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Common Questions

Common Questions

What are my Doctor’s Credentials?

Dr. Middleton is Board Certified by the American Board of Obstetrics and Gynecology (ABOG). We invite you to read her biography and watch the short video to get to learn more.

Most Commonly Asked Questions

FAQ - Obstetrics

How many weeks/months am I?

We measure pregnancy from the first day of your last period. [There are 40 weeks in the average pregnancy. So, assuming that you conceived two weeks after your period started, you are only actually pregnant for the last 38 of the 40 weeks]. When counting months, start from the conception date, not the period date. So, if you are ten weeks pregnant, you got pregnant eight weeks, or two months ago. If you did not get pregnant at the average time (you ovulated earlier or later than the 14th day), your due date will be based on the measurements from your first ultrasound.

We also commonly talk about “trimesters” (or thirds) of the pregnancy. The first trimester includes up to 13 weeks, the second trimester is 13-28 weeks, and the third trimester is 28 weeks until delivery.

When should I tell people that I am pregnant?

About 15% of diagnosed pregnancies end in miscarriage. The good news is that 85% don’t. In most cases of miscarriage, the embryo stops growing before the cardiac system is developed, and we never see a heartbeat on ultrasound. Once we see a heartbeat, the risk of miscarriage is much lower. If the baby has a heartbeat after 8 weeks from the last period, the risk of miscarriage is less than 5%. After 12 weeks, the risk is less than 1%. Many patients choose to wait to tell others about the pregnancy based on these statistics. This is a personal choice which depends on how you would feel about others knowing that you had a miscarriage if this should occur.

What/how much should I eat during pregnancy?

We need an average of only 300 extra calories daily during pregnancy (one bagel or ½ a deli sandwich). “Eating for two” will result in excessive weight gain. Most women will lose only 15-20 pounds in the first few weeks postpartum, with the rest stored as fat, so weight gain of 20-30 pounds is ideal (0-5 pounds in the first 12 weeks, and ½ pound-1 pound a week after that). Eat small frequent meals to avoid heartburn and hypoglycemia. Eat what you enjoy but make healthy choices and go easy on sugars and starches to prevent excessive weight gain and gestational diabetes.

Can I exercise?

Staying active is great for you and the baby. If you have an uncomplicated pregnancy, you can continue your current exercise regimen with a few modifications. When doing cardiovascular exercise (walking, running, biking, elliptical trainer), a good guideline is to keep your heart rate at a maximum of about 140 beats per minute. This will allow blood flow to go to the uterus and your large muscles. If you are working out with weights, modify exercises that require you to be flat on your back or your stomach after 12 weeks. Cut out abdominal exercises; they won’t be effective.
If you are not a regular exerciser, walk for 20-30 minutes 3-5 times a week. Also, consider a prenatal yoga or Pilates class.

What about sex?

Sex is safe in pregnancy unless you have complications such as bleeding, preterm contractions, or a low-lying placenta. While sex may make you have mild contractions, it will not make an otherwise healthy pregnant woman go into premature labor. Unless we tell you otherwise, continue your normal sexual practices if you want to.

Can I get my hair colored?

Hair color, including highlights, are safe during pregnancy. The portion of hair outside of the scalp is dead tissue and does not absorb anything into the bloodstream.

Can I paint my baby’s room?

Inhaling volatile paint fumes is not suitable for any human, pregnant or not. While regular casual exposure to paint does not cause birth defects, use good judgment if you are painting and make sure the room is well-ventilated.

Can I take a bath?

Exposure to very high temperatures (more than 103 degrees F) for long periods in baths, hot tubs, or saunas can increase the risk of spina bifida during the first two months of pregnancy. However, average temperature baths (98-101 degrees) are safe and can be very relaxing. If you are concerned, put a thermometer in your bathtub.

Can I travel?

If you have an uncomplicated pregnancy, it is safe to travel until you are likely to go into labor. We generally recommend staying close to home after 36 weeks, and not leaving the country in the third trimester (after 28 weeks) unless absolutely necessary. Flying is safe during pregnancy but may increase your risk for blood clots, so wear support hose on long flights and move about the cabin once an hour. On long road trips, make frequent rest stops to stretch your legs and maintain circulation.

