Obstetrics & Gynecology in Augusta, GA

6 Questions to Ask at Your Next Gynecology Appointment

For some women, visiting the gynecologist is intimidating and nerve-wracking. Some women even avoid visiting the gynecologist for these reasons. However, visiting a gynecologist is essential for every woman’s health.

Taking gynecology seriously improves your overall physical health, helps you plan and manage pregnancies and menopause, manage irregular menstrual cycles, and much more. Visiting a gynecologist doesn’t have to be a negative experience either. Keep in mind that your gynecologist sees multiple patients every day and there’s not much they haven’t seen or helped with in the past.

With that being said, it’s time to start preparing for your next up-and-coming gynecology appointment. In the guide below, you’ll discover several questions you should consider asking while visiting with your local gynecologist. Continue reading to get started.

1. Am I Updated on Health Screenings?

Women should start seeing a gynecologist between the ages of 13-15. This helps not only keep their reproductive health in great condition but also helps build a relationship between doctor and patient. It’s then important for women to continue seeing their gynecologist on a regular basis for regular health screenings.

For example, it’s recommended that a woman receive a PAP smear every few years to ensure everything’s looking great and there are no health complications. When you arrive at your appointment, be sure to ask your gynecologist if you’re up to date on all your health screenings.

Some common health screenings are as followed:

  • Pap smears
  • Breast exams
  • Skin exams (for cancer)
  • STD/STI testing

You might also want to ask your gynecologist about screenings for cervical and colon cancer.

2. What Are My Birth Control Options?

One important part of maintaining good feminine sexual health for some is birth control. Birth control is beneficial to some women for a variety of reasons. It’s essential for women looking to take control of their own reproductive health who aren’t quite ready for family planning.

Birth control can also help manage severe PMS symptoms and help regulate irregular menstrual cycles. Some birth controls even help clear acne and maintain balanced hormonal levels. If the benefits of birth control are something you’re interested in but aren’t sure if birth control is right for your body, then speak with your gynecologist about your options.

There are many different types of birth controls ranging from high hormones to no hormones at all. Each birth control option comes with its own pros and cons, which you can your gynecologist can discuss together.

3. How Can I Family Plan Safely?

When you decide it’s time to start your family, don’t hesitate to speak with your OB/GYN about family planning. It’s important to have a conversation with your doctor about fertility and how to safely plan for pregnancy. Your gynecologist might detect risk factors of infertility and provide you with a few options to get around these risk factors.

This is also a good time to have genetic testing done to ensure there aren’t any conditions that may affect the health of your future children and how to plan for them. STD/STI testing during this time is also important as you want to have a healthy body before conception.

Your OB/GYN might also suggest you start taking prenatal vitamins to provide your body with all the proper nutrients it needs to prepare for pregnancy. Any other questions you have about conception and pregnancy can be answered now as well.

4. How Can I Protect Myself From STDs/STIs?

Abstaining from sex, in general, is the only fool-proof way of avoiding contracting STDs and STIs. When this isn’t an option for you, it’s important to gather information about protecting yourself and what to be on the lookout for. For example, condoms are one great way to avoid STDs and STIs.

You can also speak with your gynecologist about receiving an HPV vaccine and scheduling regular testing. Ask about the signs and symptoms to look out for and let your gynecologist know if you’re suspicious about any current changes in your body.

5. What Are Some Ways to Make My Menstrual Cycle More Comfortable?

All women experience some type of menstrual cycle symptoms. However, not all women experience the same symptoms or the same pain levels associated with these symptoms. If you suffer from severe PMS symptoms, then you need to ask your gynecologist about managing your cycles and feeling more comfortable during that time.

There are several lifestyle changes you can make to help control these pains, such as exercising and avoiding drinking, smoking, and salty foods. You might also find comfort in soaking in a warm bath, but when your menstrual cycle causes you too much pain and discomfort, it’s time to speak with your gynecologist about other relief options.

6. Why Is There an Unusual Scent?

No woman wants to come face to face with vaginal odor. Unfortunately, this happens sometimes due to various reasons. Although infections and cleanliness certainly play a role in this, those aren’t always the reasons for it.

Hormones, bacteria, sweat, menstrual cycles, and leaking urine are all culprits as well. If you notice an unusual scent, always inform your gynecologist so proper treatment, if needed, can be given.

Let Us Help You Prepare For Your Next Gynecology Visit

At Women’s Health of Augusta, we offer state-of-the-art technology to make us better equipped to handle all Gynecological and Obstetrical care issues. We strive to provide compassionate gynecology care and attention to all your individual health needs. We’ve been providing this care to women for more than 40 years and look forward to hearing from you.

Click here to schedule your appointment today. Feel free to reach out to us regarding any questions or concerns you might have.


What to Expect From Your First Gynecology Appointment

Are you preparing for your first gynecology appointment? If so, you may be nervous and might not know what to expect.

Health professionals recommend that young women of 13-15 years old attend their first appointment with a doctor who specializes in gynecology and obstetrics. The gynecologist will perform an exam to ensure the health of your reproductive system.

Even women who have been attending the gynecologist for years tend to feel apprehensive about their annual ob-gyn appointment. Being prepared for your first exam will ease some of those nerves.

