Posts By cpramudji

5 Questions to Ask Yourself About Your Sexual Health

Remarkably, almost a third of American women have reported a low sex drive. Women who are suffering from a low sex drive and are unhappy about their sexual health may be suffering from Female Sexual Dysfunction (FSD), which is typically broken into four types: low sexual desire, arousal disorder, orgasmic disorder or painful sex.

How do you know if your sexual health is affecting you? Below are a few questions to ask yourself:

1. Do you feel unhappy about your sexual relationship?
2. Do you feel stressed about sex?
3. Do you ever feel sexually inadequate?
4. Have you felt embarrassed about sexual problems?
5. Are your sexual problems affecting your relationship?

If you answered yes to any of the above, I encourage you to start the conversation with your doctor about your sexual health. Our Female Sexual Dysfunction clinic at Houston Female Urology is a great place to begin . I recently started the clinic because I realized that women were struggling to talk about their sexual health and they also didn’t know of a supportive environment where they could comfortably have the conversation. I am so glad our clinic can provide that healthy environment many women are looking for!

Please don’t ever forget that it’s okay to take care of yourself! If you feel unsatisfied with your sexual health please give us a call. Let my team help you feel confident and beautiful again!

To learn more about the Female Sexual Dysfunction treatment pathway at Houston Female Urology please watch our below YouTube video.

-Dr.P

How To Conquer Interstitial Cystitis (Bladder Pain) Symptoms

 

Interstitial Cystitis (IC), or simply referred to as bladder pain, is chronic pain and discomfort in the bladder. Shockingly, 3 to 8 million women in the US suffer from IC, according to the Interstitial Cystitis Association. Symptoms of this disease include: urgency, urinary frequency, burning with urination, burning in the bladder, and pelvic pain.

IC can be a hard disease for women to live and cope with. However, patients should be encouraged by the options available to help manage symptoms. At Houston Female Urology, we have several treatments to help women find relief from their pain. Depending on the patient, treatments can range from a simple medication to BOTOX for the bladder. Our staff works with every patient to make sure we determine the best path to relief.

Below are a few simple steps that you can try on your own to help conquer your symptoms.

  1. Modify your diet.

Often specific foods and beverages can impact bladder symptoms. It is usually best to shop for fresh foods when possible and keep a diary as you experiment to determine which foods may trigger symptoms.

  1. Take steps to manage stress.

Common stress management tools include meditating, getting a massage, or exercising.

  1. Try to establish healthy sleeping habits.

A few tips include: cutting caffeine and alcohol, keeping your bedroom cool and comfortable, start winding down about an hour before you go to sleep, and sticking to the same bedtime every night.

To learn more about Interstitial Cystitis and the treatment options available, please visit Houston Female Urology’s YouTube page!

-Dr. P

Hope for Leaky Bladders

Are you suffering from a leaky bladder?  Is it hard for you to empty your bladder completely? Or maybe you feel like you need to go way too often.

These are common issues for many women and frequently go unaddressed. The good news is that if you do suffer from the above symptoms, I offer specialized urodynamics tests in my office that allow me to narrow down the cause of your bladder problems to properly address your symptoms and provide treatment options specific to your needs.

Urodynamics consists of several tests that provide valuable insight to how a patient’s lower urinary tract (urethra and bladder) are functioning. These tests determine how well the bladder is holding urine and evaluates the bladder’s ability to empty properly. Urodynamic testing is key to determining the cause of bladder incontinence.

It is fascinating what all the tests can tell us! Urodynamics commonly includes the following:

  • Uroflowmetry: measurement of urine volume and speed
  • Postvoid Residual Measurement: measures the amount of urine remaining in the bladder after urination
  • Cytometric Test: measures how much the bladder can hold when it communicates with the brain that it is full
  • Leak Point Pressure Measurement: determines the point at which the bladder leaks are involuntary
  • Pressure Flow Study: measures the pressure the bladder requires to urinate
  • Electromyography: evaluates for nerve or muscle damage

If you are one of the 25% to 45% of women who suffer from bladder leakage, I encourage you to give my office a call! To patients, bladder symptoms may feel like an embarrassing or uncommon problem but I promise it isn’t. Don’t let your bladder condition hold you back from the things you love, my team is here to help you get your life back again.

