In-Office Procedures

An “In Office Procedure” is a procedure that takes place in the office, and usually takes just about the same time as a regular GYN visit. After the procedure is performed, you are on your way home, again just like a regular visit. “In Office Procedures” include:


The MyoSure tissue removal procedure is a convenient treatment that targets and removes fibroids and polyps. That means that you could finally get relief of your abnormal uterine bleeding symptoms—without a major surgery. If you would like to have children in the future, then the MyoSure procedure may be a treatment option for you. The MyoSure procedure is typically done on an outpatient basis; you can return home the same day. With any medical procedure, there are potential risks to consider and discuss with your doctor when making your treatment decision.

Endometrial Biopsy

An endometrial biopsy is a way for your doctor to check for problems in your uterus. That’s the pear-shaped organ in your lower belly that holds a baby during pregnancy.

The procedure takes just a few minutes and is often done in your doctor’s office. It’s very safe.

Who Gets This Test?

Your doctor may do this type of biopsy if your Pap test shows that you have “precancerous” cells in your uterus. She could also suggest one if you have any of these symptoms:

  • Heavy or long periods
  • Periods that don’t come at the same time every month
  • No periods
  • Bleeding after menopause
  • Bleeding after taking a breast cancer drug called tamoxifen
  • A thickened uterine lining

An endometrial biopsy can’t fix or stop any of these symptoms. But it can help your doctor learn what may be wrong.

What Happens

Most of the time, you can get this test done in your doctor’s office. You won’t need anesthesia, but your doctor may suggest you take an over-the-counter pain reliever 30 minutes before your visit


While an endometrial biopsy is safe, there is a chance of bleeding and infection. The wall of your uterus could also get nicked by the tools used during the biopsy, but this is very rare.

If you think you may be pregnant, make sure to tell your doctor ahead of time. The biopsy could cause you to miscarry.

Labial Plasty Reduction

Labiaplasty (also known as labioplasty, labia minora reduction, and labial reduction) is a plastic surgery procedure for altering the labia minora (inner labia) and the labia majora (outer labia), the folds of skin surrounding the human vulva. There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their genitals because they believe they do not fall within a normal range.


A hysterosonogram or HSN is also known by the names sonohysterogram, saline ultrasound, saline sonogram, or saline infusion sonogram. A hysterosonogram is a minimally invasive ultrasound procedure that can determine if there are abnormalities inside the uterus that might interfere with pregnancy.

Colposcopy Procedure for abnormal Pap Smears:

The colposcopy procedure is a method of looking at the cervix with magnification that allows us to diagnose and properly treat the problem causing the abnormal Pap Smear.

“LEEP”  Procedure to Treat Abnormal Pap Smears:

Once the colposcopy procedure identifies the abnormal tissue growing on the cervix, the LEEP is a method of removing the abnormally growing tissue. This is painlessly performed in our office under local anesthesia.


This “In Office Procedure” often times is performed to correct mildly abnormal Pap Smears. This is where the surface of the cervix is frozen to a cold nipple-shaped probe for a few minutes. This causes the abnormal cells to slough off and have new ones take their place.


The IUD at a Glance

  • Small, “T-shaped” device inserted into the uterus to prevent pregnancy
  • Safe, effective, and long lasting
  • Must be inserted by a health care provider
  • Costs between $0 and $1,000 up front, but lasts up to 12 years

Is an IUD Right for Me?






Implanon (Nexplanon):


What is Implanon?

Implanon is a hormone implant used for birth control. A hormone-carrying plastic rod, the size of a matchstick, is inserted under the skin of your arm.

How Implanon works:

Your doctor (or nurse) inserts the rod into your skin through the use of a needle. The needle is inserted into your arm at a slight angle, and when the needle is fully in your arm, the applicator with the rod is parallel to your skin. The applicator releases the Implanon rod into your arm and the needle is removed. The rod remains in your arm for up to 3 years, but can be removed at any time.

The Implanon rod releases a steady dose of progestin into your body. Progestin is a synthetic (artificial) hormone that prevents ovulation (the ovary from releasing the egg) and thickens the mucus of the woman’s cervix. The thickened mucus prevents the sperm and egg from joining and fertilizing in case the egg is released.

