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To establish SaludMax as the leading medical group practice in the communities we serve, distinguished by the quality of medical care we provide and our commitment to the health of our patients.

To help everyone achieve lifelong well-being by providing accessible, comprehensive and quality health care

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Gynecologist Service

Pap smears are screening tests for cervical cancer. During the test, a swab is inserted into the vagina to collect cell samples. The cells are then sent to a lab for examination.
Pap smears have been instrumental in decreasing the number of cases of cervical cancer in the United States by detecting a precancerous condition called dysplasia. Dysplasia is an alteration in the skin of the cervix, vagina, vulva or anus that has the potential to progress to cancer if left untreated.

Dysplasia usually doesn't cause any symptoms, but it may be associated with abnormal bleeding or spotting.

Endometriosis is a condition in which tissue from the membrane that normally lines the uterus — the endometrium — grows outside the uterus, typically on the ovaries, fallopian tubes, intestines or other areas in the pelvis. This tissue acts just like the endometrium in accumulating blood in the monthly menses period, but it has no place to shed the blood at the end of the cycle. The accumulation of tissue and blood can cause inflammation and scarring, which can lead to other conditions, particularly pelvic pain and infertility. Blood trapped in the ovaries may develop into benign cysts called endometrioma.
Between 25 and 50 percent of infertile women are estimated to have endometriosis. Endometriosis affects more than one million women in the United States and at this time, the exact cause of the condition is unknown.

Typically, symptoms of endometriosis worsen over time. The severity of symptoms varies, and some women may not experience any symptoms at all. Symptoms may stop after menopause or during pregnancy, though they will return after the woman has the baby and begins menstruating again.
Common symptoms may include:

Pelvic pain and cramping before and during periods
Lower back and stomach pain during periods
Excessive bleeding during periods
Pelvic pain during intercourse
Fatigue
Diarrhea
Constipation
Nausea
Infertility
These symptoms can occur with other conditions. If you're experiencing any of these symptoms, see your doctor to determine the cause.

Urinary incontinence affects more than 13 million Americans, 85 percent of which are women. It is more common than most chronic conditions, affecting 25 percent of reproductive-aged women and 50 percent of postmenopausal women.

A number of factors may contribute to incontinence, including:

Childbirth, when tissues, muscles and nerves supporting the urethra may be damaged
Obesity
Hysterectomy, which increases the risk of incontinence by 30 to 40 percent
Recurrent urinary tract infections
Illness such as diabetes, lung disease or stroke
The most common types of incontinence are stress incontinence, urge incontinence (often called overactive bladder), or a combination of the two, called mixed incontinence.

Incontinence is not a normal part of the aging process, and there are a variety of treatments available. At UCSF, women with incontinence are treated at Female Pelvic Medicine and Reconstructive Surgery clinics. A leader in the field, the program was recognized as an exceptional national model in 2004 with the first annual Continence Care Champion award from the National Association for Continence.

Fibroids are round growths that develop in the uterus. They are almost always benign, or non-cancerous. Fibroids range in size from as small as a pea to as large as a melon. They are also called leiomyomas or myomas.
Fibroids are very common, affecting an estimated 20 to 50 percent of all women. They are most likely to affect women in their 30s and 40s, and for reasons we don't understand, occur more frequently in African-Americans. Many women with fibroids have family members who also have them.
Some fibroids grow steadily during the reproductive years, while others stay the same size for many years. All fibroids should stop growing after menopause. If your fibroids grow after menopause, you should consult your doctor.
Usually, fibroids cause no symptoms and don't require treatment. But if symptoms occur, you should seek medical attention.
Types of Fibroids
Fibroids can grow in different parts of the uterus:
Pedunculated fibroids are attached to the uterine wall by stalks.
Subserosal fibroids extend outward from the uterine wall.
Submucosal fibroids expand from the uterine wall into the uterine cavity.
Intramural fibroids develop within the uterine wall.
Different types of fibroids are associated with different symptoms. For example, submucosal fibroids typically cause heavy periods. In contrast, subserosal fibroids are more likely to push against the bladder, causing frequent urination.
Causes of Fibroids
Doctors and medical researchers do not know what causes fibroids to develop. There is evidence that the female hormones, estrogen and progesterone, can make them grow. During pregnancy, when the hormone levels are high, fibroids tend to increase in size. After menopause, when the hormone levels are low, fibroids stop growing and may become smaller.

