wikiHow
wikiHow Staff:
Cool. So just as a first question, could you tell me a little bit more about your expertise and background?


Rebecca Levy-Gantt:
Sure. So I'm an OB-GYN generalist. I studied and went to medical school in New York and I have been working in the OB-GYN field for about 23 years, post my residency, half the time in New York and now I live in California. Currently I own my own private practice where I see women from age 14 to 90. And my main expertise is in dealing with menopausal women and perimenopausal women, so about age 40 and above, but I definitely see women from all ages in my practice. The menopause thing is because I have a specific certification. It's called a nationally certified menopause practitioner. So I'm a specialist in hormone management and managing medical conditions of the 40 plus crowd, which is a very specific type of management that you need there. But I also take care of fertility issues, contraception, do a lot of procedures in the office--and also in the hospital I deliver about, I would say, 20 to 25 babies a year now. Not very many.


wikiHow Staff:
It's still a pretty cool moment to be there 20 to 25 times a year.


Rebecca Levy-Gantt:
Yeah.


wikiHow Staff:
Awesome. Okay, so I've got a few different sections or categories of questions. And the first is about handling menstruation. So I think this is mostly kind of in the younger range of your patients perhaps. But the first question is, how can I decide what absorbency level I need for my tampons?


Rebecca Levy-Gantt:
Okay, so that's kind of a varied question, because let's say there's somebody who has the same type of period all the time where they know pretty much how much they're going to bleed. So tampons are not used by everyone, but if women or girls feel comfortable using them, they should use a type that absorbs all the blood that they feel is coming out, but not to the point where they need to leave it in more than several hours. They don't want to leave it in more than four hours at a time, so it should be absorbent enough to be changed approximately every four hours and not have any leakage. So they come in all different types of absorbency--from the tiniest, junior type of absorbent tampon, to a really super maximum tampon. The big key with tampons is not to leave them in too long, because they can cause infections and problems.


wikiHow Staff:
Awesome. Good to know. And another question I am sure people are probably looking up on the internet every now and then, what should I do to remove a tampon if the string breaks off?


Rebecca Levy-Gantt:
Okay, first thing, don't panic. Because I definitely have seen people in my office who have panicked, tried very hard to get it out in all kinds of ways, and then end up coming in here for me to do it. So the best thing to do is to get a lot of lubricant, like some K-Y Jelly or whatever other lube that somebody would use to have sex, and they could either with a glove or just with no glove on their hand, just put a lot, a lot of lubricant on their fingertips and try to slide in around the tampon, and just see if it can easily be slid out with a lot of lubricant--and don't spare the lubricant. Just use as much as you need and you should be able to get it out.


wikiHow Staff:
That's good to know.


Rebecca Levy-Gantt:
And by the way, it can't go anywhere. There's not an endless chasm in there where you can lose it and then not be able to find it. It's still there. They just might not be able to get it out. And oh, one very good word of advice. Sometimes people think they have a tampon in there, but they have already taken it out. I've had several women come into my office saying, I know I put it in, I didn't take it out, now I can't find it. Well, it's probably already out. It hasn't traveled anywhere.


wikiHow Staff:
Good to know. And one more question about maybe having younger kids with periods maybe from the parent perspective, mother or father. How do you suggest preparing a girl for her first period?


Rebecca Levy-Gantt:
Well, I think parents have to be very aware of what happens before a young woman will get her first period because even though it doesn't happen all the time, there's usually a series of events that happen in a preteen or a young teen's life that foreshadows the fact that she's going to soon be menstruating. So usually if you start to develop what we call breast buds--so they start to have small areas of tissue that are starting to develop into breasts. If they ask or notice that they're starting to develop some hair under the arms or in the pubic area, and also the idea of changing skin, so acne or oilier skin, and a growth spurt. All of those things happen right around the time that a girl is about to get her period. So before that, or especially when those events start occurring, parents should be aware of the next step that's coming, which would be that they're going to start to menstruate.


