The Group For Women recommends getting vaccinated against HPV.  See this article for more info. Gardasil is the only human papillomavirus (HPV) vaccine that helps protect against 4 types of HPV. In girls and young women ages 9 to 26, GARDASIL helps protect against 2 types of HPV that cause about 75% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. In boys and young men ages 9 to 26, GARDASIL helps protect against 90% of genital warts cases. GARDASIL also helps protect girls and young women ages 9 to 26 against 70% of vaginal cancer cases and up to 50% of vulvar cancer cases. Important Safety Information: Only a doctor or health care professional can decide if GARDASIL is right for you or your child. Before having GARDASIL, please read the Patient Product Information. Contact The Group for Women today at 757-466-5751 to schedule your appointment.

Before health reform, too many Americans didn’t get the preventive care they need to stay healthy, avoid or delay the onset of disease, lead productive lives, and reduce health care costs. Often because of cost, Americans used preventive services at about half the recommended rate. Yet chronic diseases – which are responsible for 7 of 10 deaths among Americans each year and account for 75% of the nation’s health spending – often are preventable. Cost sharing (including copayments, co-insurance, and deductibles) reduces the likelihood that preventive services will be used. Especially concerning for women are studies showing that even moderate copays for preventive services such as mammograms or Pap smears result in fewer women obtaining this care. The Affordable Care Act, the health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010, helps make prevention affordable and accessible for all Americans by requiring health plans to cover recommended preventive services without cost sharing. Under the Affordable Care Act, women’s preventive health care services – such as mammograms, screenings for cervical cancer, and other services – are already covered with no cost sharing under some health plans. The Affordable Care Act also made recommended preventive services free for people on Medicare. In 2011, 54 million Americans with private health insurance gained access to preventive services with no cost sharing because of the law. However, the law recognizes and the Department of Health and Human Services (HHS) understands the need to take into account the unique health needs of women throughout their lifespan. On August 1, 2011, HHS adopted additional Guidelines for Women’s Preventive Services – including well-woman visits, support for breastfeeding equipment, contraception, and domestic violence screening and counseling – that will be covered without cost sharing in new health plans starting in August 2012. The guidelines were recommended by the independent Institute of Medicine (IOM) and based on scientific evidence. Beginning on Aug. 1, about 47 million women will now have guaranteed access to additional preventive services without paying more at the doctor’s office for policies renewing on or after August 1, 2012. Under the law, many private plans also must cover regular well-baby and well-child visits without cost sharing. With the addition of these new benefits, the Affordable Care Act continues to make wellness and prevention services affordable and accessible for more and more Americans. Women and Preventive Health When it comes to health, women are often the primary decision-maker for their families and the trusted source in circles of friends. They are also key consumers of health care. Women have unique needs and have high rates of chronic disease, including diabetes, heart disease, and stroke. While women are more likely to need preventive health care services, they often have less ability to pay. On average they have lower incomes than men and a greater share of their income is consumed by out-of-pocket health costs. A report by the Commonwealth Fund found that in 2009 more than half of women delayed or avoided necessary care because of cost. Removing cost-sharing requirements lets women decide which preventive services they’ll use and when. In fact, one study found that the rate of women getting a mammogram went up as much as 9% when cost sharing was removed. In addition to saving lives by catching cancer early, mammograms can also protect families from skyrocketing medical bills that result from treating the advanced stages of the disease. New Comprehensive Coverage for Women’s Preventive Care The Affordable Care Act helps make prevention affordable and accessible for all Americans by requiring new health plans to cover and eliminate cost sharing for preventive services recommended by the U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, and the Bright Futures Guidelines recommended by the Academy of Pediatrics. The law also requires insurance companies to cover additional preventive health benefits for women. For the first time, HHS is adopting new guidelines for women’s preventive services to fill the gaps in current preventive services guidelines for women’s health, ensuring a comprehensive set of preventive services for women. Previously, preventive services for women had been recommended one-by-one or as part of guidelines targeted at men as well. HHS directed the IIOM, for the first time ever, to conduct a scientific review and provide recommendations on specific preventive measures that meet women’s unique health needs and help keep them healthy. HHS based its Guidelines for Women’s Preventive Services on the IOM report issued July 19, 2011. The eight new additional women’s preventive services that will be covered without cost-sharing requirements include: Well-woman visits: This would include an annual well-woman preventive care visit for adult women to obtain the recommended preventive services, and additional visits if women and their health care providers determine they are necessary. These visits will help women and their health care providers determine what preventive services are appropriate, and set up a plan to help women get the care they need to be healthy. Gestational diabetes screening: This screening is for women 24 to 28 weeks pregnant, and those at high risk of developing gestational diabetes. It will help improve the health of mothers and babies because women who have gestational diabetes have an increased risk of developing type 2 diabetes in the future. In addition, the children of women with gestational diabetes are at significantly increased risk of being overweight and insulin-resistant throughout childhood. HPV DNA testing: Women who are 30 or older will have access to high-risk human papillomavirus (HPV) DNA testing every three years, regardless of Pap smear results. Early screening, detection, and treatment have been shown to help reduce the prevalence of cervical cancer. STI counseling: Sexually-active women will have access to annual counseling on sexually transmitted infections (STIs). These sessions have been shown to reduce risky behavior in patients, yet only 28 percent of women aged 18-44 years reported that they had discussed STIs with a doctor or nurse. HIV screening and counseling: Sexually-active women will have access to annual counseling on HIV. Women are at

