Coronavirus (COVID-19) Updates: What Are We Doing to Keep You Healthy

As COVID-19 continues to be a concern in the United States, we want to remind our patients what we are doing to make sure you have a safe experience in our office.  We have received very positive feedback from our patients who have been to our office recently and we continue to make changes regularly.

Here is a little about what we are doing:

  • Contact-less paperwork – Patients will receive paperwork via text message 3 days prior to their appointments.  Completing the forms online prevents exchange of papers at check-in.  You can even take a photo of your insurance card and securely send it to us as well as pay your co-pay.
  • Masks will be worn by all Bedford Commons team members and patients.  Although the mask mandate has been lifted in NH, Bedford Commons will continue to require masks for all patients and team members in the building. Masks are NOT optional – they are required.
  • Screening – All patients (and accompanying visitors) presenting to our office for a visit will answer a series of questions before entering our building to assess COVID-19 risk.  Our Bedford Commons team members are also screened daily.
  • COVID-19 vaccinations – We have required all of our team members to be vaccinated for COVID-19.  Although we are unable to offer COVID-19 vaccines in our office, we encourage all of our patients to receive the COVID-19 vaccine.
  • Wait in your car – In our Bedford location only, our patients can check-in and wait in their cars instead of in our waiting room.  If it’s easier for you to check in at our front desk, come on in through Door 2 when you arrive.  For our Windham and Derry locations, patients will be brought right back into an exam room.
  • Telehealth visits – If you feel uncomfortable coming into our office for a visit, we are happy to virtually see you with a telehealth visit.

Our goal as a practice is to continue to provide you with exceptional care while keeping you safe.  We are all in this together.

For our OB patients and families:

Bedford Commons OB-GYN has adopted an alternative schedule for obstetric visits in our office based off guidance from the American College of Obstetricians and Gynecologists (ACOG) to limit your exposure risk to COVID-19.  Instead of seeing our obstetric patients every four weeks through the end of the second trimester, most visits were scheduled 6-8 weeks apart.  Starting in the third trimester, we were seeing our patients every 2-4 weeks depending on risk factors.

As we have watched the COVID-19 pandemic unfold, it is clear that we will be coexisting with COVID-19 for the months ahead.  Several of our patients have asked if we will be continuing the alternative schedule for obstetric care or if we will resume the “normal” frequency of visits.  For at least the next few months, we plan on continuing to see our OB patients at a more spaced out interval.  Here’s what a typical visit schedule might look like:

  •           8 weeks visit
  •           11-12.5 weeks ultrasound* and visit (*if you’ve already had an ultrasound in your pregnancy, an ultrasound will not be planned with this visit)
  •           16 week visit
  •           20 week anatomy ultrasound and visit
  •           24 week visit
  •           28 week visit and glucose testing
  •           32 week visit
  •           36 week visit and group B strep (GBS) testing
  •           37 week visit
  •           38 week visit
  •           39 week visit
  •           40 week visit (your due date!)

At Bedford Commons OB-GYN, we believe that every woman is an individual.  It’s important to us that you feel comfortable and confident in the care you are receiving.  Although we feel that it is safe to continue more spaced out OB visits, we know that some of our patients would feel more reassured seeing us a little more often.  If you would like to see us more frequently, just let us know at your visit.  Additionally, some of our patients have risk factors or concerns that may necessitate additional visits.  We will let you know if we need to see you more often.

As of January 3, 2022, one adult visitor may accompany you to your ultrasounds; visitors will not be permitted at office visits.  We know what an important journey pregnancy is for an expecting family but for the safety of all of our patients, we can only permit one visitor at ultrasound visits only.  We hope to again return to having visitors for routine visits but need to see a reduction in COVID-19 positive cases in NH.

Some of our patients have also been asking about the safety of the COVID-19 vaccine in pregnancy.  We strongly encourage all of our patients to receive the COVID-19 vaccine, especially those who are pregnant.  Pregnancy significantly increases the risks associated with COVID-19 illness and vaccination is the best way to protect you and your baby.  Click here for more information.