-Dr. P

What is Vaginal Rejuvenation?

I am thrilled with the growth of vaginal rejuvenation treatments in my field. More and more women are starting to have the conversation with their doctors about their feminine health, and the range of non-surgical procedures to improve women’s vaginal health is expanding.

However, the language commonly used around the revolutionary treatments such as ThermiVa and MonaLisa Touch can be vague. What does the term feminine or vaginal rejuvenation mean and how does a woman know if the treatments can fix her uncomfortable symptoms?

Vaginal or feminine rejuvenation is the enhancing of the vagina’s function and cosmetic appearance.

The desire for better sex, a more youthful appearance, and convenience are the main reasons women are choosing non-surgical procedures for rejuvenation. Additional reasons include:

• Perimenopausal and menopausal women experiencing dryness, leaky bladder, or laxity
• Women suffering from dryness due to bioidentical hormones
• Women experiencing dryness from breast cancer treatments
• Women who have discomfort wearing yoga pants, a bathing suit, or riding a bike
• Women that have difficulty achieving orgasm
• Mothers that have vaginal laxity, leaky bladder, prolapse, or decreased sensitivity due to vaginal births

Lastly, I wanted to leave you with a few other notes about vaginal rejuvenation that I think are helpful to be aware of. First, the results can last up to one year and can vary from person to person. Secondly, the procedures are not typically covered by insurance.

If you are interested in vaginal rejuvenation, my team and I are available to help you determine which non-surgical treatment option is best for you. Email us today at info@houstonfemaleurology.com!

-Dr. P

7 Things You Need to Know About ThermiVa

For the past few months, I have had the joy of offering ThermiVa treatments to my patients. Many have seen incredible results with ThermiVa and I wanted to provide all of my readers more insight on the treatment and the impact it can have on feminine well-being.

First, what is ThermiVa? The ThermiVa treatments use radiofrequency energy to gently heat tissue and rejuvenate collagen. The treatment works on the internal and external areas of the vagina to restore and revive. After going through a strenuous childbirth, multiple births, or the effects of menopause, the idea of taking back control of vaginal health is enticing to many of my patients. However, they are usually left with many questions about how ThermiVa can help return youthfulness and recover relationships.

Below are a few facts that I believe are helpful to be aware of when trying to decide if the ThermiVa treatment is right for you.

1. The benefits of this treatment include:

  • Reduced dryness
  • Reduced vaginal laxity
  • Improved confidence
  • Increased sensation

2. If you are in good health, you are most likely a good candidate for ThermiVa!
3. There are no risks to the procedure.
4. ThermiVa is performed in 3 treatments that take about 30 minutes.
5. There is no downtime. Most patients resume their normal activities right after the procedure.
6. ThermiVa requires no anesthesia and patients have described the treatment as comfortable.
7. The results vary from person to person, but most patients report immediate improvement!

I know to many of my patients, ThermiVa can either sound too good to be true or just a little scary. My team is here to help answer any additional questions you may have! Please give us a call and set up your consultation to learn more.

Stay tuned for next month’s blog on vaginal rejuvenation. I will provide more detail on what exactly vaginal rejuvenation is and how it can impact your feminine health!

Dr. P

 

Squashing Myths About In-Office Cystoscopy Tests

Many women are frightened by the idea of a cystoscopy test. When I sit down with my patients to discuss the procedure, they mainly express concern about pain and discomfort.  However, this procedure can provide great insight into a patient’s bladder health and should not be feared. Below is a list of FAQ’s to help ease your mind about your upcoming cystoscopy test.

