It’s In The DNA

dna-pgx-testing

Imagine a world where your doctor knows what medications will ultimately work the best and possibly has no adverse side effects. Thanks to advances in genetics and physiology research, personalized medicine is on the rise and becoming readily available. Enter pharmacogenomic (PGx) testing. Exit trial-and-error, and “one size fits all” medications.

 

Pharmacogenomic testing studies the patient’s drug metabolizing genes by tracking the process of drugs being metabolized (or broken down) within the body. The test answers all sorts of questions including why a patient may not be having success with a medication, or is having severe side effects when other patients are having no issues with the same medication. No two patients are alike. They may have similar or even the same symptoms, but often the medication that worked for one won’t work for the other, or one will have adverse reactions where the other didn’t. A patient’s genetics will dictate how a medication works and whether or not they will experience reactions. Adverse reactions have been a real concern for healthcare providers as they are the 4th leading cause of death in the United States.

 

What exacting is PGx testing? It’s the study of how genetics may influence the efficacy of drugs.

In simple term, it’s the study of how a patient’s genes affect their body’s response to medications. This advance in testing means that the healthcare provider avoids the trial-and-error approach when prescribing medication. This informative tool helps determine the patient’s metabolism profile which in turn helps predict a personalized treatment while taking into consideration sensitivity to medicines that could produce create adverse side effects.

 

Many factors will determine how a patient responds to medications. Including:

  • Genetics
  • Age
  • Other medications currently used
  • Kidney or liver illness
  • Smoking/alcohol

 

Why should you consider having a PGx test? The obvious reason is that it will guide your health care provider in preparing a personalized solution to your health issue. The test results will help:

  • Determine serious side effects
  • The healthcare provider adjust the dose of a current medication
  • Recommend alternative medications

 

We are pleased to add this service in our practice. The testing is simple and can be done in our office or virtually as it only requires a small blood or saliva sample. We send the sample to the lab where the results will help determine if a medication will be effective, what dose would be ideal and whether or not there will be adverse side effects. Contact us for more information about PGx testing and reap the benefits of personalized medicine.

 

This information is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.  Should you have any questions or would like to discuss genetic testing, please contact the staff at Parveen S. Vahora, MD.  We are here to help.

 

Endometriosis and Stress

endometriosis pain

What exactly is endometriosis?

Endometriosis is a pelvic inflammatory disease with endometrial tissue growths outside of the womb, affecting women in their reproductive years. Symptoms are pelvic pain and infertility.

Does stress affect endometriosis?

According to research it does. Studies made in both 2011 and again in 2018 showed that the test subjects who were put through stressful situations had bigger lesions and the level of damage was more severe.

Granted, we all experience stress and usually have very few side effects from it. But this isn’t the case with those suffering from endometriosis. So, the question is, why does stress affect endometriosis? Simply put, when a body is under stress, cortisol is produced which in turn hurts the immune system. That’s why you may seem to catch a cold or the flu when you are stressed. Your immune system doesn’t function optimally when under stress. And to make matters worse, it’s been shown that stress also increases the amount of inflammation and inflammation is a big part of endometriosis.

It’s a known fact that stress affects the physical and mental health of a person. Factor in that nearly half the women diagnosed with endometriosis experience depression and/or anxiety, and it’s easy to see how widespread this problem is. Stress and pain are cyclical – each cause and affects the other.

Stress management can be a strong tool in managing endometriosis. It won’t cure it, but it will help keep the level of pain and discomfort from increasing. And the number of flare ups will decrease. You can teach yourself how to cope with stress and return to a relaxed state of mind. There are many ways to manage stress, including:

Meditation – manages feelings of depression, anxiety, and stress

Exercise – helps reduce inflammation

Yoga – boosts strength, flexibility and induces relaxation

Therapy – keep a journal of flare ups including any triggers

My goal as a physician is to help women live their best life. Women with endometriosis may find it hard to imagine a “best life.” Each flare up reminds them of their disease. I can help reduce the flare ups by working with you on a regimen to reduce stress. It truly does help alleviate a lot of the pain. Don’t suffer any longer.

This information is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.  Should you have any questions or would like to discuss endometriosis, please contact the staff at Parveen S. Vahora, MD.  We are here to help.

 

The Importance of Cervical Cancer Screening

cervical screening

As women, we should all want to know the best way to protect ourselves from illness. We have careers and families and frankly we just don’t have the time (or desire) to become ill, especially seriously ill. Sadly, cervical cancer is just that – a serious condition.

Cervical screening is the best defense against the alarming rate of cancer-related mortality. Yet, the number of screenings have dropped dramatically in the past two years, most likely due to the COVID-19 pandemic. 2020 and 2021 showed low screenings and are a concern of the American Cancer Society who recommends that women between the ages of 21 and 29 should begin cervical cancer screenings every three years, and women aged 30 to 65 should be screened every 5 years. Why? Because the screenings will detect this cancer early when there is a good chance that treatment will be successful.

An easy way to stay on top of this and not miss screenings is to be vigilant about your annual well woman visits. The cervical screening is done at the same time as your pap test.  Your doctor will keep track of your screenings and alert you when it’s time for one. Look at it this way – cervical cancer screenings save lives. The American College of Gynecologists state that it generally takes three to seven years for changes in the cervical cells to turn into cancer. Regular screening will detect any changes before they morph into cancer.

JAMA Network conducted a survey to better identify the reasons for the decreasing amount of cervical cancer screening, especially among underserved groups of people such as ethnic and minority groups and the LGBQ+ community. Their study used data from 2005 through 2019 from the National Health Interview Survey (NHIS). The NHIS asked those who had not received screening for more than three to five years the following question in their 2019 survey:

“What is the main reason that you have not had a cervical cancer screening ever or in the last 5 years?” The participants were asked to select one of the following 10 answers:

  1. Never thought about it;
  2. Didn’t know I needed this type of test;
  3. Doctor didn’t say I needed it;
  4. Haven’t had any problems;
  5. Put it off;
  6. Too expensive/no insurance;
  7. Too painful, unpleasant, or embarrassing;
  8. Don’t have a doctor;
  9. Had HPV vaccine;
  10. Other

 

The results of the survey showed that overall, the most common answer was #2 – “I didn’t know I needed this type of test.” Which of the ten answers would you have chosen? We can’t stress enough how important it is to schedule your annual wellness visit and to follow your doctor’s advice as to when to have screenings (not only cervical) on a regular basis. Nothing is more distressing to a doctor than to diagnosis late stage cervical cancer. I recently had to do just that and tell a lovely patient, a mother with a five year old son, who hadn’t had a screening in five years, that she had late stage cervical cancer that could be terminal.