Anal SEX: What You Need To Know

As with any sexual topic, what is “normal” really is in the eye of the beholder. Anal sex involves inserting the penis through the anal sphincter. The anal area has a lot of nerve endings and, for some, is very erogenous. It is estimated that 5-10% of sexually active, heterosexual women engage in anal sex. For these couples it is “normal”. That being said there are unique health risks to be aware of and precautions to be taken.

The anus is a tighter entrance and lacks lubrication that is present in the vagina. This combination increases the risks for tears. Commonly these are small tears throughout the skin or thin mucosa. Adequate lubrication can help decrease this. On rare occasions, significant trauma can occur if the colon wall is perforated.

Beyond the pain the tears cause, they significantly increase your risk of contracting an STD (such as HIV, hepatitis or herpes). Studies have shown a 30% increased risk of HIV infection compared vaginal intercourse. HPV also increases the risk of anal warts and anal cancer. For women who regularly practice anal intercourse it is not unreasonable to do a rectal pap smear in addition to the routine cervical pap smear.

Aside from STD-type infections, the anal area has a high count of bacteria from feces. This puts partners at increased risk of infection. Likewise, vaginal or oral sex after anal penetration increases risk for infection. If you notice a discharge or pain in the days after engaging in anal sex, you should be evaluated by your physician.

The anal sphincter is a muscle intended to keep stool inside. Over time, penetration of the sphincter can lead to weakening or damage to the muscle. This can lead to problems with gas or stool incontinence. Just like the vagina, the anal sphincter can be strengthened with Kegel exercises.

It is also important to realize you can still get pregnant practicing anal sex. Sperm can find their way into the vagina and to a readily awaiting egg.

So bottom line – yes, anal sex is OK if it is consensual, but take the following precautions:

  1. Wear condoms to prevent STD and pregnancy
  2. Use copious lubrication to decrease pain and trauma
  3. Avoid vaginal or oral sex after anal intercourse
  4. As with any sexual practice, if it is not enjoyable, tell your partner and stop.

April is STD Awareness Month

With STDs continuing to rise in the United States, it’s important to know the facts. April is STD Awareness Month, a perfect time to get informed on what can be a silent health risk, even leading to death.  Here’s what you’ll want to know:

  • The Centers for Disease Control and Prevention (CDC) estimate there are more than twenty million new STD (chlamydia, gonorrhea, and syphilis) infections in the U.S. each year.
  • While curable with antibiotics, many cases go undiagnosed and untreated. Consequences of this can be severe, including infertility, ectopic pregnancy, stillbirth, increased HIV risk, even death.
  • Certain groups are at increased risk, including sexually active women under 25.

The CDC currently sponsors four STD Awareness Campaigns:

  • GYT: Get Yourself Treated is for young people to understand the myths and misconceptions surrounding STDs and to learn about appropriate testing and treatment.
  • Test. Treat. Three simple actions by patients and healthcare providers can protect the health of the individual, their partner, and patients at large. First, have open and honest discussions with each other. Second, get tested or recommend appropriate testing. Finally, get or prescribe treatment.
  • Syphilis Strikes Back focuses on the prevention, diagnosis, and treatment of this potentially deadly disease which can impact pregnant women and newborn babies, among others.
  • Treat Me Right encourages patients to be proactive about taking care of their health and ask providers for what they need while equipping providers with critical communication and health information to treat their patients right.

Talk with your healthcare provider about your risk for STDs and any tests they might recommend. For more information from the CDC, go here.

Pregnant?  There’s an app for that!

In the age of smart phones and Google, it’s no surprise to me that my patients walk into our office with a wealth of information.  Search “pregnancy” on the iPhone App Store and you’ll get hundreds of results.  We’ve taken the time to review some of the available pregnancy apps and here are some of my favorites (and the best news is that they are all free!).

1. Period Tracker

Whether you’re planning for a pregnancy or trying to track your irregular bleeding patterns, Period Tracker keeps track of it all.  It tracks your period and ovulation cycles every month and is very easy to use.  It keeps track of your menstrual interval (the time from the start of one period to the start of the other) and predicts when you should get your next period.  This can be helpful for vacation planning too!

2. Sprout

Like many of the other pregnancy apps, Sprout customizes to your pregnancy after you input your due date.  It is unique in that it offers amazing 3D images of how the baby is developing from week to week.  Included in this app is a contraction timer, weight tracker, and baby kick counter.

