COMPREHENSIVE WOMEN’S HEALTHCARE

ANNUAL WELL WOMAN EXAM

Our once yearly visit screens for a variety of cancers including breast, ovarian, uterine, cervical and colon, and identify women who may be at a higher risk. It is also an opportunity to review health maintenance, discuss medications, and answer any questions you may have about your body and how it has been feeling over the past year. We also will listen to your heart and lungs, assess your neck, lymph nodes, and do an abdominal exam along with a pelvic exam. A Pap smear is a cervical cancer screening that is done during a pelvic exam, if needed. Your provider will take a small brush that sweeps across the cervix, located at the top of your vagina, collecting a small sample of cervical cells. These cells are sent off to the lab to be analyzed for cancer or precancerous changes, and our office will contact you with results and any next steps. You will also have a breast exam done by your provider annually prior to your mammogram. If you are premenopausal, we will discuss contraception options, hormones, and if you are postmenopausal, we will discuss symptoms and safe treatment options.

ONE STOP SHOP

We try to make Manatee Gynecology a one-stop-shop to meet all of your needs at one convenient location! You can also get a facial while you wait, or get those pesky unwanted hairs zapped right next door at our aesthetics spa. The day of your annual visit to the gynecology no longer needs to be dreadful! You can get a little happiness to reward yourself for taking care of your body. We commend you for staying healthy!

Contraception

Deciding what birth control is right for you can be intimidating. Our providers review the many options available and help you decide which one best suits your body and your goals. We offer prescriptions and placement of whatever you may choose, as well. We also offer permanent sterilization via surgical options.

We offer every kind of contraception out there with safety and your preferences as our number one priorities! Our Nurse Practitioners will be happy to assist you in making the choice that is right for you.

Fertility

A woman should consider fertility testing if she has been actively trying to get pregnant for 6 months to 1 year. Fertility testing helps identify the cause of infertility so that we can develop a treatment plan to give the woman her best chance at conceiving. We will perform a thorough history and physical exam, and come up with testing and a treatment plan that best suits your needs. This may include lab work, imaging, procedures, or medications.

Abnormal Uterine Bleeding

Abnormal uterine bleeding is a broad term that encompasses any bleeding coming from the uterus that is mistimed, too heavy or too light, prolonged, stopped, or changed. Here at Manatee Gynecology, we want to get to the root of the problem and treat the underlying cause. A third of women will experience abnormal uterine bleeding at some point in their lifetime, with most irregularities occurring at menarche and perimenopause.

Pelvic Pain Syndromes

Pelvic pain syndromes are severe enough to affect daily functioning and are unrelated to the menstrual cycle, pregnancy, or trauma. The pelvis is described as below the belly button and between the hips. Chronic pelvic pain affects nearly 20% of women ages 18-50, and can be caused by a number of different conditions. Such as Endometriosis, Pelvic Floor Hypertonicity, Interstitial Cystitis, IBS, Pelvic Congestion Syndrome, Pelvic Inflammatory Disease, Psychological Factors, and more. If you're unsure what may be the cause of your pelvic pain, please talk to your provider.

Endometriosis

Endometriosis is a condition in which tissue from the lining of your womb (uterus) grows outside your uterus. These deposits of tissue respond to your menstrual cycle, just as your uterine lining does — thickening, breaking down and bleeding each month as your hormone levels rise and fall. Because it's happening outside your uterus, the blood and tissue can't exit your body through your vagina. Instead, they remain in your abdomen, where they may lead to painful cysts and fibrous bands of scar tissue (adhesions). Endometriosis can only be officially diagnosed by laparoscopic surgery. Talk to your provider about Endometriosis to find out what can be done to identify Endometriosis or to treat a previously diagnosed Endometriosis.

Vaginal Infections / STI’s

Vaginitis, or vaginal infections can cause a woman a lot of stress and discomfort! Vaginal infections may be due to yeast or bacteria. We provide a wide array of testing to properly identify and treat your common, or not-so-common vaginal infections.

Screening for sexually transmitted infections (or STIs) can be done quickly in the office with either a vaginal swab or urine sample and blood tests can be ordered.

Urinary Tract Infections

A urinary tract infection is an infection in any part of the urinary system, including the kidneys, ureters, bladder, or urethra. UTI's typically require antibiotics for treatment. We also diagnose and treat UTI's typically on the same day or next day that you call the office. We also perform complete work ups for recurrent UTIs as well! Here at Manatee Gynecology, we like to focus on prevention of UTIs and can help identify ways to prevent UTIs.

