Gynecology

Dr. Butt encourages her patients to take an active role in their healthcare and approaches patient education in a hands-on, accessible manner. Whether it’s your routine annual exam, a family planning visit, or discussing the best contraceptive methods for you, Dr. Butt will work with you during your visits to ensure you are informed about your healthcare options.

Comprehensive well-woman exam

An annual well-woman exam is recommended by the American College of Obstetricians and Gynecologists (ACOG) for all women (beginning at or after age 13). This visit provides an opportunity for Dr. Butt to discuss your current health, lifestyle, and sexual practices, as well as offer preventive care.

 

Dr. Butt will obtain a comprehensive medical and social history prior to performing a physical exam. This information will allow her to develop a personalized plan for your care. For example, she may recommend more frequent PAP smears if you have a recent history of HPV. At your well-woman appointment, you can also ask questions about contraception, sexual well-being, mental health, and reproduction or fertility.

Abnormal PAP smear treatment

It may be difficult to learn that your PAP smear results are abnormal, but Dr. Butt will be there every step of the way to help you navigate the situation. Typically, an abnormal result indicates the presence of pre-HPV or precancerous cells on the cervix. Over 6 million women in the United States have human papillomavirus (HPV). Certain strains of HPV, specifically subtypes 16 and 18, are concerning because they are associated with the development of cervical cancer. Though HPV is extremely common, cervical cancer is rare, partially due to regular screenings at well-woman exams.
 
Sometimes, pre-HPV cells can resolve on their own. However, if the cells remain or advance, Dr. Butt may recommend a procedure called a colposcopy, which allows her to obtain a more detailed inspection of the pre-HPV cells. If the cells seem concerning and require removal, you may have a procedure called a loop electrosurgical excision (LEEP).
 
Dr. Butt performs these procedures in the outpatient setting, meaning you will not require general anesthesia and can often resume your daily activities after the procedure.

Colposcopy

If your PAP smear shows persistent or recurrent abnormal cervical cells (these may also be called pre-HPV or HPV-appearing cells), Dr. Butt may opt for a colposcopy to help her determine the severity of these abnormal cells. A colposcopy is a test that allows visualization of your cervix and the ability to collect a small tissue sample (biopsy) for laboratory testing.
 
During a colposcopy, Dr. Butt will use a special instrument called a colposcope to magnify the appearance of the cervical area, then place a small amount of acetic acid or vinegar on the cervical and vaginal areas. This solution will give any abnormal cells a stained appearance, allowing Dr. Butt to see the extent of cell growth. At this time, if she deems it appropriate, Dr. Butt may collect a small tissue sample from the abnormal cell area. Most patients state that having the biopsy taken feels like a sharp, momentary pinch. After the procedure, most women can continue on with their day without any pain medication.

HPV vaccination (Gardasil)

Human papillomavirus (HPV) is a common sexually transmitted infection associated with the development of cervical cancer. According to the CDC, approximately 80% of people will have an HPV infection at some point during their lifetime. While only some strains of HPV are known to be high-risk for cervical cancer, it is still important to have regular PAP smears and well-woman exams to ensure you do not have abnormal cell development in your cervical and vaginal areas.
 
The HPV vaccine, otherwise known as Gardasil, has been approved by the Food and Drug Administration (FDA) for use in both males and females and can help prevent the development of cervical cancer, vaginal cancer, genital warts, and anal cancer. The vaccine is not recommended for women who are pregnant.
 
Even if you have previously been diagnosed with one strain of HPV, the vaccine could still offer some protection from strains you have not been exposed to. Dr. Butt will thoroughly review your health history and make sure you have the appropriate vaccines on the appropriate timeline.
 
While the vaccine can be administered as early as age 9, the CDC suggests that both males and females up to age 26 have “catch-up” vaccines. Those who receive the vaccine on-time (11-12 years old) require two doses while those who receive it between 15-26 years old require three doses.
 
As HPV is a sexually transmitted infection, it can be spread through any sort of sexual contact, including oral sex, anal sex, and vaginal sex. You can decrease your risk of getting HPV and other sexually transmitted infections by making sure you use a physical barrier during intercourse, such as a condom.

Contraceptive counseling

During your appointment, Dr. Butt may discuss contraceptive options with you. There are many effective methods of birth control available, however, the most important aspect of using contraception is finding a method that works well for your lifestyle.