3. My Pregnancy Today

This is a newer app which is gaining popularity quickly.  It offers suggestions for how to keep yourself in the best possible health during a pregnancy in addition to images of the developing baby, what to expect in the weeks to come, and a due date calculator.

4. Contraction Monitor

In the midst of wondering “am I in labor?” this app is here to help keep track of contractions.  Not only does it keep track of contraction frequency like many of the contraction apps, it allows mom to rate the intensity of the contraction and keeps track of how long contractions are lasting.  This is very helpful information to provide to your health care provider when you think you’re in labor.

5. Baby Names

This app offers thousands of ideas for naming your baby.  If you’ve waited until delivery to start thinking of about a name, this offers lots of ideas in the palm of your hand.  It’s also a fun app to keep you busy when you’re waiting in line.

*It’s important to know that most apps are created for fun and are not approved by medical professionals.  If you have questions or concerns based on the information you’re reading online or on an app, be sure to discuss it with your health care provider.

HPV-What’s All the Fuss About?

If you are over 30, your pap smear is now being screened for HPV (Human Papillomavirus), and if you are under 26, you are being encouraged to get vaccinated for HPV.  If you have ever had an abnormal pap smear, you are tested for HPV automatically.  Why?  What is the fuss about?  Why is HPV so important?

What is HPV?

Well, we now know (and we didn’t know this in the past) that it is HPV (human papillomavirus) that is the cause of cervical cancer.  This virus is also responsible for other types of cancers, i.e. throat, vaginal, vulvar, anal, rectal, and penile cancers.  There are approximately 40 types of HPV strains that affect the genital region, but only 2 of these strains (named 6 & 11) have any symptoms.  These 2 strains cause venereal warts, also known as “condyloma” in medical speak.  Most people who have HPV do not have symptoms.  It is estimated that approximately 80% of all sexually active adults have been exposed to HPV at some time in their life.  It is the most common sexually transmitted disease.  Even having only one partner in life and using condoms still does not guarantee that you won’t be exposed to the virus.  So why might you catch this viral infection even if you are careful?  HPV is a skin virus.  This means it lives on skin cells on the outside of the genital area and not just on the penis or in the vagina.  Direct skin to skin contact, not just intercourse, can cause it to be transmitted.  Oral sex, vaginal sex, & anal sex all equally expose individuals to the disease, but so can intimate skin to skin contact.

How do I know if I have HPV?

We have a test for it.  All women over the age of 30 are routinely screened for high risk strains of HPV with the pap smear.  If the virus is active, you will test positive for the virus, even if the pap smear is normal.  If the virus is inactive, it will not be present on the pap smear.  Although there are approximately 40 strains of HPV, only a few are considered “high-risk”.  This means that if these strains are present, there is more potential for cervical cells to become abnormal and progress to precancerous changes.  For example, 2 strains (named 16 and 18) are responsible for two-thirds of all the cancers that I have mentioned.  You may also have been exposed to HPV, have it lying inactive in your body, have a history of normal pap smears, and you will test negative for the presence of the virus.  HPV only shows up when it is “active” or “infecting” the area tested.  This is why it is so important to have regular screening if you have ever been sexually active.  The good news is that most women will be able to suppress the virus through the normal immune system response within 2 years.  We also know that smoking will increase the risk of abnormal changes progressing to cancer, so another reason to consider quitting.

Does the HPV vaccine prevent infection?  Am I eligible to get vaccinated?

The vaccines (there are 2 different ones) prevent infection from the most dangerous HPV strains (#16, 18), and one of the vaccines (Gardisil) also prevents infection from the strains the cause venereal warts.  The vaccine is available for women and men younger than age 26.  It is actually recommended to start vaccinations prior to sexual intimacy for peak protection, therefore it is being offered anytime from age 11 forward.  If you have already been exposed to one of these HPV strains, the vaccine will not protect you against the one you have been exposed to, but will protect against the others.  If you are over age 26, the vaccines are not currently available to you.  Condom use is always recommended, but again is not 100% protective against HPV.  The more sexual partners you have, the greater the risk of exposure.

