Annual Pelvic       

During a woman's annual pelvic examination, a common procedure is the "PAP Smear" which is a screening test for cervical cancer. There are no specific signs or symptoms of "early" cervical cancer. When the cancer becomes more invasive, the patient might have abnormal uterine bleeding, post-coital (after intercourse) spotting, purulent, odorous and/or non-itchy discharge may appear after cancer invasion. Therefore, a regular Pap Smear is recommended every 2-3 years starting at the age of 21 for early detection and treatment of cervical cancer.
Cervical cancer never affects virgin women; however, studies indicate that it is directly related to the number of sexual partners a woman has had. These factors particularly relate to the HPV (Human Papilloma Virus) Infection which is transmitted during sexual intercourse and which plays a significant role in cancer development.

Breast Examination

Breast Cancer is the second leading cause of death due to cancer in women after lung cancer. Breast Cancer usually presents as a painless lump or mass, firm, not tender, and partially fixed to the underlying tissues; Therefore, it is important to have breast exams regularly. Early detection consists of two parts:
1) Monthly self-breast exam (after each period) for all women, particularly after age 40 and older.0
2) Annual mammogram for women at the age of 40 or older for low risk patients.
There are special recommendations for high risk patients (family or personal history of breast cancer or any other cancer, smoking, hormonal intake, etc.)



Osteoporosis is the most common metabolic bone disease and is estimated to cause 1.5 million fractures annually in the USA, mainly in the spine. The death rate associated with osteoporosis is very high. 
Osteoporosis affects structural integrity of the skeleton. It usually shows no symptoms until fractures occur. However, osteoporosis might present as backache, neck pain, spontaneous fracture or collapse of a vertebra.
Osteoporosis can be diagnosed by physical exam, lab, and bone density testing. Treatment options can be discussed with the doctor in full details, and will depend on various factors such as the patient's age and other risk factors.

      Infection & Bleeding

Vaginal Infection: Vaginal infections can result from the normal bacteria flora (bacteria vaginosis, and yeast), or a sexually transmitted disease (STD) such as Gonorrhea, Chlamydia, Trichomonas, Herpes, and others. It is very important to get checked for a possible STD in sexually active patients, due to a great majority of patients infected with STD show no symptoms. This can be done by a direct vaginal culture and blood test (Hepatitis, HIV and Syphlis).
Symptoms of STD's are: Abnormal vaginal discharge (greenish or yellowish in color), smelly odor, vaginal itching, vaginal pain during intercourse, pelvic pain, burning during urination, fever, low back pain or sometimes unusual vaginal spotting.
Vaginal Bleeding: Vaginal bleeding in pre-menopausal women is primarily hormonal in nature, but it is abnormal. In post-menopausal women. Therefore, any abnormal vaginal bleeding or spotting requires follow-up by pelvic exam, blood test, Pap smear, pelvic ultrasound, or uterine biopsy, depending on the patient's symptoms and risk factors.

    Urinary Incontinence

Urinary incontinence is the lost of bladder control, which has a major psychlogical and social impact. Too often, the patient is labeled "incontinent" and no attempt is made to discern the type or to provide proper treatment. 
Transient causes:
   - Bladder infection
   - Menopause (if untreated)
   - Drug induced: diuretics (water pills), opioids, etc.
   - Sever depression
   - Immobile patients -no access to bed side commode
Established causes: 
1) Urge incontinence: urinary leakage after the onset of an intense urge to urinate.
2) Stress incontinence: urinary loss occurs with laughing, coughing, or weight lifiting.
3) Overflow incontinence: blockage of the urethral lumen by a large mass, (usually by large prostate in men).
Treatment: there are different treatment options available depending on the kind of incontinence the patient has and the patient's risk factors:
 - Behavioral Therapy
 - Hormonal Replacement
 - Antispasmodic Medications
 - Surgery

           Ovarian Cysts

Ovarian cysts are common. Although most are benign. Malignant ovarian tumors are the leading cause of death from the reproductive tract (genital) cancer. Symptoms include pain and/or discomfort in the abdominal or pelvic area. Many cases of "early-stage cancer" are asymptomatic, meaning, no symptoms appear. 


Endometriosis: is the abnormal growth of uterine tissue outside the uterus (in the dependent parts of the pelvis and in the ovaries). It is a common cause of abnormal bleeding and pelvic pain with menstruation. Sometimes it can cause infertility and pelvic and vaginal pain with intercourse. 
Diagnosis: is made by pelvic exam, ultrasound, laparoscopy, and/or MRI.
Treatment: Medication such as birth control pills, analgesics surgical due to severe pelvic pain and infertility.