What if I have a cat?

Outdoor cats can be exposed to Toxoplasmosis and pass this parasite to humans through feces. One could acquire it by changing the litter box of an infected cat. If your cat goes outside, have someone else change the litter box when you are pregnant, or wear gloves and wash your hands well. If your cat lives inside and only eats processed cat food, he/she cannot get the disease. Cuddling your cat is safe and will not expose you to the disease. Dogs are not affected. Toxoplasmosis can harm a developing fetus but is rarely seen in the USA.

Which vitamins and supplements should I take?

Folic acid is a B vitamin and has been shown to reduce the risk of spina bifida. 1 mg (1000 micrograms) is recommended during the month prior to pregnancy and for the first 2 months after conception to reduce this risk. More folic acid may be recommended if you have a personal or family history of spina bifida, including a prior affected child.
A prenatal vitamin is a general multivitamin with 800-1000 micrograms of folic acid, calcium, and iron. Most women continue their vitamins after the second month to help reduce anemia and make up for any imperfections in diet. However, if you are not anemic and eat a well-balanced diet, stopping prenatal vitamins at two months of pregnancy is acceptable.

Do I have to lie (sleep) on my side?

When we lay on our backs, the large blood vessels that run close to our spine can be compressed by the pregnant uterus. In the third trimester, this can decrease blood flow to the baby. At the same time, blood flow to your head will be decreased, and you may feel dizzy and lightheaded. While there is no evidence that lying on your back sometimes is harmful, blood flow to the baby will be maximized if you tilt your abdomen even slightly to the left or the right. Assuming you have a normal healthy heart, either the right side or the left is fine. Before the third trimester, most women can lie comfortably on their back as blood flow is not significantly affected.

Should I have the baby tested for Down’s syndrome and other diseases?

Several genetic tests will be discussed and recommended during your pregnancy. The American College of Ob/Gyn (ACOG) and the American College of Medical Genetics (ACMG) recommend genetic testing for all pregnant patients. During the first trimester, you will be offered a panel of fourteen genetic tests representing the most common inherited recessive diseases which could potentially affect your baby. 

Recessive diseases require one copy of the gene to come from each parent for the disease to be expressed. Carriers of a single copy of the gene are unaffected. Therefore, if your test is positive, we recommend testing your partner.

Is an ultrasound safe?

Obstetric ultrasound has been extensively studied and found to be safe for the baby. While no fetal harm has been found, current recommendations are to limit the use of ultrasound to that which is medically useful or necessary. In our office, this includes an average of 4 ultrasounds. These include an ultrasound performed at the first visit to confirm viability, an optional ultrasound for Down’s Syndrome screening at about 12 weeks, an optional ultrasound at about 16 weeks to establish gender, and a detailed ultrasound at 20-22 weeks to assess the baby’s anatomy, and an ultrasound for growth and fetal well-being at about 35 weeks.

Only any medically necessary ultrasounds are ordered later in pregnancy. A “4D” ultrasound is not medically necessary but may be chosen at 28-32 weeks to get a picture of the baby and preserve your memories. Since there is no evidence of harm, we are happy to recommend a 4-D ultrasound for you.

Can I go to the dentist?

Routine dental work is safe during pregnancy, and we encourage you to keep up with your normal dental health routine. Most dentists will require a note from us saying that the visit is safe, and we can give you a standardized letter to take to your visit. If you need extensive dental work, we can discuss the best options for medications with your dentist.

Where will I deliver?

We deliver only at The Woman’s Hospital of Texas (TWH), just south of the Texas Medical Center. TWH has a state-of-the-art labor and delivery facility. Anesthesia and neonatology services are in-house 24 hours a day, and all rooms are large and private with private bathrooms. TWH is unique in that it offers 1:1 nursing for labor patients, assuring the highest level of care. The hospital also has a high-level nursery, including a neonatal intensive care unit. They encourage “rooming in” so that you are not separated from your baby and provide a lactation consultant to assist you after delivery.

How do I register at the hospital and take a tour?

You can register online at The Woman’s Hospital website, click on “online pre-registration” (in the “patients and visitors” section). If you would like to schedule a tour or a class, the schedule can be found on the website under “patient education” (also in the “patients and visitors” section).