So I really think that it's the parents' responsibility to make sure that they convey that this is just a very normal event that's going to happen. Because I can tell you from my generation and before, the first time we knew about a period was when we got a period, and that was probably not a great way to be introduced to it. So what ends up happening then is that people get all their information from their friends, or from now of course online, which there is a lot of good information out there. But I really think a lot of it should come from the parents as far as the preparation and the normalizing of it so that when it does occur, it's not some scary thing that makes these young girls afraid to tell their parents about it or worry that something's wrong with them. But the couple of--not the one big discussion where they have to sit down and say, I'm going to tell you about something terrible that's going to happen to you. But kind of the normalizing of it, whereas all these other things that have been happening in your body may be confusing and may be interesting to you, but here's the course of events that would normally happen, and just have a conversation or two about it over time.


wikiHow Staff:
Yeah, I like that. It's pretty important that people don't feel alone in that crazy time of puberty. So much is happening to their body. Okay, a couple more periods. What might be causing my period to not come on time, other than pregnancy?


Rebecca Levy-Gantt:
Okay, so when somebody comes into me, a young woman, and tells me that she has not gotten a period that she's expecting, you're a hundred percent correct. The number one thing that points in our brain is pregnancy because that is the most common thing. But there's a long list of other things leading from everywhere from changes in weight--so excessive weight loss or weight gain can change what's happening in the body and cause the ovaries not to work as well, so the period stops for a while or comes later than it did, so that's one thing. Two: a thyroid abnormality. The thyroid is a gland in the neck which controls all the metabolism of the body, including the function of the ovaries. So, if there is a thyroid abnormality, periods can be irregular or not come at all.


Three: other medical conditions. So if somebody has diabetes or other illnesses that are occurring that are compromising their system, as far as compromising their immune system or compromising their health in some other way, they also can have a lack of ovulation, so a lack of periods coming on time or at all. And one of the biggest ones, of course, which we see in our infertility patients is if something happens to disrupt regular ovulations. So if somebody doesn't produce an egg every month, then they don't really have the stimulus to have a period every month either. And not producing an egg every month can be caused by a lot of different things, some of the things I've just mentioned with the weight or thyroid, etc. but also other things. There are many different things that affect ovarian function. So when the ovaries are not functioning properly, the uterus doesn't get the signal to release the blood at the right time.


wikiHow Staff:
Very helpful, that's good to know. And hopefully, it doesn't cause too many people to panic.


Rebecca Levy-Gantt:
I mean, what definitely happens is as a woman ages--so you know, we in the gynecologic world call any woman over 35 as kind of elderly in the reproductive scheme of things. So once you hit 35, and of course every year progressing after that up to 40, 45, etc. until the periods stop all together, which of course menopause is another reason why the period isn't coming. But as women age, in their late 30s and above, ovulations are less frequent just because of age. So because of that there can be more irregular periods or a lack of periods.


wikiHow Staff:
That's good to know. And then one more question on periods, how can I prevent getting such large blood clots during my period?


Rebecca Levy-Gantt:
Wow, that's a really, really long answer. But the gist of the answer to that would be if you get really large blood clots and heavy bleeding, that should draw you to go to see a health care practitioner, because on our list of things that we can do for people who are having very heavy periods and want to do something about them is, of course, any type of hormonal contraception will lessen the amount of bleeding and clots that you have, and you have to find the one that's right for you. So you need somebody to talk to about that. Other medications, there are definitely other medications that lessen the amount of bleeding. And some are in the category of something as simple as Motrin or Ibuprofen where a lot of people feel like oh, wait a minute, don't I bleed more if I take something like that? But if you take them, they're in the category of medications called non-steroidal anti-inflammatories if you take them in the right way, which means you take them certain times of the month for a certain amount of time preceding a period, they very easily can cut down on the amount of bleeding and clotting that you do with your period. So again, it takes either talking to a healthcare practitioner or looking up that information to be able to take them in the right way that they actually can have an effect on the heaviness of the period or the clots. And then the third category, there are specific medications that are by prescription only, that are designed to be taken right at the time of a period and they will lessen the amount of clotting or bleeding with the periods.


wikiHow Staff:
Nice. Cool. This next section is more on medical complications. So this first question I have is, what can I do to make it easier to sleep after having a C-section?


Rebecca Levy-Gantt:
Easier to sleep after a C-section. Okay, so I have to say in the first 24 hours, pain medication. That's probably causing you not to be able to sleep. The first 24 hours after a C-section are pretty painful. So anything to reduce the amount of movement of the area of the scar will actually help you to sleep. So that means pain medication. That means if you have to wear some kind of a support garment that actually looks like a girdle, but it's actually a postpartum support garment that people can put on. And you can just imagine if it slows down or stops the amount of movement or jiggling of the area that was just cut into, just like after any other abdominal surgery, then that will lessen the pain and allow people to get a better night's sleep.


