A women’s health journey can certainly be complex and taking care of your health should be a priority. It should however also be an enjoyable one. Through expert guidance and compassionate care, we strive to find that perfect balance to make your journey as easy and stress-free as possible.

Abnormal Papsmears and HPV

The earliest microscopic change of the surface lining of the cervix is usually discovered by a screening test, called the papanicolau or “pap” smear. The purpose of this test is to detect potentially precancerous changes.

Two screening tests can help prevent cervical cancer or find it early:

  • The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
  • The HPV test looks for the virus (human papillomavirus) that can cause these cell changes.

How are the tests performed?

Both tests can be done in Dr Groenewald’s office. During the Pap test, Dr Groenewald will use a plastic or metal instrument, called a speculum, to widen your vagina. This helps to examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are then sent to a laboratory.

What do my results mean?

It can take as long as three weeks to receive your test results. If your test shows that something might not be normal, Dr Groenewald will contact you and figure out how best to follow up. There are many reasons why test results might not be normal. It usually does not mean you have cancer.

If your test results show cells that are not normal and may become cancer, Dr Groenewald will let you know if you need to be treated. In most cases, treatment prevents cervical cancer from developing. It is important to follow up with us right away to learn more about your test results and receive any treatment that may be needed.

Bleeding is classed as abnormal when it is between periods, after sex, after menopause etc. It can occur at any age, and some causes can be pregnancy, miscarriage, ectopic pregnancy etc.

What causes abnormal uterine bleeding?

Abnormal uterine bleeding can have many causes. They include the following:

  • Pregnancy
  • Miscarriage
  • Ectopic Pregnancy
  • Adenomyosis
  • Use of ssome birth control methods, such as an IUD or birth control
  • Infection of the uterus or cervix
  • Fibroids
  • Problems with blood clotting
  • Polyps
  • Endometrial hyperplasia
  • Certain types of cancer, such as of the uterus, cervix or vagina
  • Polycystic Ovary Syndrome (PCOS)

How is it diagnosed?

Dr Gary will ask you about your personal and family health history as well as your menstrual cycle. It may be helpful to keep track of your menstrual cycle before you visit. Note the dates, length and type (light, medium, heavy or spotting) of your bleeding on a calendar. You will then have a physical exam and maybe blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You may also have have test to see if you are pregnant.


Endometriosis is a hormonal and immune system disease in which cells similar to that which line the uterus (endometrium)grow outside the uterine cavity, most commonly on the membrane which lines the abdominal cavity, called the peritoneum.

What is Endometriosis and how commom is it?

Endometriosis is a condition in which a type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus. It occurs in about one in 10 women of reproductive age. It is more often diagnosed in women in their 30’s and 40’s.

What are the symptoms?

The most common symptoms of endometriosis is chronic pelvic pain,especially just before and during the menstrual period. Pain during sex. If its present on the bowel, pain during bowel movements can occur. If it affects the bladder, pain can occur during urination. Heavy menstrual bleeding is also another symptom, although many women may experience no symptoms at all.

How does Endometriosis cause problems?

Endometriosis implants respond to changes in estrogen, a female hormone. The implants may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.

Ovarian Cysts

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. They are quite common, can vary in size, and in most cases, are harmless.

What are the symptoms of ovarian cysts?

Most ovarian cysts are small and do not cause symptoms. Some may cause a dull or sharp ache in the abdomen and pain durng certain activities. Larger cysts may cause torsion (twisting) of the ovary that causes pain. Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.

How are they diagnosed?

An ovarian cyst may be found during a routine pelvic exm. If Dr Gary finds and enlarges ovary, tests may be recommened to provide more information:

  • Vaginal Ultrasound
  • Laparoscopy
  • Blood tests

How are ovarian cysts treated?

Combined hormonal birth control pills may be prescribed to treat some types of ovarian cysts. This treatment will not make cysts you already have go away, but it may reduce the risk of new cysts forming. If your cyst is large or causing symptoms, Dr Gary may suggest surgery. The extent and type of surgery that is needed depends on several factors:

  • Size and type of cyst
  • Your age
  • Your symptoms
  • Your desire to have children

Sometimes a cyst can be removed without having to remove the ovary. This surgery is called cysectomy. In other cases where the cyst is large, one or both ovaries may have to be removed.

Pelvic Organ Prolapse

What is pelvic organ prolapse?

This condition refers to the bulging or herniation of one or more pelvic organs into or out of the vagina. The pelvic organs consist of the uterus, vagina, bowel and bladder. Pelvic organ prolapse occurs when the muscles, ligaments and fascia (a network of supporting tissue) that hold these organs in their correct positions become weakened.

Symptoms include:

  • a heavy dragging feeling in the vagina or lower back
  • feeling of a lump in the vagina or outside the vagina
  • urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency or urgent desire to pass urine, and urinary stress incontinence
  • bowel symptoms, such as difficulty moving the bowel or a feeling of not emptying properly, or needing to press on the vaginal wall to empty the bowel
  • discomfort during sexual intercourse

What causes pelvic organs to prolapse?

The main cause is damage to the nerves, ligaments and muscles which support the pelvic organs and may result from
the following:

  • Pregnancy and childbirth are considered to be major factors leading to weakening of the vagina and its supports. Prolapse affects about one in three women who have had one or more children. A prolapse may occur during or shortly after a pregnancy or may take many years to develop. However, it is important to emphasize that only 1 out of 9 women (11%) will ever need surgery for prolapse in their lifetime
  • Aging and menopause may cause further weakening of the pelvic floor structures
  • Conditions that cause excessive pressure on the pelvic floor like obesity, chronic cough, chronic constipation,
    heavy lifting and straining
  • Some women may have an inherited risk for prolapse, while some diseases affect the strength of connective tissue e.g. Marfan syndrome and Ehlers-Danlos syndrome

Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders among women.  It has a diverse range of causes that are not entirely understood, but there is evidence that it is largely a genetic disease.