Does it protect against STIs?

Does it protect against pregnancy?
Yes, Implanon is over 99% effective.

Advantages of using Implanon:

  • Once the rod is inserted, you do not have to worry about getting pregnant and do not have to remember to take daily preventative measures (like with the pill)
  • The Implanon rods are reversible – once the rod is removed you can usually quickly become pregnant again
  • The rod is extremely subtle – usually no one can see the rod once it has been inserted (or feel it unlike IUDs which can sometimes be felt during sexual activity)

    Disadvantages of using Implanon:
  • Implanon can cause irregular bleeding and spotting
  • Pain and scarring can be associated with the insertion and removal of Implanon
  • May not work for overweight or obese women

Increased health risks, such as:

  • Blood clots (especially if you are a smoker)
  • Ovarian cysts
  • Headaches
  • Weight gain
  • Depression
  • Acne
  • Breast pain
  • Viral infections

More information about Implanon can be found at

Urodynamic Evaluation: This “In Office Procedure” is really a test; we test to see how the bladder is functioning. Based on these tests, we can get a better idea as to whether you should be treated for your condition by exercises, medication, or whether you may need a surgical procedure to solve the problem. We may refer you to a specialty lab where a computer is used to evaluate your bladder if further in-depth testing proves necessary.Gardasil

Administration: This “In Office Procedure” is basically a vaccination. It is a vaccination against the HPV Virus. This is the virus that causes cancer of the cervix.  Since this virus takes anywhere from 10 to 30 years to cause the cancer, we feel all girls and women between the ages of 9 and 26 SHOULD be vaccinated against four sub-types of the HPV Virus.

When these “In Office Procedures” procedures are finished, you are then able to go home.


About the NovaSure Procedure.

The NovaSure procedure is a quick, safe, simple, one-time endometrial ablation treatment. This minimally invasive procedure controls heavy bleeding by using energy to remove the lining of the uterus. The average treatment time is about 90 seconds, and only needs to be performed once to lighten or stop your periods. No pre-treatment drugs are required and NovaSure can be performed in the hospital or in your doctor’s office.

Without the side effects of hormones or the risks of hysterectomy, NovaSure has a quick recovery time so you can get back to your life sooner. Most women experience no pain after the procedure, and can return to work and regular activities the next day. learn more >>

NovaSure reduces bleeding and much more

With more than 500,000 patients treated to date, NovaSure is proven safe and successful. A clinical trial has shown that more than 9 out of 10 women return to normal or lower than normal bleeding levels following treatments with NovaSure. For some women, their periods even stopped completely.

Many women also experienced a reduction in PMS and painful periods, as well as other benefits such as less anxiety, greater self-confidence, and a boost in energy. NovaSure clinical trial post treatment survey results reveal,

  • 45% reduction in women reporting PMS
  • 64% reduction in women reporting pain
  • 68% reduction in women reporting anxiety
  • 71% reduction in women reporting a lack of self-confidence
  • Nearly 4 fold reduction in women reporting a lack of energy

NovaSure makes a difference!

Many women find that treatment with NovaSure frees them up to enjoy more of what life has to offer. According to the NovaSure clinical trial post treatment survey, 4 out of 5 women report spending more time at work and daily activities and missing fewer social and athletic events because of heavy bleeding.

A half a million women to date have chosen NovaSure to reduce or eliminate their heavy periods and improve their quality of life. Women are very pleased with the results of the NovaSure procedure; 97% say they would recommend NovaSure to other women.

Hear what women say about NovaSure as their endometrial ablation of choice.


Essure Procedure

EssureTM Tubal Occlusions: The Essure Tubal Occlusion Procedure is one of the new “In Office Procedures,” It is one of the Minimally Invasive Procedures,” which consists of “Tying the Tubes.” It was also know as a “Tubal Ligation.” Usually this “Tying of Tubes” procedure was done at a hospital or surgical center, and either as an in-patient or an out-patient.

