Morcellators in Laparoscopic Surgery

In Blog, Cancer, Gynecology, Surgical Procedures by Dr. Gary Goldman

Morcellators cut tissue into smaller pieces which can be removed through the tiny incisions made during laparoscopic surgery. The advantage of using this tool is obvious: smaller incisions equates with faster hospital stays, better cosmetics, less pain, fewer wound complications and quicker return to work. But like all surgery, there are risks, one of which is spread of an occult malignancy of the uterus called a sarcoma. Sarcoma’s account for 1/350 – 1/1,000 fibroids, which are the much more common benign growths found in the uterus. Unfortunately, sarcomas and fibroids cannot be differentiated pre-operatively. The FDA “discouraged” use of morcellators …

Routine Mammogram Recommendations

In Blog, Breast Cancer, Cancer, Gynecology by Dr. Gary Goldman

Mammograms – a hot topic for discussion. Today let’s begin with timing: when should a woman get her first mammogram? The US Preventive Services Task Force suggested last year that the baseline study should be done at age 50, conflicting with the recommendations of the American Cancer Society and most other groups, which all recommend starting at age 40. One recent study concurs with the 40 year old baseline, pointing out that about half the breast cancer deaths occur in women below the age of 50, and 71% of them had never had a mammogram. Read more here: https://www.doximity.com/doc_news/feeds/4243#entries/756881

Hot Flashes from Hell!

In Blog, Gynecology, Menopause by Dr. Gary Goldman

“OMG – not another Hot Flash! Will they ever stop? Please – help me make them stop!” This is the beginning of a very common conversation in my office. Until about 10 years ago, many women used post-menopausal estrogens, which really helped, so this was a less common complaint. Then came the publication of the Women’s Health Initiative in 2003, which pointed out the increased rate of heart attacks, strokes and breast cancer in women who used estrogens. While there are valid criticisms of this study, the fact remains that many women have chosen not to use estrogens – and …

Libido: Easy Come, Easy Go.

In Blog, Gynecology, Integrative Medicine, Menopause, Sexuality by Dr. Gary Goldman

“Where did my libido go? I used to be horny, but now, not so much.” This is a very common concern in my office, and is sometimes associated with pregnancy, early parenting, or menopause… and sometimes with any other time of your life. Rodent libido is directly tied to circulating levels of testosterone, both in males and females. But humans are far more complex; testosterone levels in women do not clearly correlate with sex drive. Our brains can directly get us all revved up, or all revved down. Many of my patients are seeking an easy answer, a magic supplement …

The Tragedy of Ebola in Pregnancy

In Blog, Gynecology, Infections by Dr. Gary Goldman

The tragedy of Ebola in West Africa is particularly striking pregnant women. Due to the diminished activity of the immune system in pregnancy, these women may be even more susceptible to infection. As noted in the accompanying article, “during the H1N1 influenza pandemic in the United States, seventeen percent of infected pregnant women died; the mortality rate for the rest of the population was only 0.02 percent.” In a prior Ebola outbreak in 1995, 14 of 15 pregnant women infected died. Because pregnant women are assumed to have no hope, they are currently at the bottom of the triage list; …

Gardasil 9 Approved for More Effective Prevention of Cancers

In Blog, Cancer, Cervical Cancer, Gynecology, Infections by Dr. Gary Goldman

Last week, the Food and Drug Administration approved the new Gardasil 9 vaccine, for the prevention of various diseases caused by nine types of Human Papillomavirus (HPV). It is not yet available for clinical use but should be over the next several months. The prior vaccine Gardasil, which was approved in 2006, covered four types of HPV: the two ‘low-risk’ types 6 and 11, which account for 90% of genital warts, and the two ‘high-risk’ types 16 and 18, which account for 70% of cervical and some additional cancers. Gardasil 9 affords the same protection against those same four types, …

Vaginas Aren’t What They Used to Be…

In Blog, Gynecology, Menopause, Sexuality by Dr. Gary Goldman

Between Mother Nature and Father Time, from childbirth to menopause, vaginas are subject to trauma, aging, and dysfunction. Problems can be numerous: vaginal laxity, diminished lubrication, painful intercourse, difficulty in achieving orgasm, decreased orgasm intensity, urinary incontinence, and pouting labia. Our options have been limited and often less than satisfactory. From fair quality over-the-counter lubricants to hormonal therapy with the potential for long-term adverse side effects, from surgical procedures requiring general anesthesia and long, painful recuperation, to Kegel exercises with disappointing results, these options are typically met with an understandable lack of enthusiasm. Finally, we have an ideal option that …

A Screening Test for Ovarian Cancer – Finally on the Horizon!

In Blog, Cancer, Gynecology, Ovarian Cancer by Dr. Gary Goldman

In a stunning breakthrough, Dr. Martin Widschwendter recently described a blood test that can find early ovarian cancer, potentially helping to save numerous lives. As published in the December 22, 2017 issue of Genomic Medicine (https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-017-0500-7), Widschwendter has demonstrated that screening for abnormal fragments of altered DNA in circulating blood can find ovarian cancer up to two years before it is otherwise clinically detectable. In this report, Dr. Widschwendter and colleagues at University College London first found multiple altered (methylated) DNA fragments common to many tumor samples from high grade serous ovarian cancers – the most common form of ovarian cancer. …