Tag Archives: Gynecology

ASK DR NOVOA – How do you determine bra size?

I was surprised to find out that many ladies don’t know how a bra vs. cup size is measured. Well, here is a general way to determine the measurements.

WITH NO BRA ON, do the following:

  1. Wrap a tape measure around your body just under your armpits, around the upper part of your back. It should lay on your chest just above your breasts. Document the measurement in inches. If it is even, this is your band size. If the number is odd, add 1 to it to get your band size.

  2. Measure around your chest at the fullest point of your breasts. Make sure that the tape measure is laying flat around your entire body and does not sag in the back. Note this measurement in inches.

  3. Subtract your band measurement from Step 2 from the measurement in Step 1. The difference determines your cup size.

A difference of 0 to 0.5 inches corresponds to a AA; 1 inch to an A cup; 2 inches, B cup; 3 inches, C cup; 4 inches, D cup; 5 inches, DD or E cup; 6 inches, DDD or F cup; 7 inches, or G cup; 8 inches, or H; 9 inches or I cup; 10 inches or J.

If you want to have a breast augmentation, IN GENERAL, if you are a 36A: adding a saline implant of 300cc size increases you to a 36B; 400cc to a 36C; 500cc to a 36D; 600cc to a 36DD; 700cc to a 36DDD; 800cc to a 36G.

A great place to go to get an exact bra fitting is Dillard’s. They have a professional bra specialist that makes excellent recommendations.
And Yes, I do have patients who are 34-38 G to H sizes.

Hope this helps. 🙂

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ASK DR NOVOA – I use tampons when I am on my period. I had sex yesterday and I don’t remember if I left my tampon in. What are the risks of leaving a tampon or broken condom in by accident?

Leaving a tampon in place is not a rare event. Condoms fail or break in up to 20% of cases.

Leaving a foreign body in the vagina can produce severe irritation and infection. One of the most severe type of infection is called Toxic Shock Syndrome. The most common bacteria causing this infection are Staphylococcus aureus and Streptococcus pyogenes. They produce a toxin which can be fatal if a tampon is left in for too long.

Signs and symptoms can include a rash resembling a sunburn, high fever, low blood pressure, malaise and confusion. The vulva can become severely inflamed, red, swollen and tender to the touch. Other more dramatic evidence is a strong foul smelling yellowish-greenish discharge.

Treatment of either a retained condom or tampon involve the obvious removal of the foreign body followed by a vaginal wash and antibiotics.

The best way to handle this situation is not to wait and see what happens. Although it may be embarrassing, your gynecologist has seen these problems many times before and it is relatively fast and easy to treat these situations by your doctor.

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ASK DR NOVOA – What is Ella?

Ella can prevent conception when taken within 5 days of unprotected intercourse.

In comparison, Plan B should be taken within 3 days of unprotected intercourse.

Side effects of Ella, similar to those of Plan B, include: headache, nausea, abdominal pain, pain/discomfort during menstruation (dysmenorrhea), fatigue, and dizziness.

The drug should not be taken by women who are pregnant or nursing.

Similar to Plan B, Ella DOES NOT cause abortion, only the prevention of ovulation.

Plan B is available over the counter. Ella requires a prescription.

I would strongly recommend using either product if you have unprotected intercourse, forget to take your pill, or if the condom breaks, etc.

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ASK DR NOVOA – How many Erogenous Zones does a woman have?

There are 5 Erogenous Zones.

And for those men that don’t know what Erogenous means, shame on you! Anyway,

  1. The Mind: Without desire and arousal, it is very difficult for a woman to get excited enough to reach orgasm. Most would consider The Mind the most important which represents inherent compatibility.

  2. The Clitoris: You all should know what and where this is.

  3. The G-spot, or Grafenberg-Spot: It is located about 2-3 inches inside of the vagina at the 12 o’clock position if looking at the vaginal opening as a circular clock.

  4. The U-Spot: This is a small patch of sensitive tissue located just above and on either side of the urethral opening.

  5. The A-Spot: AFE-zone or Anterior Fornix Erogenous Zone. Also referred to as the Epicentre, this is a patch of sensitive tissue at the inner end of the vagina between the cervix and the bladder. If you can understand all these “Hot Spots”, you can appreciate why the female response is so complex and why it is important to take your time and appreciate the beauty of all women.

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ASK DR NOVOA – Is it possible to have an orgasm by doing exercises?


This phenomena is called CORERGASM, or Exercise Induced Orgasm (EIO) and is the ability to have an orgasm by doing core muscle exercises, including abdominal workouts, biking and spinning, lifting weights and climbing poles or ropes. It has been described in the literature as far back as the 1950’s in the famous Kinsey Report of 1953 and does not appear to be a rare event. This is interesting in that EIO is not sexual in nature and in fact women can often feel self-conscience about this level of stimulation in a public place.