Now, using the EssureTM procedure, it can be done right “in the office.” You can be on your way home within 15-20 minutes after the procedure has been completed.  Just make sure you aren’t the one driving—you are likely to see double.

Overview of Essure procedure

essureEssure is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. This gentle procedure can be performed in a doctor’s office in less than an hour.

Trusted by women and doctors for over five years, Essure is covered by most insurance providers.  If the Essure procedure is performed in a doctor’s office, depending on your specific insurance plan, payment may be as low as a simple co-pay.

Essure offers women what no birth control ever has:

  • No cutting
  • No going under general anesthesia
  • No slowing down to recover
  • No hormones
  • No guessing – your doctor can confirm when you can rely on Essure for birth control
  • Short procedure time – Essure only takes about 13 minutes to perform*
  • Trusted by women and doctors for over ten years

*Average hysteroscope time

And you’ll never have to worry about unplanned pregnancy again.
The Essure procedure is permanent and is NOT reversible.  Therefore, you should be sure you do not want children in the future.

About the Procedure

The Essure procedure does not require any cutting into the body. Instead, an Essure trained doctor inserts small flexible micro-inserts™ through the body’s natural pathways (vagina, cervix, and uterus) and into your fallopian tubes.

The procedure can be performed in the comfort of a doctor’s office without general anesthesia, and most women resume their normal activities within one day.

During the 3 months following the procedure, your body and the micro-inserts work together to form a natural barrier that prevents sperm from reaching the egg. During this period, you must continue using another form of birth control (other than an IUD or IUS).

Three months after the Essure procedure, a doctor will perform an Essure Confirmation Test, to confirm that the tubes are fully blocked and that the women can rely on Essure for permanent birth control.

Unlike birth control pills, patches, rings, and some forms of IUDs, Essure does not contain hormones to interfere with your natural menstrual cycle. Your periods should more or less continue in their natural state.

Benefits of the Essure procedure

Can be performed in a doctor’s office

Because there is no cutting or general anesthesia required, the Essure procedure can be performed safely and comfortably in a doctor’s office.

No cutting or burning

The Essure micro-inserts are passed through the body’s natural pathways and inserted into the fallopian tubes.  Unlike tubal ligation, there is no cutting into the body, burning, or destruction of the fallopian tubes.

No going under general anesthesia

The Essure procedure can be performed in your doctor’s office without the need for general anesthesia.  Although some physicians may offer general anesthesia, this is not a requirement of the procedure.  You should discuss your options with your Essure physician.

No hormones

Unlike many temporary methods of birth control such as birth control pills, the patch, the ring and some IUDs, the Essure micro-inserts do not contain hormones so they will not interfere with your monthly cycle.

No guessing

Your doctor can confirm when you can rely on Essure for birth control.

No slowing down to recover

Most women return to their normal activities within one day.

Short procedure time

The Essure procedure only takes about 13 minutes* for an Essure trained physician to perform. Most women are on their way in an average of 45 minutes.

Covered by insurance

The Essure procedure is covered by most insurance providers.  If the procedure is performed in a doctor’s office, depending on the insurance plan, your payment may be as low as a simple co-pay.


FDA-approved and in use for over five years, the Essure procedure is 99.80% effective based on 4 years of follow-up, and is the only birth control method with zero pregnancies in clinical trials.

Risks of the Essure procedure

  • Perforation, expulsion, or other unsatisfactory location of the micro-insert
  • Pregnancy & theoretical increased risk of ectopic pregnancy
  • Risks associated with anesthesia
  • Pain, cramping, vaginal bleeding, menstrual pattern changes
  • Nausea/vomiting, or fainting
  • As with all procedures, there are risks associated with the Essure procedure – talk to one of our physicians if Essure is right for you.

Essure Procedure Video:

Watch Now!

Patient Information Booklet:

The Patient Information Booklet is a very detailed overview of the Essure procedure. Your physician should review this information with you thoroughly before you make an appointment to have the Essure procedure. Download >>

Essure Frequently Asked Questions

Essure Procedure Video:

This animated video provides an overview of how the Essure procedure is performed and how it works with your body to prevent pregnancy.

Essure Procedure Video.

