Services

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.

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.

COMMON SURGERY FOR PATIENTS 50 and Up

Hysterectomy – abdominal or vaginal
Vaginal prolapse repair
Bladder repair
Incontinence surgery – minimally invasive
Dilation and curettage with hysteroscopy

Menopause

As you get older, your body slowly ceases to produce estrogen and progesterone. These two hormones thicken the lining of the uterus each month before your period. These hormones also protect the body from developing uterine cancer and osteoporosis. The decrease in hormones is responsible for many symptoms of menopause such as hot flashes, insomnia, depression, vaginal dryness, and low sex drive. Since these hormones are valuable to our health, many women choose to replace them through a pill, patch, or cream. Estrogen by itself helps to relieve menopause symptoms and prevent osteoporosis. When taken with progesterone, the combination therapy prevents growth of the uterine lining to help prevent cancer of the uterus. Since there are some risks associated with Hormone Replacement Therapy, it is important to take the lowest dosage possible and reevaluate your therapy each year. Your doctor can help you decide which, if any, type of Hormone Replacement Therapy is right for you.

Perimenopause

Menopause is diagnosed when a menstrual period has been absent for 12 months. However the entire process takes several years and begins when the ovaries start producing less estrogen. This stage is known as perimenopause. During perimenopause many women suffer from all the same symptoms as a woman who is fully into her menopause. Dr. Rehder is experienced in treating perimenopause with hormone therapy to ease your transition into menopause. All of this can be done without increasing your risk for cancer in the future. In fact hormone therapy has been shown to decrease the risk of uterine cancer by preventing an unhealthy buildup of uterine lining. Please feel free to make an appointment for treatment of perimenopause even if you are still having some menstrual periods.

Bio-identical Hormone Replacement Therapy

A more natural method of treatment, called bioidentical hormone replacement therapy (BHRT), is becoming increasingly popular among doctors and patients alike. Unlike synthetic hormones, bioidentical hormones are made to have the identical molecular structure of the hormones made by your own body, so your body can metabolize them as it was designed to do, minimizing side effects. Additionally, as opposed to the general, mass-produced synthetic hormones, bioidentical hormones are individually matched to each woman's specific hormonal needs. Although bioidentical hormone replacement therapy is not FDA approved, many of the hormones used have been individually approved. This treatment has been used in clinical trials for over 20 years and is considered a generally safe procedure that offers women more specialized, effective treatment for their troubling menopause symptoms. Dr. Rehder can help you to choose whether bioidentical hormone therapy is right for you and has many years of experience working with compounding pharmacies to prepare individualized prescriptions for hormone therapy.

Dropped Uterus/Pessary

Pelvic organ prolapse occurs when one or more pelvic organs prolapses or drops from its normal location and pushes against the walls of the vagina. It happens frequently when the muscles in the area are weakened from childbirth or surgery. Symptoms of pelvic organ prolapse include feeling pressure in the vagina from the pelvic organs, feeling very full, feeling a pull or stretch in the groin and having incontinence problems. Some women can even feel a ‘ball of tissue’ pushing out through the opening of the vagina. While this condition may be upsetting, treatment is not an emergency and prolapse can even sometimes get better with time.

For pelvic organ prolapse that does not improve on its own or results in severe symptoms, surgery may be necessary to repair the problem. Pelvic prolapse repair surgery includes many different procedures, depending on which organ is affected. These surgeries can include repair of the bladder or urethra, repair of the vaginal wall, closure of the vagina or a vaginal hysterectomy. Bladder testing prior to treatment will produce the most successful and satisfying result for women with prolapse. Dr. Rehder normally performs a simple bladder test in her office to help determine the correct treatment for her patients with prolapse. This test is not painful, lasts about 20 minutes, and is covered by your insurance. If surgery is required, it is often less painful than other types of surgery and Dr. Rehder has been doing this sort of surgery for over 25 years. Some women who want to avoid surgery can have the prolapse treated in our office by insertion of a rubber supportive ring into the vagina. This supportive ring is called a pessary and this treatment is also covered by all insurances including Medicare.

Bladder Problems

Urinary incontinence (UI) is a common condition that involves the uncontrolled loss of urine. It can occur while laughing, coughing, sneezing or jogging. Urine leakage with movement is known as stress incontinence. It can also come on as a strong urge to urinate without enough time to reach a bathroom, known as urge incontinence. While neither condition is serious, they can be embarrassing and affect your daily life. Incontinence can affect people of all ages, but women are especially susceptible after pregnancy and as they get older. Urinary incontinence should be evaluated by a simple bladder test called urodynamic testing. Dr. Rehder does bladder testing in her office and the test is covered by your insurance. This test will show whether treatment will require medication, surgery, or physical therapy. Treatment of urinary incontinence is simple in most cases even if surgery is required. Dr. Rehder commonly performs corrective surgery through a 1 inch incision which is hidden inside the vagina and most of her patients go home the same day.