Vulvovaginal yeast infections are often characterized by itching, abnormal discharge, and irritation of genital tissue. These infections are most commonly caused by the fungus Candida, and are diagnosed via culture or microscopy. Chronic yeast infections can be challenging to cure, as effective treatment regimens are often complicated and may require a series of multiple medications.

Vulvar skin conditions are a collection of skin disorders that affect the external female genitalia. Itching is by far the most common symptom, but patients may also have pain with intercourse, burning with urination, or a sensation of rawness. It is common for vulvar skin disorders to be confused as sexually transmitted infections, so it is important that patients receive a thorough exam and biopsy to be correctly diagnosed. Treatment involves medication such as steroids or biologics, as well as lifestyle changes.

Pudendal neuralgia refers to nerve-related pain originating from the pudendal nerve. On the vulva, this pain is often felt around the clitoris and/or perineum, but can also manifest around the anus. Common causes include sacral trauma, pelvic floor spasms, childbirth, and straddle injuries that may occur from riding a bike or horse. Diagnosis is based off of clinical examination and treatments vary depending on the root cause of the pain.

There are many different causes of pain in the clitoris. Infection, trauma, and vascular issues, such as clitoral priapism (a persistent erection of the clitoris), can lead to debilitating discomfort. One such cause, clitoral adhesions, are common, and can result from an infection underneath the clitoral hood due to trapped debris such as pubic hair, dead skin cells, or toilet tissue. A thorough exam, often including vulvoscopy, is necessary to properly diagnose the root cause of clitoral pain. Treatment is based on removing the offending agent through surgery or medication.

Although some vaginal discharge is very normal, patients with excessive amounts of chronic vaginal discharge often complain that it affects their quality of life. This may be due to an abnormally strong odor, a sensation of irritation, or requiring consistent use of pads or liners. Possible causes include infections, hormonal changes, and certain medications. Treatment often requires microbial testing to determine if an infection is present, followed by dietary changes, supplements, or medications.

Vulvodynia and Vestibulodynia are painful conditions that affect the vulva and vaginal vestibule, respectively. They are often caused by hormonal, inflammatory, or nerve-related issues, and can be present for many years before patients seek care. Diagnosis is made with a thorough exam of the painful area, and often involves blood work and testing for bacterial infection. Treatment is dependent upon the underlying cause of the pain, and can include hormone therapy, topical nerve/pain medication, or surgery.

Lichenoid disorders of the vulva are a group of inflammatory skin conditions that often present with intense itching as well as changes to skin pigmentation. These include lichen simplex et chronicus (LSC), lichen sclerosus (LS), and lichen planus (LP). LSC is considered a type of eczema of the vulva, and while bothersome, is not life-threatening. LS and LP, on the other hand, can progress to cancer if not properly treated. As such, it is very important to have biopsy confirmation of the disease and treat aggressively with medication.

Vulvar itching can have numerous causes such as infections, inflammatory or allergic reactions, and nerve-related conditions. While the itching itself may be simply bothersome, the underlying condition may prove to be more serious. Thus, it is important to fully investigate the cause of the itching in order to make an accurate diagnosis and prescribe proper treatment.

Physiologic menopause is defined as the absence of regular periods for more than one year. Surgical menopause occurs when the ovaries are removed prior to the onset of physiologic menopause. It is very important to note that menopause is not a disease, though the associated symptoms can substantially impact quality of life. These symptoms commonly include hot flashes, night sweats, mood swings, and vaginal dryness. Treatment often takes the form of hormonal and non-hormonal medication, counseling, and dietary and lifestyle changes.

Primary Ovarian Insufficiency (POI) is an autoimmune disease that causes the onset of menopause prior to the age of 40. Previously known as Premature Ovarian Failure, or premature menopause, POI is often found in women who have additional autoimmune diseases, such as Lupus or Type-1 Diabetes. Symptoms are similar to physiologic menopause, and include hot flashes, mood swings, and vaginal dryness. Women experiencing POI should receive hormone therapy to reduce the occurrence of menopause-related complications such as osteoporosis, Alzheimer’s, dementia, and heart disease.