What are common signs and symptoms of polycystic ovary syndrome (PCOS)?

  • Common PCOS signs and symptoms include the following:
  • Irregular menstrual periods—Menstrual disorders can include absent periods, periods that occur infrequently or toofrequently, heavy periods,  or unpredictable periods.
  • Infertility —PCOS is one of the most common causes of female infertility.
  • Obesity—Up to 80% of women with PCOS are obese.
  • Excess hair growth on the face, chest, abdomen, or upper thighs—This condition, called hirsutism, affects more than 70% of women with PCOS.
  • Severe acne or acne that occurs after adolescence and does not respond to usual treatments
  • Oily skin
  • Patches of thickened, velvety, darkened skin called acanthosis nigricans
  • Multiple small cysts on the ovaries

What causes PCOS?

Although the cause of PCOS is not known, it appears that PCOS may be related to many different factors working together.These factors include insulin resistance, increased levels of hormones called androgens, and an irregular menstrual cycle.

Post Menopausal Bleeding

Menopause is defined as the absence of menstrual periods for 1 year. Most women experience this generally between ages 45 to 55 years of age. Any bleeding after menopause is abnormal and should be reported to your healthcare provider immediately for assessment.

How can I tell if bleeding is abnormal?

Any bleeding after menopause is abnormal and should be reported to your health care provider. Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause. A good rule to follow is to tell Dr Gary if you notice any of the following changes in your monthly cycle:

  • Very heavy bleeding
  • Bleeding that lasts longer than normal
  • Bleeding that occurs more often than every 3 weeks
  • Bleeding that occurs after sex or between periods

What are some of the common causes of abnormal bleeding?

  • Polyps—Polyps are usually noncancerous growths that develop from tissue similar to the endometrium, the tissue that lines the inside of the uterus. They either attach to the uterine wall or develop on the endometrial surface. They may cause irregular or heavy bleeding. Polyps also can grow on the cervix or inside the cervical canal. These polyps may cause bleeding after sex.
  • Endometrial atrophy—After menopause, the endometrium may become too thin as a result of low estrogen levels. This condition is called endometrial atrophy. As the lining thins, you may have abnormal bleeding.
  • Endometrial hyperplasia—In this condition, the lining of the uterus thickens. It can cause irregular or heavy bleeding. Endometrial hyperplasia most often is caused by excess estrogen without enough progesterone. In some cases, the cells of the lining become abnormal. This condition, called atypical hyperplasia, can lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Bleeding is the most common sign of endometrial cancer in women after menopause.

Urinary Tract Infections

Women are more prone to getting UTI’s due to their anatomy. During intercourse, bacteria near the vagina can get into the urethra, spreading through to the bladder, upper urinary tract and even the kidneys.

What are the signs of a UTI?

One sign is a strong urge to urinate that cannot be delayed (urgency). As urine flows, a sharp pain or burning, called dysuria, is felt in the urethra. The urge to urinate then returns minutes later (frequency). Soreness may be felt in the lower abdomen, in the back, or in the sides.

Other signs may show up in the urine. It may

  • have a strong odor
  • look cloudy
  • sometimes be tinged with blood

Blood in the urine may be caused by a UTI, but it also may be caused by other problems. Tell Dr Gary promptly if you see blood in your urine.
If the bacteria enter the ureters and spread to the kidneys, symptoms also may include

  • back pain
  • chills
  • fever
  • nausea
  • vomiting

If you have any of these symptoms, please call Dr Gary’s offices right away. Kidney infections are serious. They need to be treated promptly. Symptoms linked with a UTI, such as painful urination, can be caused by other problems (such as an infection of the vagina or vulva). Tests may be needed to confirm the diagnosis.

Uterine Fibroids

Uterine fibroids are non-cancerous growths of the uterus that often appear during childbearing years. Uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer.

What are uterine fibroids?

Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall, or attached to it by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.

What are symptoms of fibroids?

Fibroids may have the following symptoms:

  • Changes in menstruation
    • Longer, more frequent, or heavy menstrual periods
    • Menstrual pain (cramps)
    • Vaginal bleeding at times other than menstruation
    • Anemia (from blood loss)
  • Pain
    • In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
    • During sex
  • Pressure
    • Difficulty urinating or frequent urination
    • Constipation, rectal pain, or difficult bowel movements
    • Abdominal cramps
  • Enlarged uterus and abdomen
  • Miscarriages
  • Infertility

Fibroids also may cause no symptoms at all. Fibroids may be found during a routine pelvic exam or during tests for other problems.

Vaginal Infections

Vaginitis is an inflammation of the vagina which is caused by a change in the balance of the yeast and bacteria that normally link in the vagina. Factors such as the use of antibiotics, changes in hormone levels and sexual intercourse as the most common causes.

What can cause vaginitis?

A change in the balance of the yeast and bacteria that normally live in the vagina can result in vaginitis. This causes the lining of the vagina to become inflamed. Factors that can change the normal balance of the vagina include the following:

  • Use of antibiotics
  • Changes in hormone levels due to pregnancy, breastfeeding, or menopause
  • Douching
  • Spermicides
  • Sexual intercourse
  • Infection

How is vaginitis diagnosed?

To diagnose vaginitis, your health care provider will take a sample of the discharge from your vagina and look at it under a microscope. Dr Groenewald also may suggest other tests.

How is vaginitis treated?

Treatment will depend on the cause of the vaginitis. Treatment may be either with a pill or a cream or gel that is applied to the vagina.

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