Schedule your wellness appointment today and don’t delay your cervical cancer screening.

This information is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice.  Should you have any questions or would like to discuss cancer screenings, please contact the staff at Parveen S. Vahora, MD.  We are here to help.

Say Goodbye to Incontinence

emsella treatment

It’s true! A new breakthrough FDA approved treatment for incontinence has become available and we are so happy to be able to offer this  non-invasive treatment to our patients. The Emsella treatment is greatly improving the quality of life of patients suffering with incontinence. In fact, studies show that to date, 95% of patients treated with Emsella report an improved quality of life.

What is incontinence?

The short answer is that it’s an involuntary leaking of urine. The two most common types are urge and stress incontinence. Urge incontinence happens both suddenly and frequently. In the case of stress incontinence, pressure from coughing sneezing, etc. can put pressure on the bladder resulting in leakage. Both of these may be  because of weak pelvic floor muscles which are important in controlling incontinence.

 

emsella for men

What causes incontinence?

There are a multitude of reasons. The most common are aging, childbirth, obesity, and menopause which all weaken the pelvic floor muscles that support the pelvic organs.

What exactly is Emsella?

Emsella is a unique chair where the patient sits (fully dressed) for a series of treatments. Electromagnetic energy delivers thousands of impulses that create muscle contractions with the goal of stimulating and re-educating the patient’s muscles. The treatment is completely non-invasive. There will be sensations of tingling and muscle contractions during the procedure that typically lasts around 30 minutes. Treatments are twice a week for a total of six sessions.

Each patient is different and will receive a treatment plan specifically designed for them. A plus is that you remain clothed during the treatment and can resume normal activity immediately after the treatment. And, even better, often patients notice improvement after only one session!

Does your partner keep you up at night with frequent bathroom trips?

Patients may also see a reduction in nighttime urinary frequency.  A good night’s sleep is just a short “sit” away.

“I am so pleased with my results from the Emsella treatment. After going through childbirth twice, I found that as I aged urine leaks were becoming more prevalent. I didn’t want to go through a surgical procedure and was excited to try the Emsella treatment as a surgical alternative. It really works! It forces kegel exercises without having to do actually do them. I recommend Emsella wholeheartedly!”  — Laurean Callander

Contact us and come in for a consultation so we can tailor a treatment plan that best suits your needs and so that you can say “Goodbye” to incontinence!

We Are Members of Privia Medical Group

As of November 16, 2021, we are proud members of Privia Medical Group!

Endometriosis – The Controversy Continues

teen tax with sex doctor
Endometriosis is in the news…again. You may have heard about the recent controversial case reported by the BBC of 23-year-old Hannah Lockhart who had such severe pelvic pain that it was completely disrupting her life, resulting in her seeking a hysterectomy. She isn’t alone. But it did stir up a touchy issue. She was refused the procedure because of her age and the fact that she didn’t have any children. A hysterectomy would involve the complete removal of her uterus, thus eliminating the possibility of her ever becoming pregnant and giving birth.

What is endometriosis?
It’s a painful condition where endometrial tissues form outside of the uterus. In other words, the tissues that normally grown within the uterus, grow in other parts of the body. These tissues “build up” and like the uterine lining, shed (bleed) in the monthly hormonal cycle. However, unlike the uterine lining, there is no natural outlet for these tissues (blood) to be discharged. The result is severe pain.

Should a woman have to make that painful life-changing decision of children or surgery? Should the option of hysterectomies be taken off the table for women of child-bearing age? These are topics still being discussed. And, of course, each woman should have the opportunity to learn about all available options, from medication to surgery, and make that decision for herself.

Endometriosis is a common ailment.
There are many women of all ages who deal with the severe symptoms of endometriosis from migraines, nausea, abnormal bleeding, lengthy monthly periods and, in all cases, pain. Lots of pain. According to the BBC article, endometriosis affects approximately 176 million women, where up to 20% are of childbearing age. And, in many cases, the advice given is to prioritize the ability to have children over the elimination of pain.

The controversy continues today as many are seeking aggressive treatments and having to choose between not having children or living with debilitating pain. Or worse yet, being denied surgeries because they are of child-bearing age. Becoming informed of all options is the answer. And surgery may not be the answer for everyone. Today we have other options and very often surgery isn’t recommended unless there is no viable alternative.

Dr. Vahora specializes in painful conditions and offers many treatment options for endometriosis. Her treatments include customized medications, holistic treatments, laser treatments, and surgery. Dr. Vahora has the experience and tools to both treat the condition of endometriosis and ease the pain. There are options and hopefully ones that will eliminate the agonizing decision of whether to live with pain or not to live with pain.


This information is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice. Should you have any questions or would like to discuss endometriosis pain, please contact the staff at Parveen S. Vahora, MD. We are here to help.

Gynecologic Well Woman Checks

well woman checks
Women have amazing, wonderful, yet complicated bodies. So much can “go right” when we take the time to know as much as possible about our bodies and how they work. It’s important for all women of all ages to develop an open relationship with their gynecologist, guaranteeing that any health issues can be comfortably discussed. Let’s face it, sometimes things can go a bit wrong and having a strong relationship with your gynecologist means you’ll get the best state-of-the-art solution to any issue you may be experiencing. You owe it to yourself to be pro-active with your health.

Being a Well Woman
Well women make a point to visit their gynecologist annually. This annual checkup covers a gamut of services to ensure that your health is at its best. Tests such as STD, bone density, and pap smears are common. In addition, this may be the time to discuss birth control options or dependent upon your age, perhaps a discussion about menopause.