Bladder Complaints / Prolapse

Bladder problems may be common, but they are not normal! Common bladder complaints that we hear are overactive bladder, stress incontinence, urge incontinence, urinary frequency, cloudy urine, blood in urine, weak stream, trouble starting urination or stopping urination, incomplete emptying, etc. We perform complete assessments of the bladder from physical exam to cystoscopy (looking inside the bladder with a camera). We also assess, diagnose, and treat bladder, rectal, and uterine prolapse. This occurs when the muscles and ligaments that support a woman's pelvic organs weaken, and the organs drop, creating a bulge in the vagina. This problem can manifest itself as pressure, pain, discomfort, incontinence, or constipation. Our surgeons provide surgical repair for many kinds of prolapse.

Vulvodynia

Vulvodynia is chronic pain or discomfort anywhere on the vulva that lasts more than 3 months without an identifiable cause. In some cases, vulvodynia may affect activities of daily life, such as sitting, standing, exercise, intercourse, etc. Treatment modalities differ with every patient, and there is no cookie-cutter approach to treatment. Talk with your provider if you're experiencing pain or discomfort on your vulva.

Vaginal Dryness

During menopause, the walls of the vaginal become thinner and do not produce as much lubrication which can cause dryness, painful intercourse, irritation, and itching. Vaginal dryness may also occur with different medications. At Manatee Gynecology, we offer an array of treatments for vaginal dryness, including nonhormonal and hormonal creams, inserts, vaginal rings, and suppositories, and we also use Mona Lisa Touch Laser.

Painful Intercourse

Painful intercourse, also known as dyspareunia, is defined as pain that occurs during or after intercourse. This can be caused by a variety of different things, such as dryness, trauma, psychosocial causes, hormone changes, musculoskeletal problems, etc. If you're experiencing painful intercourse, please let your provider know! We can help. Painful intercourse, also known as dyspareunia, is defined as pain that occurs during or after intercourse. This can be caused by a variety of different things, such as dryness, trauma, psychosocial causes, hormone changes, musculoskeletal problems, etc. If you're experiencing painful intercourse, please let your provider know!

You don't have to suffer! There can be multiple reasons for painful intercourse involving both the skin and muscles.

Pelvic Floor Hypertonicity

A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Many people with this experience pelvic health concerns such as constipation, painful intercourse, urinary frequency, and pelvic pain. A hypertonic pelvic floor may also be accompanied by tension in surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus, and hamstrings. Our providers are trained in identifying hypertonicity and will direct you in proper treatment.

Pelvic Floor Physical Therapy

Here at Manatee Gynecology, we offer pelvic floor physical therapy. Our Nurse Practitioners are highly trained in the pelvic floor and are here to help you with low or high-tone problems such as urinary symptoms, constipation, painful intercourse, etc.

Constipation

Constipation is infrequent bowel movements or difficult passage of stools that persists for several weeks or longer, typically defined as less than 3 BMs per week. The main cause of constipation is not eating enough fiber, such as fruits, vegetables, and cereals. A change in your routine of eating habits or ignoring the urge to pass stools can also lead to constipation. You could also have Dyssynergic Defecation which occurs when the pelvic floor muscles are unable to coordinate with the surrounding muscles and nerves to produce a normal bowel movement.We get into the details of why your anal sphincter isn't working the way it should. Don't be too shy to talk about your bowel movements. We are here to help you and offer you more than just a laxative. We offer testing and treatment to identify the cause and get you the help you need.

Breast COmplaints

Breast exams are always done at your annual exam as well as whenever you have a breast complaint. If you notice a breast lump, skin changes, nipple discharge, or breast pain, a thorough breast exam by a Medical Provider is appropriate. Breast problems can cause mental anguish. At Manatee Gynecology, we offer the convenience of breast imaging within the same building, and we can usually schedule mammograms and breast ultrasounds the same day as your appointment if we know in advance. This eliminates the worry that comes with waiting for a mammogram.

Your once yearly visit to screen for cancers, review health maintenance, discuss medications and answer questions can conveniently be coupled with your mammogram appointment, all in our state-of-the-art women’s facility on the same day. It is our goal to simplify the process for your wellbeing and increase conveniences for working women, mothers and grandmothers so you can continue to take care of your families or spend time with your friends. We understand you may be concerned and encourage you not to worry, we've got your back...and your front!

Bone Health

Osteoporosis is a bone disease that develops when the structure and strength of bone changes. This can lead to a decrease in bone strength that increases the risk of fractures. The body constantly absorbs and replaces bone tissue. With osteoporosis, new bone creation doesn't keep up with old bone removal. Many people have no symptoms until they have a bone fracture. Treatment includes diet, muscle building exercises, and medications to help prevent bone loss or strengthen already weak bones. We care about you and your bones! We offer DEXA Scans (a bone imaging test) right here in our building. Osteoporosis screening usually begins at menopause.

