Fort Sanders OBGYN

Products And Services

• Annual Exams – PAP test and Breast exam

  All women from 21 to age 65 should have a physical exam yearly. The exam is used to screen for many health problems as well as being a time to discuss any concerns you may have.

• Hormone Evaluation

  Fatigue, Premenstrual Syndrome, Irregular bleeding, Hot Flashes, and Night Sweats can all be an indication of Hormone Imbalance. We now offer Bioidentical replacement options as well as more standard treatments.

• Menopause

  This is a natural stage in women’s lives when they stop ovulating (releasing eggs). The normal range is from age 35 through 60. It may be accompanied by unpleasant symptoms that can often be treated by providers in our office.

• PMS

  Premenstrual syndrome refers to any of the unpleasant symptoms that some women experience in the 5 to 14 days prior to their cycle each month. Examples: Irritability, bloating, cramps, emotional stresses and headaches. There are options to help.

• Abnormal Bleeding

  The average cycle for women occurs every 21 to 35 days and menstruation usually lasts for 3 to 7 days. Sudden changes in your bleeding pattern can indicate problems. See your practitioner for bleeding in between cycles, bleeding more than 7 days or extremely heavy bleeding. Bleeding after Menopause as well as frequent spotting after sex should always be evaluated. If you are not sure if your bleeding is abnormal then call to discuss your concerns with one of our nurses.

• Bladder Problems

  Urinary leakage with exercise, coughing, or sneezing is called Stress Incontinence. Besides this many women also experience frequency, urgency, urge incontinence, and bladder pain. We offer detailed office testing to help determine the potential causes. It is not “normal” to leak urine no matter how many children you might have.

• Abnormal PAP’s – Evaluation and Treatment

  A phone call or letter from the office informing you of an abnormal PAP result is always alarming. Not to worry, this is almost never an emergency. Although abnormal results are serious nothing is going to change rapidly in the next few weeks. Typically the first step is to schedule a more detailed exam in the office called a Colposcopy to determine exactly what is happening with the cervix. Many low grade changes of the cervix will spontaneously regress and do not need treatment. High grade changes do need treatment but we offer the full range of treatment options so we can tailor the treatment to your specific situation.

• STD Screening and Education

  If you are under the age of 27 and you have had sexual activity or if your partner is new since your last exam then you should consider screening for certain infections that could potentially affect your health. If you are concerned that your partner is not faithful, you have a vaginal discharge, or you experience blisters or bumps vaginally then please let us know. We can offer advice on how to best avoid exposure to sexually transmitted diseases as well as treat infections that are already present.

• Pelvic Pain

  Bad cramps with your cycles, new pains in your lower abdomen, pain with sex, or pain with urination can all be signs of problems. In addition to the physical exam we often consider scheduling an Ultrasound to give us more detailed information of what may be the source of your pain. Once we have determined the potential cause we can usually offer options on how to correct the problem.

• Endometriosis – Evalutaion and Treatment

  Endometriosis is one of the most common causes of pain and bad cramping that women have to deal with. It can occasionally also create difficulty in becoming pregnant. Endometriosis is the presence of the normal lining tissue from inside of the Uterus (endometrium) spreading outside of the Uterus. Commonly it will be on or near the Ovaries. There are medical as well as surgical options available for diagnosis and treatment.

• Adolescent Gynecology

  Involves the evaluation, treatment, and counseling of young women from pre-puberty through the late teenage years for concerns about development and any genital symptoms. Dr. Christine Gale has completed a Fellowship specializing in Adolescent Gynecology.

• Laparoscopic Hysterectomy

  If you decide that the best treatment option for a gynecologic problem you may be experiencing is Hysterectomy then talk with us about Laparoscopic options. We offer Laparoscopic Assisted Vaginal Hysterectomy, Laparoscopic Supracervical Hysterectomy, and the DaVinci Robot Laparoscopic Hysterectomy. Three dime-size incisions may be all that is required. Although there are still reasons why an old fashioned incision may be the best approach for your surgery we hope to minimize the number of women needing this option. Ask about options and consider a second opinion if you are told that you have to have a large incision.

• Urethral Slings

  These small strips of mesh material are now the most common way to try and correct Urinary Stress Incontinence. They provide close to a 90% probability of being dry and are performed as a day surgery procedure. Dr. Saunders now offers the new Mini-Arc sling that allows most women to return to their average day-to-day activities within 48 hours.