Unexpected Medical Bills Don’t Make Good Surprises

Understanding your high deductible health insurance plan

Remember the days of paying a $25 copay for every office visit and that was all you were personally responsible for?  With the increasing number of high deductible health insurance plans out there, it has become increasingly more confusing for patients to figure out what they will be responsible for in regards to healthcare costs.  We hear words like “subject to your deductible”, “preventative care”, “100% covered” with no clear understanding with what to expect when the bill ultimately comes in the mail.  I think the key is in understanding preventative care versus diagnostic care.

Preventative Care

Preventative care in gynecology includes the annual examination physical, lab tests, screenings and other services intended to prevent illness or detect problems before you notice any symptoms.  Because of the Affordable Care Act (passed in March 2010), most health insurance plans cover preventative care at 100% and often you won’t have to pay a cent.  It’s important to check with your health insurance plan to find out what services are included in preventative care as well as to make sure you are visiting an in-network provider.

Diagnostic Care

Diagnostic care involves treating a problem you already have, checking out new symptoms, or following up on abnormal lab tests.  When you receive diagnostic care, you may have to pay out-of-pocket with your plan until you have met your deductible and your co-insurance requirements.

Insurance in Action

That all sounds good, but in practice it can seem a little more confusing.  Let’s look at two patients’ examples to help to clarify.

Sue – During her yearly annual gynecology exam, Sue’s provider orders some lab tests, including a pap test to screen for cervical cancer.  Sue has never had an abnormal pap test.  The pap test is considered to be preventative.  Sue’s pap test comes back abnormal and requires additional testing for HPV through the laboratory.  Although the pap test is a preventative test, the additional testing for HPV is considered to be diagnostic because it’s being done because something was abnormal.  Sue’s visit would still be considered to be preventative care but the additional testing is diagnostic.

Julie – During Julie’s annual gynecology visit, Julie is asked about her periods.  Julie talks to her provider about her abnormal bleeding patterns.  Her periods are becoming heavier and sometimes she bleeds in between periods.  Julie’s provider is concerned about what might be causing the change in bleeding patterns.  To further investigate what is going on, Julie’s provider orders some lab tests and an ultrasound.  Because these tests are being done to follow-up on symptoms that Julie is having, these tests are considered to be diagnostic.  Part of Julie’s visit to her provider is considered to be preventative and part of her visit is considered to be diagnostic because of the symptoms she is reporting.

There are a million (probably more) health insurance plans out there and all plans have different coverage.  Please understand that 100% covered is not the same as 100% free of charge.  If you have specific questions regarding your healthcare plan, please call the number on the back of your insurance card to get more information.

For more information on health insurance in general, click here to watch a quick video.

So really…How much sex is “Normal?”

Happy Valentine’s Day to everyone! The holiday marked for hearts, flowers, and romance is a great day to talk about one of life’s greatest pleasures. Sex! Sex is one of those categories that, while not taboo, is not openly discussed, and leaves us wondering “Am I normal?” Based on surveys of married couples, 1-2 times per week is average. But remember- this is not a competitive sport! If the amount and type of sex you are having is good for you and your partner then it is “normal” too.

Guess what, that biological clock that’s ticking is no myth, and it’s what sometimes causes the sex drive in females to increase. In your early 20’s, menstrual periods are typically regular. Pre-programmed into us for “propagation of the human race” is the increase of desire around ovulation (when we are most fertile). The hormones inducing ovulation increase both sexual interest and the ability to orgasm. If your sex drive isn’t as high as it usually is, it could be your method of pregnancy protection. Birth control pills decrease testosterone, which for some women can decrease desire. For others, however, the confidence of pregnancy protection gives them freedom and peace of mind which can increase desire.

As life transitions into marriage and stable relationships, a level of confidence is reached. Many women feel more knowledgeable about what they like and can ask for it. The increase in experience increases the orgasm potential. This is why you hear “women have their sexual peak in their 30s”. Many women notice a dramatic increase in sex drive during the second half of pregnancy (after the morning sickness a fatigue resolve!). The skyrocketing progesterone and estrogen levels, the increased blood flow and vulvar swelling, and the intimacy pregnancy brings with a partner can all contribute to an increased desire.

