A pap smear is a sampling of the cells of the surface of your cervix to screen for cervical cancer. We start doing these checks at the age of 21, regardless of sexual activity and continue until you are 65 years old. Cervical cancer is caused by HPV, or human papilloma virus. This virus is so common that almost 80% of people with a cervix will contract it at some point in their lives. Most will clear the virus with the help of their own immune system, but some will continue to test positive. We check your pap smear every 3 years as per the most recent guidelines, and at the age of 30, we start automatically testing for HPV as well.

HPV stands for human papilloma virus. There are over a hundred different strains of the virus, with some considered “high risk” and other strains “low risk.” High risk HPV can lead to cervical cancer. Some low risk strains can cause genital warts. When we test for HPV, we test for high risk HPV in the context of cervical cancer screening. More recently we have started to sub-test for certain “extra high risk” strains and will monitor you even more closely if you have one of those. There is no medication for HPV, but there is a vaccine that is strongly recommended for all children before puberty. If you haven’t had it, you can still get it as an adult. Most people clear HPV on their own in about two years, which is why screening regularly is so important. When we screen for cervical cancer with pap smears and colposcopies, developing cervical cancer is extremely rare.

Individuals that have an abnormal pap smear will need an additional test called a colposcopy (or “colpo”). This is a microscopic exam of the cervix. Most colposcopic exams will involve us taking a biopsy, or tiny piece of tissue of the cervix, to allow us to see if you have abnormal cellular changes that could require a follow-up procedure. Removing advancing abnormal cells prevents most individuals from developing cervical cancer.

PCOS or polycystic ovarian disease is a condition where your ovaries stop releasing an egg every month. Instead, your ovaries start secreting male hormones, which can cause excessive hair growth, acne, and difficulty losing weight. There are lab tests and imaging we can do to confirm the diagnosis of PCOS, but the most important part remains your story – your signs, symptoms, and bleeding pattern. Treatment depends on where you are in your life and goals – are you trying to get control of your irregular cycles, trying to have a baby, or concerned about the long-term effects of the condition? We can guide you through the different treatment options depending on your needs.

If you have gradually more painful menstrual periods, pelvic pain outside of your periods, and have developed pain with intercourse over time, you may have endometriosis. Endometriosis is a condition where endometrial glands have found their way and implanted themselves outside of the uterus. The most common location of endometriosis is the pelvis. The “gold standard” for the diagnosis of endometriosis is surgery – a diagnostic laparoscopy with biopsies. We don’t have to do surgery on every patient that we suspect has endometriosis. Painful periods due to endometriosis are treated the same way as painful periods in someone who does not have endometriosis, and these treatments all help reduce the further progression of endometriosis. Treatment options include non-steroidal anti-inflammatory medications such as ibuprofen, hormonal birth control, Lupron, and other newer medications, such as elagolix and relugolix. Some individuals need surgery to experience improvement in their symptoms. Endometriosis is a progressive disease that tends to worsen over time if untreated and can cause pain and infertility. Recognizing the symptoms and initiating a treatment that works is the best way to improve both future fertility and quality of life.

In order to help you find the right birth control for you, we need to get to know you a little better. Everyone is different – is taking a daily pill easy for you? Would you prefer a long-term method that requires less impact on your daily routine? Do you prefer a non-hormonal method? The birth control methods available are safe and can be used long term, are reversible, and easily accessible. What’s best for you depends on your preferences, medical history, and goals. We can help you navigate the options.

If you find out that you’re pregnant and you want to end the pregnancy, we recommend that you schedule an appointment as soon as possible. There are two types of abortion that we provide– medical and surgical. The medical abortion can be performed if the pregnancy is less than 10 weeks along (about 8 weeks after you miss your period). You take a pill in our office and the next day you take another set of pills at home. These pills will start the bleeding, cramping, and passing of the pregnancy, much like a very heavy period. You’ll have access to your Moxie team during this process in the event that you’re concerned about anything, and we’ll follow up with you afterwards to ensure that everything has resolved appropriately. A surgical abortion is the other option (also called a dilation and curettage, or “D&C”). This is a minor surgical procedure that can be done either in the office under local anesthesia or in the operating room under general anesthesia, depending on your preference. We offer both options and will discuss the risks and benefits of the procedure with you to help you make choices based on your personal situation. Your Moxie team will be with you every step of the way and provide trauma-informed support as you navigate these options.

It is normal to have a certain amount of vaginal discharge (this is how the vagina keeps itself clean and healthy). The color, consistency, and smell of your discharge will change during the course of your life and menstrual cycle. Many things can influence your discharge – including hormonal birth control, lifestyle and hygiene products, and sexual activities. Some people have a lot of discharge, and some have a little, our bodies are all different. Abnormal discharge can present in the presence of a yeast infection, bacterial vaginosis, or a STD. Sometimes the diagnosis is easy to establish due to accompanying symptoms, such as fishy odor, itching, burning, or irritation. To treat you with the right medication we can take a swab and send it to the lab for testing. If you’re having recurrent infections, a detailed conversation with your Moxie practitioner can help get to the bottom of what might be causing them.

