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Obstetrics and gynecology (or obstetrics and gynecology; often abbreviated to OB/GYN, OBG, O&G or Obs & Gynae) are the two surgical-medical specialties dealing with the female reproductive organs in their pregnant and non-pregnant state, respectively, and as such are often combined to form a single medical specialty and postgraduate training program. This combined training prepares the practicing OB/GYN to be adept at the surgical management of the entire scope of clinical pathology (non-malignant) involving female reproductive organs, and to provide care for both pregnant and non-pregnant patients.1 An obstetrician-gynecologist, or ob-gyn, is a doctor who specializes in the care of women. He or she has completed special training in obstetrics, which is the care of pregnant women. This includes the preconception (before pregnancy) period, pregnancy, labor and childbirth, and after a baby is born. Ob-gyns are also trained in gynecology. Gynecology covers a woman’s general health care, including care of her reproductive organs, breasts, and reproductive health. Gynecology also includes management of hormonal disorders, treatment of infections, and training in surgery to correct or treat pelvic organ or urinary tract problems. Your ob-gyn also offers preventive health care. This can help you make informed choices that prevent health problems. Preventive health care includes exams and routine tests to detect problems early, before you become sick.  Since ob-gyns are trained to evaluate overall woman’s health, they provide care for a wide range of medical issues; much more than just pregnancy and problems of the reproductive system. For many women, the ob-gyn is their primary care physician-the doctor they turn to first for health care. All ob-gyns are graduates of college and an accredited medical school. Each must also complete an additional four-year course of special training called a residency in obstetrics and gynecology. This training equips the ob-gyn physician to provide general care to women, in addition to specialized care related to pregnancy and the reproductive organs. Following residency plus at least two additional years of practice, a doctor may apply for board certification by the American Board of Obstetrics and Gynecology. He or she must pass two tests to become board certified. The first is a written test covering both medical and surgical care. Passing this test demonstrates that the candidate has the necessary knowledge and skills to treat women. The second is an oral exam before a panel of national experts. This exam reviews the skills, knowledge and ability to treat different conditions, and includes a review of cases the candidate has treated during the preceding year.  An ACOG Fellow is a full member and all Fellows are board certified. Founded in 1951, ACOG has over 46,000 members and is the nation’s leading group of professionals providing health care for women. The organization also offers a range of educational programs to help doctors keep up with the latest advances in women’s healthcare.2

  1. http://en.wikipedia.org/wiki/Obstetrics_and_gynaecology
  2. This information is adapted from patient education information developed by the American College of Obstetricians and Gynecologists.

Menopausal symptoms can be managed by testosterone and sometimes estrogen pellet implant. Symptoms that can be relieved include : fatigue, hot flashes, insomnia , low sex drive, and bone loss. The pellets are made of bio-identical hormones and last four months.This therapy is also very effective during peri-menopause. It has been shown to be both safe and highly effective.

The term “NFP” or “Natural Family Planning” has long been used to describe healthy and ethical alternatives to contraception.  However, since the phrase “family planning” has essentially become a euphemism for contraception, the term “Fertility Awareness” is a more accurate term to describe these methods of avoiding pregnancy that are both highly effective and completely respectfully of all religious traditions’ teachings on marital love.

Despite the common misconceptions among those unfamiliar with the modern “Fertility Awareness Methods (FAM),” these approaches are highly effective. For example, they are at least as effective as birth control pills and far more effective than the highly promoted latex barrier methods.*  Best of all, it does not require that women have regular cycles and it has no harmful side effects whatsoever.

On the contrary, this method helps restore women’s reproductive health even when there are problems.  For example, if a woman has irregular cycles or abnormal bleeding, this type of charting is particularly useful for me as I work to determine the root cause of the problem.

*Hilgers TW and Stanford JB: The Use-Effectiveness to Avoid Pregnancy of the Creighton Model NaProEducation Technology: A Meta-Analysis of Prospective Trials. J Repro Med 43:495-502, June1998.

Natural hormone balancing is the science of using natural hormones to treat the  symptoms that come with the menstrual cycle or menopause. These include mood swings, fatigue, weight gain, abnormal periods, foggy thinking, sexual dysfunction and cycle related migraines.

Hormones are used that are identical to the ones a woman normally produces and are associated with better safety profiles than synthetic hormones. These hormones can be delivered by the oral, trans-dermal or subcutaneous pellet implant. Imbalances are detected by symptoms as well as laboratory testing of blood or saliva. Results from these treatments are often dramatic but are not universally successful. Hormone systems that can be evaluated include the female (estrogen/ progesterone/ testosterone) as well as the thyroid and adrenal.

We consider the development of the modern surgical robotic equipment to be one of the greatest advances in surgical technology.  It is a wonderful example of modern technology at the service of human individuals.  These surgical tools allow women to now have even complex surgeries completed laparoscopically that in the past would have required the much larger abdominal incisions of traditional abdominal surgery for such procedures as difficult hysterectomies, myomectomies (removal of fibroids), removal of extensive scar tissue, and removal of severe endometriosis.

For more information on da Vinci surgery in gynecologic surgery click here.

We believe deeply in the noble Hippocratic principle of “First, do no harm.” Accordingly, we always seek to avoid any unnecessary medications, interventions, or surgery.  When our patient’s condition does require surgery, we strive to perform this surgery in a safe manner that causes as little pain and scarring as possible.

Examples of  minimally invasive surgery (MIS) includes laparoscopic (“key-hole incisions”) surgeries, daVinci surgery (robot-assisted), hysterocopy (small scope through the cervix), and the latest state of the art single-incision procedures (more here).  The principle is limiting the number and size of incisions (if any) to the least and smallest necessary to safely complete the procedure.