However, if you aren’t feeling particularly frisky post-baby…you are not alone! Immediately after delivery, the same hormones that got you riled up plummet. The baby is putting new demands on the household, adding exhaustion and stress to the mix. Breastfeeding relies on prolactin which further decrease the sex hormones. This leads to thinning of the vaginal tissue which may cause pain and decreased lubrication. So if you aren’t hitting records in the bedroom post-baby, it’s okay.

As ovulation reestablishes itself, the hormones stabilize and desire improves. That being said this is time of navigating parenting styles, partner work load discrepancies (both in and out of the home), self vs family time. Finding this balance is difficult but key in having a healthy relationship and sex drive.

Perimenopause hits on average mid 40’s. The hormonal changes may decrease spontaneous interest but should not decrease the ability to enjoy sex or orgasm. Menopause itself, as defined by 1 year without a period, brings a significant decrease in estrogen and testosterone. This leads to decreased lubrication and blood flow to the vagina. Over the counter lubricants are important during this time, to ensure that there is no pain involved. If these are not enough, then prescription local estrogen replacement can be help tremendously.

So you can see, your sex drive will change as you go through life. In general, women who have a stronger emotional connection with their partner will tend to have an increased desire for sex. As such, intangible aspects of life have a strong effect on your sex life. Relationship issues, stress, fatigue, exercise and self-image are all important contributors to how much you are turned on. As you age, you may be less the “initiator” and may become more “receptive”. And bottom line- if it is okay for you and your partner it’s normal- whether that is daily
or once a year!

Don’t Put Food In Your Vagina

One of the common misconceptions about women’s health is that yogurt cures yeast infections. How did this idea get started? And why isn’t it true? And if there is no benefit from using yogurt in the vagina or on the vulva, are there other food-related products that are useful?

First of all, what is a yeast infection?

Candida albicans is a fungal organism commonly found in nature and frequently found on humans. It is a yeast-type fungus, which has to do with the microscopic form it takes. That is why vaginal infections (vaginitis) caused by this fungus are called “yeast infections.” These infections cause itching, burning, often a vaginal discharge, and are common. It is a lucky woman who has never had a yeast infection!

Where does the yogurt idea come from?

In order to understand the mistaken connection between yogurt and yeast infections we need to review some microbiology. Lactobacillus is a Genus of bacteria that metabolizes sugars and produces lactic acid. There are many types that are found in animals (including humans) and in foods, and these types are specific as to where they “live.” Lactobacillus acidophilus is the type most commonly used to make yogurt (by fermenting the lactose sugar in milk). It is NOT the type found in the vagina, just its cousin.

Why doesn’t it work?

Lactobacillus is the most abundant bacteria in the vagina, and there are at least four to five types found there, but none are acidophilus . Due to the production of lactic acid by these bacteria, the pH of the vagina is kept acidic, which helps in the natural defense against infection. Therefore it is known as the “good bacteria.” But when something disrupts the natural vaginal defenses, such as a course of antibiotics, there can be an overgrowth of Candida albicans causing an infection. Putting yogurt, and thereby acidophilus bacteria in the vagina doesn’t produce any beneficial effect. It doesn’t kill off the yeast, and it certainly doesn’t grow and produce more of the “good bacteria” because it is a different type of lactobacillus!

How can so many websites be wrong?

The idea of self-treatment of yeast infections with yogurt started back in the 1980’s, before there were any over-the-counter yeast infection medications (antifungals) available. This seemed to go out of fashion for a while, but now with the growth of the internet it is even easier to spread and therefore perpetuate false information. One website author picks up misinformation from another website and republishes it, making it look like multiple sources agree. Even Wikipedia states that yogurt is a treatment for yeast infections! Yogurt is not, in fact, a treatment for anything; it is just a healthy food, a great source of calcium, and a tasty snack. And by the way, some websites also recommend other food remedies for vaginitis including sea salt, apple cider vinegar, and garlic. Applying these products to the vagina or vulva will be smelly, ineffective, and probably painful for inflamed skin, and can even make the inflammation worse, so don’t use them either.

So don’t believe everything you read, don’t believe everything you hear, and DON’T PUT FOOD IN YOUR VAGINA!