Gynecologist Eases Discomfort, Educates

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Recent innovative surgical procedures and bioidentical hormone therapies have given females more options for the care and well-being of their bodies.

"I think half my job is education," said physician Cynthia Booth, Payson's only gynecologist and owner of Preferred Women's Care. "There is so much information out there that a lot of times women will get, not necessarily confused, but maybe overwhelmed."

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Payson's only OB GYN physician Cynthia Booth said that eating healthy and exercising properly are the two things women, or anyone, can do improve their overall health.

Whether your visit to Booth and nurse practitioner, JeanAnn Schwark is for a routine exam or to seek medical attention for a serious condition, you'll feel right at home.

In place of cold, white exam rooms, Booth's offices and patient rooms are painted in warm yellows and earth tones. Booth and Schwark store their medical supplies in wooden chests of drawers rather than sterile cabinets. The office is designed to keep patients feeling warm and cozy.

"Whenever there is a gynecological problem there is a lot of anxiety, so we try to make the whole thing as comfortable as we can," said Schwark.

One of the most common, and perhaps misunderstood gynecological conditions is pelvic organ prolapse. A University of Iowa study found that as many as nine out of 10 women will seek treatment for this condition before the age of 80.

Many women cross their legs when they feel a sneeze coming on, hoping to prevent a urine leak. This happens when the muscles of the pelvic floor no longer support the bladder, uterus and rectum. In layman's terms, prolapse is when gravity takes over and the bladder or other organs succumb to the laws of nature, creating urinary incontinence. Sneezing unexpectedly, coughing and even laughing can cause the bladder to leak.

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"Any teenager who has questions about birth control or pregnancy, if they are concerned about their own health, they can come and talk to us at any time," said nurse practitioner, JeanAnn Schwark.

"We have some great new urinary incontinence procedures that are all done down below with minimal risks to the patients and seem to work well," Booth said. "With regard to the prolapse, what we are doing is adding the use of mesh and tissue graft materials to help achieve a more permanent procedure because (the prolapse) tends to recur."

According to www.nursing center.com, urinary incontinence, or UI, seems to be more prevalent in Caucasian and Hispanic women. UI increases with age, and the number of children a woman has given birth to vaginally.

"Some people can't really help [prolapse] because it is in their genetics," said Booth. "The type of collagen that they have in their tissues doesn't really want to bind together well.

Preferred Women's Care also provides relief for perimenopausal and menopausal women. In a town where approximately 52 percent of the residents are women and 30 percent of those are over 50, a large part of Booth's practice includes prescribing hormone replacement therapies.

Bioidentical and transdermal hormones are the hot treatments for helping women deal with the symptoms of menopause.

"The term bioidentical means it is supposed to be the same as your biological hormones," Booth said. "So we are talking estrone, estrial, estrodial, progesterone. These are still all synthesized somewhere. Somebody manufactures them. What they do is put it in a compounding medium that can either be put into a pill and ingested or put into a cream and rubbed on. It is kind of a misnomer that it is just more natural. They aren't going out and grinding up the plants."

Transdermal hormones are applied to the skin, significantly lowering the required dosage because the medication doesn't pass through the cleansing processes of the liver first -- a process that lessens a drug's potency.

Endometrial libration is the latest refined technique Booth uses for women who bleed too heavy and too often and are finished with their child bearing years.

For this particular procedure Booth takes about 90 seconds; total operating room time is usually 15 minutes, done under a local block with sedation if the patient so desires.

Booth said she goes in through the cervix with a device that cauterizes the inside lining of the uterus, also known as the endometrium. After the procedure, the patient will no longer have periods, but if they do, bleeding is minimal.

"It saves a lot of older women hysterectomies," Booth said. "I can't tell you how many older women sit in my chair and when I ask them why they had their hysterectomy their reason was excessive bleeding."

In the past there were two options for a woman having a hysterectomy: a vaginal or an abdominal cut.

Laparoscopic-assisted vaginal hysterectomy has been around for some years according to Booth.

Now there is laparoscopic supercervical or "subtotal" hysterectomy.

It is a procedure where a doctor goes in laparascopically through the navel. The uterus, and possibly the fallopian tubes and ovaries, are removed through the little hole in the navel. The uterus is amputated off the cervix but the cervix is left intact so a woman would still need pap smears to check for cell abnormalities.

Booth said keeping the cervix intact helps women and men maintain sexual satisfaction. In most cases recovery is faster, and the risk of vaginal prolapse -- a weakness in the walls and support structures of the vagina -- is lessened.

The American College of Obstetricians and Gynecologists recommended in their October 2004 Green Journal that cervical cancer screening begin approximately three years after the onset of vaginal intercourse or no later than 21 years of age.

Pap smears are usually taken once a year during a woman's annual gynecological exam. The test was developed in 1943 by Dr. George Papanicolaou to detect cervical and uterine cancer.

Pap smears look for cellular abnormalities, specifically for the human papillomavirus -- HPV for short. The smears also tests for dysplasia -- the abnormal development of tissues, organs or cells.

"We used to see [HPV] and treat it," Booth said. "That was overkill. In truth the immune system most times can clear this by itself, especially in young women, teens and twenties, so we will follow it a lot of times as long as it is not to the point where it is a moderate or severe dysplasia."

Severe dysplasia occurs when precancerous cells show up. This condition requires prompt treatment.

For sexually active women using hormonal birth control like the patch or the pill, there is good news.

Women only need to menstruate four times a year instead of 12 because birth control causes the lining of the uterus to thin. Therefore it doesn't need to shed every month.

Here's how hormone-based birth control works: A woman takes or wears the birth control for three weeks.

After the third week, she stops taking the birth control and menstruates the fourth week.

According to Booth, new research indicates that taking the placebo for five days rather than a full week is safe.

If you can't get in to see Booth, make an appointment with Schwark. She can do basically everything Dr. Booth does with the exception of delivering babies because she is not a midwife.

"I take care of bleeding problems, menopause, birth control, obstetric visits, well-woman care, and a full range of gynecological problems," Schwark said.

Booth's general obstetrics and gynecological practice, Preferred Women's Care, PLLC, also has a little mix of infertility in there as well.

Booth received her medical degree from Creighton University in Nebraska in 1995.

She fulfilled her residency at St. Joseph's Hospital and Medical Center, and Maricopa Medical Center. She has been in practice for six years.

Booth became fascinated with her surgical specialty when she attended her first cesarean section.

"I thought about other surgical specialties to go into because I love surgery, but I kept going back to OB GYN because I love women's health care, I love women and I love obstetrics.

"I thought, if I was going to get up in the middle of the night all the time what would I really want to do?

"Delivering a baby is not a half bad thing."

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