Keep reading to learn about what to expect from your first gynecology appointment.

Waiting Room

Like most doctor appointments, you will first meet with a receptionist and be asked to fill out paperwork. Be sure to bring all required information to your appointment.

This typically includes your insurance card, a photo ID, and a form of payment if your insurance does not cover the entire cost of the visit.

Routine Check-Up

Once you are called in, a nurse or medical assistant will give you a routine check-up. This includes taking your height and weight, checking your blood pressure, and taking a urine test.

Sometimes, the nurse or medical assistant will need to take a blood sample or they may send you out for blood work at a lab.

They will also confirm your medical history, history of medications, and ask if there’s anything you’d like the doctor to know.

Before they leave, they will give you a gown to change into for the exam.

Meeting Your Gynecologist

Once you are all changed, your gynecologist will knock on the door to make sure you are ready for them to come in. Here, they will introduce themselves and answer any questions or concerns the nurse/medical assistant relayed to them.

They will also ask questions about your menstrual cycle and past/current sexual activity.

Likewise, they may ask you if you’re interested in going on birth control. If you are interested, they will determine the right form for you.

Don’t worry about opening up to your gynecologist about anything that is bothering you, even if it feels embarrassing. They are there to help you with no judgment.

Breast Exam

Now, it is time for the exam. The first part of the exam is the breast exam.

You will usually be asked to lay down while the ob-gyn manually examines your breasts. They will palpate each breast to feel for any lumps or look for any abnormal areas on your skin or nipples.

If all is well, the test will be complete. If there are any concerns, your doctor will send you out for more testing.

Pelvic Exam

After the breast exam, it will be time for your pelvic exam. Keep in mind that if you are under 21 and not sexually active or don’t have any health concerns, your doctor may not even choose to perform a pelvic exam.

However, if you are sexually active, a pelvic exam is a standard part of your visit.

This part may feel uncomfortable and invasive, but a good gynecologist will go above and beyond to make sure you feel at ease.

You will be asked to lay back on the exam table and bend your knees to place your feet into the two stirrups at the end of the table. Your doctor will often remind you to make sure you’re scooted to the edge of the table and to keep your legs relaxed and spread apart.

External Exam

The first portion of the pelvic exam is the external exam. During this, the doctor will examine the external part of the vagina, checking your vulva, clitoris, and labia for any abnormalities.

Your doctor will usually talk you through each part of the exam as they perform it to ensure you feel safe and relaxed. Be sure to also take deep breaths to lower tension and anxiety.

Internal Exam

Next, is the internal exam. Your doctor will take a metal device called a speculum which is coated with a lubricant to minimize discomfort.

With the use of a light and the speculum, the doctor will be able to get a view of your cervix and make sure there are no spots, redness, or sores.

This is also when the doctor will swab the inside of the vagina to check for any STDS.

You should not experience any pain during the internal exam, although you may feel slight pressure or discomfort.

Pap Smear

If you are 21 years or older, you will need to receive a pap smear. A pap smear will check for cervical cancer or HPV cells.

The ob-gyn will use a thin brush to swab your cervix. This may feel a bit odd or uncomfortable, but not painful. Many people describe it as a mild pinching or scratching sensation.

Bimanual Exam

Lastly, your doctor will perform a bimanual exam. The speculum will be taken out of the vagina and they will insert two gloved fingers, also containing lubricant.

They will then press around your abdomen to make sure your pelvic organs feel normal.

Completion of the Appointment

After your pelvic exam, your appointment is complete. Your ob-gyn will leave the room for you to get changed back into your clothes.

They also may provide you with wipes if you need to dry your private area.

Be sure to schedule your next annual visit upon leaving. After your appointment, you may need to pick up any prescription your ob-gyn prescribed or go for further testing if necessary.

First Gynecology and Obstetrics Appointment

If you have an upcoming appointment, it’s normal to be nervous, but remember, it’s something every woman will need to go through at some point during their life and is necessary for your health and wellbeing.

If you are ready to search for a gynecologist near me? Women’s Health of Augusta provides many different types of quality gynecology services.

Contact us today to schedule an appointment.

obstetrics and gynecology

Obstetrics and Gynecology: Understanding the Differences

There are now over 110,700 gynecologists and obstetricians across the US. Not many people realize there’s a difference between obstetrics and gynecology, though. Understanding the difference between OB and GYN can help you seek the help you need.

You can visit a women’s health care specialist based on your specific goals and concerns. Otherwise, you could visit the wrong physician.

What is the difference between OB and GYN doctors, exactly? Which specialist should you visit? Keep reading to find out.

After reading this guide, you can make a more informed choice with your health in mind.

Read on to learn everything you need to know about gynecology and obstetrics today!


Before we discuss the difference between obstetrics and gynecology, let’s look at each specialty separately. What exactly is obstetrics?

Obstetrics is a branch of medicine that focuses on surgical and medical care before, during, and after women give birth. This specialty focuses on caring for and maintaining the patient’s health during each stage of maternity.

These stages include:

  • Pregnancy
  • Labor
  • Childbirth
  • The postpartum period

Obstetricians are responsible for delivering babies. They can also provide therapies to help patients get pregnant. For example, some obstetricians specialize in offering fertility treatments.