• Uterine Ablation

  If you are experiencing heavy or frequent bleeding and you have made the choice to not consider any more children then this may be the treatment option for you. Uterine (Endometrial) Ablation is a minor procedure designed to destroy the majority of the lining tissue inside of the Uterus. Typically these procedures take less than ten minute to perform and give approximately a 90% probability of reducing you bleeding to light normal. Some lucky patients never have any more cycles! We offer both in-office as well as outpatient surgical choices. Call today if your periods are controlling your life.

• IUD/Nexplanon

  Our physicians will help each patient with their contraceptive needs. Our office offers two options of long term contraception, IUD (intrauterine device), as well as Nexplanon. Many times an IUD can help treat heavy periods in women.

• Colposcopy/LEEP

  The PAP smear is a screening tool used to detect potentially abnormal cells on the cervix. If there is evidence of abnormalities then we can utilize a microscope (Colposcope) to evaluate the cervix in more detail. If we determine that there are significant Pre-Cancerous cells on the Cervix then one option for treatment is a LEEP procedure. LEEP stand for Loop Electrical Excision Procedure. After numbing the Cervix with Novacaine we shave off the area of abnormal cells using a wire loop.

• Uterine Prolapse

  Uterine Prolapse is the dropping of the uterus into the vaginal canal. Quite commonly this problem can occur after childbirth and can cause pressure, pain, or bulging from the vagina. Although surgery is typically needed to correct this problem the newer options can be performed on an outpatient basis with a quick return to most activities.

• Bladder or Vaginal Prolapse

  Similar to uterine prolapse, the bladder and the vagina itself can drop after childbirth or injury. The symptoms are similar. New treatment options are very effective and durable.

• Cystocele and Anterior Repair

  A Cystocele occurs when the thin wall of tissue that separates the bladder from the vagina weakens, allowing the bladder to bulge (prolapse) into the front wall of the vagina. It is often associated with Stress Urinary Incontinence but can cause other problems as well. An Anterior Repair is an out-patient procedure that returns the bladder and urethra to its normal position and strengthens the wall between the bladder and the vagina.

• Rectocele and Posterior Repair

  A rectocele occurs when the thin wall of tissue that separates the rectum from the vagina weakens, allowing the rectum to bulge (prolapse) into the back wall of the vagina. Constipation, pressure, and splinting (the need to apply pressure in the vagina to allow for bowel movements) are common symptoms. A Posterior Repair is an out-patient procedure that returns the rectum back into its normal position and strengthens the wall between the rectum and the vagina. Common factors that contribute to the loss of normal pelvic support are: pregnancy and childbirth, menopause, chronic coughing, obesity, chronic constipation, years of strenuous activity or heavy lifting, and/or other gynecological, bladder, or rectal surgeries.

• Urinary Incontinence

  Do you leak urine when you laugh or when you exercise? Do you leak before you can make it to the restroom or feel like you live in the bathroom? You may have Urinary Incontinence. Evaluation The first step in getting your urinary incontinence treated is to mention your symptoms to your doctor. Further evaluation will depend on your symptoms and your exam. Fort Sanders OB/GYN was the first practice in Knoxville to offer detailed, electronic bladder testing called Urodynamics. Urodynamics is a simple in-office test that provides your doctor with information about your bladder’s capacity, your voiding patterns, leaking episodes, and your bladder’s neurologic function. Treatment Fort Sanders OB/GYN has always been a leader in offering the best options for correction of urinary leakage. Our physicians offer medical therapies, minimally invasive bladder slings, and interstim. Dr. Erin Saunders is fellowship trained in urogynecology. Interstim Therapy Many women cannot tolerate medications for Overactive Bladder or Urge Incontinence due to side effects. Interstim is an implantable stimulation divide much like a pacemaker for the heart. There is a simple test-phase for the first week to make sure the therapy will work and then there is a second phase where the permanent device is placed under the skin. Minimally Invasive Bladder Slings A surgical procedure that uses a narrow strip of mesh tape to correct stress urinary incontinence. This procedure is completed through the vagina and two small groin incisions; it creates stabilization and support for the bladder and the urethra (the tube carrying urine from the bladder to the outside of the body) Stress Incontinence Stress Incontinence is the involuntary leakage of urine during episodes of increased intra-abdominal pressures, including exertion such as coughing, sneezing, laughing, exercising, or intercourse. Urge Incontinence Urge Incontinence or Overactive Bladder is the involuntary loss of urine that occurs when a person has a strong, sudden need to urinate. Leakage is usually caused by abnormal bladder contractions. Urgency and Frequency Urgency is the severe and sudden need to empty the bladder. This can be related to a severe form of Overactive Bladder or due to Interstitial Cystitis.