Gynecologic services range from annual pap smears and cancer screenings, to endometriosis and
hormone therapy, and much more. Dr. Vahora is also one of the few doctors in the area offering
pre-cancer screenings, also known as genetic testing. The list of services goes on to include periand
premenopausal issues as well as investigative services to determine if any alternatives to
surgery or hormones are the solution.

General Gynecology
There are a multitude of services your gynecologist can offer. Including:

  • Hormone Therapy – Bioidentical hormones, systemic, local therapy and non-hormonal options
    are explored
  • Prolapse – a condition when structures (uterus, rectum, bladder, etc.) fall out of position.
  • Pelvic Pain
  • Fibroids – Growths (benign tumors) that develop on the reproductive organs and tissues.
  • Hysterectomy
  • Dyspareunia (pain with intimacy)
  • Menopause
  • Sexual Health
  • Genetic Testing

Knowledge of your own body should be every woman’s goal. And an important part of your body knowledge is the result of an open honest relationship with a compassionate gynecologist. Dr. Parveen S. Vahora fits that bill to a tee. She is a board-certified, fellowship-trained gynecologist offering general gynecologic specialist services. Dr. Vahora takes the time to get to know her patients on a personal level. This ensures a comfortable atmosphere between doctor and patient.


This information is not intended to be exhaustive nor should any discussion or opinions be
construed as professional advice. Should you have any questions or would like to discuss well women checks, please contact the staff at Parveen S. Vahora, MD. We are here to help.

The Genes Tell All

genetic testing

The science of genetic testing is becoming one of the most beneficial tests in determining if a person may have a likelihood to inherit a susceptibility to certain illnesses or diseases. This is especially true with cancers. Genetic testing looks at a person’s genetic makeup to see if there is evidence of vulnerabilities.

How is the testing done?
Genetic testing may sound like a complex or invasive test. It’s not. It’s actually really quite simple. A small sample of bodily fluid or tissue is taken. Normally a small blood sample is collected. However, it may be that saliva or skin cells are collected instead based on the type of test being conducted. Regardless, the collection process is quick and painless. Once collected, the sample is sent to a specialized lab where it is examined for evidence of vulnerabilities.

Test Results
The DNA test will result in one of the following outcomes: positive, negative, true negative, or benign.

Positive. This may indicate that there is an increased risk of developing cancer in the future. Having this information helps a patient talk to her doctor to formulate a lifestyle to help lower the risk. Also, it provides needed information for family members who might also have inherited the variant.

Negative. This means the lab didn’t detect the variant that is present in other family member(s).

True Negative. A true negative result does not mean that there is no cancer risk, it means that the patient has not inherited the susceptibility.

Benign. Benign tests reveal genetic changes that are common in people without cancer. All of us have benign variants that don’t necessarily mean we are at risk.

Is Testing Important?
In a word, yes! It’s very important, especially in gynecological-related cancers. The results of the test can greatly aid in the management and treatment as well as in preventive measures for future cancer patients – or as Dr. Vahora calls them “Previvors!”. Dr. Vahora uses the results to tailor medical care specifically unique to each patient. To see if genetic testing is right for you, take this quick one-minute questionnaire: (https://www.hereditarycancerquiz.com/vahoramd).

Genetic information also benefits family members. Families with the variant become aware of the possible inherited risk. Our website has a page devoted to genetic testing containing pertinent information as well as a comprehensive list of commonly asked questions.


This information is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice. Should you have any questions or would like to discuss genetic testing, please contact the staff at Parveen S. Vahora, MD. We are here to help.

Menopause and Breast Cancer Survivors

menopause and breast cancer

Recently a study was done to evaluate the changes in sexual function of breast cancer survivors who also were experiencing genitourinary syndrome of menopause (GSM) after they had received fractional CO2 laser therapy. The study results were published in Menopause.

Let’s break down the meanings of GSM and fractional CO2 laser therapy for a better understanding.

GSM (Genitourinary Syndrome of Menopause)

During menopause levels of estrogen decrease often resulting in the skin of the vagina and vulva becoming thinner. Once referred to as vaginal atrophy, it is now referred to with the broader term of GSM. GSM’s most common symptom is vaginal or vulvar dryness and loss of elasticity. This lack of lubrication causes pain during intercourse and can even result in the tearing of flesh. GSM can also result in risks of urinary infections.

Fractional CO2 Laser Therapy

Fractional carbon dioxide (CO2) lasers are on the cutting edge of non-surgical rejuvenation treatments. This treatment has been typically used to improve skin texture and decrease wrinkles and discoloration of the skin. The laser treats both the superficial and deeper skin layers at the same time and is effective in treating the collagen of the dermis.

The Study

The purpose of the study was to evaluate the efficacy of the fractional CO2 laser therapy on GSM in breast cancer survivors. 50 patients, mean aged 53.3 years, participated in the study with very promising results. The majority of the patients were satisfied and reported no adverse effects. The study concluded that the treatment was feasible and effective.

The Ins and Outs of Pelvic Pain

pelvic pain symptoms

Many women suffer from chronic pelvic pain and aren’t sure what it is and why it’s happening to them. And most of them have heard that the solution is surgery which scares them. That isn’t necessarily true, and surgery is not recommended in most cases. Let’s start at the beginning and clear up some myths about chronic pelvic pain by first understanding what the causes of chronic pelvic pain are, what the symptoms are, and what treatment options are available.

What is chronic pelvic pain?

If your pain is below your bellybutton and between your hips and lasts for at least six months, you are most likely experiencing chronic pelvic pain. This pain can have a big impact on all aspects of your quality of life, including your sex life as intercourse may be very painful. The pain can go from dull aches to severe pain that disrupts your sleep.

What are the causes of pelvic pain?

There are a variety of causes, ranging from endometriosis, interstitial cystitis, vulvodynia, uterine fibroids, and vulvar/vaginal atrophy to name the most common.