 

Barrier methods of birth control such as the male condom, female condom, and female diaphragm physical protection from pregnancy but also from sexually transmitted infections (STIs). While these barrier methods are effective when used correctly, they each have a failure rate between 13-25%, meaning they would ideally be used in conjunction with a hormonal form of birth control if you are attempting to prevent pregnancy.

 

Hormonal methods of birth control include oral contraceptive pills, transdermal (skin) patch, vaginal ring, intramuscular injection, and implant (Nexplanon). These methods all have lower failure rates than physical protection methods, however, they do not offer the same protection from STIs. Additionally, some women may not be ideal candidates for certain forms of hormonal birth control, such as women with a history of blood clots, breast cancer, or smoking.

 

For those interested in permanent contraceptive methods, Dr. Butt may suggest tubal ligation (females) or a vasectomy (males), which are inpatient surgical procedures.

IUD insertion and removal

The intrauterine device (IUD) is a very effective form of contraception used by many women and is known as one of the longer-acting forms of birth control as its protection can span years. Most women are good candidates for getting an IUD.  This device must be placed and removed by a trained healthcare professional. After placement, you will likely not even notice the presence of the device in your uterus.
 
There are several forms of IUDs available. The most commonly chosen devices are the Skyla (effective for 3 years), the Mirena (effective for 5 years), and the Paragard/copper IUD (effective for 10 years). Dr. Butt will take your current and future fertility plans into account and recommend the form of contraception she believes is the best fit.
 
The placement of an IUD can be done quickly in an outpatient setting, meaning you can have it placed at Dr. Butt’s office. The procedure will involve a speculum exam, mild cervical dilation, and insertion of the device. This encounter typically takes less than 10 minutes. Most women tolerate the procedure very well and require only ibuprofen or acetaminophen after the IUD placement to manage their discomfort.
 
You can have the IUD removed at any time, or when it expires between three and ten years later. The removal process is similar in appointment length and discomfort level to the initial placement.

Nexplanon insertion and removal

Nexplanon is a type of contraceptive implant that offers long-term birth control. It is a small, flexible piece of plastic that releases a constant, low dose of progesterone hormone which leads to non-permanent thinning of the uterine lining. Dr. Butt can both insert and remove your Nexplanon for you in the office.
 
Prior to insertion, she will use a small amount of topical lidocaine to numb the skin of your upper arm, then quickly place the implant just under the surface of your skin, between the biceps and triceps muscles. You should not feel any pain during this quick insertion procedure. Dr. Butt will palpate (touch) the area after the procedure to ensure its correct placement. Nexplanon can be visualized on X-ray if needed, which can be helpful for viewing if it is in the correct location.
 
Several benefits to this contraceptive implant include that it is a non-estrogen form of birth control (important for those who are sensitive to estrogen), it can be taken out at any time should you decide you would like to go off birth control, and it reduces the chance for user-error that is associated with physical forms of birth control such as condoms. Nexplanon is effective at preventing pregnancy in 99% of cases when utilized for one year. This form of birth control does not protect against STIs, however, so you should use a physical form of protection, particularly during intercourse with a new partner.
 
Dr. Butt may recommend against Nexplanon as a birth control method for you if you have a history of breast cancer, liver disease, blood clots, or stroke. The implant may also be less effective as a form of birth control for women with a BMI over 30.
 
Nexplanon can help prevent pregnancy for up to 3 years. When it comes time to remove the implant, Dr. Butt will make a small incision at the site of the implant to remove it. This procedure can be done at the office and will not require any sedative or pain medications afterward. Your fertility may return very quickly after removal of the implant (in some cases, women have become pregnant within one week after their implant was taken out), so you should discuss other birth control options with Dr. Butt if you do not want to become pregnant at the time of your Nexplanon removal.

STD testing and treatment

Sexually transmitted diseases (STDs), also known as sexually transmitted infections (STIs), can be passed through sexual contact such as penetrative sex, oral sex, and anal sex. Anyone who engages in one (or multiple) of these types of intercourse is at risk of getting an STD. Additionally, those with multiple sexual partners are at an increased risk of getting an STD due to more exposure points.
 
Some of the more common STDs include chlamydia, gonorrhea, HPV, and herpes. Depending on your sexual activity history and current practices, Dr. Butt may recommend screening for one or more of these infections.
 