What is an in-office cystoscopy?
A cystoscopy test is a procedure that allows me to examine the bladder lining, by inserting a scope into the bladder through the urethra. A cystoscopy test can be compared to a colonoscopy, but for the bladder.

Why would a woman need to have this procedure?
A woman would need a cystoscopy test if she has a polyp, tumor, or other abnormality. Additional reasons for a cystoscopy include blood in the urine that a physician found in a laboratory exam, bladder irritation, overactive bladder, or continuous bladder infections.

What misinformation have women heard about this procedure that’s wrong? Why should they not be nervous?
Most women think a cystoscopy test is very painful. Usually women hear this from others who have had a cystoscopy performed in the past, using a rigid scope. Now, we use a flex scope that is much smaller and less painful. The cystoscopy test only takes two to three minutes and the level of discomfort felt can be compared to a pap smear.

How should women prepare for this procedure?
It is important to come to the office with a full bladder so we can take a urine sample.  If you feel like you might have an infection, please let my office know before the procedure so we can treat the infection before performing the cystoscopy.

What does the process of having an in-office cystoscopy look like at Houston Female Urology?
First, the patient comes in for a regular appointment. We then take a urine sample to check for infection. Next, the medical assistant prepares the area and inserts a numbing jelly in the urethra. Once the area is numb, I fill the bladder with water. The scope is then inserted through the urethra into the bladder for the quick test. The results are discussed with the patient right away. Once complete, the patient will get dressed and go to the bathroom to empty the bladder. If there is any discomfort, we can provide a medication to help.

Will the patient feel much pain after they leave the office?
A patient should not feel any pain once they leave our office. There can be a slight burning but the feeling should go away after a couple of hours and is not a common side effect.

Please call my office if you have any other questions about your cystoscopy test. My team is always available to make sure you feel comfortable before coming in for your visit!

-Dr. P

There’s blood in my urine?

It’s a scary thing to find. When a patient sees blood their urine (hematuria), there are often many unknowns that race through their mind. I always stress that patients need to seek medical attention the first time they see it. Don’t even ignore a small amount. Call our office immediately, and make an appointment.

During the appointment, we will look at the entire urinary tract, first with imaging of the kidneys by a CT scan or a renal ultrasound and follow that with a KUB. Then, we will do a scope of the bladder, called a cystoscopy. It is a quick procedure with numbing medicine. While it sounds intimidating, patients are often surprised at how easy it is. The discomfort is similar to a Pap smear.

The most common cause of hematuria is a UTI. The infection can irritate the bladder wall to the point that it often bleeds. Other things we look for are a kidney stone, kidney tumor or bladder cancer.

While it is uncommon, occasionally we find a bladder or kidney tumor as the source of bleeding. Obviously, the sooner that a tumor is found and treated, the better. Tumors in the kidney and bladder will need to be removed surgically. Fortunately, we have great, minimally invasive options to remove these tumors without a large incision.

Often we will see patients for microscopic blood in the urine detected by their primary care doctor. While not as serious, it still requires a complete panel of testing.

Your treatment options will depend on what the testing shows. A UTI will be treated with antibiotics, water and other measures of prevention. If we find a kidney stone, then the treatment could be a number of various options to eliminate the stone, including laser and shock wave therapy, which are both minimally invasive options.

Whatever the cause, it is of the utmost importance to call our office at the first sign of blood in your urine. Our caring staff is here to help you.

– Dr. P

Thanking God for the privilege

It has been a long time since I wrote in my blog.  The holiday season is very busy for surgeons (having met their deductible, many people try to have surgery before the end of the year), and then the time just got away from me.   I started this entry right before Thanksgiving.

As a Christian, my life is dedicated to trying to bring glory to God in any little way that I can.  Now, I often fail, but it’s a striving and a focus that informs my day to day living.  I don’t think that we have a “spiritual life” and a separate “secular life”.   I think it is all integrated.   As such, when I come into an exam room or the operating room, I am thinking “What is God doing here?  How can I join in with His work?”  Sometimes it is as simple as giving her an antibiotic, other times it is praying about a struggle in her life, or praying that the surgery and recovery go well, and using my surgical skills to help her.