  • Endometriosis: Endometriosis is the result of tissues that would normally grow inside the uterus, and that begin to grow outside of it. Menstruation and sex become very painful with this condition. Another result of endometriosis is difficulty in becoming pregnant.
  • Interstitial Cystitis: This condition is also known as painful bladder syndrome. The symptoms are pain in the bladder and a need to frequently urinate.
  • Vulvodynia: This is when the vulva experiences chronic discomfort. It could be in in the form of burning, stinging, rawness, throbbing, and swelling.
  • Uterine Fibroids: These are pelvic tumors that commonly cause heavier and longer than normal menstrual periods, pressure, and pain.
  • Vulvar/Vaginal Atrophy: This occurs due to the thinning of the vaginal walls as a result of a reduction in estrogen. The lining of the vagina becomes drier, thinner, and painful.

What treatments are available?

Surgery isn’t always the answer. Laparoscopy is the preferred option in most cases. Laparoscopy allows the doctor to see the entire interior of the abdomen and pelvis via a small, noninvasive incision. This option is less painful with a shorter recovery period and less scarring. Therapy, including the prescribing of antibiotics, is another option that in some cases can be used on its own and in other instances combined with laparoscopic surgery. These are some options to discuss with your doctor who will walk you through each of the procedures.

The important fact to take away is that you don’t have to live with pain! Dr. Vahora is experienced in all aspects of pelvic pain and will work with you to find the ideal solution for your chronic pelvic pain. Don’t spend another day in pain!

Gifting Intimacy Wellness and Female Health for Valentine’s Day Makes Sense on Multiple Levels

By Parveen Vahora, M.D.

health and wellness magazine banner

Originally published: https://healthandwellnessfl.com/gifting-intimacy-wellness-and-female-health-for-valentines-day-makes-sense-on-multiple-levels/

Two Breakthrough medical procedures can help you and your partner feel better about your relationship and experience what you once had in the past. If you struggle with incontinence issues or vulvovaginal atrophy, two in-office, safe and effective advancements are available to help you feel whole again.

VVA and Urinary Incontinence
Many women experience a shift in their bodies after childbirth, reproductive disorders, surgery, and aging. Have you ever felt that intercourse just wasn’t pleasurable any longer? Maybe you are one of the millions of women that experience vulvovaginal atrophy (VVA).

When the regularity of a woman’s menstrual cycle ceases, the estrogen receptors decrease along with estradiol in the uterine lining, disrupting the thickness and lubrication of the tissues. Estrogen increases gland secretion and blood flow to the urogenital tissues. When estrogen is limited or obsolete, it leads to vaginal dryness, pain, PH imbalance, and urinary changes such as overactive bladder and incontinence.

Due to the limited estrogen supply, the walls of the vagina start to thin out, causing dryness, burning, and inflammation. This can make intercourse very painful and can cause urinary disorders, interfere with daily activities, and completely disrupt your life due to the extreme pain and discomfort that it can cause.

Dr. Parveen Vahora explained, “MonaLisa Touch®, is a non-hormonal treatment, has no side effects, and only takes a few minutes to perform right in the convenience of my office, and it’s helped countless women treat their vulvovaginal atrophy and associated symptoms and pain. Women can get their confidence and intimacy back. It also works well to strengthen the pelvic floor muscles, decreasing urinary incontinence and urgency.”

MonaLisa Touch®
No medications, no cutting, no lengthy healing times: This innovative laser therapy is for VVA. It’s quick, efficient, and can be safely performed in the comfort and privacy of Dr. Vahora’s office. The laser does not hurt or cause any pain. You will only feel slight vibrating sensations from the machine, and the best part is that the entire procedure is accomplished in an outpatient office setting. Women no longer have symptoms of dryness, pain, itching, or irritation.

 

Weakened Pelvic Floor
Pelvic floor muscles are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. Strong pelvic floor muscles give you control over your bladder and bowel. Weakened pelvic floor muscles mean your internal organs are not fully supported and you may have difficulty controlling the release of urine.

 

EMSELLA™
EMSELLA™ is the key to effectively eliminating or significantly reducing urinary incontinence. EMSELLA is a unique chair that patients can simply sit and relax in (fully clothed) for 20 to 30 minutes in the comfort of their gynecologist’s office. It produces vibrations that cause the pelvic floor muscles to contract. One session is the equivalent of doing 11,000 Kegel exercises.

EMSELLA utilizes electromagnetic energy to deliver thousands of supramaximal pelvic floor muscle contractions in a single session. These contractions re-educate the muscles of incontinent patients.

EMSELLA produces high-frequency vibrations with thousands of contractions per session that tighten the pelvic floor muscles and the bladder sometimes as quickly as the first treatment. Most women will undergo just six sessions in a full three-week program to restore their pelvic muscle strength. The best part is, 75% of treated patients totally eliminated or decreased the use of hygienic pads, and 95% of treated patients have an improved quality of life.

EMSELLA is for both for men and women, and can also improve frequency and urgency of urination, as well as reduce day and night leakage. It also improves sexual function in men and women.

Give yourself and your partner the Gift of MonaLisa Touch® or Emsella.

Don’t just live with your discomfort, get the relief and new beginning that you are worthy of. Call today to schedule an appointment and/or consultation at Info@ParveenVahoraMD.com or call (727) 376-1536.

 

New patients are welcome!
Schedule your consultation today. We also offer TeleHealth/Virtual consultations.

 

 

Menopause and Breast Cancer Survivors

menopause and breast cancer

Recently a study was done to evaluate the changes in sexual function of breast cancer survivors who also were experiencing genitourinary syndrome of menopause (GSM) after they had received fractional CO2 laser therapy. The study results were published in Menopause.  Let’s break down the meanings of GSM and fractional CO2 laser therapy for a better understanding.

GSM (Genitourinary Syndrome of Menopause)
During menopause levels of estrogen decrease often resulting in the skin of the vagina and fulva becoming thinner. Once referred to as vaginal atrophy, it is now referred to with the broader term of GSM. GSM’s most common symptom is vaginal or vulvar dryness and loss of elasticity. This lack of lubrication causes pain during intercourse and can even result in the tearing of flesh. GSM can also result in risks of urinary infections.

Fractional CO2 Laser Therapy
Fractional cardon dioxide (CO2) lasers are on the cutting edge of non-surgical rejuvenation treatments. This treatment has been typically used to improve skin texture and decrease wrinkles and discoloration of the skin. The laser treats both the superficial and deeper skin layers at the same time and is effective in treating the collagen of the dermis.

