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gynecology

Gynecology

MUSC Health is proud to have earned U.S. News & World Report 2017-2018 national ranking as one of the top 50 hospitals for gynecology. The score is based on various data categories, including volume of high-risk patients, nurse staffing and patient survival.

From the most basic gynecology services including routine screenings to complex care and fertility needs, our team is available to help meet the needs of all women beginning at adolescence through senior life. Our services feature the newest technology including 3-D mammograms and specialized diagnostics. In addition when needed, Women’s Health offers counseling and support from our behavioral health specialists.

Among some of the special features of our gynecology programs are:

  • Ultrasound imaging, saline infusion sonography and fibroid imaging
  • Non-surgical gynecology options including alternatives to hysterectomy
  • Minimally invasive gynecologic surgery including laparoscopy, hysteroscopy and robotics
  • Comprehensive bladder and pelvic health services
  • Cancer screening programs and collaboration with MUSC Hollings Cancer Center
  • Family planning and birth control options
  • Evaluation and management of pediatric gynecologic issue
  • Infertility support to help overcome recurrent pregnancy loss, premature ovarian failure, polycystic ovarian syndrome, uterine abnormalities, and abnormal reproductive hormone issues
  • Breast health services including screening recommendations, prevention tips, how to identify high-risk breasts, imaging options and more

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Common Services and Conditions Treated;

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Child & Adolescent Gynecology Including Sports Physicals

We understand that pediatric and teenage girls have unique needs and require specialists trained for those needs. Our team of physicians are available for consultation, sports physicals or to treat common or rare gynecologic issues. The specialists are part of the gynecology team at MUSC Health but also work closely with the pediatric specialists to treat those needs.

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Contraception Including IUD & Nexplanon

A variety of contraception or birth control methods are available, and your gynecologist will help you identify which one is best for you. Our providers are trained to provide long-acting reversible contracption sucha s IUD's and implants

An intrauterine device (IUD), which is a small, t-shaped plastic device that is wrapped in copper or contains hormones. The IUD is inserted into the uterus by your physician and provides very effective contraception for many years. Another option is a nexplanon, a small, thin plastic rod that is inserted under the skin of the upper arm. The rod slowly releases etonogestrel into the body to prevent the release of an egg. Both may be good options for you and can be discussed with your doctor.

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Cancer Screening

Cancer screenings help your physician find a disease even before there are any symptoms. Often through screenings your gynecologist can find the disease early and develop a more effective treatment plan. At MUSC Women’s Health, your gynecologist follows current recommendations for annual cancer screenings. See the Hollings Cancer Center Cancer Screening Guidelines for more information.

Only cervical cancer has a screening test, the Pap test. This test can also help prevent cervical cancer by finding precancers, the cell changes in the cervix that may become cervical cancer. Your physician can also work with you to help you identify potential warning signs. See the Hollings Cancer Center Cancer Screening Guidelines for more information.

The pap smear is one of the most successful cancer screening tests. This test helps to detect cervical pre-cancer, or abnormal cells of the cervix, and allow for increased surveillance and early treatment if indicated. In addition to the pap test, many gynecologists are also using a test for the human papillomavirus (HPV) to enhance the detection of abnormalities in the cervix.

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Evaluation (Colposcopy) for Abnormal Pap Test

Should you have an abnormal Pap test, your physician will likely recommend a colposcopy. A colposcopy helps to give your physician a close view of the cervix and is used to detect abnormal cells on and near the cervix.  A colposcope, an instrument that resembles binoculars with a bright light mounted on a stand, is used to conduct a colposcopy.

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Evaluation Abnormal Uterine Bleeding

There are many conditions that may cause abnormal uterine bleeding, which can occur at any age, and your gynecologist can help determine the cause.

For young girls, bleeding before the first period is always abnormal and should be reviewed. With adolescents, many will have irregular bleeding in the first few months after their menstrual period. Typically, this resolves itself. However, if irregular bleeding continues, further evaluation is necessary.

Premenopausal women have many different conditions that can cause abnormal bleeding ranging from changes in hormone levels to uterine fibroids and endometrial polyps. Other causes may be pregnancy, an infection, other medical illnesses and even cancer. To determine the cause, it is best to be seen by your gynecologist.

Hormonal changes often trigger irregular bleeding in women in menopausal transition and menopausal women, but a variety of conditions can also trigger unusual bleeding. Further evaluation is needed by your physician.