I used to pray with every patient before surgery and take a spiritual history on every patient, but that began to seem a little too rote and forced.  Now I follow the leading of the Spirit.  When I feel that I need to pray or ask probing questions, I do it.  It is amazing how God answers, often in ways I didn’t expect.   Just the other day, I prayed with a patient who had just found out she had rectal cancer.  I could see that she needed the comfort of knowing that God will be with her in her fight.

Patients are often surprised to have their doctor pray with and for them. Sometimes I feel a little silly praying for a what is for me a simple routine bladder lift; I mean, it’s not brain surgery or heart surgery. But then again, for the patient, there is nothing simple or routine about it.  I typically pray for the surgery to go well, for the entire OR team, for the patient to be healed and to recover well, and for her to have peace as she goes into surgery.   Most patients are very grateful for the prayer.  Occasionally I can see that someone feels uncomfortable, so I try to be sensitive to that before I pray.

I have some examples that show how God has answered prayers in my practice and in my life.  One day the robot at the hospital broke down before my case.  That was just one of many things that had happened that day.   There were odd delays and unexpected events that occurred. Everyone did great and no one was harmed by any of the issues.   But it was really stressful on me, because things weren’t going smoothly.   I just continued to lean on the Lord and pray for my patients and for our whole surgical team.   One of my patients told me that she was shocked when I prayed for her, but she told me that a sense of peace filled her heart and any nervousness that she had was gone.  Her surgical procedure was changed at the last minute due to the equipment malfunction so there was a lot of anxiety for her.  But the Lord gave her amazing peace.  She is now several weeks postop and doing great.

Another example was a stone case. I had been covering this patient in prayer for a few days prior to the surgery date due to her underlying health issues and the size of her stone.  This case went from a simple laser case to an open bladder case because the stone was bigger and harder than anticipated.    I was also concerned because I thought the bladder had partially ruptured when I was using the laser.  When I realized that I had to open her up, I called my office to let them know that I would be running late for my other patients due to the change in the plan.  I didn’t know it at the time, but my staff then all took a moment to join hands and pray for our patient.   Well, the open surgery went about 500% better than I had expected:  there was no rupture, the bladder was not as malformed as I thought it might be given her underlying disease, and the stone popped right out (it was about a 4 inch stone).  Another answered prayer!  She recovered beautifully and is doing better than ever.

Not only do I pray for my patients, but my staff does, too.   We all get to participate in what God is doing.  He cares about every part of our lives, even our urological health!

I have always been so thankful for the privilege of being a doctor and specifically a female urologist.  I hope that God is honored in my service to my patients.   I am humbled for the opportunity.

Causes of Urinary Tract Infections in Women

Urinary tract infections (UTIs) are some of the most common conditions that we see in our office every day.   Almost every woman will have an infection at some point in her life.   UTI is a catch-all term that means an infection anywhere in the urinary tract, which in women could mean kidneys (pyelonephritis, characterized by fever) or bladder (also called “cystitis”, with typical painful urination, frequency, urgency).   We often use “UTI” and “bladder infection” interchangeably.

They seem to occur at times of hormonal or sexual change:  a young teen starting her period is more prone, a honeymooner beginning to be sexually active, a woman going through or who has gone through menopause.   The vaginal pH is very sensitive to estrogen and when that pH is out of whack, the bacterial balance gets off kilter and a UTI is more likely to occur.

UTIs also occur when the body is stressed, either physically or mentally.  The immune system is weakened and the normal barriers to infection are not as strong.  We see this a lot: after surgery, when a husband dies, or work is super-busy patients are more likely to get infected.