Weight Management

Weight management refers to behaviors, techniques, and physiological processes that contribute to a person's ability to attain and maintain a healthy weight. Most weight management techniques encompass long-term lifestyle strategies that promote healthy eating and daily physical activity. If you're struggling to lose weight, talk to your provider about what may be the cause, and what they can do to help!

HORMONE REPLACEMENT THERAPY

Hormone Replacement THerapy

Perimenopause and Menopause can be a very challenging time for women. Common symptoms include hot flashes, night sweats, mood changes, weight gain, low libido, painful intercourse, vaginal dryness, and many more. Relief is possible with a variety of both prescription and non-prescription treatment methods and lifestyle modifications. However, safety is our number one priority! We make sure that your mammograms are up to date, and there is nothing putting you at an increased risk with use of HRT.

Our providers help you navigate through the transition and educate you on what to expect. Dr. Marion Pandiscio and Sammie Billman, in particular, are passionate about caring for women experiencing menopause, and are members of the National Menopause Society. All of the providers at our office are highly trained and experienced in menopause treatment.

Don't suffer in silence! Let your provider know what you are feeling.

ADVANCED SURGICAL SERVICES

IN-HOSPITAL PROCEDURES

Our fellowship-trained surgeons are comfortable with minimally-invasive surgeries, utilizing the newest technologies, to treat complicated and serious gynecological conditions. We have a private operating suite in our office where we can perform many procedures, and we enjoy privileges at Blake Hospital. Just minutes from our office, Blake prioritizes laparoscopic and robotic surgeries, and furnishes state-of-the-art operating theaters.

Hysterectomy

Our surgeons perform hysterectomies using advanced laparoscopic and robotic techniques. A hysterectomy is a surgical procedure to remove the uterus. Hysterectomies are done when medically necessary amd may also involve removal of the cervix, ovaries, and fallopian tubes. Partial hysterectomies allow for hormone regulation by leaving the ovaries in place, while total hysterectomies do not. Dr. Desai completed a fellowship in Minimally Invasive Gynecological Surgery at the University of North Carolina, Chapel Hill where she further enhanced her skills in Laparoscopic and Robotic Surgery. If you're struggling with abnormal bleeding or pain, please talk with your provider at your appointment about what can be done!

Laparoscopy

Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. This minimally invasive procedure is used to aid in the diagnosis and treatment of disorders such as endometriosis, fibroids, cysts, ectopic pregnancy, sterilization, etc. Laparoscopic surgery may also be performed to remove tubes and ovaries for medically necessary problems or permanent sterilization.

Myomectomy / Acessa

A myomectomy is a surgical procedure to remove uterine fibroids. These common noncancerous growths appear in the uterus. Uterine fibroids usually develop during childbearing years. Although most women are not bothered by a fibroid, some women may experience pain or abnormal bleeding. With a myomectomy, the fibroid is removed and the uterus remains intact. The Acessa procedure uses laparoscopy radiofrequency ablation (energy as heat) to cause coagulative necrosis of the fibroid tissue. The treated tissue softens and shrinks over time, allowing fibroid symptoms to resolve without difficult and time consuming surgery. Our surgeons are trained and experienced in all methods of fibroid treatments!

A & P Repair (Colporrhaphy)

Anterior colporrhaphy (aka cystocele repair) tightens the vaginal wall overlying your bladder. Posterior colporrhaphy (aka rectocele repair) tightens the vaginal wall overlying the rectum. If you have a cystocele and/or rectocele, you may be a candidate for this outpatient procedure.

Dr. Pandiscio & Dr. Biggs both perform A&P Repairs.

Surgical Treatment for Urinary Incontinence

A sling procedure is a minimally invasive surgery designed to treat urinary incontinence. It involves placing a mesh sling under the urethra to provide support and prevent involuntary leakage of urine. This effective treatment helps restore confidence and improve quality of life for those struggling with urinary control issues.

Dr. Biggs performs sling procedures.

Labiaplasty

A labiaplasty is surgery to reduce the size of the labia minora, which are the flaps of skin at both sides of the vaginal opening. Labiaplasty has both functional and cosmetic benefits. Most women undergo surgery to reduce the excess labia which twists and turn and causes pain and irritation. If you're interested in this procedure, ask about a consult with Dr. Pandiscio!