When will I deliver?

Most people deliver close to their due date (40 weeks from the last period). About 10% of women deliver before 37 weeks. It is more likely that you will go over your due date in the first pregnancy than in subsequent pregnancies. While it is sometimes safe to go as long as 2 weeks over the due date, we generally recommend induction by 41 weeks. If you have had a preterm (less than 37 weeks) delivery before, you are more likely to have another preterm delivery.

If you are planning a C-section, we generally will schedule it at about 39 weeks or 37 weeks if you have twins.

Who will deliver me?

You may be delivered by any of the doctors in our call group. Our doctors share a call schedule for nights and weekends, and each doctor is responsible for deliveries and surgeries at the hospital on one day of the week. If you would like to be sure that Dr. Middleton delivers you, she may offer induction at full term (on or after 39 weeks) on a day that she is on call.

How long will I stay in the hospital?

After an uncomplicated vaginal delivery, you can stay 24-48 hours. After an uncomplicated C-section, you may be ready to leave as soon as 48 hours or as long as 96 hours. We see most of our patients 2 weeks after a C-section and 6 weeks after a vaginal delivery.

Who will my baby’s doctor be?

You will need a pediatrician with privileges at The Woman’s Hospital of Texas to see your baby before discharge. If you do not have one already, we will recommend some excellent doctors for you to consider (look at the online form called “referral list”). Some patients like to meet and interview the doctor before delivery, or you may be comfortable meeting the doctor when he/she comes to see your baby in the hospital. After discharge, the first visits with the pediatrician are usually at 2 weeks of life, and you can make this appointment as soon as the baby is born.

Should I take a childbirth class?

If this is your first baby, you may want to take a childbirth class. While this is not required, it may help you to be more comfortable about what to expect. Most people take a class in the last 2-3 months of pregnancy. The hospital has a great childbirth class as well as many other educational opportunities that you can schedule by visiting The Woman’s Hospital and looking at the “patient education” (in the “patients and visitors” section). The childbirth class costs $65.00, includes a book, and is offered at various times of the week to suit your schedule.

Should I get an epidural?

This is a personal choice, but in our practice most patients opt for an epidural. Epidurals are a very safe and effective means of controlling the pain associated with childbirth. Complications from an epidural are extremely rare and often easily corrected (such as a severe headache). You do not have to make arrangements for an epidural before your delivery day. Anesthesiologists are available 24 hours a day to help you whenever you request their services.

Do I need a birth plan?

Some patients like to write a “wish list” of events that they hope to happen at the birth of their baby. While forming a written birth plan is optional, we generally do not recommend it. Instead, we feel that it is important to discuss your wishes with your physician so that she can make the other doctors in the practice aware if you have special requests and convey your wishes to the nursing staff at the hospital. We do our best to adhere to your plan within the boundaries of safety, knowing that the labor process is very dynamic and unpredictable, and unplanned events happen frequently. An important part of forming a birth plan is accepting that it may change and allowing your doctor to always make the best decisions for you and your baby during the labor process.

Can I deliver vaginally after a C-section?

Vaginal birth after C-section (VBAC) is offered, but only in the right patient. There is a 1% risk that when a mother is in labor with a C-section scar on the uterus, the scar could open up and expel the baby and the placenta into the mother’s abdomen. This is called a uterine rupture and is a catastrophic emergency that can result in the death or permanent disability of the baby, as well as serious complications for the mother, including severe blood loss and hysterectomy. As a mother myself, this 1% risk is too high when it comes to a baby’s safety, when not attempted in the right patient. After all, we go to enormous lengths to prevent much rarer events such as injury in a car accident (using car seats) or exposure to life-threatening illnesses (getting vaccinations), for example.

When will I get induced?

We cannot predict when a patient will have a medical need to be induced, such as high blood pressure, poor fetal growth, low amniotic fluid, or being more than a week past your due date. Your doctor will explain in detail why induction of labor is necessary if this should occur. The decision to induce labor results from a complex set of decisions, the endpoint of which is that the mother’s and/or baby’s health will be better with the baby on the outside than the inside. If we recommend a medically necessary induction, we expect your full cooperation, even if induction was not your desire.

