IUD Insertion
What Happens During IUD Insertion? After you have talked to the clinician about the procedure and what to expect, you will undress from the waste down and put on a gown. When the clinician reenters the room, a vaginal exam will be performed using a lubricated speculum. The cervix is then cleansed and a small device called a uterine sound is inserted into the cervix in order to measure the size of the uterus. After this measurement is obtained, the clinician will prepare the IUD to be inserted at the appropriate depth based on your uterine measurement. The IUD is then inserted into the cervix and uterus just as the uterine sound was. Cramping occurs when the clinician is both measuring the uterus and placing the IUD. Once the IUD is in place, the strings are trimmed to a length of about one inch and the speculum is removed from the vagina. The procedure itself is typically fast, however depending on the shape & size of your cervix/uterus the time the procedure takes can vary significantly. Most patients will feel some degree of cramping during and after the procedure. Some patients experience nausea and vomiting after the procedure as well, though this is uncommon. You will be able to leave the clinic as soon as you feel well enough. We recommend taking ibuprofen 800 mg every 8 hours for 3 days following insertion.
What pain control options are offered for IUD insertion? We know that IUD insertion can provoke anxiety in patients due to the intimate nature of the procedure. Pain with IUD insertion is different for everyone, but many patients feel a strong cramping sensation during and after IUD insertion. Most patients tolerate the procedure well. Many patients have anxiety about IUD insertion, which is why we offer options for pain control prior to IUD insertion. We use topical lidocaine gel for all IUD insertions but if you would like something stronger, there are other options available. If you choose to have conscious sedation, you will be given oral medications after you arrive at the clinic that will help relax you. This option requires that you have someone drive you to your appointment. Another option is to have a cervical block to numb the cervix with a lidocaine injection prior to IUD insertion. Whatever you decide, we are here to guide you through your options and to help make your experience more comfortable. If you are interested in sedation or other pain options prior to your IUD insertion, or if you have questions about IUD insertion, please send us a message or schedule an appointment for a birth control consultation.
Wellness Exams
What happens during a breast exam? During your breast exam, you will be asked to raise your arms behind your head to help your clinician examine each breast more easily. The exam should be painless as your clinician gently feels each breast in small, circular motions, checking for any abnormal lumps or potential cysts. Clinical breast exams are important for detecting early signs of breast cancer. While not all lumps are cancerous, identifying them early can reduce risks and help your clinician monitor any areas of concern. If any lumps are found, your clinician will recommend imaging studies to determine whether they are cancerous.
What does a pap smear test for? A Pap test is a procedure that collects cells from the cervix (the lower part of the uterus) to be examined closely in a lab under a microscope. It checks for changes in the cells that could indicate pre-cancerous conditions or cancer.
Vaginitis: BV and Yeast
What can I do to prevent BV? • Help keep vaginal bacteria balanced by avoiding soap and using only warm water to clean the vulva. • Avoid douching, which gets rid of normal vaginal bacteria that helps prevent you from infection. • Practice safe sex by using condoms, getting tested regularly, being monogamous, and limiting your number of sexual partners.
You may be more at risk for BV if you: • Have a new sex partner • Have multiple sex partners • Douche • Do not use condoms • Are pregnant • Are African American. BV is twice as common in African-American women as in white women • Have an IUD, especially if you also have irregular vaginal bleeding
What can I do to prevent yeast? • Do not use scented feminine products such as toilet paper, bubble bath, body wash, pads, or tampons. • Avoid douching, which gets rid of normal vaginal bacteria that helps prevent you from infection. • Wear underwear that has a 100% cotton gusset and avoid synthetic materials. • Change out of damp workout clothes as soon as possible. • If you have diabetes, make sure your blood sugar is under control.
You may be more at risk for yeast infections if you: • Are pregnant • Have uncontrolled diabetes • Use vaginal douches or wipes • Use a hormonal birth control with high doses of estrogen • Recently took certain medications like antibiotics or steroids • Have a weakened immune system
HIV PrEP
Is HIV PrEP safe? PrEP is safe. Some people using PrEP may experience side effects such as nausea, diarrhea, headaches, fatigue, or stomach pain. These effects are generally mild and tend to subside over time.
How do I take HIV PrEP? There are two daily oral medications that are approved for HIV PrEP. There is also a bimonthly injectable PrEP medication. Regardless of the route you choose, HIV testing is required every 2-3 months in order to continue taking PrEP. Your clinician can help you decide which method would work best for your lifestyle.
What do the results of my pap test mean? It can be concerning to receive an abnormal pap result. Your clinician will be calling to explain the results and how to follow-up, but until then here is what you need to know: There are 3 main result categories, some of which have sub-categories: • Negative for intraepithelial lesion or malignancy (NILM) o This indicates that no signs of cancer, pre-cancer, or other major abnormalities were detected. • Epithelial cell abnormalities oThis indicates that the cells lining the cervix or vagina have changes that could be cancerous or pre-cancerous. This category is further divided into different groups for squamous cells and glandular cells. o Atypical squamous cells of uncertain significance (ASC-US) refers to cells that appear abnormal, but it is unclear whether this is due to infection, irritation, or a potential pre-cancer. Usually ASC-US cells are not pre-cancerous, but require additional testing to confirm. o Atypical squamous cells where high-grade squamous intraepithelial lesions (HSIL) cannot be ruled out (ASC-H) refers to cells that appear abnormal and are more concerning for a potential pre-cancer. This result requires further testing and possible treatment. o In low-grade SIL (LSIL), the cells appear slightly abnormal. AKA mild dysplasia or cervical intraepithelial neoplasia grade 1 (CIN1). The abnormal cells often resolve on their own. o In high-grade SIL (HSIL), the cells appear significantly abnormal and are less likely to resolve on their own. They are also more likely to develop into cancer if left untreated. AKA moderate to severe dysplasia or CIN2 and/or CIN3. • Glandular cell abnormalities o Atypical glandular cells (AGC) refer to cells that appear abnormal and have concerning features that may indicate cancer. Further testing is warranted. o Adenocarcinoma refers to cancer originating in the glandular cells.