Additional information about the Essure procedure is available at or by calling the Essure Information line at 1-877-ESSURE1.

Overactive Bladder

overactivebladderOveractive bladder (OAB) is characterized by the urgent and frequent need to urinate and being regularly wakened two or more times in the night by the need to urinate (nocturia). OAB may sometimes result in urinary in-continence, when the extreme urge to urinate can’t be controlled long enough to get to a toilet. This type of incontinence is called urge incontinence.

In people with an overactive bladder, the layered, smooth muscle that surrounds the bladder (detrusor muscle) contracts spasmodically, which results in sustained, high bladder pressure and the urgent need to urinate (called urgency). Normally, the detrusor muscle contracts and relaxes in response to the volume of urine in the bladder and the initiation of urination.

People with OAB often experience urgency at inconvenient and unpredictable times and sometimes lose control before reaching a toilet. Thus, overactive bladder interferes with work, daily routine, intimacy and sexual function; causes embarrassment; and can diminish self-esteem and quality of life. Overactive bladder is very common in older adults. Both men and women can have it, but it’s more common in women.

Overactive bladder can cause other problems too. Hurrying to the bathroom can lead to falls and broken bones, especially in women who have gone through menopause. That’s because older women are more likely to have brittle bones that break easily. In both men and women, overactive bladder can cause sleeping problems, depression, and urinary tract infections.


Involuntary contractions (spasms) of the bladder muscle cause the associated symptoms of OAB. In many cases, there is no identifiable cause for these contractions. But there are a number of factors that have been found to contribute to OAB. These include: bladder infection, abdominal or pelvic trauma, bladder stones, bladder cancer or prostate cancer, or another medical problem.

Some brain problems, such as Parkinson’s disease or a stroke, can also lead to overactive bladder. Some medications can cause symptoms that mimic overactive bladder. Talk with your doctor about the medicines you’re taking to find out if they could be affecting your bladder, but don’t stop taking your medicine without the doctor’s OK.

The most common symptoms of OAB are:

  • Urinating more than eight times in a 24 hour period
  • Sudden and strong urges to urinate even if you have just gone to the bathroom
  • Taking trips to the bathroom only to urinate just a little bit each time
  • Leaking urine when you have the urge to urinate
  • Getting up two or more times a night to go to the bathroom
  • Uncontrollable urges to urinate that sometimes result in wetting accidents


While overactive bladder is more common as we age, it is not a normal part of aging and can affect anyone at any age. A complete medical history, including avoiding diary; a physical examination; and possibly one or more diagnostic procedures help the physician determine an appropriate treatment plan for overactive bladder.

Other tests may be ordered if your doctor thinks your symptoms could be caused by other problems, such as diabetes or prostate disease.

Medical History

The medical history includes information about bowel habits, patterns of urination and leakage (when, how often, how severe), and whether there is pain, discomfort, or straining when voiding. The patient’s history of illnesses, pelvic surgeries, pregnancies, and medications currently used also supply the physician with information relevant to making a diagnosis. In the elderly, a mental status evaluation and assessment of social and environmental factors may be performed.

Physical Examination

A physical examination includes a neurologic status evaluation and examination of the abdomen, rectum, genitals, and pelvis. The cough stress test, in which the patient coughs forcefully while the physician observes the urethra, allows observation of urine loss. Instantaneous leakage with coughing indicates a diagnosis of stress incontinence. Leakage that is delayed or persistent after the cough indicates urge incontinence.

The physical examination also helps the physician identify medical conditions that may be the cause of overactive bladder. For instance, poor reflexes or sensory responses may indicate a neurological disorder.


Examination of the urine may identify medical conditions associated with overactive bladder, such as the following:

  • Bacteriuria-presence of bacteria in urine; indicates infection
  • Glycosuria-excess glucose in urine; may indicate diabetes
  • Hematuria-blood in urine; may indicate kidney disease, stone disease or bladder cancer
  • Proteinuria-excess protein in urine; may indicate kidney disease, cardiac disease, blood disease
  • Pyuria-presence of pus in urine; indicates infection or inflammation


This simultaneously measures intra-abdominal, total bladder, and true detrusor (bladder muscle) pressures. This allows involuntary detrusor contractions to be distinguished from increased intra-abdominal pressure. The voiding cystometrogram detects outlet obstruction in patients who are able to void.


