Services

Services for Younger Patients

Your First Pap Smear

A typical adolescent exam includes obtaining your personal and family medical history, a full medical assessment, and a minimally invasive exam depending on your size. Annual pelvic exams and pap smears are recommended for all women over the age of 18, but younger patients may receive a modified exam. Pap smears are an important way to screen for cervical cancer. Since a gynecological exam may be overwhelming for a teenager, we carefully explain the exam process and answer any questions you may have. Examination of the vagina is not needed in all patients. When necessary, we do use baby-sized instruments to obtain pap smears for younger patients. Our gentleness performing exams results in happy patients who return for many years.

Irregular Periods

You may have irregular periods if you get them less than 21 days apart, greater than 35 days apart, or if they are inconsistent from month to month. While many women experience some irregularities after their first period, these tend to regulate within 2 years. Periods may become irregular due to hormone imbalances which may be caused by stress, diet and exercise, or PCOS (Polycystic Ovarian Syndrome). Lifestyle modifications as well as prescription medications may help you achieve regular periods.

Painful Periods

Dysmenorrhea is a menstrual disorder that involves painful cramps with or without an underlying gynecological disorder. Many women experience dysmenorrhea. Symptoms include abdominal pain, backache, nausea, vomiting, headache, dizziness, and diarrhea. These symptoms typically peak within 24 hours of the start of your period and last only a few days. An evaluation may be done to determine if there is a cause of your painful periods, such as endometriosis or ovarian cysts. Treatment is available and may involve medication or laparoscopy to look for endometriosis.

Birth Control Options

Birth control methods have many different variable factors including frequency of intercourse, convenience, permanence and effectiveness. We offer the following types of birth control: cyclic birth control pills, continuous birth control pill (no periods), NuvaRing Vaginal Ring, contraceptive patches, Implanon, DepoProvera, diaphragm fitting, and tubal ligation. The decision is ultimately yours, but using our knowledge and experience can help you make the right choice.

STD's

Most sexually transmitted diseases (STDs) have no symptoms, especially in women, so it is hard to know if you have been infected. Periodic testing is recommended for anyone with multiple sexual partners, even if they are having protected sex. Annual testing is recommended for all sexually active women under the age of 26. Condoms do not provide full protection from STDs. It is important to communicate with your partner and ask them if they have or have ever had an STD. At Women’s Gynecologic Associates, we offer safe and confidential STD testing and treatment.

HPV

Human Papillomavirus (HPV) is a type of virus that can cause genital warts or cervical cancer. There are more than 100 different kinds of HPV and a few of them may create a higher risk of cancer of the cervix, vagina, vulva, and anus. Other types of HPV can cause genital warts, while some others will show no symptoms. The virus is contracted through sexual contact. The risk of catching HPV can be reduced by the use of latex condoms. While there is no cure for HPV, treatment for the symptoms caused by HPV, such as genital warts, cervical changes, and cervical cancer is available. HPV testing is available in our office and may be covered by your health insurance.

Gardasil

Gardasil is a series of 3 shots which protect against the high risk forms of HPV. They protect against four different types of HPV; 2 of which cause 70% of cervical cancer and 2 of which are responsible for 90% of genital warts. Gardasil is recommended and covered by your insurance for women ages 9 through 26. With Gardasil vaccination you can greatly reduce your risk of getting genital warts or cervical cancer.

Abnormal Pap Smears

An abnormal Pap smear doesn’t necessarily indicate a condition like HPV or cervical cancer. Pap smears detect any changes within the cervical cells, not just cervical cancer. Abnormal pap smear results may indicate other conditions such as inflammation or infection. False positives are also possible from Pap smears, however further testing is recommended to protect your health whenever the pap smear is abnormal.

We may recommend that you have a colposcopy test if your pap smear is abnormal. With colposcopy we use a microscope to examine the cervix more closely and we take a biopsy of the cervix. In our office, numbing cream is applied to the cervix before biopsy, so that the test is not painful. After your biopsy returns we recommend any treatment indicated to prevent cervical cancer. Some patients will need a mini-surgery called LEEP procedure to remove precancerous cells from the cervix. Other patients require only a simple pap smear in our office every 3 months for follow-up until the pap smear returns to normal.