IN-OFFICE PROCEDURES

Hysteroscopy

Hysteroscopy: Hysteroscopy is a procedure that allows your doctor to look directly inside of your uterus. It uses a hysteroscope, a long tube with a light and a camera on the end.

Polypectomy/Fibroids: Polyps are tissue growths that can occur all over the body. Sometimes polyps or firboids grow in the lining of the uterus or on the cervix and need to be removed.

All three of our physicians perform these procedures.

Ablation: (NovaSure) Looking for a cutting-edge way to treat heavy periods? This is an in-office procedure that treats heavy menstrual periods in just minutes by destroying the lining of your uterus - you can be free from your monthly bleeding!

Dilation & Curretage: A physician removes tissue from the lining of your uterus. This tissue is sent off for biopsy to help diagnose causes of certain gynecological problems such as abnormal vaginal bleeding.

The MyoSure® tissue removal procedure is a hysteroscopic treatment designed to remove uterine tissue, including fibroids and polyps. The simplicity of this technique allows women to alleviate heavy periods, frequent urination, and other abnormal uterine symptoms without having to undergo major surgery. MyoSure leaves the uterus intact!

Cystoscopy

A cystoscopy is a procedure to look inside the bladder using a thin camera called a cystoscope. A cystoscope is inserted into the urethra (the tube that carries pee out of the body) and passed into the bladder to allow the doctor to see inside. A cystoscopy is performed to check for the cause of problems such as blood in your urine, frequent urinary tract infections (UTIs), problems peeing, etc.

Dr. Desai & Dr. Biggs perform this procedure right here in the surgical suite in our office! It's a quick procedure that does not require anesthesia.

LONG-acting reversible contraception

IUD: Interested in a long-acting and reversible option for pregnancy protection? An Intrauterine Device (IUD) may be the way to go. An IUD is a small T-shaped device that sits in your uterus and works in a variety of ways to protect you from pregnancy, and helps women who struggle with heavy and excessively painful periods. This can be inserted by one of our providers during a quick office visit, and removed just as easily.

We don't want you to suffer through an IUD insertion. They're uncomfortable enough as it is, we want to make it easier on you! We offer Ibuprofen or Intramuscular Toradol Injections, Cytotec to dilate and soften the cervix, use of a heating pad among others. We also offer an option for oral anti-anxiety medication and in-office sedation if necessary. Your comfort and pain free procedures are important to us!

Nexplanon: This hormone-releasing implant is the most effective birth control method available today. Placed in our office, the matchstick sized rod is inserted just under the skin in the upper inner arm for 3 years of worry free, long acting pregnancy protection.

Endometrial biopsy

A biopsy of tissue from the lining of the uterus is used to evaluate abnormal bleeding. It can be performed by any of the providers in our office, and does not require sedation.

VUlvar Care

Vulvoscopy: A vulvoscopy looks at the vulva under a microscope to identify disease that may not be able to be seen by the naked eye.

A vulvar biopsy is performed using local anesthesia to send the sample to the lab for testing. All of the providers in our office can perform this procedure!

Cervical CAre

Colposcopy: A colposcopy, or “colpo”, is an examination of your cervix using a special microscope to identify any areas of unhealthy cells. One or more biopsies are usually taken during this procedure to confirm the level of cellular changes present.

Cryosurgery: A procedure that uses nitrogen gas that freezes and destroys precancerous cells on the cervix. After these unhealthy cells are destroyed, the body can replace them with new, healthy cells.

LEEP: A small electrical wire loop is used to remove the abnormal cells from your cervix during this in-office procedure, after your cervix has been numbed with a cervical block.

Cone Biopsy: Cone biopsy involves using a surgical knife (scalpel) to cut abnormal tissue from your cervix. The tissue is sent to a lab where a pathologist studies it for precancerous or cancerous cells. Cryosurgery and LEEP are done in office in our surgical suite under light sedation, Cone Biopsies, however, are done at the hospital.

Pudendal Nerve Block

A Pudendal Nerve block is a procedure to treat symptoms of genital, pelvic, tailbone, and/or rectal pain by blocking the nerve impulses. The pudendal nerve is located deep in the pelvis and follows a path that comes from the sacral area and later separates into three branches, one going to the rectal area, one to the perineum, and one to the clitoris. The leading cause of this problem is myofascial dysfunction. Indeed, hypertonic muscles (too tight muscles), myofascial trigger points, joint dysfunction, and connective tissue restrictions can cause pudendal nerve irritation and the symptoms of pudendal neuralgia: sharp, shooting, or burning pain in the territory of the nerve. Dr. Desai often uses Pudendal Nerve Blocks in conjunction with Pelvic Floor Physical Therapy.