Some patients may choose an “elective” induction which is not medically necessary but is timed to provide convenience for family members, work schedules, or to coincide with your doctor’s schedule. Elective inductions are scheduled at 39 weeks or more. They are generally only appropriate for patients who have had a baby before, as elective induction can potentially increase the risk of a C-section in first-time moms.

Will I have an episiotomy?

There is no evidence that routine episiotomies are beneficial, and we try to avoid them. At times your doctor may decide that it is safer to make a small episiotomy than to risk a large tear, but this decision is not made until the baby’s head is partially delivered. There are various factors that we cannot control, including the size of the baby and your body’s ability to stretch, which ultimately affect your ability to deliver without an episiotomy. It is less likely that you will have an episiotomy with each successive pregnancy.

Should I have my baby boy circumcised?

The American Academy of Pediatrics does not recommend circumcision for any medical reason. Still, many couples opt to have their baby boy circumcised for religious, cultural, or cosmetic reasons. If you decide to have your baby circumcised, we will call a urologist to perform the procedure with local anesthesia, usually on the day after birth.

Should I collect my baby’s cord blood?

Blood from your baby’s umbilical cord contains stem cells, which may be collected and stored after the baby’s birth. Stem cells have numerous current and possible future medical uses that warrant consideration. 

There is currently no public banking system, but you can pay a private company to store it for you. 

If you are interested in cord blood collection, visit the websites of Cord Blood Registry and Viacord to learn more. We can give you the necessary collection kits in our office if you decide to proceed. 

How do I prepare for breastfeeding?

In our experience, the best breastfeeding class comes when you have your baby in your arms. While physically preparing the breasts is unnecessary, you may want to mentally prepare by taking a breastfeeding class, which can be scheduled through The Woman’s Hospital under “patient education” (in the “patients and visitors” section). 

Most of our patients have found that the lactation consultant, in the hospital can get you off to a good start without any other preparation. If you need help after the baby is born, we can recommend a lactation consultant which can be arranged at home or at a location such as The Motherhood Center or A Woman’s Work. Information can be found on their websites at Motherhood Center or A Woman’s Work

Also, our doctors have a “standing prescription” at A Woman’s Work which will allow you to purchase some breastfeeding supplies tax-free.

When should I call the doctor? How do I contact my doctor in an emergency?

If you have a true emergency that cannot wait until the office reopens (if you are in labor, for example), our office number will prompt you to connect to an operator who will page the doctor on call. While we are always available in emergencies, we ask you to use your judgment and not disturb the doctors after hours with matters that can be dealt with the next business day.

It is always best to call if you are worried or not sure if you are in labor. If you feel that you need to go to the hospital at any time, please call us first so that the doctor on call can advise you and let the hospital know you are coming. During business hours, you can always email a nurse with non-urgent questions.

How does my insurance work?

Since every insurance plan is different, it is important that you understand the way your policy works. Before your first visit, our staff will check on your benefits and will be able to explain this to you when you arrive. Most insurance companies pay us for the prenatal care (about 13 visits) and the delivery in one lump sum after you deliver. Usually, you will have one co-pay for the whole package (the “global fee”). If you have visits unrelated to standard prenatal care, these will be additional charges to your insurance and will have additional co-pays. Tests such as ultrasounds are billed separately and have separate co-pays. Most policies have a deductible or patient portion you will be asked to pay before you deliver.

The hospital will bill your insurance separately, as will other doctors at the hospital, including the anesthesiologist and pediatrician. We offer in-office lab services. However, it is an independent business entity that will bill your insurance separately. Our Office Manager will meet with you in the first trimester to review your insurance benefits and answer any questions you may have.

What can I expect at my appointments?

If you have a normal pregnancy, your scheduled visits will be monthly until 30 weeks, then every 2 weeks until 36 weeks, then weekly until delivery. At each visit, we will record your weight and blood pressure, check your urine, listen to the baby’s heartbeat, and assess the baby’s growth.

We do our best to be on time, but occasionally the doctor is delayed due to unpredictable events. Bring a book to your appointments, as we cannot predict when this may happen. We will do our best to inform you of the delay if there is one.

Some appointments will include specific events as follows:

What if I have other questions?