Infertility

Infertility is the inability to achieve pregnancy after one year of unprotected intercourse. Infertility may be due to a problem with the woman, the man, or a combination of the two. In a smaller percentage of the population, we are unable to locate a cause. When pregnancy is desired, a thorough evaluation is done. This may include physical exam, pelvic sonogram, basal body temperature, hormone tests, and sperm count. Additional tests as well as treatment are tailored based on the individual/couple.

Endometriosis

Endometriosis is when tissue that normally lines the uterus (endometrium) is found outside of the uterus. This tissue responds to the hormones which regulate your monthly menstrual cycle. Symptoms may include painful cramps, pelvic or back pain, pain with sex, pain or change in bowel movements, and pain or increased frequency of urination. Depending on your symptoms, treatment may include medications that reduce pain, medications that control your hormones, or surgical removal of the tissue. Dr. Rehder has been performing laparoscopy with use of laser removal of endometriosis for over 25 years.

Breast Problems

Almost 1 in 8 women in America will develop breast cancer in their lifetime. An initial baseline screening is generally done at the age of 35 and yearly mammograms are recommended as a routine screen for women over the age of 40. Please call for an appointment if you notice any breast lumps, bleeding from the nipples, or breast pain. In addition, we perform breast exams during your annual exam/pap smear. We can also treat breast problems such as fibrocystic breasts, breast infections, and nipple discharge as needed.

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Heavy Bleeding

Heavy menstrual bleeding is a common problem that most women experience at some point in their life. However, some women experience this heavy bleeding during every menstrual cycle, causing it to often affect their daily life.

Women with heavy periods may experience:

Bleeding for more than 10 days
Heavy menstrual flow
Large blood clots in the menstrual flow
Constant pain in the lower abdomen
Fatigue

Treatment
Many women can modify their heavy periods with hormonal supplements to balance estrogen and progesterone levels. Dr. Rehder may also recommend anti-inflammatory drugs to relieve pain symptoms and reduce blood loss, or oral contraceptives to regulate ovulation and control excessive bleeding.
If conservative methods are unsuccessful, surgery may be required. These may include dilation and curettage, endometrial ablation, or hysterectomy. Dr. Rehder has been performing these procedures for over twenty-five years and will recommend the treatment that is the simplest and safest for your particular condition.

Premenstrual Syndrome - PMS

Premenstrual syndrome (PMS) is a group of symptoms that women commonly experience before their monthly menstrual period, usually going away after the period starts. About 85 percent of women suffer from at least one symptom of PMS during each menstrual cycle. Most cases are fairly mild and may not interfere with a woman's normal activities. Severe cases of PMS may be diagnosed as premenstrual dysphoric disorder (PMDD).

The specific cause of PMS is not known, but it is linked to the hormone changes involved in the menstrual cycle, and can also be affected by stress and emotional problems. Some of the common symptoms of PMS include: breast tenderness and swelling, fatigue, difficulty sleeping, bloating, constipation or diarrhea, joint/muscle pain, acne, appetite changes, anxiety, and depression. There are many treatments currently available for PMS, many of which involve simple life changes, and prescription medication may be prescribed for severe cases of PMS.

Gynecologic surgery

Dr. Rehder has a special interest in gynecologic surgery. This is partly because she has experienced so much surgery personally. Dr. Rehder needed laparoscopy surgery for painful periods and infertility in her mid- twenties. She went on to have three children. She has been through the experience of hysterectomy, prolapse repair, incontinence surgery and jokingly comments that she has had almost every gynecologic surgery known to women! However difficult these experiences were, they have given her a true compassion for those who have to go through surgery. She also has a real passion for doing surgery the right way and with a gentle approach to the body. Dr. Rehder has taken time to cultivate many relationships in the operating room with anesthesia personnel, nurses and OR techs. All of this makes for a peaceful and organized working atmosphere. Dr. Rehder currently operates at both West Penn Hospital and Shadyside Hospital so that she can meet the needs of all of her patients despite many different types of health insurance. She has trained her nurse practitioner, Ann Hodgin, and her physician assistant, Amber Cvetich to assist her in the operating room; thus our patients can be sure they will meet at least two familiar and friendly faces the day they come for surgery. Dr. Rehder also offers to say a prayer for each of her patients the day of surgery before going into the operating room. Many of our patients say that this really meant a lot to them. We would love to have the opportunity to work with you if you need a surgical procedure.