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Evaluation Pregnancy Loss – Ectopic Pregnancy

About 10 percent of known pregnancies can result in early pregnancy loss, which occurs during the first 13 weeks of pregnancy.

If the fertilized egg implants in your fallopian tube or someplace else in the abdomen, you have an ectopic pregnancy.  Sometimes, you may not even know you are pregnant but several warning signs can occur including nausea and vomiting, dizziness or weakness, sharp abdominal cramps, or pain on one side of your body or in your shoulder, neck or rectum. An ectopic pregnancy requires immediate help from your physician. There are a variety of causes for an ectopic pregnancy that can be determined by your doctor.

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Family Planning

Family planning and birth control are an essential part of many women’s lives.

MUSC Women’s Health is pleased to offer a comprehensive family planning program with a team of family planning specialists. The program, in operation for years, has expanded the medical and support teams to better serve the Charleston community.

Family planning services include:

  • Contraceptive consultation for medically or socially complicated patients
  • IUD insertion and removal including lost IUDs
  • Implanon insertion and removal
  • Tubal ligation including the Essure procedure
  • Medical management of miscarriage
  • Office-based uterine evacuation for miscarriage

Helpful Resources:

Bedsider.org (a free birth control support network):

I’d like to know a lot more about birth control in general.

How do birth control methods compare to each other?

What if my birth control failed?

Where can I obtain emergency contraception?

I’d like to set up free reminders to take my birth control.

Association of Reproductive Health Professionals:

What are my options if I have had a miscarriage?

I would like to know more about different types of birth control.

How do hormones prevent pregnancy?

For questions about birth control and family planning:

To schedule an appointment, please call 843-792-5300. If you’re a physician wanting to refer a patient, please call our nurse manager at 843-792-4500.

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Fertility

Fertility issues can be heartbreaking. The MUSC Women’s Health team of specialists can help identify the causes and develop an individualized treatment plan. Fertility services are available in the downtown Charleston location at 135 Cannon Street.

Fertility services include:

  • Infertility consultation
  • Recurrent pregnancy loss evaluation and treatment
  • Polycystic ovarian syndrome evaluation and treatment
  • Premature ovarian failure evaluation and treatment
  • Uterine abnormality evaluation and treatment
  • Menopausal therapy
  • Abnormal hormonal problems of the reproductive system

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Low & High-risk Preconception Counseling

Perhaps you have a health problem or family health history that may complicate your pregnancy. The best time to consider potential health issues is in advance of becoming pregnant. In fact, since 2005 the CDC has recommended a preconception visit.

The MUSC team of women’s health physicians can meet with you and help to minimize the impact of health concerns before you become pregnant. If necessary, you may be referred to the maternal fetal medicine specialists who can conduct further evaluation and monitor your pregnancy regardless of where you live. Testing and counseling help you to have the healthiest pregnancy possible.

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Menopausal & Post Menopausal Health

Menopause occurs when a woman stops having a monthly period. Typically, this occurs in a woman’s late 40s to early 50s. A woman is considered post menopausal when she has not had a period for a full year.

Perimenopause usually starts in a woman’s 40s although it can happen in her 30s too and lasts until menopause. During this time the ovaries slowly produce less estrogen until menopause, when the ovaries stop releasing eggs.

Symptoms of menopause can include: hot flashes, vaginal dryness, discomfort during sex, night sweats and/or cold flashes, dry skin, eyes or mouth, insomnia and emotional changes including mood swings, mild depression and irritability.

Others also experience:

  • Headaches
  • Weight gain
  • Difficulty with concentration and possibly temporary memory lapses
  • Joint and muscle aches and pains
  • Hair loss and thinning hair
  • Changes in sex drive
  • Heart racing

The MUSC gynecologists have helped thousands of women with the transitions of menopause and after. While every woman is different and reacts uniquely to menopause, the physicians work with each woman to make certain no other cause is contributing the changes.

Some women seek relief through 'hormone therapyy while others choose to transition naturally without hormone replacement. Hormone Replacement Therapy uses female hormones (estrogen and progesterone) to treat common symptoms of menopause. Your physician can discuss options to find the best treatment course for your situation.

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Minimally Invasive Gynecologic Surgery

MUSC Women’s Health includes a team of specialists who are specifically trained in minimally invasive surgery techniques including laparoscopy, hysteroscopy and robotics.

With laparoscopic surgery, the surgeon uses very small incisions on the abdomen to insert a thin, lighted scope and thin surgical instruments. Laparoscopy can offer the opportunity to look at pelvic organs and to take tissue biopsies if needed. More advanced laparoscopic techniques can allow for removal of fibroids, treatment of endometriosis, removal of ovarian cysts, and even hysterectomy.