Obstetricians can also offer guidance in Neonatal Intensive Care Units (NICUs) for patients who deliver their babies prematurely.

These specialists will ensure patients have a healthy pregnancy and that they deliver a healthy baby.

You might need to consult an obstetrician if you experience any complications during your pregnancy, too. For example, you might require their expertise regarding:

  • Preeclampsia
  • Placenta issues
  • Signs of fetal distress
  • Ectopic pregnancy
  • Delivery through Cesarean section

Once you have the baby, your obstetrician can also help if you’re experiencing postpartum depression or other post-pregnancy issues.


It’s normal for people to use the terms “obstetrics” and “gynecology” interchangeably. However, there are differences between the two specialties.

A gynecologist specializes in caring for a woman’s reproductive health through all stages. They can offer care and treatment from the time a woman gets her first period. They’ll offer help all the way to a woman’s post-menopausal stage, too.

Gynecologists can offer treatment for any conditions that affect the reproductive system as well. These conditions might involve the:

  • Cervix
  • Ovaries
  • Uterus
  • Fallopian tubes
  • Vagina

GYN doctors can also perform screenings related to reproductive health. These screenings can include pelvic exams, pap smears, and breast exams. You might need to visit a GYN doctor for a tubal ligation or hysterectomy as well.

They can also provide human papillomavirus (HPV) shots.

You might consider visiting GYN doctors for advice regarding sexual matters. For example, you can discuss contraceptives and sexual practices during an appointment. They can offer advice regarding protection against sexually transmitted diseases, too.

In other words, you can visit a gynecologist for concerns related to female reproductive health that aren’t related to pregnancies.

A few related issues might include:

  • Endometriosis
  • Irregular menstruation
  • Uterine fibroids
  • Ovarian cysts
  • Cervical and vaginal polyps
  • Prolapse of pelvic organs
  • Cancers of the reproductive system
  • Conditions that cause pain during sex
  • Vaginal infections

If you become pregnant, however, you’ll need to visit an obstetrician.

Differentiating the Two

Between 2018 and 2028, the US will experience only a 2% increase in obstetricians and gynecologists.

In fact, many areas don’t have enough women’s health care physicians under either specialty. In 2020, there was a gap of 8,000 positions that remained unfulfilled in obstetrics and gynecology. The number could increase to a shortage of 22,000 positions by 2050.

The main difference between an OB and GYN is their focus. An OB focuses on pregnancies. GYN doctors, on the other hand, focus on all other fields of women’s health care.

When to Visit an OB/GYN

It’s best to treat potential health and medical issues by taking a preventative approach. Even if you’re healthy, consider finding a local OB/GYN. A specialist who focuses on both obstetrics and gynecology can cover your women’s health care needs.

You can schedule a preventative checkup once a year with a local specialist.

During your appointment, your OB/GYN can conduct evaluations or schedule any immunizations you might need. They can also request lab tests to determine if you have a specific condition.

Your doctor will determine which tests you need based on your age group.

You can also visit an OB/GYN to schedule a pelvic exam. Your doctor might recommend other screenings or tests based on your health and age.

You should also visit an OB/GYN if you notice any changes to your reproductive cycle. For example, these changes might include:

  • Your first menstrual cycle
  • Pregnancy
  • Perimenopause
  • Menopause

Some changes are normal. However, you should schedule an appointment if any changes are unexpected or unusual. For example, you might notice changes in the volume or frequency of your menstrual bleeding.

You should also visit your OB/GYN if you experience pain during intercourse or while urinating.

Reproductive Needs and Goals

You can also schedule a consultation appointment based on your reproductive goals. For example, you might need an appointment to discuss:

  • Safe sex tips
  • Contraception
  • Sterilization
  • Birth control
  • Treatment and prevention of pain during sex
  • Vaccinations
  • Urinary tract infections
  • Abnormal vaginal discharge
  • Planning a pregnancy
  • Prenatal care
  • Infertility treatment

Let your OB/GYN physician know about any new symptoms you begin experiencing, too.

For example, you might experience pain before or during menstruation. You can ask your OB/GYN questions about cramps, bleeding, or mood swings.

If you’re going through menopause, you can also discuss symptoms like hot flashes, bone loss, or low libido. Your OB/GYN can help with solutions like hormone replacement therapy or other treatment options.

Having a go-to OB/GYN will give you peace of mind. Even if you’re healthy, you can schedule annual appointments to assess your reproductive health. If there are any areas for concern, you can work with your doctor to develop a treatment plan.

Obstetrics and Gynecology: Differentiating OBs and GYN

To recap, what is the difference between obstetrics and gynecology? Obstetrics focuses on childbirth. Gynecology, on the other hand, focuses on a woman’s overall reproductive health.

You can visit your local OB/GYN to discuss your reproductive health needs or to plan a pregnancy.

Eager to schedule your next consultation appointment? We can’t wait to see you.

Contact us today to get started.