The Study
The purpose of the study was to evaluate the efficacy of the fractional CO2 laser therapy on GSM in breast cancer survivors. 50 patients, mean aged 53.3 years, participated in the study with very promising results. The majority of the patients were satisfied and reported no adverse
effects. The study concluded that the treatment was feasible and effective.

For a breakdown of the specific results of the study, read more at:
https://journals.lww.com/menopausejournal/Abstract/9000/Patient_reported_sexual_function_
of_breast_cancer.97010.aspx


This information is not intended to be exhaustive nor should any discussion or opinions be construed as professional advice. Should you have any questions or would like to discuss menopause concerns with your gynecologist, please contact the staff at Parveen S. Vahora, MD. We
are here to help.

Vulvar Atrophy and Lichen Sclerosus – What You Need to Know

Vulvar Atrophy

You may or may not have heard of vulvar atrophy or lichen sclerosus, but odds are that you know someone who has been diagnosed one of them. The names sound alarming but know that these two conditions are treatable. The common factor between them is painful intercourse.

Vaginal atrophy occurs most frequently after menopause. It’s a thinning of the vaginal walls. This thinning is accompanied by drying and inflammation and occurs when your body’s estrogen levels decrease. This can make intercourse painful and can lead to urinary tract distress.

Other symptoms of vaginal atrophy include:

  • Vaginal burning
  • Itching
  • Frequent urination that may also include a burning sensation
  • Vaginal discharge that is unusual
  • More frequent yeast infections
  • More frequent urinary tract infections (UTIs)

This condition often goes untreated for long lengths of time at which point the skin becomes quite damaged. Potent topical steroids have been used to relieve symptoms and curb further skin damage. Laser systems, such as the MonaLisa Touch™ have shown to be effective in improving the condition of the vaginal tissue and relieving itching.

Lichen sclerosus is not as common as vaginal atrophy and is most commonly experienced in postmenopausal women. Lichen sclerosus can be the result of an imbalance of hormones or an overactive immune system. It’s a thin area of skin that appears patchy and white, usually showing up in the genital and anal area and making intercourse painful.

Note that lichen sclerosus is not limited to those areas and in some cases may affect the skin in the breast and upper arm areas. Symptoms other than the white blotchy skin, include itching, discomfort even pain and bleeding. Know that it is not contagious and can’t be spread through intercourse.

The MonaLisa Touch™ system has been highly successful as a treatment for both vaginal atrophy and lichen sclerosus. Its laser pulses are aimed at the vagina tissues and affected areas to create micro-lesions, triggering natural repair by stimulating the production of collagen and blood flow. All of this promotes lubrication which then restores hydration and elasticity to the tissue.

The MonaLisa procedure is both safe and effective. It’s a great alternative for women who don’t want to take estrogen.

New Year – New You: Resolve to Better Your Intimacy and Fulfillment

By Parveen Vahora, M.D.

health and wellness magazine banner

Originally published: https://healthandwellnessfl.com/new-year-new-you-resolve-to-better-your-intimacy-and-fulfillment/

It’s 2022, and the New Year inevitably arouses resolutions of change. Most of our initiatives are backed with good intentions but often fall to the wayside; however, when it comes to restoring vaginal health and wellness, there are ways to not only manage your health, stave off or treat disorders, but also to turn back the clock.

In the new year, it’s essential not to forget about your overall health. Making sure you schedule your annual medical appointments is critical; this also includes your gynecological visit. Regular wellness exams are essential to early diagnosis and staying healthy, but many women also secretly suffer from sexual dysfunction.

Many women try to hide their condition from their partner or suffer in silence because they believe it’s “normal” for them, but that couldn’t be further from the truth.

Whether your pain is caused by endometriosis, pelvic conditions, vaginal atrophy, hormonal dysfunction, or from medications, there are answers! And the best part is there are new options! Depending on your health and overall needs, these treatment options include medications, noninvasive procedures, and surgery.

Turn Back the Clock and Increase Pleasure
There is an alternative treatment option that is working for many women. It’s called MonaLisa Touch, an advanced technique that has helped countless women with no drugs, and it’s 100% noninvasive!

 

MonaLisa Touch®
Noninvasive Advanced Treatment
MonaLisa Touch® is an advanced laser technology for the vulvovaginal area. There are no medications, no cutting, and no lengthy healing times with this procedure. It’s similar to having a gynecological wellness exam. The laser does not hurt or cause any pain, and patients will only feel tiny vibrating sensations from the machine. The best part is that the entire procedure is accomplished in an outpatient office setting.

The laser assists with the body’s cell renewal, regenerates the mucous membrane, and helps restore collagen and renew the proper trophic balance to the membrane. MonaLisa Touch® is a functional vaginal rejuvenation treatment based on a unique fractional CO2 laser. This device was created specifically for the vaginal mucosa and is presently the most effective procedure for preventing and treating vaginal atrophy and relieving the associated pain.

Now it’s possible to have relief from vulvovaginal atrophy due to the MonaLisa Touch’s® ability to gently improve the tissue of the vaginal mucosa. The laser stimulates collagen production, improving the functionality of the treated area and restoring the proper trophic balance to the mucous membrane.

Rejuvenation
You and your partner will both benefit from this procedure, as intercourse will be pain-free and pleasurable once again. MonaLisa Touch® allows restoration, healing, and a renewed enjoyment of each other. You’ll be amazed at how effective this procedure gets you back to where you once were in your relationship.

MonaLisa Touch® is quick, safe, convenient, and offers incomparable results!

Rejuvenate Your Sex Life
You and your partner will both benefit from this procedure, as intercourse will be pain-free and pleasurable once again. Mona Lisa Touch allows restoration, healing, and a renewed enjoyment of each other. You’ll be amazed at how effective this procedure gets you back to where you once were in your relationship.

 

Incontinence Issues
EMSELLA™ is the answer to conveniently improve urinary incontinence with the most advanced noninvasive technology. EMSELLA is a unique chair that patients can simply sit and relax in (fully clothed) for 20 to 30 minutes in the comfort of their gynecologist’s office. It produces vibrations that cause the pelvic floor muscles to contract. One session is the equivalent of doing 11,000 Kegel exercises.