And then the third thing would be position. So it's very important that you get into a good position. I always tell my post-C-section patients, this is the time to utilize all your pillows. So maybe a body pillow that supports your back so you can lie slightly on your side and maybe another pillow under your belly so that it's not feeling like it's stretching out or causing pain when it moves around too much when you sleep. Another pillow to support your head properly. So proper positioning in the bed is really key after a C-section for helping you sleep. And also, unfortunately, since you had a C-section, that means you also have a newborn baby. So if you are breastfeeding on demand, that's another thing that would absolutely keep you from sleeping. So I have to say probably in the first 24 or 48 or even 72 hours, there's not going to be a lot that I would recommend that people take or do to make them sleep more deeply, just because they need to be available for the baby.


wikiHow Staff:
Makes sense. And in what cases, if any, would you advise someone to get a vaginoplasty?


Rebecca Levy-Gantt:
Oh, boy. You know, I'm one of those really old school gynecologists that's against doing anything to the vagina and vulva area for cosmetic reasons, because I truly believe that the reason that a lot of women think there is something wrong in that area, as far as the way it looks, is because they've been told that through either people that had a comment to make, partners that might have said something about the area, or pictures they've seen, or porn or something that they've seen that tells them the way that it should look. When, in actuality, there's a huge variety to the way that area should and can look that would be completely normal. So if it's truly for cosmetic reasons, I'm really against it.


That being said, I have done a few, because there are some--it's a minor number of people, but it definitely exists out there, that there are women that just have these very, very irritated, large or what we call hypertrophic, overly grown areas in the genital area. Like very long labia--they try to ride a bike and it's rubbing or irritating them, or they get a lot of infections because of the size or shape or thickness of the tissue down there. I had one young lady who was a teenager who was an equestrian. She was riding horses and the size and shape of her labia--when she first came to me and told me that I said, well, let me look and see if that really looks abnormal to me. But she was right. The size and shape of them were completely abnormal and in a way to be obstructing her from being able to do what she was doing. So I did a non-cosmetic therapeutic labiaplasty on her. So for things like that, I do think there's a reason to do them, but I think they really have to be evaluated on a case-by-case basis.


wikiHow Staff:
Yeah, I definitely, I don't think it's an old school mantra to kind of--if anything, it's more of a reflection on culture today of everyone kind of saying certain bodies should be certain ways. So, yeah, I'm with you on that.


Rebecca Levy-Gantt:
Yeah. Because I have definitely over the course of my 20 plus years doing this, I've had people come in and just say, there is something wrong with me. And for me, who have seen thousands and thousands of women's bodies, to have people feel so badly about that part of their body because someone had said there's something wrong, when in actuality it's just a variation of normal, it's painful to watch that.


wikiHow Staff:
Yeah. Okay, so I'm kind of in the vein of fears of potential mothers. A question I have here is, what can I do to lessen my chances of having a miscarriage?


Rebecca Levy-Gantt:
Oh, that's kind of a sad question because there's really not a lot that people can do. If someone gets pregnant and if the baby is chromosomally normal and they have all the right pregnancy hormones in their body and their uterus is accepting of implantation, and everything is going along well, then you would think no one would miscarry. But unfortunately, some miscarriages happen for absolutely no reason. But the majority of miscarriages actually happen from some type of a chromosomal abnormality, which means that when the sperm and the egg meet, something happens where the chromosomal content did not go together properly to form a new human being. So most of those wash out and they cause miscarriage; some of them don't and they produce abnormal, nine-month pregnancies that actually end up delivering. But the majority of them are what causes a miscarriage. So there's really nothing that you can do to prevent that kind of miscarriage.


That being said, I'm always a fan of people being as healthy as they can be when they get pregnant. Because my favorite thing is for people to come to me in what we call a preconception counseling session, where people come in and they would say, I'm thinking about having a baby, how can I best get ready? But I would say maybe 2% of people come in with that kind of a consultation in mind. I usually will see people who are already pregnant. So there's not a lot of counseling I can give them as to how to be healthy entering your pregnancy because you're already pregnant. But of course, the advice that I would give is, you want to be at your best health and your best weight when you become pregnant. Because if you have undiagnosed diabetes or an undiagnosed other type of problem like severely high blood pressure, and then you get pregnant, you're already behind the eight ball for miscarriage because people who are diabetic and hypertensive will miscarry more frequently as well because they can have other medical problems that make the uterus not a good place for that baby because it's not as healthy. So, getting as healthy as possible prior to being pregnant would be my first advice. So you want to be normal or as close to normal of a BMI as possible. You want to be following exercise recommendations so that you're active and exercising before pregnancy so that you can continue to do that while you're pregnant.