The actual mechanism of affect appears to be, at least in the case of climbing poles or ropes, direct rhythmic pressure against the clitoris. The amount of stimulation needed to reach orgasm requires multiple sets or extended pressure, and not an automatic response.

Although research indicates that exercise can lead to orgasm without the help of sexual fantasies, it doesn’t tell us whether or not exercise can actually improve women’s sex lives. It can, however, allow a woman an opportunity to better understand her own natural feelings and experiences of orgasm.
Soooo, I don’t know quite how to end this one, except to say, see you at the Gym.

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ASK DR NOVOA – I was thinking about having Vaginal Rejuvenation Surgery. What exactly is a “normal size” down there?

The determination of “normal” is very broad. However, I usually make a recommendation based on the number of fingers that can be inserted into the vagina without producing pain. If the average man has a penis girth (circumference, thickness, etc…) of 5 inches, then the diameter is approximately 1.59 inches or 2 fingers wide. Most patients needing Vaginal Rejuvenation Surgery (VRS) can accommodate 4 fingers across or 3 inches in diameter without producing pain. As a comparison, a can of Coke is only 2 inches in diameter. Therefore, both the male and female partner can notice a significant level of relaxation making it difficult or impossible to reach orgasm. VRS can reduce the size of the vaginal opening to 1.50 inches. A more complex surgery, called Virginal Size Restoration Surgery (VSRS) can reduce the vaginal opening to 0.5 inches or slightly wider than a Sharpie Marker. When combined with Kegel exercises, a woman is able to significantly increase the level of compression or “squeezing” during intercourse, thus increasing the level of sensitivity. FYI, VRS and VSRS do not change the length of the vagina. This why there was no mention of length in my commentary. However, we have found that girth appears to be more important to most women rather than length, but that’s for another subject because penis enlargement cosmetic surgery has become very very popular.

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ASK DR NOVOA – I drank before I realized I was pregnant. Can this harm the baby?

Probably Not.

This is a very common question. Although alcohol is known to cause growth problems and mental retardation when the mother uses alcohol is excess (fetal alcohol syndrome), the exact amount needed to cause problems very early in pregnancy has not been determined. I go by the “All or None” philosophy. Either so much was used prior to the patient knowing that she was pregnant that it leads to a loss of the pregnancy (ALL) or no harm comes to the pregnancy (NONE).

Obviously, once you know your pregnant, you need to stop drinking, but I rarely see a problem when it is done prior to the first 6 weeks of pregnancy. In fact, drinking too much is usually how you got pregnant in the first place. 🙂

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ASK DR NOVOA – I sometimes leak a little bit of urine when I sneeze or cough. Is this normal?


What you are describing is Stress urinary incontinence (SUI) which is the accidental leakage of urine when you cough, laugh or sneeze. It is the most common form of urinary incontinence in women.
SUI occurs when your bladder neck sphincter, which acts like a valve to the bladder, allows for a loss of urine due to excessive pressure placed on it from pressure on the bladder. As a result, the sphincter opens slightly and allows a small amount of urine to leak out.

This means you can leak urine when you: (1)cough, laugh or sneeze (2) exercise (particularly jumping) (3) lift or do any movement that puts pressure on the bladder (4) have sex or an orgasm.

In severe cases even walking or getting up out of bed or a chair can cause leaking. You may also notice that SUI is worse during the week before your period.

It is estimated that 4% of all women suffer from this problem, but it increases to one in three between the ages of 35 and 60.

Stress urinary incontinence is rare in men, and is usually a result of injury or prostate surgery.

SUI is due to weakness in the sphincter muscle and the pelvic floor muscles that support the pelvis and abdomen. The following conditions have been linked to SUI.

  • Pregnancy: due to carry the extra weight of a baby and having a baby and uterus rest on the bladder.

  • Childbirth: Vaginal deliveries have a higher risk of causing SUI. The more deliveries and larger babies, the higher the risk.

  • Being overweight: Extra weight puts more pressure on the abdomen and bladder.

  • Hysterectomy: a hysterectomy is an operation where the uterus is removed. This operation can cause damage to the pelvic floor and associated nerves of the bladder.

  • Smoking: a chronic cough from smoking puts more pressure on the bladder.

  • Menopause: After menopause, estrogen levels decrease which may affect the strength of the bladder neck and uretrhra. Also, postmenopausal women are more likely to be overweight and have had a hysterectomy.

  • Inherited weakness of the pelvic floor muscles, although this is rare.

  • Medication can affect the pelvic floor. Examples are alpha-blockers used to treat high blood pressure, some antidepressants and sedatives, and some muscle-relaxant drugs.

Stress urinary incontinence is generally managed by non-drug methods such as:

  • lifestyle changes to reduce pressure on your bladder (stopping smoking, losing weight and watching fluid intake).