But usually they occur for no good reason at all.  As women, we have naturally short urethras (the tube that goes from the bladder to the outside), and bacteria are always getting in there.  If we are flushing them out and the local area is healthy, then we don’t get infected.  When there is a compromise in the system, we tend to get infected.

What are the natural immune barriers?  Well, first of all, if you are overall healthy and exercising, not smoking and taking care of yourself in general, then the blood flow to your pelvis is good and that makes the whole area healthier and able to function normally.   Drinking plenty of water to stay hydrated and to flush the bladder regularly will wash out any bacteria that are trying to take an opportunity in the bladder.  The bladder itself has a natural layer of glycosaminoglycans that protects the bladder wall from infection.  These are the fundamental blocks to infection.

When a patient comes in with recurrent UTIs, we will ask about their fluid intake, sexual correlation, other health issues, surgeries in the area, and menopausal status.  We will do a thorough examination of the pelvic area, including measuring how much urine is left behind after voiding to make sure the bladder empties well. And we will look at the urine under the microscope.

If someone has more than 3 UTI in a year, then we will look more in depth:  renal ultrasound to look at the kidneys, x-ray to look for stones and a bladder scope (cystoscopy) in the office to evaluate the bladder wall.  Sometimes we will order a CT scan if there has been blood in the urine.

Some other causes of recurrent UTI that we are looking for:  urinary stones, urinary obstruction, and although unlikely, bladder tumors. In thousands of scopes for UTI, I’ve found two tumors, but I sure wouldn’t want to miss one.

So drink your water, exercise to keep that blood flowing and to help manage stress, and eat lots of fruits and veggies.  And hopefully you will be able to stay away from the urology office!

Dr. P

 

Preventing Kidney Stones in women

Did you know that women are just as likely to get kidney stones as men???  I don’t know why, but there is a perception that women don’t get stones as often as men.  But we all have two kidneys, which is where stones originate.

Stones are literally just that: rocks.  If you have never actually seen a kidney stone, they look exactly like rocks.  They are made of minerals that crystallize in the kidneys and then conglomerate together to form a stone.  As long as the stones are sitting up in your kidney, they usually don’t cause any pain.  But if they decide to pass and start heading down the urinary tract, look out.   It is the worst pain that humans endure.  Women who have had natural childbirth and have a passed a kidney stone will tell you that they would much rather have a baby any day!

You do not want a kidney stone!  As much as a I love stone surgery (laser surgery is like playing a video game, all that time playing Ms. Pac-man is paying off now, Mom), I know you don’t want to have to go through that.  Here’s how to prevent them:

  1. Number one is to drink more water and lemonade.  The solution to pollution is dilution.  If there is so much water flushing through the kidneys that the minerals can’t crystallize, then you won’t get a stone.  Lemonade naturally has citric acid which is a stone inhibitor.   Homemade lemonade is best, but I’ll be happy if you drink Crystal Light or Chik-fila lemonade.  Definitely better than soda or iced tea.  Those drinks actually cause stones.
  2. Drink enough water so that your urine comes out clear.
  3. Avoid soda and iced tea.  Yes, repeating myself.
  4. Become a vegan.  Well, as much as possible.  Not only is it the healthiest lifestyle for yourself and the planet, but some of the biggest culprits of kidney stones are meat and dairy.  By meat, that includes chicken and fish, as well as beef and pork.   You do not need to eat animals to live.  I have seen so many people develop kidney stones after doing the Atkins Diet.  If you feel you can’t give up your meat, at least limit it to two servings the size of your palm per day.  Animal protein metabolizes into something called acid ash which causes stones.  It also leaches the calcium from your bones and causes osteoporosis.  Read The China Study (the most comprehensive study on nutrition ever conducted) and become vegan.  It is not as hard as you think.  I did it five years ago.

If you have a family history of stones, you are more prone to get one yourself, so get on this!  If you have ever had a stone, you have a 10% chance each year thereafter that you will get another one.

Be healthy and hydrated!!

Dr. P