Decreasing chances of miscarriage for sure would be before you get pregnant to look into your family history and see if there's anything particular that goes through your family. Are there multiple people with autism? Are there multiple people that have been diagnosed with genetic problems or mental retardation or other things that exist in your family that you could possibly test for, either before as the carrier state or after you get pregnant to test for those specific things? Because knowing about them puts you in a great position to be able to know what you're at risk for. So if you know what you're at risk for and those things could potentially cause a miscarriage, you want to be able to be aware of that and to have whatever testing is available for you to be able to do that. So being as healthy as you can before pregnancy, following a healthy diet, continuing all those things into your pregnancy, of course, and knowing your family history are a really good start.


wikiHow Staff:
Thanks for outlining all the main points, that's really helpful. I want to see if we can fit in one more question within medical complications. How might having HPV change my pregnancy?




Rebecca Levy-Gantt:
This is kind of an evolving thing right now because in the past, I would say maybe 20 years ago, we were very worried that any woman that had HPV might end up being a high-risk pregnancy because of it. And then the pendulum kind of swung in the other direction, so now we know that pretty much almost everybody has HPV at some point. So we are less concerned of it being a major factor in becoming high risk in pregnancy. However, there are a couple of ways that HPV in general will affect the outcome and the prognosis for a good pregnancy and what type of delivery you can have. And one of those things would be women who have HPV in the form of genital warts. So there is a whole class of HPV strains which cause growth on the area on or around the vulva area at the introital area, which is the area right at the opening to the vagina. So I have seen, and it's not uncommon, to have genital warts in that area that can actually grow so large and so cumbersome, they will be in the way of having a normal vaginal delivery. They can bleed or they can spread or you can actually worry about them spreading to the baby. So having a lot of genital warts in the area, which are caused by HPV, and at the time of a delivery, might even prompt me if we can't remove them in some way or get them out of that area, might prompt me to say someone might need a C-section. So that's one way that HPV can affect pregnancy and delivery. The other way is that the common strains of HPV that we see now are the ones that affect people's pap smear.


So when someone is newly pregnant, they usually do have a pap smear if they haven't had one recently. So we do it at the beginning of pregnancy as one of the early pregnancy tests that we do, just to make sure someone has a negative pap going into pregnancy, and sometimes signs that the patient has actual HPV on the pap smear. And sometimes it's causing changes on her pap smear that are what are considered high-risk or high-grade changes. So dysplasia, which is precancerous cells caused by HPV, can appear on someone's pap smear, and once they are pregnant it's a dilemma as to whether they would require treatment during the pregnancy. In other words, a biopsy or some type of treatment on the cervix. So the cervix is, of course, the opening to the uterus, opening to the womb. That's where the baby needs to come out for a vaginal delivery. And if there are abnormal cells, and if there are precancerous cells on there, it would all depend on the degree of how bad or how high grade the cells are, as to whether or not that patient would need treatment on the cervix and whether that treatment would interfere with their ability to have a vaginal delivery. Now, if you're talking about pre-pregnancy, so let's say someone has an abnormal pap smear, and they do need treatment on their cervix, some of the treatments that we do for precancerous cells or dysplasia on the cervix actually destroy or remove part of the cervical tissue.


So if you've had that procedure, and some of the names of those procedures, in case people are interested would be something called a LEEP or a cone biopsy, those are things that we do to remove high-grade precancerous cells on the cervix--usually not during pregnancy, we would do that in a non-pregnant state. So having had that done, in 5% of cases, when someone does get pregnant, that would have an effect on the person's ability to have the cervix stay closed for a nine-month period of time. So they might develop something called an incompetent cervix. So again, that's only 5% of people. So as I explain to my patients, that means that 95% of people don't have the problem. But that's a potential problem that if you're going all the way back, that HPV caused the problem on the cervix, the cervix could have a high-risk precancerous change that would require a procedure or a treatment, and then the treatment, not necessarily the HPV per se, but the treatment might cause something that would affect their ability to hold a pregnancy in and they could develop incompetent cervix, and then we have treatments for that as well. We might need to place a stitch or something like that to hold the cervix closed. So ultimately, that's a result of HPV, but a kind of indirect result.
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