A Healthy Thankfulness

 I stepped off the bus apprehensive about the scene unfolding in front of me. The Infirmary or “Home for the Poor” as it was otherwise known, was a collection of dilapidated barracks housing abandoned physically and mentally ill men and women who were deemed to have no value to either family or society. The Infirmary was located on a purposefully isolated knoll in coastal Jamaica symbolically situated to reinforce their desire to forget its existence. The contrast surrounding its physical location was as stark as the dichotomy of the island itself. A lush forest populated with exotic fruit trees and bathed in rainbow colored foliage surrounded the ramshackle open aired barracks originally commissioned by Queen Victoria in 1898. On an island where five-star luxury resorts share the same zip code as cockroach infested hovels, the mocking beauty of the surrounding forest was in contradistinction to the decaying dormitory of the forgotten.
We were greeted gleefully (and a bit unexpectedly) at the door of the men’s quarters by a thirtyish Jamaican, physically mature but with the mind of a child. Richard had a toothless smile the size of the island itself as he exclaimed, “Oh boy, they’re here! Oh boy, they’re here!” in raid fire succession. His repetitive phrases were sincere and he instantly touched our hearts and calmed some of our apprehensions. We came to learn that Richard had been housed at the Infirmary all of his adult life, and his apparent inability to understand the destitution of his surroundings was counted as a blessing.

Entering the first cinder block building I was struck by numerous sensations all vying for attention. Visually the scene was disturbing: cot after cot of ancient bodies positioned as if trapped in their bed by some invisible barrier. The distinctive odor, one I had come to associate with hopelessness, was a mixture of urine, putrid food, and stale, unmoving air, and it covered the room like an unseen fog.

Our small band of church mission workers spent an hour in the Infirmary talking, praying, bathing and cleaning our hosts. Soon, we loaded up a few of the less ill and mobile onto our bus and made the short trip to the Jamaican beachfront frequented by the locals. There were no hotels, Tiki bars, or swimming pools, just a few kids and adults enjoying a respite from the oppressive heat. Those who were ambulatory walked arm in arm with their chaperone to the shoreline, while others were carried fireman style to the water. We sat in the cool, shallow waters of the Caribbean and spent the next few minutes rubbing soft sand on the resident’s life-weary skin, all the while hoping that they might forget for just a moment that they had to return to their reality.

Earlier in the day I had observed a skeleton-thin, talkative gentleman pacing to and fro among the cots greeting other residents all the while holding up an obviously grossly oversized pair of trousers. As I sat in the gentle cleansing waves with Zebe, the owner of the XXL pants, I asked him if he could have anything in the world – anything at all – what would he ask for? He took the question quite seriously and pondered it briefly then looked me in the eye and in his most thoughtful voice exclaimed, “A belt. Yes, I would very much like a belt!”

This is a time of year when we invoke thankfulness in an almost nonchalant fashion. I have to remind myself to punch through the complacency of abundance and rethink what it means to be thankful. We are bombarded with admonitions to be thankful for a free country, good health, and material comforts. All of these things are grand and worthy of thanks; however, thinking of Zebe reminds me that the things that I see as worthy of thanks are largely due to my perspective.

Regardless of circumstances, I can choose to be thankful. Tethering my appreciation only to objects or accomplishments is a set up for disappointment as those things may not always be present; however, if my basis for thankfulness is rooted in my ability to choose, then no circumstance can dissuade me. Choosing to be thankful for your good health (and your ability to change it if you are not satisfied) leads to joy, peace of mind, and goodwill.

I see the world through my own lens. In other words, where you are in the world, physically, emotionally and spiritually, colors how you understand thankfulness. If I had cancer, I would be very thankful for the anti-nausea medicine that follows the powerful chemotherapy; whereas, such medicine would not enter my thoughts otherwise. If I have all my worldly possessions stashed under a six by three foot cot, I am thankful for a belt. It is a matter of perspective.
Let us celebrate this season of thankfulness with an understanding and appreciation of our choices, and hopefully, this will lead us to action that will translate into healthy blessings for ourselves and others.

Is Health Care Reform Really Necessary?

    Health care reform is about as hot a topic as pepper sauce on Texas armadillo meat.  The pundits and politicians are bantering about like hens in a hen house clucking about this plan and that reform.  It is politically and philosophically prudent to be on the side of some type of change in the health care system.  No one disagrees that the system is unsustainable in its present configuration.  I concur that the situation is dire; the patient is in cardiac arrest and something has to be done.  However, I differ from many in believing that the solution is one that is simpler yet more impractical than a government take over.  I realize that sounds somewhat contradictory – simpler yet impractical – so let me explain.

    First, it is important to understand that we have two separate but intertwined problems: health insurance and health care.  As I am not an insurance expert so I will only opine about health care.  We will never cure this country’s ills without a strong dose of personal responsibility.  The government, politicians, insurance magnates, and even doctors are not only inadequate to change the system but incapable of effectively bringing about change because the change has to begin from within.  It has to come from the individual; the man in the mirror.  The biggest healthcare crisis in this country is not cancer, AIDS, heart disease or lack of insurance; it is people not choosing to live their lives in a healthy manner.  Until we as individuals start adopting the things we know to do to stay healthy, we will persist as a nation in need of sick care delivery instead of health care. 