The Experts Do Agree About Hormone Therapy Ten years have passed since publication of the first results of the Women’s Health Initiative (WHI) hormone therapy trials. The debate that followed gave women and their providers the impression that the experts don’t agree on the topic of hormone therapy. Top women’s health organizations have now issued a solidarity statement to demonstrate the experts do agree on the key points. The medical societies listed below take the position that most healthy, recently menopausal women can use hormone therapy for relief of their symptoms of hot flashes and vaginal dryness if they so choose. These medical organizations also agree that women should know the facts about hormone therapy. Below are the major points of agreement among these societies. Hormone therapy reduces menopausal symptoms Hormone therapy is the most effective treatment for menopausal symptoms such as hot flashes and vaginal dryness. If women have only vaginal dryness or discomfort with intercourse, the preferred treatments are low doses of vaginal estrogen. Hot flashes generally require a higher dose of estrogen therapy that will have an effect on the entire body. Women who still have a uterus need to take a progestogen (progesterone or a similar product) along with the estrogen to prevent cancer of the uterus. Five years or less is usually the recommended duration of use for this combined treatment, but the length of time can be individualized for each woman. Women who have had their uterus removed can take estrogen alone. Because of the apparent greater safety of estrogen alone, there may be more flexibility in how long women can safely use estrogen therapy. Hormone therapy risks Both estrogen therapy and estrogen with progestogen therapy increase the risk of blood clots in the legs and lungs, similar to birth control pills, patches, and rings. Although the risks of blood clots and strokes increase with either type of hormone therapy, the risk is rare in women ages 50-59. An increased risk in breast cancer is seen with 5 or more years of continuous estrogen with progestogen therapy, possibly earlier. The risk decreases after hormone therapy is stopped. Use of estrogen alone for an average of 7 years in the WHI did not increase the risk of breast cancer. Additional information In large population studies, estrogen therapy applied to the skin (transdermal patches, gels, and sprays) and low-dose estrogen pills approved by the United States Food and Drug Administration (FDA) (the US government group that monitors drug safety) have been associated with lower risks of blood clots and strokes than standard doses of estrogen pills, but studies directly comparing oral and transdermal hormone therapy have not been done. Many options for FDA-approved hormone therapy (estradiol and progesterone) that is biochemically identical to the body’s own hormones are available for those who want it. We don’t have scientific proof that custom-compounded bioidentical hormone therapy is any safer or more effective than FDA-approved hormone therapies. Many medical organizations and societies agree in recommending against the use of custom-compounded hormone therapy for menopause management, particularly given concerns regarding content, purity, and safety labeling of these formulations. There is a lack of safety data supporting the use of hormone therapy in women who have had breast cancer. Nonhormonal therapies should be the first approach in managing menopausal symptoms in breast cancer survivors. The Bottom Line Hormone therapy is an acceptable option for the relatively young (up to age 59 or within 10 years of menopause) and healthy women who are bothered by moderate to severe menopausal symptoms. Individualization is key in the decision to use hormone therapy. Consideration should be given to the woman´s quality of life priorities as well as her personal risk factors such as age, time since menopause, and her risk of blood clots, heart disease, stroke, and breast cancer. Medical organizations devoted to the care of menopausal women agree that there is no question that hormone therapy has an important role in managing symptoms for healthy women during the menopause transition and in early menopause. Ongoing research will continue to provide more information as we move forward. The North American Menopause Society● American Society for Reproductive Medicine ● The Endocrine Society Click here for link to this article.