A hysteroscopy is often performed if your physician needs to get a closer look at your cervix and inside your uterus. The doctor inserts a hysteroscope which is a lighted thin tube into the vagina. If necessary, if anything is abnormal, a sample can be taken for further analysis.

At MUSC Women’s Health, physicians are also trained to perform robotic surgery. Robotic surgery is a form of laparoscopic surgery that utilizes the da Vinci Surgical System to perform complex surgeries through incisions that are less than an inch long. 

When compared to surgeries requiring larger incisions, laparoscopic and robotic surgery offer the following advantages:

  • Decreased blood loss
  • Shorter hospital stay
  • Smaller incisions
  • Less pain
  • Quicker recovery when compared to traditional open surgery.

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Alternatives to Hysterectomy

Our goal is to help patients avoid surgery if that is possible. The MUSC Women’s Health physicians can recommend alternative treatments that along with hormonal support and lifestyle changes are options for care of endometriosis, fibroids, heavy bleeding and perhaps polyps.

Possible alternatives include:

  • Medical/hormonal management
  • Uterine artery embolization (UAE)
  • D&C and hysteroscopy
  • MRI-guided focused ultrasound
  • Endometrial ablation
  • Laparoscopy and endometriosis excision
  • Myomectomy

Talk to your physician to discover what option works best for your lifestyle.

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Ovarian Mass

An ovarian mass or cyst is a closed sac located within the ovary that contains fluid or a solid material. Most found in pre-menopausal women will be “normal” and usually are related to the egg in the ovary. Many will go away over time. Your physician may choose to monitor the situation, particularly if they are found in a woman who is still having normal periods.

The ovarian mass or cyst that does not get smaller or disappear is more likely to be a tumor. These tumors are usually non-cancerous in younger women. Your physician may require an ultrasound or other imaging test to determine more characteristics of the mass.

Often an ovarian cyst doesn’t cause any symptoms and a woman is unaware of it until it is found by her physician during a routine pelvic exam.

Symptoms of an ovarian mass include:

  • Difficulty urinating or frequent urination
  • Dull ache in the lower back
  • Pain or bloating in the abdomen
  • Pain during sexual intercourse
  • Weight gain
  • Nausea
  • Painful menstruation and abnormal bleeding
  • Loss of appetite

If you are experiencing any of these symptoms, talk to your physician.

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Reproductive Infectious Disease

The Reproductive Infectious Disease team at MUSC Women’s Health can help patients diagnose and manage difficult-to-treat vaginitis and disorders of the vulva, like recurrent yeast infections, active or recurrent vaginitis and active or recurrent bacterial vaginosis.

The team also diagnoses and treats other infections including:

  • Genital herpes
  • Vulvovaginal candidiasis (acute and recurrent)
  • Genital warts
  • HPV Infection
  • Inflammatory vaginitis
  • Syphillis
  • Mucopurulent endocervictis (cervicitis)
  • Chlamydia
  • Pelvic inflammatory disease
  • Gonorrhea

The Reproductive Infectious Disease team also specializes in handling HIV in pregnancy. The team’s mission is to eliminate perinatal transmission of HIV in the state of South Carolina. Learn more about HIV in Pregnancy program.

The team includes Dr. David Soper, one of the most recognized experts in obstetrical and gynecological infectious diseases in the United States as well as internationally at MUSC Women’s Health. Dr. Soper’s research involves infections in women. He is one of a handful of physicians in this country with postgraduate training in both obstetrics and gynecology and infectious diseases.

Dr. Soper is a consultant to the CDC for updating the Sexually Transmitted Disease Treatment Guidelines. He has authored more than 100 scientific publications related to infectious diseases in obstetrics and gynecology. His textbook is highly regarded in this country and now is available in Spanish.

The clinical interest of our reproductive infectious diseases specialist Dr. Gweneth Lazenby, include the resurgence of syphilis, antenatal care for HIV-infected women, sexual dysfunction, and primary prevention of sexually transmitted diseases (STD), including HPV. Dr. Lazenby directs the MUSC Reproductive Infectious Diseases clinic, which include HIV clinics for women an STD clinic, which screens for common sexually transmitted diseases:  gonorrhea, chlamydia, trichomonoas, genital warts, herpes, syphilis, hepatitis, and HIV.