Since you are seen frequently, write your questions down and bring them to your next appointment. If you have non-urgent questions which cannot wait until your next appointment, call or email us and you will get a reply by the end of the business day.

What medications can I take?

Please refer to our medication list at the end of this document to see safe choices for medications in pregnancy. If you need a medication that is not on the list, please email us during business hours for advice.

No medication is considered to be 100% safe for long-term use in pregnancy. Each medication carries risks and benefits. Therefore, it is recommended that you:

  1. Limit medication use unless you are severely impaired, or the medication is recommended by your doctor.
  2. Minimize the number of days or doses taken.

These medications are generally safe choices for:

  • Claritin
  • Allegra
  • Zyrtec
  • Flonase
  • Benadryl

Increase your fluids and rest. Report a fever over 101.0.

  • Tylenol Extra Strength
  • Tylenol
  • Mucinex DM.
  • Saline Nasal spray.
  • Robitussin DM, and/or Cough Drops

Increase fiber and fluids in your diet

  • Metamucil
  • Surfak
  • PeriColace
  • Fibercon
  • Milk of Magnesia
  • Miralax
  • Imodium A-D

Report any headache not relieved by Tylenol

  • Tylenol,

  • Extra Strength Tylenol

  • Acetaminophen

  • Maalox
  • Mylanta
  • Tums
  • Pepcid
  • Prilosec OTC
  • Prevacid
  • Nexium
  • Anusol Cream or Suppositories
  • Preparation H
  • Tucks
  • Witch Hazel
  • Dom Burrows soaks
  • Zovirax cream
  • Valtrex
  • Mylicon
  • Mylanta
  • Gas-X
  • Vitamin B6 (25 mg) 4 times a day
  • Ginger in any form
  • Unisom (will make you sleepy)
  • Dramamine for motion sickness
  • Cepacol Lozenges

  • Warm salt water for gargling

  • Chloraseptic throat spray

  • Tylenol for pain

  • Calamine lotion
  • Any topical steroid including hydrocortisone
  • Neosporin Ointment
  • Any benzoyl peroxide products


What does it mean when I am required to “fast” before my surgery?

In general, no food or drink is to be taken for at least eight hours before your hospital surgery. Most instructions indicate that nothing is to be taken by mouth after midnight on the night before the procedure. It is important to adhere to these guidelines to help prevent risk of complications such as vomiting during surgery.

What if I have medical conditions such as diabetes or high blood pressure?

We typically ask for a “Medical Clearance” from your doctor to ensure that you are in good health before surgery. We will also have you meet with our Anesthesia team prior to your surgery date to review your medications and health records.

Which of my medications should I stop taking, and which should I take the morning of my surgery?

Always make sure your medication list is updated every time you visit with us. (Especially all over the counter and herbal medications). Medications such as aspirin must be discontinued in advance, sometimes weeks before your scheduled surgery.

When you meet with the Anesthesia team during your preassessment visit, he or she will review which medications need to be held and which can be taken on the day of surgery. Please call our office PRIOR to your surgery date, if you have any questions or concerns.

What if I smoke? Do I really need to quit prior To surgery?

It is highly encouraged to quit smoking 2 to 6 weeks before surgery. Smoking may cause breathing problems during surgery and has been shown to delay the healing and recovery process.

What is the point of bowel prep?

In some cases, a laxative or enema is indicated to empty the bowels before surgery. Our nurses will review these instructions in detail with you. Please call our office if you have any questions.

I am sick the week of my surgery; do I need to cancel?

If you have any unexpected medical problems before your scheduled surgery, such as a fever, cold, cough, or flu, please contact the office immediately as your surgery may have to be rescheduled.

Post-Operation Questions

What effects will I feel from the general anesthesia after my surgery?

  • If you have had a general anesthetic, you may have a sore throat for the first 24 hours due to the airway placed in your windpipe.
  • Due to the sedation during surgery, you may experience dizziness, drowsiness, or lightheadedness.

How do I take care of my incision when I get home?

Try to keep your incision clean and dry. You may shower after 24 hours from your surgery. Do not soak or bathe.