Identifies abnormal voiding patterns. In a simple uroflowmetry, typically a stop watch is used to measure the amount of time a patient needs to urinate into a calibrated vessel. The doctor then assesses the ratio. In a complex uroflowmetry, electronic equipment is used to record the volume of urine and elapsed time. The physician then assesses the ratio.

Bladder Stress Test

To see whether you’re leaking urine, your doctor might do a bladder stress test, which consists of filling your bladder with fluid and then asking you to cough.


If your urinalysis reveals blood in your urine, if you have frequent urinary tract infections or if your doctor is contemplating surgery for you,a cystoscopy might be scheduled. In this procedure a thin, lighted instrument called a cystoscope is used to evaluate the lining of the urethra, bladder, and prostate (in men). The cystoscope is inserted into your urethra and slowly advanced into the bladder, allowing the doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be inserted through the cystoscope that allows the doctor to remove samples of tissue (biopsy) or samples of urine. Small bladder stones and some small growths can be removed during cystoscopy. This may eliminate the need for more extensive surgery.

Urodynamic Testing

Cystometry may be used to measure the anatomic and functional status of the bladder and urethra. The cystometer is an instrument that measures the pressure and capacity of the bladder; thus evaluating the function of the detrusor muscle (the muscle surrounding the bladder).

TreatmentBladder Training with Timed Voiding

This treatment is used for urge and overflow incontinence. The patient keeps a voiding diary of all episodes of urination and leaking, and the physician analyzes the chart and identifies the pattern of urination. The patient uses this timetable to plan when to empty the bladder to avoid accidental leakage. In bladder training, biofeedback and Kegel exercise help the patient resist the sensation of urgency, postpone urination, and urinate according to the timetable.

Bladder Training

The most common OAB treatment that doesn’t involve medication is bladder training. This helps change the way you use the bathroom. Instead of going whenever you feel the urge, you urinate at set times of the day, called scheduled voiding. You learn to control the urge to go by waiting – for a few minutes at first, then gradually increasing to an hour or more between bathroom visits.

Pelvic Floor Exercises

You can use a type of exercise called “Kegels” to strengthen the pelvic floor muscles that control urination. When doing Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. A special form of training called biofeedback can help you locate the right muscles to squeeze. It helps to start with just a few Kegel exercises at a time, and gradually work your way up to three sets of 10. Another method for strengthening pelvic floor muscles is electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum. While this sounds unpleasant, there is no pain associated with this therapy.

Weighted Cones

Another technique that can strengthen the pelvis and bladder muscles is the use of weighted cones. The tampon-shaped cone is inserted into the vagina and held there by contracting your pelvic muscles. As your muscles strengthen, the weight of the cone is gradually increased. This helps improve your ability to hold urine until you get to a bathroom. While pelvic exercises often help, the mainstay of OAB treatment is the use of medications called anticholinergics.

Drugs for Overactive Bladder

With OAB an inappropriate signal from our nervous system causing the muscles in the bladder wall to contract and release urine at the wrong time. Medications called anticholinergics can combat this problem by blocking the nerve signals and reducing bladder muscle contractions. They relax the smooth muscle of the bladder, reducing detrusor muscle contraction and subsequent urgency, frequency and urge incontinence (wetting accidents).

Elimination and Challenge DietBladder control problems that are not the result of neurological damage, poor muscle tone, or hormone deficiencies may result from irritability within the bladder or urethral tissues caused by chronic inflammation and/or food sensitivities. An elimination and challenge diet can help determine a food sensitivity.

Until you get your overactive bladder under control, wearing absorbent pads can help hide any leakage that occurs.

Some other helpful tips for preventing urge incontinence include going to the bathroom on a regular basis, especially before physical activity, avoiding drinking caffeine or a lot of fluids before activities not drinking any fluids right before you go to bed, and avoiding lifting heavy objects.