Symptoms of fibroids may include: 

Heavy Vaginal Bleeding — Excessively heavy or prolonged menstrual bleeding is a common symptom. Women describe soaking through sanitary protection in less than an hour, passing blood clots and being unable to leave the house during the heaviest day of flow. As a result, some women develop anemia, also known as a low blood count. Anemia can cause fatigue, headaches and lightheadedness.
If heavy bleeding interferes with your everyday activities or if you develop anemia, you should see your doctor to discuss fibroid treatment options.

Pelvic Discomfort — Women with large fibroids may feel heaviness or pressure in their lower abdomen or pelvis. Often this is described as a vague discomfort rather than a sharp pain. Sometimes, the enlarged uterus makes it difficult to lie face down, bend over or exercise without discomfort.

Pelvic Pain — A less common symptom is acute, severe pain. This occurs when a fibroid goes through a process called degeneration. Usually, the pain is localized to a specific spot and improves on its own within two to four weeks. Using a pain reliever, such as ibuprofen, can decrease the pain significantly. However, chronic pelvic pain can also occur. This type of pain is usually mild but persistent and confined to a specific area.

Bladder Problems — The most common bladder symptom is needing to urinate frequently. A woman may wake up several times during the night to empty her bladder. Occasionally, women are unable to urinate despite a full bladder.
These symptoms are caused by fibroids pressing against the bladder, reducing its capacity for holding urine or blocking the outflow of urine. Treatment for bladder problems can provide great relief.

Low Back Pain — Rarely, fibroids press against the muscles and nerves of the lower back and cause back pain. A large fibroid on the back surface of the uterus is more likely to cause back pain than a small fibroid within the uterine wall. Because back pain is so common, it is important to look for other causes of the pain before attributing it to fibroids.

Rectal Pressure — Fibroids also can press against the rectum and cause a sensation of rectal fullness, difficulty having a bowel movement or pain with bowel movements. Sometimes, fibroids can lead to the development of a hemorrhoid.

Discomfort or Pain With Sexual Intercourse — Fibroids can make sexual intercourse painful or uncomfortable. The pain may occur only in specific positions or during certain times of the menstrual cycle. Discomfort during intercourse is a significant issue. If your doctor doesn't ask you about this symptom, make sure you mention it.

Menopause is a normal phase of a woman's life, one that more than 4,000 women enter each day. It is defined as the period in time when the ovaries cease functioning and menstrual periods stop. The production of hormones in a woman's body begins to decline, however, several years before the onset of menopause. You may also hear the term perimenopause or climacteric, which means the time from when menstrual periods start to diminish up to a year after the final menstrual period. In the United States the average age of menopause is 51.

In the past, menopause was often treated as an illness, a subject only talked about behind exam room doors. Today, women want to understand the physical changes that are happening to their bodies. They are seeking immediate relief for their menopausal symptoms, including hot flashes and vaginal dryness. They are also considering the impact of menopause on their risk of chronic disease and their long-term health.

There is abundant information available today for women facing questions about menopause, particularly questions about hormone replacement therapy. Unfortunately, much of this information, including information from medical research, can be confusing and difficult to interpret. UCSF Women's Health can provide individual consultation about menopausal issues including hormone replacement therapy. The Women's Health Resource Center can also provide written information for women who wish to read more on their own.

Common symptoms of menopause include:

Reduced fertility
Changes in menstrual periods
Hot flashes
Vaginal dryness
Insomnia
Emotional changes
Libido changes
Most of these symptoms will stop after menopause is completed.

However, menopause also increases the risk of contracting heart disease or osteoporosis, which continue after menopause is completed. Although not associated with menopause, cancer is associated with advancing age in women

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