Part of the problem is one of education.  For example, many feel that getting regular mammograms and doing self-breast exams are excellent preventive tools for breast cancer.  They are not!  They are simply tools of early detection. The cancer already exists when the utility of mammograms and self-breast exams are realized.  These tools prevent nothing other than higher morbidity and mortality, which is a good thing!  But we have to move back one level if we are to prevent breast cancer.  For example, decreasing your body mass index (BMI) a simple measurement that assesses your amount of body fat, can reduce the occurrence of breast cancer 40%!  Reducing obesity, stopping smoking, increasing your intake of fruits and vegetables, limiting alcohol intake; these are behaviors that all substantially reduce the likelihood that you will develop a breast cancer.  Are mammograms and self-breast exams important?  Of course, they are, but our focus should not only be on early detection but also prevention.  There are multiple factors that go into disease development, many of which we don’t understand.  My point is that, in general, a skinny vegetarian has a lower incidence of breast cancer than an overweight couch potato, and when you expand that to whole populations you begin to see how individual decisions can have a massive collective effect.

Another example from the field of women’s health is cervical cancer.  The Pap smear revolutionized the care and treatment of cervical cancer in the 50’s as it allowed for the detection of the disease in it earliest stages. As time went by and research progressed it became apparent that a major cause of cervical cancer is infection with the Human Papilloma Virus.  Pap smears can pick up changes in the cervical cells long before they develop as a cancer, but the Pap only detects the changes once they are there.   Two things can prevent HPV infection (and thereby most cases of cervical dysplasia): an HPV vaccine and monogamy.  Having multiple sexual contacts dramatically increases your risk of infection with HPV and thus greatly increases your risk of cervical dysplasia and cancer.  Again, prevention is different from early detection.  If you want to prevent cervical cancer, develop effective programs supporting vaccination, abstinence, and monogamy.  How many politicians are willing to handle that hot potato? 

     These are but two examples illustrating that the answer to our health care crises begins at home.  Providing health insurance to everyone will only reduce the number of uninsured, a noble undertaking, but it will do little to solve the problem of reducing and preventing disease.  At the beginning of this diatribe I stated that the answer was simple; personal responsibility.  I also said it was impractical.  An individual has every right to live the life they choose.  I have no moral authority to tell anyone that they must stop smoking, for example.  They choose their lifestyle, but they, in turn, must take responsibility for their actions.  Here is where the hypocrisy arises.  We clamor for personal rights but we cower from accepting personal responsibility.  Do we as a society have a moral imperative to take care of the sick and helpless?  Absolutely!  But that is paralleled by a moral responsibility of the individual to make decisions that improve their health.  I am my brother’s keeper, but in turn, it is my brother’s responsibility to not embrace behaviors that jeopardize his health and my good will.

    Will we ever be a society of both free will and moral accountability? We must if we are to survive this health crisis.                 

Diabetes and Sex

Distressed Desire

Diabetes and Sex

After the publication of my book, A Woman’s Guide to Hormone Health, I had the opportunity to speak around the country to audiences of women about some very “feminine” subjects.  I was in San Diego speaking to a group called The Red Hot Mammas (sort of a cross between a menopause support group and a motorcycle gang) and during the question and answer session a grandmotherly octogenarian sheepishly raised her hand and asked, “Doc, my sex drive has driven off and I don’t have a map!  What do I do?”  I heard an audible “thank goodness” from several other folks in the audience as they wanted to ask the same question but didn’t have the courage of my blue haired inquisitor.  Over the ensuing years I don’t think I have ever hosted a forum where this topic didn’t raise its libidinous head.

Next to questions about losing weight, a declining or absent sex drive is one of the top complaints heard in gynecologist’s offices nationwide.  A recent report from the National Institutes of Health states that 43% of women will experience some form of sexual dysfunction at sometime in their life.  A majority of these problems, especially in perimenopausal and menopausal women, is a lack of desire.  Loss of libido is defined by the Diagnostic and Statistic Manual (the book doctors use to categorize diseases) as “persistently low sexual desire resulting in distress or relationship dysfunction, where lack of desire is not due to another condition or circumstance.”  There are two important parts of this definition that are cogent to understanding the causes and treatments of this problem.  First, the lack of desire must cause a problem either in the person’s psyche or in their relationships.  So, for example, a woman with a low desire who is purposefully abstinent may not view that lack of desire as bothersome.  Secondly, the low libido should not be due to a physical problem or medication.  A common example of this in the menopause is the woman who experiences pain with intercourse due to vaginal changes in lubrication.  It only makes sense that if it hurts, consciously or unconsciously, you are going to avoid intimacy like Republicans avoid taxes.  Also various medications can have libido squashing side effects.  For example, many of the anti depressants such as Prozac and Zoloft can flatten libido like a steamroller on asphalt.

The causes of a low or non-existent sex drive are legion, but they can generally be divided into four categories: physical, psychological, relationship, and hormonal.

Physical reasons include many nonsexual diseases such as arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases.  Think of poor sex drive as side effects of these disease processes, and often once the physical malady is remedied, the libido returns.  In addition, a glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive.  Any surgery related to your breasts or your genital tract can affect your body image, sexual function, and desire for sex.  A huge secondary cause is fatigue. The exhaustion of caring for aging parents or young children can contribute to low sex drive.