EMSELLA produces high-frequency vibrations with thousands of contractions per session that tighten the pelvic floor muscles and the bladder sometimes as quickly as the first treatment. 75% of treated patients totally eliminated or decreased the use of hygienic pads, and 95% of treated patients have an improved quality of life. EMSELLA can be effective for both men and women for frequency of urination, leaking with coughing, sneezing, or getting up at night to use the bathroom, and it even enhances sexual function.

Whether you have VVA or suffer from incontinence or anything in between, Dr. Vahora provides a unique emphasis in helping patients improve sexual health and helping you turn back the clock.

 

Regular Gynecological Wellness Visits Are Critical Even if You Don’t Have Symptoms or Are Ignoring Them

By Parveen Vahora, M.D.

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Originally published: https://healthandwellnessfl.com/regular-gynecological-wellness-visits-are-critical-even-if-you-dont-have-symptoms-or-are-ignoring-them/

It’s almost the New year! However, before we start celebrating, you might want to prepare a bit for important wellness visits and examinations. Have you had your gynecological wellness examination this year? Are you due or overdue?

Some common conditions can proliferate quite quickly in females. It’s imperative to stay on top of your appointments and maintain regular examinations. Even if you don’t think any is wrong, it’s not wise to cross your fingers and procrastinate. Anything that is detected early will be easier to treat and offer optimal outcomes.

Let’s say you do have symptoms of something new—Even more critical that you get seen by your gynecologist as soon as possible. Ignoring symptoms is dangerous, to say the least. Being proactive saves lives and can mitigate long-term issues.

Cervical Cancer Screening
Even if you don’t need a pap smear, you should absolutely still schedule your gynecological wellness exam every year to evaluate for disease and disorders, including cervical cancer.

The most important thing that women can do to prevent cervical cancer is to have regular cervical cancer screenings. These are given during a Pap test or wellness exam, which should be at least every year, or if you are at high risk or have had HPV, cancer, precancer, or other genital disorders, your routine visits should be several times per year. There are preventative tests that Dr. Vahora includes in her regular cervical cancer screening called, Papanicolaou (Pap) test, which checks for HPV specifically.

Pain Down There or Pain with Intercourse is Not something to Take Lightly.

As we age, many women think pain, burning, dryness or discomfort with intercourse is normal. It’s not. It means that you need to get to the root cause of your issue which is often related to hormonal imbalance.

Many Conditions and Disorders Can Disrupt Vaginal Mucosa and Hormones.
Lack of estrogen, cancer treatment for ovarian cancer, cervical, breast cancer, others can disrupt the vaginal mucosa. If you have had an oophorectomy or hysterectomy, vaginal changes also occur quickly due to a disruption in hormones and vulvovaginal tissues. Menopause is a one of the primary issues of dryness, pain with intercourse and other disorders.

You do not have to live in pain and discomfort. There are viable treatments that have helped countless women find relief and turn back the clock. Along with hormone replacement (women who have had breast cancer usually cannot take hormone therapy), there is an innovative procedure called MonaLisa Touch®.

MonaLisa Touch®
Now it’s possible to have relief from vulvovaginal atrophy due to the MonaLisa Touch’s® ability to gently improve the tissue of the vulvar and vaginal mucosa. No medications, no cutting, no lengthy healing times: This innovative laser therapy is for VVA. It’s quick, efficient, and can be safely performed in the comfort and privacy of Dr. Vahora’s office. With this treatment, women no longer have symptoms of dryness, pain, itching, or irritation. Women can enjoy intimacy once again. The MonaLisa Touch® treatment also helps urinary symptoms such as incontinence and urgency.

 

REGULAR WOMEN’S WELLNESS EXAMS ARE ESSENTIAL

Your Wellness Visit
Both Dr. Vahora and Cammy Acevedo can identify any concerns such as heavy bleeding pelvic pain, menopausal symptoms, low libido, and pain with intercourse. If you have a family history of cancer, genetic testing can be offered. These conditions can be further worked up, and custom-tailored procedures and treatment options can be addressed to meet your specific needs. We can also identify if you have vulvovaginal atrophy (VVA) or pain with intercourse and talk about treatment options including to see if you are a candidate for the MonaLisa Touch® treatment.

 

Urinary Incontinence: An In-Office Therapy That is Incredibly Convenient

By Parveen Vahora, M.D.

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Originally published: https://healthandwellnessfl.com/urinary-incontinence-an-in-office-therapy-that-is-incredibly-convenient/

Many women have a disorder that they try to keep under wraps. If you are one of them, then you are familiar with crossing your legs and willfully praying you don’t leak. Does laughing, jumping, or sneezing bring on an accidental urine stream? Avoiding surgery is a common quest. Wearing pads and pullup panties to conceal leaks is inconvenient to say the least.

You’re not alone, in the United States, urinary incontinence affects 15 million women. Many people are familiar with Kegel exercises. These are accomplished by contracting the pelvic floor, but they are rarely completed accurately or effectively, and they can be awkward and time consuming.

Did you know men suffer from urinary incontinence related to prostate issues, obesity, neurological disorders and other conditions? Strengthening the pelvic floor muscles is also beneficial for men when it comes to certain disorders that lead to male urinary incontinence.

Pelvic floor muscles are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. Strong pelvic floor muscles give you control over your bladder and bowel. Weakened pelvic floor muscles mean your internal organs are not fully supported and you may have difficulty controlling the release of urine.1

THERE IS A BETTER WAY: EMSELLA™ TREATS BOTH WOMEN AND MEN

A new device called EMSELLA™ is the key to effectively eliminating or significantly reducing urinary incontinence. EMSELLA is a unique chair that patients can simply sit and relax in (fully clothed) for 20 to 30 minutes in the comfort of their gynecologist’s office. It produces vibrations that cause the pelvic floor muscles to contract. One session is the equivalent of doing 11,000 Kegel exercises.

EMSELLA utilizes electromagnetic energy to deliver thousands of supramaximal pelvic floor muscle contractions in a single session. These contractions re-educate the muscles of incontinent patients.1

EMSELLA produces high-frequency vibrations with thousands of contractions per session that tighten the pelvic floor muscles and the bladder sometimes as quickly as the first treatment. Most women will undergo just six sessions in a full three-week program to restore their pelvic muscle strength.