Signs or symptoms to call the office about:

  • any redness or warmth around the incision
  • any drainage or pus from the incision
  • if the incision is starting to open
  • if the incision is exquisitely tender
  • if you have a fever

What can I eat when I get home?

You may return to a normal diet as quickly as you are comfortable doing so. If nauseated, start slowly with clear liquids (jello, tea, broth) and advance gradually to more solid foods. Typically, you will not be sent home unless you tolerate a regular diet. Once you are home, if you are not tolerating any food or water, call your doctor immediately.

What should my level of activity be when I go home?

In the first 24 hours after your surgery:

  • Do not drive or operate power equipment and do not engage in activities that require coordination for the ability to respond quickly. You may walk, ride in a car, or climb stairs after your surgery.
  • Rest the first day home. You may resume light activity the next day. You may feel weak or tired for a few days after your surgery. Increase your activity as tolerated.
  • Do not do any heavy lifting or vigorous exercise for
    • 1-2 weeks if you had a laparoscopy
    • 4-12 weeks if you had a hysterectomy or prolapse surgery, as directed by your surgeon
  • There are no restrictions on activity after a D&C or ablation.
  • You may drive when you can control the car thorougly and are not taking any narcotic pain medication.
  • Please abstain from sexual intercourse until your two-week follow-up appointment, where further activity instructions will be given.
  • No baths, hot tubs, or swimming are allowed until you see your doctor for your 2–3-week postoperative check. Showers are okay.
  • Activity such as walking can help bowel function return to normal and decreases the chance of postoperative blood clots.
  • Avoid tampon use until you see your doctor for your 2–3-week postoperative visit. No touching.
  • You may return to work when you are released to do so by your surgeon.

Is vaginal bleeding normal after my surgery?

You will have some vaginal spotting or bleeding after your procedure.

When can I resume sexual intercourse?

  • If you had a colposcopy and a biopsy, you are advised to abstain from intercourse, tampon use, baths, and swimming for 1 week.
  • If you had a LEEP or cryotherapy, you are advised to abstain from intercourse, tampon use, bath, and swimming for 4 weeks. After a LEEP, avoid vigorous physical activity (heavy lifting, etc.) for 48 to 72 hours.
  • If you had a hysterectomy, you are advised to abstain from intercourse for at least 6 weeks but wait until you are instructed by your doctor.

I was given a prescription for more than one pain medicine. Which one should I take?

We typically will give you a prescription for a high dose Motrin and a narcotic (Tylenol #3 or Tramadol). If your pain is moderate, start with Motrin. Take as directed on the prescription bottle. If your pain is severe, you may take the second prescribed medication as directed on the bottle. If your pain is uncontrolled with both, please call the office to discuss further management with the doctor.

Things to remember – narcotics are constipating and may make your bowel movements painful. Please do not drive or drink alcoholic beverages while taking pain medication.

Why am I experiencing constipation after my surgery?

It may take some time for your bowels to normalize after major surgery. In addition, taking narcotics for pain medication can also add to constipation.

I have burning when I urinate, what should I do?

A burning sensation while urinating, frequency, or urgency are signs of a possible urinary tract infection. This type of infection is not uncommon after a surgery where a foley is placed into your bladder. Call our office to schedule an appointment. A urine sample will be collected, and you will be given antibiotics.

If you feel burning at the end of urination, you are probably experiencing bladder spasms. While this may happen after any surgery, it is most common after a hysterectomy. This usually improves gradually during the first several weeks after surgery. If you don’t have frequency, urgency, or burning, this is not a problem. However, if the discomfort is bothersome, you may try “AZO-standard” over the counter. If this does not offer enough relief, medications may be prescribed temporarily.

What will we be discussing at my follow up appointment?

After surgery, we like to see you back in the office between 1-2 weeks, depending on the type of surgery you underwent. At this time, we will review your recovery process and make sure you are on track. We will examine your incision and ensure there are no signs of infection. We will also let you know when you can resume normal activities.

What signs or symptoms are worrisome after my surgery?