Frequently Asked Questions What is breast density? The term “breast density” describes the composition of a woman’s breasts. High breast density means that there is a greater amount of milk producing, milk transporting, and connecting tissues, as compared to fatty tissue. What are some factors that affect breast density? Genetics: high breast density tends to run in families Pregnancy: breast density decreases with each pregnancy Age: younger women typically have denser breasts How do I know if I have dense breasts? A radiologist (the physician who interprets your screening mammogram) makes an assessment of breast density after your mammogram has been completed. If your breasts are dense then the radiologist will share that information with the physician who referred you for your mammogram and will also notify you. What does it mean if I have dense breasts? Your breast tissue may hide cancer or other abnormalities from the radiologist interpreting your screening mammogram. You may be at an increased risk of breast cancer, but, at this time, the amount of this risk is not understood and is controversial. I’ve been told I have dense breasts. Now what? There are currently no specific recommendations on how to lower breast cancer risk for women with dense breasts. It’s important that you continue getting regular mammograms and any further screening tests as recommended by your healthcare provider. Regardless of your breast density, there are steps you can take to lower your overall breast cancer risk such as not smoking, limiting alcohol use, exercising regularly, eating a healthy diet, and maintaining a normal weight. References: National Cancer Institute. Mammograms.http://www.cancer.gov/cancertopics/factsheet/detection/mammograms American College of Radiology and the Radiological Society of North America. Mammography.http://www.radiologyinfo.org/en/info.cfm?pg=mammo#part_ten Susan G. Komen for the Cure. The ABCs of Breast Density.http://ww5.komen.org/Content.aspx?id=19327353285&terms=density American College of Radiology. American College of Radiology Statement on Reporting Breast Density in Mammography Reports and Patient Summaries. http://www.acr.org/About-Us/Media-Center/Position-Statements/Position-Statements-Folder/Statement-on-Reporting-Breast-Density-in-Mammography-Reports-and-Patient-Summaries

The September issue of Hampton Roads Magazine features Dr. Holly S. Puritz on the cover! Also, Drs. Crockford and Groves were selected “Top Docs” by their peers.  Look for the magazine on newstands today! Read the article here: Hampton Roads Magazine – September 2012

We are pleased to let you know that effective September 1, 2012, The Group For Women will once again be participating with Anthem’s HealthKeepers HMO plans.  Please call to schedule your appointment 757-466-5751.

FIRST, THERE WAS BEST OF. In March, residents voted for their favorite businesses in each city, and winners were announced in May. Then residents voted again as those winners competed in a region-wide contest of the most popular categories. Now, here is your Best Of The Best – Hampton Roads: Gold Award – OB/GYN – The Group for Women (757) 466-6350 Thank You to all of our patients for voting us the best OB/GYN in Hampton Roads!!

