reason women choose family physicians is for the seamless transition from pregnancy to post-partum to newborn care. Questions regarding diaper rash, breast feeding and post partum blues can all be addressed at the same visit with a doctor who knows them well and has followed the whole family through this beautiful event. Pregnancy is a normal physiological process that usually requires very little, if any, intervention-only observation and guidance. For those high risk pregnancies that require surgical consultation or intervention, OB/GYN referral can be arranged. Life is busy and sometimes complicated for a growing family. For the same reasons you might choose Target for your one-stop shopping for groceries, clothing and household needs, some women prefer family doctors to deliver maternity care, for that seamless, continuity of care.

Preeclampsia, a problem unique to pregnant women, is a disorder involving high blood pressure that tends to happen in the latter half of pregnancy. Preeclampsia involves high blood pressure and protein in the urine. Sometimes if preeclampsia becomes severe, there are also abnormalities with the liver, kidneys, or even the brain. Some women have only mild symptoms and a slight elevation in their blood pressure while others have significantly elevated blood pressure and are very sick. Preeclampsia can be unpredictable at times and can progress from a mild to more severe state very quickly. If a physician diagnoses preeclampsia in a pregnant woman, she needs to be monitored very closely. Sometimes, she will even require early delivery depending on the severity of her condition and how the baby is doing. We do not know the actual cause of preeclampsia but the treatment for it is delivery of the pregnant woman. Some patients require medications to control their blood pressure and some women are put on a medication called magnesium sulfate to prevent seizures. Pregnant women at risk for preeclampsia are women pregnant with their first baby, women with underlying medical conditions like diabetes and high blood pressure, as well as women who have had preeclampsia before. If you are pregnant and have any underlying medical problems or if you have had issues in prior pregnancies, it is important to receive early and frequent care from your obstetric provider. Early detection of the disorder leads to treatment so that mom and baby can have the best outcomes!

Yes, the American College of Obstetricians and Gynecologists recommends that all pregnant women receive the Tdap vaccine between 27-36 weeks of gestation. The Tdap protects against three different infections: tetanus, diphtheria, and pertussis (whooping cough). Pertussis can be life threatening to infants from birth to one month and recent outbreaks show that infants younger than three months are at high risk of contracting the disease. Tdap is safe to receive during pregnancy and should be received in the third trimester. The antibodies your body will make from the vaccine are transferred to your fetus and are therefore protective until the baby can be vaccinated at 2 months of age. It is also important to insure that any primary care giver for your infant is vaccinated at least two weeks before having contact with your baby. If you did not receive the vaccination during your pregnancy it is safe to receive while you are breastfeeding and is therefore still recommended. CRMC routinely offers this vaccination to all OB patients, but if you have further questions they can be addressed at your next prenatal visit.

Fortunately, with quality of life issues being at the forefront in health care, there are several excellent options for the treatment of stress urinary incontinence (SUI). SUI is the involuntary loss of urine associated with activities such as coughing, sneezing, running, and sex and is caused from lack of support in the mid-urethra. When there is an increase in abdominal pressure, the lack of muscular support at the mid-urethra results in urine more easily exiting the bladder and resulting in an incontinent episode. This is an extremely common problem and there is no "right" age to see your OB/GYN about SUI. A woman should feel very comfortable seeking medical help for this quality of life problem. The importance of a thorough history and problem focused physical cannot be overemphasized to diagnose SUI and offer treatment options. A patient's diet, weight and co-morbidities are just a few factors that can impact one's bladder control. Because SUI is primarily a pelvic support issue, the two main treatments are physical therapy and surgery. There is some off-label use of medications for SUI treatment but the majority of interventions focus on dealing with the midurethra support. Physical therapy can be hugely helpful to women with incontinence. The sling serves to artificially re-support the midurethra to prevent stress incontinence. Not only is this an extremely successful surgery, but it is also an outpatient and low risk procedure.

CRMC offers water birth as an option to patients who desire this type of delivery. The American College of Obstetrics and Gynecology (ACOG) along with the American Academy of Pediatrics ( AAP) recently issued a statement about the safety of water births. In the wake of this, some hospitals that have been offering water birth decided to reevaluate their positions on the matter. The official statement by ACOG and AAP in effect states that immersion in water during delivery is still consider experimental and hospitals that plan to offer this type of birth need to make their patients aware that there has been no proven benefit to mother or baby to deliver underwater. However, it is still reasonable to offer this type of delivery as long as there is informed consent on the patient’s side and the hospital is willing to participate in clinical trials to further study this as an option. The benefits seen involve decreased pain or use of anesthesia and decreased duration of labor. CRMC has enrolled in clinical trials and continues to offer the water birth option to patients.

Irregularities in a woman’s menstrual cycle can sometimes be a normal consequence during times of hormonal change, such as around puberty or menopause. But how do you know if your irregular periods are something more? Anytime a woman has a regular cycle but is now skipping periods or bleeding for much longer than her usual time, it can be a sign of a hormonal or structural problem. Bleeding after intercourse, bleeding in between periods or having two or more menstrual cycles in a month could also signify a problem. The OB/GYN physicians of Cuyuna Regional Medical Center are here to help! In addition to a physical examination, the physician may order blood work or an ultrasound to help discern the reason for abnormal bleeding. There are many approaches to the treatment of abnormal bleeding, including medical and surgical options. It is important for a woman to see her physician if she has any concerns about her menstrual cycle as well as for routine well woman health examinations.