  • pelvic floor exercises – Kegel exercises, with or without vaginal cones/biofeedback

If these treatments don’t work, your doctor may recommend surgery such as:

  • bladder neck suspension or sling

  • collagen injections around the urethra (periurethral bulking injections)

  • implantation of an artificial urinary sphincter or sacral nerve stimulator

  • tension-free vaginal tape (TVT)

The key to determining whether or not there is a problem is if it bothers you. Although occasional “accidents” can and do occur, if it becomes a problem to you, then seek medical attention from your Gynecologist.

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ASK DR NOVOA – Why does sex decrease after marriage?

Wow, this one is complicated and has multiple parts to the answer.

The average number of times per week that most happily married couples have sex is 1-3 times per week. I have often heard people joke that the quickest way to stop having sex is to get married. As a gynecologist and sex educator, I often discuss this situation with my patients. I also try to address the fact that it only becomes a problem when one of the two, or both partners has a complaint about it. You have to remember that it is not about quantity; it is about quality. Some couples are very happy with having sex just a few times a week; while others are fine with just a few times a month.

The top 4 categories I have seen affecting one’s sex include: (1) Boredom (2) Relationship Problems (3) Exhaustion and (4) Medical . (1) Boredom- the same routine with the same partner over and over again is very common, especially when the relationship is a long standing one. Let’s face it, there are only so many tricks you can pull out of the hat and after a while, the audience has seen every trick and the Velveteen rabbit can end up looking just like a plain old raggedy white rabbit. (2) Relationship Problems- If you can’t stand your partner, its really hard to want to have sex with them and, of course, enjoy yourself. (3) Exhaustion- Being a wife/mother/income earner is now more common than not. This combination of energy draining responsibilities can sap the energy out of even the Energizer Bunny. (4) Medical- the sexual drive is affected by age, especially after age 35, as well as, hormonal imbalances or the use of drugs such as anti-depressants or anti-psychotics.

There is no specific recommendation to answer this question. But I recommend the following to my patients. First, have open and fair discussions about what you want with your partner and ask them to do the same. Next, experiment with new positions and locations and try fantasy role-playing. It’s ok to be a little crazy but don’t try anything illegal unless you are ready to get caught and end up on the local 6pm news and YouTube.com. Next, consider marriage counseling if there are been problems in the marriage, especially in cases of infidelity. Next, take some time off with your partner. A weekend would be good, but just one day a week is more convenient and acceptable. Consider the following. After working hard all week, get rid of the kids! Send them to the in-laws. Get them out of the house!!! On Friday, you and your Man should stay in and watch TV and cuddle and get the energy back in your batteries. It is not necessary to have sex, just relax and enjoy each others company. But on Saturday, LET THE GO TIMES ROLL!!!! With the house empty and your system recharged and no one in the house to hear your screams, get the trampolene out and pretend you are characters in the circus. Have fun, experiment and absolutely NO JUDGING. It doesn’t have to be perfect the first time you try this. Remember, no one is a perfect ice skater the first time around. Everybody falls and looks like a clown. But with a little practice, a lot of quality time, and soul-mate bonding, it can be better than winning the Super Bowl and going to Disneyland. Hell, you are already in Disney World. The last one, MEDICAL, you will need to take to your doctor about. I have used TESTOSTERONE on some of my patients with great results to improve their libido, intensity and frequency of orgasms. But some meds, like Zoloft and Paxil, can actually make it difficult or impossible to reach orgasm.

I could go on and on, but I hope these little pointers help to improve your sex life and increase your frequency after marriage from 1-3 per week to as often as you and your Man want.

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ASK DR NOVOA – What is your opinion about ROBOTIC SURGERY?

Robotic Surgery or Robotic Assisted Laparoscopic Surgery is, in my opinion, a technology looking for a surgical procedure. The da Vinci Robotic device is one of the newest technologies promoted as the next generation of superior technology offered to women for minimally invasive surgery. Unfortunately, I would have to disagree. Although the da Vinci is an excellent device for complex surgical procedures to include the management of cancer, in most uncomplicated surgical diagnoses, it is “over-kill”. The device generally requires more time to set up, longer operating room time, the placement of more trocar port sites, and is more expensive. In most cases, a well trained laparoscopic surgeon can perform most GYN surgical procedures with traditional laparoscopic techniques thus avoiding the placement of larger and more port sites which inevitably lead to more pain and more scarring. Also, most doctors performing da Vinci assisted procedures are still on a “learning curve” which can put patients at risk for complications. It makes me extremely angry when I see a patient come in for a consult after a da Vinci procedure and I have to tell her that she could have had the procedure done in the traditional manner with a better outcome. So, before deciding on a da Vinci procedure, go see an expert in laparoscopy who can do the procedure with fewer instruments with lower risks and less cost.

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