by Tina D. Fries Abnormal bleeding. Uterine Fibroids. Pelvic pain disorder. Endometriosis. These are some of the most common reasons more than 600,000 total abdominal hysterectomies are performed on women each year in the United States, making hysterectomy one of the most commonly performed surgical procedures. By age 60, one in three women will have undergone the procedure, with 65% of them having both uterus and cervix removed, with or without ovaries or fallopian tubes, in the most invasive way: through a 4-8 inch abdominal incision requiring an extended hospital stay and a 4-6 week recovery time. But there are alternatives to total abdominal hysterectomy. Vaginal hysterectomy — with or without the assistance of a laparoscope — is performed by removing the uterus through an incision in the vagina, requiring a 2-day hospital stay and 4-week recovery period. Since 2001, Surgeons Jon L. Crockford, M.D., and C. Dwight Groves, M.D. of The Group For Women, a Division of Mid-Atlantic Women’s Care, PLC, have been teaming up to bring a third, minimally invasive alternative called laparoscopic supracervical hysterectomy (LSH) to women in Hampton Roads. Laparoscopic supracervical hysterectomy is performed by making three half-inch long incisions in the patient’s abdomen through which the upper two thirds of the uterus is removed. The bottom third of the uterus — the cervix — is left in place and therefore no incision is made in the vagina. While not an appropriate option for women with malignancies, LSH offers a number of benefits for the patient with benign disease including a short, one night or less hospital stay, significantly shorter recovery time of 7-14 days, less scarring, less risk of injury to surrounding organs, fewer post-surgicalncomplications such as infection, better long-term support of the top of the vagina and maintenance of sexual health, including earlier resumption of sexual activity. “With this procedure, we’re not seeing the GI complications or the infection complications,” said Dr. Groves. “We don’t have the wound problems we had before. For obese patients this may actually be better than the other options.” Equipment Advances Increase Safety LSH uses specialized equipment including a laparoscope, a thin lighted endoscope connected to a camera that allows the surgeon to see the patient’s organs on a monitor, a harmonic scalpel for cutting and a uterine morcellator with a thin rotating barrel that removes the organs in tiny pieces through a long, cylindrical tube. “Given recent advancements in technology and new instruments on the market we are able to accomplish a large operation inside the body through small, minimal incisions,” said Dr. Crockford. “We now have the technology to do this procedure safely and quickly.” Both physicians affirm that wasn’t always the case, given the equipment of yesteryear. “It was dangerous when they first started doing laparoscopy in the 1950s,” said Dr. Groves. “Getting the initial point of entry used to be the most dangerous part of the surgery and they used monopolar electricity which resulted in burns.” But with advances in equipment and technique, incandescent lights gave way to fiberoptics, blades for entry were set aside in favor of blunt, clear-tipped trocars, and air pumps were replaced with computerized equipment to monitor the precise amount of air being injected. “We used to put our eye to the eyepiece and now we have a camera and digital images so it’s actually better than the naked eye,” said Dr. Crockford. Unique Learning Curve Dr. Crockford and Dr. Groves trained in LSH at Florida Hospital Celebration Health in Orlando under the medical direction of Steven McCarus, M.D., nationally recognized for laparoscopic surgical expertise. “The learning curve with this procedure is a little different,” explained Dr. Groves, who earned his medical degree from Marshall University in Huntington, West Virginia and completed both internship and residency with Eastern Virginia Medical School. He practiced with The Group for Women early in his career and returned in 2000 to log a total of 12 years there. “Normally with surgery things are very tactile, but this is a very visual thing, very remote,” he said, zeroing in on one of the major challenges physicians face in using robotic techniques. “We’re outside of the body so we have to work with visual cues without the benefit of the sense of touch.” Dr. Crockford earned his medical degree from the University of Virginia and completed both internship and residency in obstetrics and gynecology at Barnes Hospital, Washington University School of Medicine in St. Louis, Missouri. He has been practicing with The Group for Women for 26 years. Since completing their training in LSH, Dr. Crockford and Dr. Groves have performed 270 of these procedures with consistently positive outcomes and an estimated one percent conversion rate to abdominal hysterectomy. They perform an average of 2-5 per week, the vast majority of them at Sentara Leigh Hospital. While national averages indicate that 65% of women continue to have traditional abdominal hysterectomy, the frequency and demand for LSH at Sentara Leigh Hospital during 2003 actually reduced this figure to 45%. To aid physicians like Dr. Crockford and Dr. Groves in their work, Sentara Leigh Hospital is in the process of developing a state-of-the-art operating room equipped for advanced laparoscopic procedures with voice-activated robotics. Do No Harm Leaving the cervix unharmed has many benefits for the patient. The cervix provides key support to the upper vagina. The uterosacral ligaments attach the vagina to the spine via the cervix and with LSH these supports are left intact. “What we’re doing with this surgery is we are saving the cervix,” said Dr. Groves. “The first rule of medicine is ‘do no harm’ and I think that applies very nicely here. With the availability of regular pap smears to screen for cervical cancer, there’s no reason to remove a healthy cervix. If it’s diseased, by all means take it out. But why increase infection rate, bleeding and the possibility of complications unnecessarily?” One of the primary complications following total abdominal hysterectomy is posthysterectomy vaginal vault prolapse which results from not maintaining support to the top of the vagina. “LSH preserves the pelvic