The best part is, 75% of treated patients totally eliminated or decreased the use of hygienic pads, and 95% of treated patients have an improved quality of life.1

No Surgery | No Drugs | No Pain |
No Downtime—Just Sitting in a Chair!

You just sit on the EMSELLA chair, fully clothed for 30 minutes, twice a week for three weeks and your pelvic floor muscles are tightened and lifted so that there is a substantial improvement in incontinence, leaking and off label “sexual gratification”. It is a remarkable option to strengthen pelvic muscles, and to eliminate leaking during exercise, sneezing, laughing or for those who have an urgent need to relieve their bladder.1

Who is a good candidate?
EMSELLA is a great option for women and men of any age who desire solution for urinary incontinence and improvement in their quality of life.

 

How Long Does EMSELLA take?
Your provider will tailor a treatment plan for you. A typical treatment takes about 30 minutes, with approximately 6 sessions, scheduled twice a week.

 

Is EMSELLA Painful?
You will experience tingling and pelvic floor muscles’ contractions during the procedure. You may resume daily activities immediately after the treat.

 

How Fast Will I See Results?
You may observe improvement after a single session. The results will typically continue to improve over the next few weeks.

 

This innovative treatment is helping numerous women and men find their freedom, confidence, and to get their life back without having to worry about urinary incontinence. It’s even been featured on the Doctors TV show and in various other news and media outlets.

Along with urinary incontinence, EMSELLA can also help with Urinary frequency, prolapse, nocturia (waking up to urinate) and erectile dysfunction.

Parveen Vahora, M.D.
Dr. Vahora specializes in pelvic pain and endometriosis and is passionate about educating fellow physicians and the community on these topics. She is fellowship trained in minimally invasive surgery. Another focus of hers is sexual health and she offers MonaLisa Touch® for patients who have issues from having children, going through menopause, as well as post-menopausal women, cancer survivors, and those suffering from pain during intercourse or intense dryness or incontinence or prolapse.

Continually participating in research in the field of gynecology, Dr. Vahora is also a professional speaker, educating health care practitioners on hereditary cancers, multimodal pain management options, dyspareunia due to vulvovaginal atrophy and SERM treatment, and many other gynecological concerns.

Dr. Vahora looks at the whole person when administering highly acclaimed treatments, not simply their symptoms. She is a woman gynecologist and is well¬-known in her community for her deep commitment to positive outcomes for her patients. Most importantly, her patients love her because she listens, and her care is highly effective because of that.

 

Your Sex Life Between Menopause and Retirement

sex and retirement

When you were younger, you undoubtedly overheard your mother and her friends talking about how sex just wasn’t the same after menopause. How the urge just wasn’t there and how it just wasn’t “good” anymore. They may have been experiencing a hormonal issue called hypoactive sexual desire disorder which acts to decrease sexual desire. Well, that was then, and this is now. Hypoactive sexual desire disorder still exists, but the times have changed and there are more open conversations about sexual issues. Today, sex can be great at any age, even post menopause.

Let’s back up a bit and think about when the first signs of change in the sexual experience began. Most likely it was when perimenopause started to make changes in your hormones. This change in hormone levels affect the genital tissues and circulation, which in turn affect the levels of sexual pleasure. Don’t despair. There are solutions.

Chances are that when you went through (or are going through) menopause, your household changed a bit. Your children have grown up and moved out creating an opportunity for more sexual freedom in the house without interruption! It would be a shame to not take advantage of this newfound opportunity. Let’s help things along. The following are a few ways to improve your sex life after menopause.

Vaginal Dryness. It’s completely normal to begin experiencing vaginal dryness during menopause. This dryness makes sex uncomfortable and automatically reduces the desire to have sex. There are many good vaginal lubricants available over the counter and by prescription. Using these lubricants will not only make sex comfortable, they will help keep the vaginal tissues healthy. I keep a variety of samples in the office, and we can talk about how these can be used depending on your dryness.

Genital Arousal. The lack of estrogen directly affects genital arousal. The blood supply to the genital area decreases resulting in a delay in arousal; it can even be responsible for creating fewer satisfying orgasms. Uh oh. This absence of estrogen creates tissue shrinkage resulting in elasticity greatly decreasing, and your natural lubrication drying up. As your doctor, we can work on a plan that can adjust your estrogen level to remedy this.

Sexual Routine. If the act of sex has become very routine over the years, it’s time to change your habits and become intimate again. The key is to have a true connection with your partner. However, you may find it difficult to discuss this with your partner. This is where, as your doctor, I can be of help. Don’t hesitate to open up and discuss your feelings, especially your desires and disappointments.

Knowledge. Knowledge is key. Let’s talk about everything you are experiencing from hot flashes to vaginal dryness to difficulty being aroused or reaching orgasms. Menopause can have a big impact on you emotionally and physically. By talking it out together, we can put a plan in place that can have you feeling great.

Sexual health is an important part of your overall wellbeing. I’m here to help you regain your sexual health and to remind you that you’re not alone. The majority of women experience similar issues!

Teens Talk With Your Doctor About Sex

teen tax with sex doctor

Sometimes it can be difficult to discuss sex and sexual issues with an adult, especially if it’s all new to you. Trying to have open conversations about sex can be frustrating as it’s not unusual for a teenager to be reluctant to openly discuss and question sexual issues with an adult. Here’s where your doctor can be a valuable resource.

Girls: Time to open up

Talk to your doctor about everything that’s on your mind regarding sex and sexual activity. This is a “no judgement” zone, so feel free to discuss anything. For example, you may want to discuss or know about:

  • They seem to be on a roller coaster ride ranging from depressed, to angry, to happy, etc.
  • Sexual feelings. Sensations are occurring more often or maybe they aren’t happening at all
  • Birth control options
  • Safe sex and STDs (sexually transmitted diseases)
  • Eating issues and body image
  • Body odor

It’s extremely important to talk openly and honestly. Ask lots of questions. Especially if you have found information or sought advice on the internet. Every girl is different, so you shouldn’t rely on advice or diagnoses found online. Tell your doctor everything – she can’t help you if she doesn’t have all the details. If you are embarrassed to start the conversation, write up a list of your questions, concerns, symptoms and problems and present it to your doctor. This way I can open up the conversation and before you know it, you’ll feel at ease and able to talk openly. Remember, as your doctor, I’ve seen and heard it all many times before. You’re not alone or the first to experience what your body is going through.