I already alluded to the role of hormones, and any major hormonal shift such as menopause, pregnancy, and breast feeding can affect desire.

There are many psychological causes of low sex drive such as anxiety, depression, poor body image, low self-esteem, and a history of physical or sexual abuse.  One of the most overlooked but common causes of poor libido is stress.  This can be stress related to work, finances, kids, or just life.

We all know that much of a satisfying sex life originates as much above the neck as it does below the waist; therefore, relationship issues are huge in dissecting libido malfunction.  For many women, emotional closeness is an essential prelude to sexual intimacy. If you are having problems between the sheets, don’t pull the covers over your eyes!

So what can be done about this tsunami of libido lack?  Obviously if there is an underlying issue, such as medications or hormone problems, they must be addressed first and often sex drive creeps back.  If stress and relationship issues are paramount then talking with a counselor skilled in addressing sexual concerns can help with low libido. Therapy often includes education about sexual response, techniques, recommendations for reading materials, and couples exercises.

  In women suffering from painful intercourse, vaginal estrogen may markedly improve vaginal elasticity, lubrication, and response. Testosterone, present in females at a much lower concentration than males, has a libido enhancing effect for women; however, testosterone supplementation is controversial and should be closely regulated by a knowledgeable clinician.

It is critical to remember that libido can’t be separated from the context of a relationship. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex.

Don’t go gently into that dark night

    The worn out paradigm of aging as simply a time when our knees buckle and our belts won’t is rapidly and mercifully passing away. Some scientists estimate that of all the human beings that have ever lived to be sixty-five or older, half are currently alive today!  The seventy-five and older age group is the fastest growing segment of our population.  These are folks who are not satisfied with the status quo.  They are not happy to go gently into that good night.  We (and I must include my rapidly aging self) want to grow old with gusto.  We want to come to the end of life with nothing left, knowing we expended every waking moment in a purposeful embrace of the miracles around us.  We want to age without becoming aged!

   In 1984 the MacArthur Foundation sponsored a study that assembled a group of scholars from several major disciplines to conduct long term research designed to discover what constitutes “successful aging”.  They studied those folks who remained vigorous well into their seventh and eighth decades, and then experienced a “compression of morbidity”.  In other words, they lived to the max and then had a rapid demise. 

     One of their key points was that there was not a way to prevent aging or reverse the aging process.  Human’s will always age, that is a given of biological and cellular processes.  The whole industry of “anti-aging” potions, pills and pundits is a misnomer; there is nothing that will stop aging.  The key, and what they wanted to discover, is how some individuals age without the ensuing (some would say inevitable) “falling apart”.  We tend to think of this as aging gracefully, yet I believe that is much too passive.  We must, as the study found, take an active role in doing some things and avoid doing other things.

     So what did these scientists conclude?  They discovered that successful aging involved three major components: a low risk of disease and disease related disability, high physical and mental function, and active engagement with life.  It was noted that these were by nature interrelated, yet each provided and independent variable that could be controlled.  They further defined active engagement as having relationships with people and behavior that is productive.  They were quick to point out that successful aging is largely a result of individual choices and behaviors and not genetics. 

   The researchers discovered many specific characteristics of people who “aged well”, and I want to summarize just a few of the most important behaviors they ascertained.  For a more thorough reading of their findings I refer you to the book Successful Aging by Dr.John Rowe and Dr.Robert Kahn.

  Here are my top ten keys to successful aging culled from the MacArthur Study and my own research.

   1. Exercise.  Whether you are 10 or 100, exercise is the key to getting and staying healthy.  Surprisingly the studies indicate that only a minimum of exercise (20-30minutes a day) can have a marked effect in lowering your risk of a number of diseases such as cancer, diabetes, and hypertension.

2. Get regular check ups.  One of the secrets to successful aging is either preventing risk factors or identifying problems very early.  Both of these tasks are facilitated by regular exams.

3.  Stay current on routine screenings.  Somewhat linked to regular checkups, availing yourself of things like mammograms, Pap smears, prostate exams, colonoscopies, bone densities, and blood screenings can be a lifesaver and allow you to enjoy a disease free old age.

4. Don’t smoke.  Enough said.  You would have to be a total fool to not realize the damage that this does to your system.

5. Take an aspirin a day.  The evidence is mounting that a 61 mg aspirin a day can reduce the incidence of heart disease, stroke and colon cancer, especially in older folks.  Remember that some people should not take aspirin, so check with your doctor before starting something new.

6. Get appropriate vaccines.  For older folks the pneumonia and flu vaccines are important as these infections are responsible for thousands of deaths every year in people over 65.

7. Eat fewer total calories.  The studies are conclusive that decreasing your total calorie intake is associated with lower rates of disease and longer lives.  Specifically try to increase the protein and reduce the fat, but keeping the overall amount of calories lower is the most important guideline.

8. Develop social networks.  As the song goes, people who need people are the happiest (and healthiest) people.  An expanding network of family, friends, church membership, and social activities have all been associated with longer, less sickly aging.

9. Stay mentally engaged.  Retire only if you must and if you must, find something else to keep you mentally active and challenged. 