Chlamydia is one of the most common sexually transmitted diseases in the US. More than half of all cases are asymptomatic, and the person does not know they have it. Untreated, it can cause scarring in your fallopian tubes and pelvis that can have consequences for your fertility. Most STDs can be treated with a short course of antibiotics. Anyone who is sexually active can get an STD, so we recommend testing at least once a year starting when you become sexually active until around age 25. We also encourage people of all ages that are sexually active to get tested when they have a new partner, have had a known exposure to an STD, or if they suspect an exposure.

Herpes simplex virus (or HSV) is a virus that has two strains known in humans – HSV1 and HSV2. There are two common locations for herpes – oral (cold sores) and the genital area. Herpes can be transmitted in various ways: sharing saliva can transmit cold sores, oral sex with an active cold sore can cause genital herpes, and genital contact can transmit genital herpes from person to person. Herpes is extremely common and is diagnosed by swabbing an “active” lesion. Active lesions are lesions that are not scabbed over yet. A herpes outbreak lasts about 5-7 days and goes through predictable stages: redness and itching, development of small blisters or vesicles that open up and form small painful sores. The sores then scab over and heal without leaving a scar. We treat HSV with antiviral medications, and the dose is different for a first outbreak than for subsequent outbreak. You can transmit HSV to your partner between outbreaks and that is why we recommend suppression – a daily low dose of the antiviral medication. This helps to prevent outbreaks in you and reduce the possibility of spreading the virus to your partner(s). If you have never had a lesion, you do not have HSV. HSV is not accurately diagnosed with a blood test, and can only be diagnosed if active lesions appear.

If you have had regular periods your whole life and haven’t had a menstrual period for 12 months or more, then we consider you to have reached menopause. Before this happens, you may have symptoms that can affect your quality of life, including hot flashes, night sweats, vaginal dryness, brain fog, and feeling emotional and overwhelmed more easily. We can discuss remedies, medications, and alternative treatments that can improve these symptoms. The symptoms tend to improve over time on their own but some individuals can suffer from them for a long time. Hormone replacement is an option that we can discuss when you have reached menopause.

If you missed your period and have done a home pregnancy test and it is positive, we recommend scheduling an appointment for when you’re 7-8 weeks pregnant (counting from the first day of your last menstrual period). During your first prenatal visit, we’ll offer you an ultrasound to confirm some very important things: that the pregnancy is in the right place (your uterus), the number of fetuses (usually just one!), if there is fetal cardiac activity (heartbeat), and confirm your estimated due date. We’ll also discuss the course of your care and what tests and ultrasounds we offer, what to expect at appointments, and answer any questions you have.

We believe that however you give birth is natural, but specifically, birthing in the hospital with minimal interventions is possible. We strongly support your goals of experiencing an empowering birth with a team you trust. Having your baby in the hospital does not mean that an IV is started automatically or that you can’t eat until after the birth. You can move around during labor and have intermittent monitoring of the baby as long as you and your baby are doing well. We support different positions for both laboring and pushing, and encourage you to do what works for you. For some that is laboring at home with support of family or a doula until your labor is very active, and for others it may be enjoying the comfort an epidural may provide. We believe that you know that’s best for you, and we’re here to support that.

If you have had a c-section in the past and want a vaginal birth, it’s called a VBAC or “vaginal birth after cesarean.” Most c-sections are made with a transverse incision in the lower uterine segment, and a vaginal birth after such a procedure or even after multiple low-transverse c-sections, is well researched to be safe. A very small number of people attempting a VBAC will experience a complication called a “uterine rupture” – an opening of the scar where the c-section was done. It happens in less than one percent of women attempting a VBAC, and only a fraction of those will experience further complications such as harm to the baby. The vast majority of birthing people attempting VBACs have successful and uncomplicated vaginal deliveries. We support VBACs and will stand by you in your effort to avoid another c-section.

We’re strongly in favor of birth plans. The exercise of writing a plan helps you to consider things that are important to you, and these preferences and desires will be honored by your team whenever possible. It will bring up questions and lead to many productive discussions during your prenatal visits, and can help you address any anxiety you may have around the unknowns of labor and birth. A birth plan can also clarify your preferences to your Moxie team and the hospital staff. As your team, we strive to have a clear sense of what your preferences are, and we work to make sure that you’re familiar with our practices and philosophy throughout the course of your care. We encourage clear communication and collaboration, and welcome conversations and written preferences about this incredibly important experience.