That old adage about “knowledge being power” is especially true here. The more you know about your body and sex, the more apt you are to make good decisions. Don’t spend sleepless nights wondering or worrying about your changing body and sex. Everybody goes through it. Talk to your doctor and let us help.

Parents: What you need to know

Ease your teen by letting her know that a gynecologist is educated in all aspects of sexual health and can answer any questions from emotional concerns to the physical changes girls go through. And, most importantly, assure her that the conversation is private – only between them – with no judgements. It’s an opportunity for your teen to be completely honest about her feelings and know she can ask any and every question on her mind. Set an appointment for your teen with a doctor – and if she’s uneasy going to your doctor – choose a doctor that’s all her own. Assure her that she should feel free to talk about anything, even if it’s a bit embarrassing or things she don’t want to discuss with a parent.

How to wean off of birth control

wean off birth control

You’re a young married woman and want to stop taking birth control. You may want to get pregnant or you had some side effects that didn’t agree with you. Regardless of the reason, you’ll want to stop safely. Is there a right way? There really isn’t a “right way.” However, there are some things steps you can take both prior to quitting and for a few months after quitting that will be easy on your body.

Preparing to stop
If you desire to become pregnant, the things I recommend right away are prenatal vitamins, keeping ovulation kits handy and a cervical cap to put in after sex.

Regardless of your desire to become pregnant, the first thing I always recommend to every woman is to use a period tracker app on your phone. The app alerts you when you are ovulating and is a great tool to help your doctor guide you through various expectations.

Whether you are on the pill, using a ring or patch, planning ahead of stopping is always recommended. First, talk with your doctor and ask for advice on how to safely wean off birth control without affecting your overall health. Since contraceptives release hormones into your body, you’ll want to make sure your body will adapt to the changes it will encounter after you stop.

Diet is an important part in the preparation to stop. Begin fueling your body with nutrients a few months prior to stopping. Your doctor will provide a healthy diet and exercise regimen to ensure that your body has a smooth transition.

A positive side effect of taking oral birth control is good skin, or the decrease of hormonal acne. Stopping will cause your hormones to return to their previous level and if you are prone to skin break outs, you will find they come back. By knowing this in advance, you can take the extra care to minimize this by using products your gynecologist suggests.

Planning the date to stop is also important. You can safely stop any time, but it makes much more sense to stop the pill when you finish the pack. With the ring or patch, you’ll want to stop right after your period. Stopping any of these mid-cycle will alter your period and make it hard to know when to expect it.

After you stop
Stopping any form of birth control will affect your menstrual cycle. Your body will need some time to adjust. You might skip your period for a couple of months or experience some spotting or bleeding between. Your menstrual cycle may even become irregular for a while. This is common and your cycle will return to normal fairly quickly.

You may experience mood swings due to hormonal fluctuations. Exercise is a great way to alleviate this! Plan to begin a regular exercise routine – you’ll get an endorphin boost!

Pay attention to your diet by adding nutrient rich foods and vitamins to your daily menu. Now for the less than great news: it’s a good idea to skip alcohol for the first few months after quitting as your hormones are affected by alcohol. Talk to your doctor to see what is best for you.

Last, but certainly not least, try to reduce stress. Your hormones will start to balance out in the first couple of months after stopping the pill. Reducing stress will help keep them in balance.

Do consult with your gynecologist throughout and after the “weaning” stage. Dr. Vahora has worked with young women weaning off of birth control for many years and will share the tips and tricks to make weaning a nearly seamless and comfortable transition.

Sex and Aging. Is it Safe?

sex and aging

We don’t often hear conversations about seniors and their sexual activity. Why? There’s really no reason not to talk about it. It’s natural and many seniors enjoy sexual activity. There really is no age limit.

Is It Safe?

Sexual activity can actually be very good for your health! However, since it’s rarely a topic of conversation, you may be wondering if it’s safe. That depends completely on the state of your personal health. If you experience discomfort and have abstained because of that, good news. There may be a simple explanation that can be caused by hormonal issues or HSDD (low sexual desire disorder) to name a couple. These can be successfully treated!

The Myth

Let’s start at the beginning of the senior sexual myth. Because we don’t talk or hear about it, the assumption is that seniors just lose interest in sex. Not true! Not all seniors lose interest. In fact, the odds are that the majority still enjoy all types of intimacy, including intercourse. They just aren’t talking about it! Granted, the frequency may diminish a bit as we age, but the quality will most likely increase, and there are some great benefits in staying sexually active.

The Benefits

As we mentioned earlier, staying sexually active has no age limit. And, there are many benefits of remaining active into your silver years. Research has shown that sexual activity provides the brain with endorphins and oxytocin resulting in a noticeable improvement in a person’s mood and attitude. In short, it benefits your spiritual and emotional health. And there’s more.

According to the Society of Obstetricians and Gynecologist of Canada (https://sogc.org), sexual activity can be an antidote to aging!

  • Boosts your immune system
  • Burns fat
  • Relieves stress
  • Improves mental and physical health
  • Helps minimize the risk of incontinence

Seek Help and Advice

Aging does not mean that you will lose your desire for intimacy and sex. If you are experiencing a lack of desire, talk to your Doctor. Be open and honest. And don’t be embarrassed to talk about it as there may be an underlying medical or emotional reason. Hormone issues can play a big role in changing desires and can be easily treated with medications.

Our bodies change as we age. As women, our vagina goes through changes. It can become shorter and narrower, the walls can become thinner, and natural lubrication can lessen. All of this can cause pain resulting in sexual desire diminishing dramatically or completely disappearing.

Solutions?

First and foremost, let’s talk about it! Talk with your Doctor to determine if staying sexually active is right for you and what treatment options you have. Chances are that you’ll discover that staying sexually active is right for you and that there are solutions to make intimacy enjoyable and satisfying again!