It is important to be screened regularly for STDs because some do not cause any symptoms whatsoever, or do not cause symptoms for a long period of time after exposure. While you may not experience symptoms, having an untreated STI can lead to future complications such as genital infections, reproductive difficulties, certain genitourinary cancers, or chronic pain in your pelvic region.
 
The CDC has various recommendations for the frequency of STI screenings based on age, sexual partners, and prior infection. You should be screened annually for chlamydia and gonorrhea if you are a woman under the age of 25 who is sexually active, are a male engaging in intercourse with another male, have a history of an HIV infection, have been a victim of rape or intercourse against your will, or are a woman above the age of 25 who has new or multiple partners. For HIV, you should be screened at least once during your sexually active years. HPV screening can be done at your Well Woman Exam and may be recommended either annually or every three years, depending on your specific history.
 
If you have a positive STI/STD result, Dr. Butt may suggest further testing or start you on a treatment plan. She will counsel you on the appropriate measures to take in terms of informing your current or past partner(s), and will make sure you feel safe and supported while helping you work through what may be a confusing, scary time.

Vaginal infections

Vaginal infections can be incredibly uncomfortable and affect your daily activities. These infections are usually associated with vaginal irritation, itching, or burning as well as a change in vaginal discharge or odor. There are three primary types of vaginal infection: yeast infections, bacterial vaginosis, and sexually transmitted infections.
 
Yeast infections (vaginal candidiasis or vulvovaginal candidiasis) develop as a result of the overgrowth of a particular type of fungus in the vaginal area. Some women have recurring yeast infections and can recognize the signs and symptoms early. Common symptoms include vaginal itching, increased discharge that is thicker than usual, pain with intercourse, and in some cases a change in odor. As yeast infections can be incredibly uncomfortable, Dr. Butt recommends you reach out to her as soon as you feel discomfort so she can decide on the best treatment course for you.
 
Bacterial vaginosis, also referred to as “B.V.”, is a condition involving an overgrowth of normal vaginal bacteria. This can happen to any woman; however, it is more common in women who are sexually active, have a new partner or multiple partners, or use vaginal douching products. Symptoms of bacterial vaginosis include a fishy odor from the vagina, a burning sensation during urination, vaginal discharge that is gray or whitish, and vaginal itching. If Dr. Butt suspects you may have this condition based on a gynecological exam and your reported symptoms, she may order laboratory cultures to rule out other vaginal infections. She will then start you on the appropriate course of treatment.
 
Vaginal infections can also be transmitted through unprotected intercourse. Trichomoniasis is the most common nonviral STD and often presents with symptoms similar to both yeast infections and bacterial vaginosis. It is caused by a parasite (Trichomonas vaginalis) and can lead to symptoms such as pain during intercourse, burning during urination, vaginal itching, a fishy odor, and a change in vaginal discharge amount or color. This is diagnosed through a gynecological exam and laboratory testing of vaginal fluid. Trichomoniasis can be fully treated with an antiprotozoal and antibacterial medication.

Management of fibroids

Fibroids, also known as uterine fibroids or uterine leiomyomas, are a common form of noncancerous tumor found in the smooth muscle of the uterus. In many cases, a fibroid will resolve (go away) on its own. These masses can range from as small as 1cm to as large as 10cm or greater. The size and location of a fibroid may influence the severity of symptoms or complications experienced.
 
Fibroids are usually found in women of reproductive age, and may not cause any issues or symptoms whatsoever. In some cases, however, fibroids can cause abnormal bleeding from the uterus, abdominal pressure or a feeling of bloating, problems conceiving, and abdominal pain.
 
Other possible symptoms of fibroids include constipation, urination frequency, back pain, menstrual periods that last longer than normal, and pain during vaginal intercourse. Uterine fibroids are not known to increase your risk of uterine cancer.
 
While the exact cause of uterine fibroids is unknown, research has suggested possible factors such as changes in certain growth factors and gene fluctuations. Current literature has indicated an association between genetics and the development of fibroids, so if a close female relative of yours had fibroids in their life, you may be at an increased risk of having them as well. In addition, fibroids occur at a higher incidence in black women and women whose first menstruation (menarche) was earlier than average.
 
Uterine fibroids can be diagnosed by pelvic ultrasound. Dr. Butt will recommend the best course of action for you, taking into account any symptoms you experience as a result of your fibroid(s) as well as your reproductive goals. In some cases, surgical removal of a fibroid (typically done via hysteroscopy) may improve your chances of conceiving.