Category Archives: Gynecology

Gynecological questions

Make Him Change or Donate to Goodwill

As an Gynecologist and Sexual Educator, I am often asked by my patients why they don’t enjoy sex or find it difficult or impossible to reach orgasm. After a physical examination and lab work, we discuss the problems they have with their partners or husbands. These types of problems are very common, affecting over 40% of women under the age of 40 and greater than 60% of women over the age of 40. Unfortunately ladies, the problem is not with you, it is with them. My best advice in order to fix an unsatisfactory love life is first to stop trying to change yourself for him and instead ask him to change for you. You will usually find that a man willing to listen to what you want in bed is usually the one you want to keep, and the man that thinks he is “God’s Gift” is the one you should “rewrap” and give to Goodwill. SINCERELY, DR. NOVOA

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Sexual and Reproductive Coercion

The American College of Obstetrics and Gynecology (ACOG) recently published a committee opinion discussing the subject of Sexual and Reproductive Coercion (SRC).

SRC is a pattern of physical violence or psychologically coercive behaviors intended to control a woman’s sexual decision making, contraceptive use, or pregnancy.

These behaviors are examples of intentional attempts of others, most commonly the male sexual partner, to control the sexual and reproductive rights of a woman.

The coercion includes contraceptive sabotage, where a patient’s partner intentionally hides birth control pills, refuses to wear a condom during intercourse, makes holes in condoms, or forcefully removing intrauterine devices or vaginal contraceptive rings in an attempt to get their partner pregnant against their will.

The coercion, however, may also include pressure from family and friends by embarassing or pressuring a woman through guilt or intimidation into having a child before the woman is ready. It also includes forcing a woman to have an abortion or termination of pregnancy.

Sexual and reproductive coercion is commonly associated with sexual and physical violence. One study involving adolescent mothers on public assistance reported birth control sabotage by over 50% of their dating partner.

Recommendations in order to assist patients at risk for sexual or reproductive coercion include (1) offering  hotline numbers and referrals to local domestic violence shelters and agencies, (2) offering long-acting methods of contraception less detectable to their partners such as the IUD, the Implanon or Depo Provera Injectable. (3) When using an IUD, trimming the string inside the cervix in order to prevent the partner from feeling the string or being able to pull the IUD out, (4) Provide Emergency Contraceptive (Plan B) pills and (5) Provide harm-reduction strategies and safety planning.

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What is too attractive?

Hi Ladies. This FYI for all you beautiful/attractive/sexy ladies that like to dress as attractively as possible when you go to work. The Iowa Supreme Court has upheld a defense of the firing of an employee by her employer because she was “irresistibly attractive” and threatened his marriage even though there was never any sexual harassment or flirtation going on.

Although the laws of Texas are different, employers can fire employees in Texas without cause. So consider the following article before going to work.

What is even more concerning is, What if the GIRLFRIEND doesn’t like you???? In this case, it was the WIFE and marriage, but what if its the girlfriend and someone he is just dating, or that he is just interested in you but has to fire you to avoid issues of sexual harassment????


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Filed under Blog, Cosmetics, Gynecology, Obstetrics, Questions of the Day

ASK DR NOVOA – I was recently pregnant but lost the baby. I didn’t believe my doctor so I repeated my pregnancy test about a week after the loss. The test says I am pregnant. Does this mean I am pregnant again?

No. I doubt that you are pregnant.

Both urine and blood pregnancy tests are extremely sensitive and can accurately determine if you are pregnant just a few days before your missed period.

The lowest level of HCG, which is the hormone of pregnancy that can be determined by home pregnancy tests is 20mIU/ml.

However, once pregnant, your level of HCG will double every 2-3 days. So after a few weeks, your HCG level can literally be greater than 10,000mIU/ml.

If there is a loss of a pregnancy, such as a miscarriage, HCG will no longer be produced, but you will continue to test positive on a pregnancy tests from 1-3 weeks depending on how high the HCG level reached.

Eventually HCG will no longer detectable since your body eliminates it just like any other hormone, but until this happens, you may not have a period or ovulate, so you need to realize that getting pregnant again may take a few months.

Therefore, it is best not to test for pregnancy after a miscarriage for at least a month after the loss in order to confuse you about being pregnant again.

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ASK DR NOVOA – I heard that there is a procedure that can stop me from having periods and can be done in the office. Is this true?


The procedure is called an endometrial ablation. The most common device used is called Novasure.

The procedure involves the placement of a small device in your uterus which produces an electrical charge and cauterizes (burns) the thin layer of tissue which procedures the menstrual flow each month.

The procedure takes approximately 2 minutes to do and is only done once. It can be done in the office. Down time is minimal and complications are rare.

It completely eliminates menstrual bleeding in approximately 80% of patients; significantly reduces menstrual bleeding in 10% of patients and has a failure (no changes in menstrual bleeding) in 10% of patients.

The procedure is not meant for women wishing to have children in the future. Although it can stop you from having your period forever, it is not considered to be a form of birth control and therefore, you should consider to have your tubes before, during or after having this procedure done.

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ASK DR NOVOA – I occasionally have this bad vaginal smell and discharge. I clean myself and am always self-conscience since I always think I have it. My Primary Care doctor said its BV. What is BV?

BV, represents Bacterial Vaginosis and is cause by a variety of bacteria in the vagina. What happens is that your vagina has a natural balance of bacteria and yeast. When there is a balance, the discharge is white or clear in color, has no smell and produces no discomfort. When you have too much bacteria, the discharge can be heavy yellow or greenish in color, can have a strong fishy or foul smell and can cause the area to be red, itchy and tender to the touch. When you have too much yeast, the discharge is heavy, white in color, have the consistency of cottage cheese, has no bad smell and may produce an itch.

Although not considered a sexually transmitted disease, BV can occur or worsen by having sex with a partner who has a heavy amount of natural bacteria themselves, especially uncircumsized men.

The treatment is usually easy. If it is the most common bacteria, Lactobacillus, your doctor may recommend either Flagyl or Cleocin.

You should never try to treat BV as if it is a yeast infection because it will make things worse.

BV can recur and if its does, you should ALWAYS see your GYN first because there are over 20 different organisms that can mimic BV. A simple culture test can identify the source of the infection and you can start to feel better after about 3 days with different medications.

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ASK DR NOVOA – I have heard that a woman can start crying or may even faint right after achieving an orgasm. I have never seen it happen. Is this possible?


Crying is very common with orgasm.

Fainting is not very common and in some circles very rare requiring a very high degree of arousal. This is why the French call Orgasm, “La Petite Morte” which means “the little death”. It is a reference to the refractory period following orgasm. The term has generally been interpreted to describe the post-orgasmic fainting spells or unconsciousness some lovers experience following orgasm.

Crying or fainting can usually be achieved by either vaginal or oral sex and is most commonly associated with male to female stimulation [Men Don’t Cry 🙂 ].

Fainting can be seen after one orgasm, but is more common when a combination of oral and vaginal penetration is maintained with stimulation continuing from one orgasm to another producing a “stair-step” level of stimulation until an orgasmic plateau is achieved lasting from a few seconds to up to 30 seconds. The techniques to achieve this are varied but are reproducible from one partner to the next.

So guys, this may be the only time that seeing a girl crying may be good. If she starts laughing, better go back to the drawing board. 🙂

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