Mona Lisa TOuch

This is a novel non-hormonal approach to managing distressing vaginal symptoms including painful intercourse, vaginal dryness, Lichen Sclerosus, and urinary incontinence. Mona Lisa Touch is a fractional CO2 laser for gynecologic use that delivers energy to tissue. It is a series of treatments with a state-of-the-art laser that is performed in our office to improve vascularization and connective tissue within the vagina and on the vulva. This laser is used for atrophy, Lichen Sclerosus, patches of white. It's an easy procedure with no downtime.

Dr. Desai, Dr. Pandiscio, and Sammie Billman currently perform Mona Lisa Touch.

SPECIALIZED UROGYNECOLOGY

Urodynamic studies

Bladder pressure, muscle function, flow rates, and other factors are analyzed in order to assist with developing a treatment plan.

Kaleigh Braden performs UDS testing.

Cystoscopy

A cystoscopy is a procedure to look inside the bladder using a thin camera called a cystoscope. A cystoscope is inserted into the urethra (the tube that carries pee out of the body) and passed into the bladder to allow the doctor to see inside. A cystoscopy is performed to check for the cause of problems such as blood in your urine, frequent urinary tract infections (UTIs), problems peeing, etc. Dr. Desai & Dr. Biggs perform this procedure right here in the surgical suite in our office! It's a quick procedure that does not require anesthesia.

Bladder Instillations

Bladder instillations or bladder cocktails are mixtures of medicines put directly into the bladder. The American Urological Association’s practice guideline for IC indicats bladder installations as a second-line treatment option when diet modification, stress management, and over-the-counter products are not enough. The solution is inserted into the bladder through a catheter. We ask patients to hold it for at least 20 minutes.

Dr. Desai & Kaleigh Braden perform bladder instillations.

Bladder Botox

Dr. Desai can inject Botox into your bladder to treat urge incontinence or overactive bladder. This helps the muscles relax, which will give you more time to get to the bathroom when you feel the need to urinate. Bladder Botox is not the first line treatment, but can be used if other treatments have failed. Bladder Botox is not a permanent solution, but results may last up to 6-9 months.

Post-tibial nerve stimulation

PTNS is a non-surgical treatment for overactive bladder. This treatment is delivered by an accupuncture needle that is placed in the ankle where the tibial nerve is located. When the tibial nerve is stimulated, impulses travel to the nerve roots in the spine to block abnormal signals from the bladder and prevent bladder spasms. This is a great option for those that have failed medications in the past! Talk to your provider about what your options may be.

Anorectal Manometry

Anorectal Manometry is a non-surgical diagnostic test performed to evaluate patients with bowel dysfunction like accidental bowel leakage or constipation. This test measures the pressures of the anal sphincter muscles, the sensation in the rectum, and the neural reflexes that are needed for normal bowel movements.

Kaleigh Braden performs ARM testing.

STATE-OF-THE-ART IMAGING

Imaging Department

As part of our commitment to offering comprehensive care for women, most scans or studies that are indicated based on your exam can be performed in our office. The luxury of having our own state-of-the-art imaging equipment is that you don’t leave our offices with a referral for imaging, which may take weeks to schedule. Instead, we are often able to schedule you right away, allowing us to begin diagnostic testing and quicker reach diagnosis and treatment.

If your provider noticed something on your breast exam, or you are having complaints, we offer same day breast imaging, when possible, so you don't have to wait and have to suffer from the mental anguish of the unknown!

ULTRASOUND

Sounds waves are used to create images of the pelvic structures, including the uterus and ovaries, along with breasts, kidneys, and other soft tissue areas. These images allow the physician to identify abnormalities or causes of symptoms.

BONE DENSITy TESTING

A DEXA scan is a specialized X-ray that is used to measure the density of bone. It usually takes measurements of the lower spine and both hips. This allows us to screen for and manage conditions due to low bone density, including Osteoporosis, which can put women at risk for bone fractures.

WELL WITHIN
SKIN & LASER CENTER

As an all-female team of medical providers who care exclusively for women’s most delicate and intimate health concerns, we distinctly understand that women are beautiful at all ages and respect aging as a natural process that we are blessed to experience. Well Within Skin and Laser Center is our NEW aesthetics wing, with state-of-the-art Cynosure Lasers, led by Dr. Kinnari Desai. We will make sure you look your best, so you can feel your best! At Well Within Skin and Laser Center, we focus on enhancing your natural beauty, not changing it. We embrace your uniqueness and want to help you stand out!