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Recurrent Vulva & Vaginal Infections

About five percent of women suffer from chronic or recurrent infections (four infections per year). Persistent or recurrent vulva and vaginal infection can cause daily symptoms of itching, irritation or burning. Among the most common recurrent infections are: yeast, bacterial vaginosis and trichomonas.

Yeast infections occur in 20 percent of all women over their lifetime. A new of conditions predispose women to yeast infections including diabetes, pregnancy, antibiotic use and immune-suppression. Bacterial vaginosis (BV) is an imbalance in the bacterial environment. Three or more episodes a year indicate chronic BV. Trichamonas is a sexually transmitted infection, which is often accompanied by a copious, yellow discharge. Diagnosis and treatment for these vaginal infections occur after a physical exam.

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Vulvar Skin Disorders

The vulva is located in the external part of a woman’s genitals. Among the problems of this area are:

  • vulvovaginitis, which is a swelling, redness, inflammation or infection of the vulva
  • Allergy skin problems
  • Vulvar pre-cancer or cancer
  • Vulvar pain
  • Vestibulitis
  • Lichen sclerosus

Symptoms might include redness, itching, pain or cracks in the skin. Treatment requires a physical exam.

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Pain With Intercourse

Intercourse pain can cause emotional effects in addition to painful sex.  Sometimes pain results if there is not sufficient vaginal lubrication. For some cases, there be no underlying medical cause and sexual therapy may help. There are also a number of additional medical conditions that can cause a woman to experience painful sex. A physician should be seen if there are symptoms like bleeding, genital lesions, irregular periods, vaginal discharge or involuntary muscle contractions.

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Lichen Planus

A chronic recurrent rash due to inflammation of the skin and mucous membranes is called lichen planus. There is no known cause or cure. It can be found in the lining of the mouth or vagina. It can be very itchy and is usually found in adults. While it can involve any portion of the body, it often occurs in the wrists ankles, and oral and genital tissues.

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Lichen Sclerosus

Lichen sclerosus is a problem of the skin where small white spots appear usually in the genital and anal area. The spots are typically shiny and smooth and develop into patch that become thin and crinkled. They appear in women usually after menopause, and often are itchy and sometimes pain and bleeding.

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Lichen Simplex Chronicus

Lichen simplex chronicus is a skin disorder with chronic itching and scratching. More common in women, it can start when something rubs or irritates the skin, such as clothing. This causes an individual to scratch or rub the area. The continual scratching causes the skin to thicken, leading to more scratching.

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Second Opinion

MUSC Women’s Health offers a gynecology second opinion program where a patient has the opportunity to review all of their options with our comprehensive team of specialists. We provide for quick coordination of appointments with our team of specialists based on your individual needs.

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Ultrasound

An ultrasound scan is a device using high-frequency sound waves to create images inside the body. The imaging can help a physician see the uterus, tubes and ovaries to uncover maladies. We also use 3-D ultrasonography to help evaluate anatomy of the uterus and ovaries more thoroughly. 

Saline infusion sonography is used to evaluate the shape of uterus and the endometrial (uterine lining) cavity. It will also show the ovaries. The procedure helps the physician detect any abnormalities.

This safe, state-of-the-art tool can help a physician see a clear view of a number of issues including fibroids and ovarian cysts.

MUSC Health ultrasound offers some unique benefits:

All MUSC Health ultrasound sites are AIUM Accredited. Accreditation is earned by the American Institute of Ultrasound in Medicine (AIUM), and MUSC Health ultrasound has been accredited since 1998. Each accreditation is for three years, and we received our latest in January 2017. According to AIUM, “Accreditation by the AIUM says that a practice has demonstrated that all of its interpreting physicians meet relevant ultrasound training guidelines, case volume requirements, and continuing ultrasound education; all sonographers are or will become appropriated certified by a specific date; ultrasound equipment is adequately maintained; safeguards are in place to protect patients and staff; ultrasound examinations and reports meet or exceed accepted guidelines for content timelines, and record retention; and there is regular monitoring for quality assurance.”

In addition to accreditation, MUSC Health perinatal sonographers collaborate on each case with expert maternal fetal medicine physicians and a gynecology ultrasounds physician who specializes in gynecology ultrasound. They also participate in monthly team board meetings in collaboration with maternal fetal medicine physicians, neonatal physicians, genetic counselors, palliative care providers, fetal MRI specialty physician, and pediatric surgery specialist giving our patients the depth of medical experience to ensure the best outcome. 

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