  • Fever of 100.4°F or higher
  • Severe abdominal pain not being relieved by your pain medication. After laparoscopy, it is not unusual to have shoulder, chest, stomach, or lower abdominal pain for 2-5 days. Your pain medication should relieve this.
  • Persistent nausea and/or vomiting and cannot keep down fluids or food or experience diarrhea for more than 24-48 hours, or you do not have a bowel movement within 3-4 days of your surgery.
  • Bright red vaginal bleeding that soaks more than 2 pads in an hour and/or passing large/painful blood clots.
    Increased redness, swelling, or pain around any incision(s).
  • Pain with swelling, heat, or redness around an IV site.
  • Pain or tenderness and swelling in the legs, especially the back of the calf.
  • Difficulty urinating or having any signs of a urinary tract infection such as painful or frequent urination, urgency, foul odor, or low back pain.
  • Difficulty breathing, unusual shortness of breath, or chest pain.

If you have more questions, be sure to contact us right away at 832.615.1109.


When should I take my daughter to see the gynecologist for the first time?

The American College of OB/GYN recommends that girls have their first “reproductive health visit” sometime between the ages of 13-15, to start establishing care and evaluate pubertal development, growth, etc. However, if there is a problem or concern sooner, it is certainly appropriate to seek help at that time.

Will my daughter need a pelvic exam during her first visit to the gynecologist?

Mostly likely, no. The first visit to see the gynecologist is usually mostly talking to help girls and their parents understand if what they are experiencing is normal and to address anything concerning. It’s uncommon for me to need to perform an internal exam on my young teen patients.

What about testing for infections?

Often, any needed testing for infection can be done with a urine test or a small swab in the vagina.

What about a Pap smear?

Many people are not aware that we no longer recommend Pap smears (a screening test for cervical cancer) for anyone under the age of 21, so teenagers DO NOT need Pap smears!

What happens during the first visit to the gynecologist?

Mostly we spend time talking, usually together with parents, to address any concerns and answer questions. Then we do a physical exam that mostly involves just looking and, when ready, teaching girls about their anatomy, reassuring them about what is normal.

Will you talk to my daughter alone?

It depends on her comfort level. I always try to take some time to talk with the patient when her parents are not present, so she can feel comfortable discussing things that might be sensitive and to explain doctor-patient confidentiality. I always congratulate both girls and parents on taking the time for their first visit. It is a big step towards a young woman taking care of herself and a great opportunity for parents to discuss important and possibly uncomfortable values with their children.

Do you recommend the HPV (human papilloma virus) vaccine?

Absolutely! It’s a very effective cancer prevention strategy. In Australia, where much of the eligible population has been vaccinated, the rates of HPV-related diseases have dramatically decreased. They have experienced as much as a 93% drop in 6 years.

How common is HPV anyway?

Extremely common: almost everyone who is sexually active will be infected with some strain of the virus at some point in their lives.

What health problems are caused by HPV?

Genital warts (about 1 in 100 sexually active people will have them at any given time), abnormal Pap smears and cervical cancer are the most common problems (11,000 women are diagnosed with cervical cancer in the US every year).

Is the HPV-vaccine just for people who are sexually active?

No- the vaccine is much more effective if given in early adolescence before the chances of exposure to HPV is higher. Also, the immune response in a young person is much larger, and potentially longer lasting than the production of antibodies seen after vaccination in an adult.

At what age should girls and boys be getting the HPV vaccine?

Between the ages of 11 and 12 but as old as 46 to catch up the series of 3 vaccines is recommended.


How long is the Viveve treatment?

The non-invasive, low-risk procedure takes approximately 30 minutes to complete in our office.

How many treatments does it take to achieve results?

Only one treatment is needed compared to other procedures requiring two to four treatments.

What is Radiofrequency technology?

Radiofrequency (RF) technology has been used in medical applications for over 75 years. Systems based on radiofrequency have been successfully used for non-ablative skin rejuvenation, treatment of unwanted hair, atrophic scar revision, inflammatory acne, and vascular lesions. The radiofrequency device produces a heating of the collagen helix in the applied area, causing proteins to reform and rebuild.

Are there any side effects during or after the treatment?

Most women don’t experience any side effects during the procedure or afterward.

Is the treatment painful?

Most women experience a heating and cooling sensation during the treatment but usually no discomfort or pain.

Can I go back to work right after the treatment?

Yes. In most cases, you can return to normal activity immediately following your treatment.