10. Be continually productive.  By that I mean participate in either voluntary or paid activities that generate goods or services of economic value.  That is a broad calling, but studies indicate that those who continue to find purpose, find health.   

     Remember, the goal is not just to live long, but to live long and well!


Estrogen and the brain women's health Augusta, ga

Estrogen and the Brain

A middle aged woman came into my office the other day telling a tale of woe that sounded like a bad country song.  Her husband was fooling around, her son was in prison, her daughter was pregnant, and her dog had the mange!  She said she was depressed and then commented, “I suspect it’s my hormones.”  I looked at her incredulously and told her it had nothing to do with her hormones. It was her life!

Hormones, or lack thereof, have been blamed for everything from hot flashes to homicides.  While the mystery of female hormones in particular are ripe with misinformation, we are learning every day of the impact of estrogen, progesterone and testosterone on the female body and mind.  In previous columns I have expanded on the use of hormones in the menopause, the impact on PMS, and the importance in PCOS but I want to address some recent findings on the amazing interaction of estrogen in particular on the female brain.

A study out of the University of Southern California has come to the conclusion that women have better brainpower after menopause if they had their last baby after age 35, used hormonal contraceptives for more than 10 years, or began their menstrual cycle before turning 13.  For years obstetricians have talked of the risks involved with having a baby after 35, yet over the past decade the number of women giving birth in their third and forth decades has dramatically increased.  Now this study helps offset many of those fears by reassuring women that if they are older mothers they may actually be smarter later in life!  Roksana Karim, lead author of the study and assistant professor of clinical preventive medicine at the Keck School of Medicine of USC, states, “the study provides strong evidence that there is a positive association between later age at last pregnancy and late-life cognition.”

The authors speculate that this effect is due to surges of estrogen and progesterone experienced by mothers during pregnancy.  Interestingly, this beneficial effect seems to exists for women who had additional estrogen exposure during various times in their life, like with birth control pill use and early onset of puberty.  Much has been made of the known risks of prolonged estrogen exposure like breast cancer and uterine cancer, but the effect of estrogen on the brain has been less publicized. 

Estrogen has long been known to effect such brain functions as memory, mood, and mental state, showing, in many incidences, a profoundly positive impact.  For example, there are noted to be many estrogen receptors in  the areas of the brain responsible for memory and both naturally produced estrogen and estrogen taken as a medication has been shown to improve memory.  Some of the most exciting research to date is looking at the impact of estrogen in reducing the onset or progression of neurodegenerative diseases like Alzheimer’s and senile dementia.  It is way to early to make any assumptions about using estrogen therapeutically for these problems, but it looks promising.

Don’t worry guys, what is fascinating about some of this research is that the positive effect of estrogen on brain function applies to males also.  In rat and monkey models, aging males given estrogen showed improvement in mental functioning and a decrease in brain cell deterioration.  Granted, there are a number of problems associated with men using estrogen, so the hope is that the research will lead to the development of treatments that will maximize the benefits and minimize the downsides.

Whenever hormones are often touted as a treatment for anything, caution is to be advised.  These are powerful substances that have multiple and profound effects on many body systems.  All we have to do is look at relatively recent past history to understand the consequences of acting too aggressively.  In the 50s and 60s estrogen was marketed as a “feel good” pill that kept a woman sexy and young for decades.  Only later did we learn of the risks involved, and as a result many women developed diseases as a direct result of unopposed estrogen use.

I’d like to think that medical researchers and clinicians are wiser today and are looking at these exciting developments through the lens of unintended consequences.  If there is a way to improve memory, reduce dementia, help depression, and decrease the incidence of Alzheimer’s disease using estrogen, then full speed ahead with the caveat that the negative side of the equation be adequately explored.

As we all learned in medical school, “First, do no harm.”    


Human Body

Be Thankful and Be Amazed


We take a lot for granted.  In these months devoted to celebrations and new beginnings, take a moment and ponder your own amazing human body.  Now many of you may wish you had a sturdier chassis, a bigger motor, a smaller bumper, or a flashier exterior, but the reality is that the model you operate within is nothing short of extraordinary.  Consider the following:

  • The average human brain has about 100 billion nerve cells.
  • Nerve impulses to and from the brain travel as fast as 170 miles per hour.
  • Your stomach needs to produce a new layer of mucus every two weeks or it would digest itself.
  • It takes the interaction of 72 different muscles to produce human speech.
  • The average life of a taste bud is 10 days.
  • The average cough comes out of your mouth at 60 miles per hour.
  • Relative to size, the strongest muscle in the body is the tongue.
  • Human thigh bones are stronger than concrete.
  • Our eyes are always the same size from birth, but our nose and ears never stop
  • growing.
  • The average human blinks their eyes 6,205,000 times each year.
  • Your skull is made up of 29 different bones.
  • The average surface of the human intestine is 656 square feet .
  • 15 million blood cells are destroyed in the human body every second.
  • The average human will shed 40 pounds of skin in a lifetime.
  • Every year about 98% of the atoms in your body are replaced.
  • Every human spent about half an hour as a single cell.
  • There are 45 miles of nerves in the skin of a human being.
  • The average human heart will beat 3,000 million times in its lifetime and pump 48
  • million gallons of blood.
  • During a 24-hour period, the average human will breathe 23,040 times.