Insulin is a hormone that is produced in the pancreas in response to sugar (glucose).  When glucose levels rise, the pancreas releases insulin to help move glucose into cells, where it can be utilized for energy.  If there is too much insulin, however, insulin resistance can occur.  If this happens, glucose is pushed into a storage form for “a rainy day,” which leads to weight gain.  As this cycle continues, other complications of this inappropriate storage will occur, such as elevated cholesterol, high blood pressure, and eventually, the development of diabetes. 

At Haven Center, we customize a treatment plan for each patient depending on their goals and the severity of their condition.  We are fortunate to be able to offer two new drug therapies in our office that are specific for the treatment of insulin resistance.

Genitourinary Syndrome of Menopause (GSM) is a result of hormonal deficiencies in the female reproductive tract and surrounding tissue. Previously known as vulvovaginal atrophy, GSM is now the preferred name for a collection of symptoms including vaginal dryness, painful intercourse, recurrent vaginal infections, recurrent urinary tract infections, and regression or shortening of genital structures. Up to seventy-five percent of menopausal patients will experience symptoms associated with GSM which are often progressive in nature. Treatment includes either local or systemic hormone therapy, vaginal moisturizers, and lubricants.

Menstrual-related mood disorders such as Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD), encompass a wide variety of emotional health concerns that correlate with changes in the menstrual cycle. Symptoms of these conditions overlap and may include irritability, depression, anxiety, and fatigue. In the case of PMDD, however, they are often more severe, and patients may report suicidal or homicidal ideations. Both disorders demonstrate an improvement in symptoms after the onset of menses. Diagnosis is based off of a thorough history of symptoms as well as menstrual charting. Treatment is often centered around minimizing hormonal fluctuations, and can also include antidepressants and counseling.

In addition to world-class subspecialty care, we also provide exceptional routine gynecologic care at Haven Center.  We offer well-woman exams, Pap smears, and breast exams, as well as providing diagnosis and treatment for PCOS, endometriosis, abnormal bleeding, and more – all in a spa-like, comfortable environment.

According to the Gay and Lesbian Medical Association (GLMA.org) “studies show that lesbian, gay, bisexual, transgender and (LGBT) populations, in addition to having the same basic health needs as the general population, experience health disparities and barriers related to sexual orientation and/or gender identity or expression.” At the Haven Center, we are knowledgeable about and sensitive to the unique needs of the LGBTQ+ population. All patients at our clinic receive the same level of exceptional, affirming, inclusive, and respectful healthcare, regardless of sexual orientation or gender identity/expression.

Sexual medicine for patients who are undergoing, or who have completed, therapy for cancer is a very complex and often misunderstood practice. Not only is treatment data limited, but most patients and providers are unaware that many options exist to support healthy sexual functioning. Whereas previous generations of cancer survivors were told that they were no longer candidates for hormone therapy, new medications and treatments have been shown to be safe and effective in this population.

We recognize that past experiences may have a long-lasting effect on mental and physical well-being. Trauma is associated with many sexual conditions and may contribute to vulvovaginal disorders as well. As such, we utilize traumasensitive language and trauma-informed care principles throughout our practice.

At the Haven Center, we utilize multiple forms of analgesic therapy to reduce or eliminate pain associated with in-office procedures and routine gynecologic exams.  In addition to relieving discomfort, these tools can lower procedural anxiety as well.  With our nitrous oxide sedation system, we can provide rapid-onset pain and anxiety relief that clears the bloodstream within minutes, allowing our patients to drive themselves home after the procedure.  We also utilize numbing creams, distractionary techniques, and other modalities to improve the overall patient experience.

Pediatric and adolescent gynecology refers to the medical and surgical management of gynecologic concerns in patients under 18 years of age. It requires specialized evaluation and examination techniques to reduce the possibility of trauma associated with a gynecologic exam.  Not only is our office uniquely suited to ensure that even the youngest patients feel comfortable and receive the highest level of care, but we are the only gynecologic provider in the region to offer multiple forms of adjuvant pain and stress-relieving therapy.