The following are commonly cited advantages of MIS:

  • Smaller incisions
  • Less scarring
  • Less pain
  • Shorter hospital stay
  • Faster recovery
  • Early return to normal daily activities

The latest advance in the art of minimally invasive surgery (MIS) is that of laparoscopic procedures performed through one small incision in the umbilicus (“navel”).  This new technique has the advantage of a nearly invisible scar hidden in the wrinkles of the navel, less pain, and still the quick recovery characteristic of modern laparoscopic procedures.  Since these procedures are unique and difficult to learn, Dr. Cudihy is one of the few gynecologic surgeons in the region currently performing them.  He has used this technique in the past for such varied cases as hysterectomies, removal of abnormal ovaries, removal of endometriosis, and for treatment of ectopic pregnancy.  Not all patients are ideal candidates for this technique.  For more information call or send an inquiry here.

For more information on the non-robotic equipment Dr. Cudihy uses for Single-Incision Laparoscopy see the following link:
http://www.appliedmedical.com/References/ProceduralIndex.aspx
For more information on the newly developed DaVinci equipment Dr. Cudihy plans to use Single-Incision Laparoscopy see the following link:
http://www.intuitivesurgical.com/products/davinci_surgical_system/da-vinci-single-site/

Recent evidence supports the fact that tubal reversal surgery should be the first choice (instead of IVF) for those women hoping to get pregnant again despite having had a tubal sterilization.*

In order to make this procedure as painless as possible and to allow patients to go home the same day, Dr. Cudihy performs tubal reversal surgery using the DaVinci surgical (robotic) equipment laparoscopically.

Since we so strongly believe in the principle of restorative reproductive medicine and because insurance companies usually do not cover the cost of this surgery, Dr. Cudihy has made arrangements with Lafayette General Medical Center and the anesthesiology service to be able to offer this procedure with at least a 50% discount in cost for those who have to pay out of pocket.  Please contact our office for more details and exact pricing because this depends in part on how much, if any, your insurance might pay for.

*Hirshfeld-Cytron J, Winter J: Laparoscopic tubal reanastomosis versus in vitro fertilization: Cost-based decision analysis. Am J Obstet Gynecol 2013
(Jul);209:56.e1-6
[PMID 23583214]

We are sometimes asked “are there healthy alternatives to the pill for painful, heavy, and irregular menstrual cycles?”

Yes, there are much better alternatives to the pill for menstrual problems; and furthermore, the pill is not the best treatment for painful, heavy, or irregular cycles.

The best approach requires consideration of the various potential causes of the abnormal bleeding, and then determining what type of further evaluation (if any) might be needed to arrive at the appropriate diagnosis. Only after a proper diagnosis is made can the best treatment be applied.  Treatment might include medications such as natural hormones designed to work cooperatively with a woman’s cycles, or a minor surgical procedure to remove fibroids or polyps that are causing the problem.

Despite the recent trends of treating almost all menstrual problems “birth control pills;” since the underlying problem is never a deficiency of the artificial and dangerous hormones found in birth control pills, this is never the best long term treatment and only delays a true diagnosis and treatment for the actual problem.

When it comes to infertility, we advocate a concept described as “Restorative Reproductive Medicine,” or “RRM,” which has been used to describe an alternative approach to the more common practice of “Artificial Reproductive Technology,” aka “Assisted Reproductive Technology,”  or “ART. ”  The key difference is that with ART the process of sexual intercourse is bypassed either by artificial Insemination or fertilization of the oocytes in the Laboratory environment (i.e., in vitro fertilization)1; however, with a restorative reproductive medicine approach (RRM), we seek to diagnosis and the correct the cause of the couple’s infertility.  This approach has also been described by the term “NaProTechnology,” short for “Natural Procreative Technology.”

With RRM we use the very best of modern science and technology to restore fertility in a way that allows conception to occur in the privacy of marital intimacy rather than replacing such a sacred event with an impersonal medical procedure like artificial insemination or IVF with embryo transfer.

Restorative approaches often use a fertility Awareness (aka NFP) method of fertility monitoring as a foundation in evaluating a woman’s cycles.  Luteal Phase Defencies and Polycystic Ovarian Syndrome, are just two examples of common problems that can be corrected with this approach.  Frequently, surgical evaluations will find endometriosis as an important cause of infertility and associated pelvic pain. This holistic and restorative approach to infertility has been shown by many physicians to be as or more effective than ART/IVF without the exorbitant costs and serious medical risks to mother and baby.2-6

1. http://en.wikipedia.org/wiki/Assisted_reproductive_technology
2. Van Voorhis BJ (2007). “Clinical practice. In vitro fertilization”. N Engl J Med 356 (4): 379-86. PMID 17251534.
3.  Kurinczuk JJ, Hansen M, Bower C (2004). “The risk of birth defects in children born after assisted reproductive technologies”. Current Opinion in Obstetrics and Gynecology 16 (3): 201-9.PMID 15129049.
4. Hansen M, Bower C, Milne E, de Klerk N, Kurinczuk JJ (2005).”Assisted reproductive technologies and the risk of birth defects-a systematic review”. Hum Reprod 20 (2): 328-38. PMID 15567881.
5. Olson CK, Keppler-Noreuil KM, Romitti PA, Budelier WT, Ryan G, Sparks AE, Van Voorhis BJ (2005). “In vitro fertilization is associated with an increase in major birth defects”. Fertil Steril84 (5): 1308-15.PMID 16275219.
6. Zhang Y, Zhang YL, Feng C, et al. (September 2008). “Comparative proteomic analysis of human placenta derived from assisted reproductive technology”. Proteomics 8 (20): 4344-56.PMID 18792929

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