As a physician I am perpetually in awe of our incredible body.  Even when it doesn’t function well, such as in disease, it has an uncanny ability to attempt to rectify the malady.  While the rest of the universe spirals away towards increasing chaos and entropy, the human body strives for homeostasis.   Modern medical and scientific research has explained many of the previously unknown mechanisms driving this tendency towards self preservation; however, there is still a vast depository of components and interactions that are still wrapped in a cloak of mystery.  Even knowing how something works on a cellular level, like the immune system or the blood clotting cascade, can only give one pause to contemplate the precision and perfection it embodies.

Understanding the physical properties and dynamic interaction of our body is only a small part of what makes us human.  We are so much more than our physical beings.  The mind and spirit of each person is so amazingly unique and pervasively interactive that they have to be praised and acknowledged along side the biochemistry.  Ever since man could ponder he has speculated about this interaction between mind, body, and spirit and those much wiser than I conclude that this triumvirate so intertwined as to be enmeshed.   The only logical conclusion is that true health is a balance of these three entities.  You can be physically fit but emotionally tattered, or you can be a spiritual giant and physically decrepit.  To fulfill the miracle that is your health, a balance must be achieved.

The ancient Greeks knew that balance was the ideal.  Socrates, prior to his Hemlock cocktail, said, “Everything in moderation,  nothing in excess.”  This advice is often overlooked in our contemporary society where we are often defined by our excesses.  Get more bling – run farther – close more deals – take more vitamins – all promulgating the idea that more is better.  It’s not, especially when it comes to your health.  For example, eating balanced meals of moderate calorie intake is more healthy than either eating too much, too little, or too restrictively.  It is hard for me to accept, but even exercising to an extreme can have some negative consequences.  Severe emotional extremes, high highs and low lows, is actually a psychological disorder. Embracing balance is the best way to allow mind, body, and spirit to flourish.

Let me give you a personal example to illustrate this point. I like to run marathons and, in the midst of training, inevitably I will come down with a cold.  This happens almost always after a long training run when my body hasn’t had a chance to recover and it’s resources are devoted to damage control instead of immune surveillance.  A healthier approach would be to take the necessary rest days between long training runs to allow my body to compensate.  Sometimes taking my own advice is akin to getting a root canal with pliers!

For many, good health is a choice.  Choose wisely.

Diabetes and Sex

Diabetes and Sex

Diabetes and SexHere is some more uplifting statistics.  Women who have had gestational diabetes or have given birth to a baby weighing more than 9 pounds are at an increased risk for developing type 2 diabetes later in life.  The prevalence of diabetes is at least 2 – 4 times higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women. The risk for diabetes also increases with ag e. Because of the increasing lifespan of women and the rapid growth of minority populations, the number of women in the United States at high risk for diabetes and its complications is increasing.

     And to top all this off, when glucose isn’t under good control, a woman’s sex life can suffer.  If your sugar is up, your libido may be down!  Most of us associate diabetes and sexual problems with hubby, and indeed it is (hence all the TV commercials), yet women are effected, albeit somewhat indirectly also.  Diabetes educator Ann Albright, PhD, RD says, “It’s not diabetes per se that harms your intimate life. It’s the complications of uncontrolled blood sugar levels that cause problems for both men and women — the only difference is that many women simply aren’t as aware of this complication as men are.”

This problem was not widely recognized until a landmark study in 1971 showed, “35% of women with diabetes reported being unable to have an orgasm during intercourse, compared to just 6% of the women who didn’t have diabetes.”  The mechanism was thought to be a decreased lubrication that may arise from elevated blood sugars.  This dryness may mimic what is commonly seen in menopause where lubrication also declines which results in decreased sensitivity and even pain with intercourse. Let’s face it, if it hurts it’s hard to find pleasure.

Another area affected is the tiny blood vessels that supply the vaginal and vulvar area, especially in the region of the clitoris.  These vessels can become damaged by high sugars and limit the sensitivity and response from these areas.  This results in both a decline in response but a definite decrease in desire.  Prolonged elevation in blood glucose can also lead to nerve damage called neuropathy and this can also affect the pleasure sensation.

Women with diabetes are also prone to two types of medical problems that also can interfere with intimacy: Yeast infections and urinary tract infections.  Whenever I see a patient with recurring infections, I always check for diabetes.  Frequent infections can make sex uncomfortable and unfortunately the longer you go without, the more painful it may be to resume.

Dr Albright also reminds women that “The demands of the diabetes itself can affect you emotionally and if you’re a woman the stress of those demands is simply more likely to play out in the bedroom.”

So what is a woman to do?  If you think this may be an issue with you, talk about it.  Not to just anybody of course, but mainly your husband and especially your doctor, both your internist/endocrinologist and your gynecologist.  Many of the problems can be reversed by better sugar control.  There are both over the counter and prescription medicines that can enhance lubrication and increase tissue sensitivity.  If you are having problems between the sheets, don’t pull the covers over your eyes!  Remember, sexual functioning and libido are complex and multifactorial so focus on the big picture, get it out in the open, and ask about solutions