• Obstetrics

  At Fort Sanders OBGYN, we offer routine management of common pregnancy discomforts, assess the growth and development of your baby, and prepare you for your birth experience. Some of our services include: -Ultrasound -Fetal Doppler monitoring -Lab work for diagnosis and treatment of anemia and gestational diabetes -Treatment of common discomforts of pregnancy -Additional services such as 3D ultrasound For more information and a complete list of our Obstetrical services, click on our Pregnancy tab.

• Recognize these symptoms?

  • Hot Flashes • Night Sweats • Fatigue • Can’t think clearly • Change in Sex Drive • PMS • Weight Gain You may be Suffering from a Hormone Imbalance

• What is BioIdentical Hormone Replacement Therapy?

  • Matches your natural hormones and restores them to the proper levels • Individually Customized to your body • Measurable Results utilizing the lowest dosage of hormones required to restore balance

• What are Bio-Identical hormones?

  Bio-Identical hormones are compounds that exactly match the natural hormones that your body makes on its own when it is in balance. To be truly Bio-Identical we believe that the hormone levels should be tested to insure that they are at the proper levels.

• We offer both salivary testing and blood testing

  The Salivary glands in the mouth contain all of the natural hormones at levels that reflect the rest of the body tissues. By collecting saliva specimens in a small tube we can get an accurate representation of the bodies hormone levels. NASA uses Salivary testing of Cortisol levels as a way to monitor stress on Astronauts. Lastly, there is no pain involved. A simple blood draw to collect a tube of serum can provide accurate hormone levels. Your physician will use your hormone results to create personalized hormone dosage.

• BioIdentical options : hormone creams and hormone pellets?

  Bio-Identical hormones generally should be supplied in a way that bypasses the GI system. When hormones are absorbed rather than swallowed they go directly to the tissues rather than be altered by the Liver. This is called the “first pass effect”. Hormone creams allow us to have better control of the day-to-day dosing in case we need to make changes. Creams also allow us to gradually spread out your visits to the office. BioIdentical Pellets are implanted into the subcutaneous (in the posterior hip region) through a simple in-office procedure. Pellets are the size of a grain of rice. The pellets slowly dissolve in your body and dispense small amounts of hormones. Pellets are usually placed every 3-4months.

• Is Bio-Identical hormone replacement therapy FDA approved?

  No. Even though Bio-Identical hormones are legal to prescribe and use in the United States the FDA has not given its approval for their use. Part of the problem is that everyone will require their own unique combination of hormones. There are also no placebo-controlled studies to prove whether Bio-Identical hormones are safer than standard hormone replacement.

• Are Bio-Identical hormones safer than standard hormones?

  There are no studies that prove whether Bio-Identical hormones are safer than standard hormones. Are Bio-Identical hormones safe for anyone? We believe that certain women should not take hormone replacement therapy of any type until detailed studies on safety have been performed. Women who have a personal history of breast cancer, who have had a blood clot, or who have had a stroke should not take Bio-Identical hormone replacement therapy.

• Does Insurance cover Bio-Identical Hormone replacement therapy?

  Insurance companies do not pay for Bio-Identical hormones. The main reason is lack of FDA approval. They will cover issues related to under active Thyroid problems.

• Do I have to come in every 3 to 4 months for testing?

  To begin with you might have to come in this often to get to the proper balance. However, once you are feeling well and your hormones are properly balanced then your visits can be less often.

• Once I start my hormones, how quickly should I feel better?

  We typically see improvement within the first 2 to 3 weeks but it may take up to 8 weeks to really notice the full effect from your hormones. We want to achieve balance without overdosing you. We do not consider the overdosing of hormones to be Bio-Identical. Using the lowest amount of hormone to get balance is actually the recommendation of the FDA and the American College of OB/GYN.

• What is Adrenal fatigue?

  The Adrenal gland produces Cortisol which controls our response to stress. During times when we are under excess stress our body’s ability to produce proper levels of Cortisol can be affected. Fatigue, foggy mind, poor sleep, and weight gain are common symptoms of Adrenal fatigue. Proper nutrition, exercise, and short term Cortisol supplementation can reverse this problem.