<?xml version="1.0" encoding="UTF-8"?><rss version="2.0" xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:wfw="http://wellformedweb.org/CommentAPI/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:atom="http://www.w3.org/2005/Atom" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:slash="http://purl.org/rss/1.0/modules/slash/" > <channel> <title>Ultrasounds Archives - goldsteinmd</title> <atom:link href="https://www.goldsteinmd.com/category/ultrasounds/feed/" rel="self" type="application/rss+xml" /> <link>https://www.goldsteinmd.com/category/ultrasounds/</link> <description></description> <lastBuildDate>Tue, 21 Jan 2025 22:50:58 +0000</lastBuildDate> <language>en-US</language> <sy:updatePeriod> hourly </sy:updatePeriod> <sy:updateFrequency> 1 </sy:updateFrequency> <image> <url>https://www.goldsteinmd.com/wp-content/uploads/2017/12/cropped-header-logo-2-1-32x32.png</url> <title>Ultrasounds Archives - goldsteinmd</title> <link>https://www.goldsteinmd.com/category/ultrasounds/</link> <width>32</width> <height>32</height> </image> <item> <title>NOT ALL TRANSVAGINAL ULTRASOUNDS ARE EQUAL</title> <link>https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal</link> <comments>https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Wed, 15 Jan 2025 23:55:14 +0000</pubDate> <category><![CDATA[Abnormal Bleeding]]></category> <category><![CDATA[Ultrasounds]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/blog/</guid> <description><![CDATA[<p>Dr Steven R. Goldstein Gynecologist in NYC Most of my patients are aware that I use vaginal sonograms as part of the overall evaluation of gynecologic care and maintaining gynecologic health. However, increasingly I have become aware that there are many women who are now demanding a vaginal sonogram of their healthcare provider. More and … <a href="https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal" class="more-link">Continue reading<span class="screen-reader-text"> "NOT ALL TRANSVAGINAL ULTRASOUNDS ARE EQUAL"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal">NOT ALL TRANSVAGINAL ULTRASOUNDS ARE EQUAL</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>Dr Steven R. Goldstein<br /> <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">Gynecologist in NYC</a></p> <p>Most of my patients are aware that I use vaginal sonograms as part of the overall evaluation of gynecologic care and maintaining gynecologic health. However, increasingly I have become aware that there are many women who are now demanding a vaginal sonogram of their healthcare provider. More and more educated, intelligent women have come to realize that the traditional bimanual examination, with two fingers in the vagina and a hand on the lower abdomen for palpation, is extremely ineffective at detecting early changes that might, indeed, be ominous, if not lethal. Thus, many women are asking for periodic vaginal sonograms.</p> <p>Most of the time such procedures are then referred to radiology for performance. A technician (preferred term “sonographer”), then performs the vaginal sonogram. They may take 50, 60, 70 or more still images of various anatomic structures, label them, and even write an initial report. Later, a radiologist will come by and “read” the images and finalize “the report.” Unfortunately, in some instances, the physician will merely sign off on what the sonographer has written. More competent radiologists will read the images themselves and only use the sonographer’s impression as a springboard. However, this is still now being read off of static images. This loses much of the advantage of vaginal sonograms.</p> <p>I have championed the concept of “dynamic ultrasound”. This is one in which the patient is examined with the probe to see if there is any pain, to see if the pelvic organs have normal mobility, and that there is no scar tissue or adhesions. There is much more to a <a href="https://www.goldsteinmd.com/services/transvaginal-ultrasounds-and-sonohysterograms/" target="_blank" rel="noopener">vaginal sonogram</a> than simply the anatomy. For instance, sometimes an ovary will look normal, but not be in its normal anatomic location because of some scar tissue either from previous surgery or infection. Such patients may or may not have pain. Some such patients who desire fertility may have compromised fertility that would go otherwise unrecognized and simply delay their ultimate diagnosis and treatment.</p> <p>Only in the US and Australia are most vaginal sonograms performed by technicians. I perform the examination myself routinely. Sometimes I am asked if a copy of the study can be sent elsewhere. I reply that the study was actually going on in my head while I was performing the examination and, while a sample of representative still images are kept for measurements for the chart, these do not constitute the actual study. That is performed in real time by me.</p> <p>Vaginal sonograms are operator dependent and equipment dependent. It is not like having a blood test where, if the machine is calibrated, the result will be standard regardless of where it is done. Too many patients will say “I had a vaginal sonogram” thinking it is as standard and reliable as if they had a blood test. In my writing and teaching I am trying to spread the word to those who perform vaginal sonograms, be they physicians or technicians, that it needs to be done in such a dynamic fashion with movement of the probe, and the other hand on the lower abdomen. Then it really becomes an examination with ultrasound not simply an ultrasound examination.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal">NOT ALL TRANSVAGINAL ULTRASOUNDS ARE EQUAL</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/not-all-transvaginal-ultrasounds-are-equal/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>What are Uterine Fibroids?</title> <link>https://www.goldsteinmd.com/blog/what-are-uterine-fibroids</link> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Sat, 25 Feb 2023 16:26:50 +0000</pubDate> <category><![CDATA[Fibroids]]></category> <category><![CDATA[Abnormal Bleeding]]></category> <category><![CDATA[Ultrasounds]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=5670</guid> <description><![CDATA[<p>An article from Dr. Steven R. Goldstein M.D, a top Gynecologist in NYC. What are uterine fibroids? Fibroids are the most common benign pelvic tumors. They are hormonally responsive to estrogen and, thus, they are not seen prior to women getting their first period and they will shrink in size after menopause when no more … <a href="https://www.goldsteinmd.com/blog/what-are-uterine-fibroids" class="more-link">Continue reading<span class="screen-reader-text"> "What are Uterine Fibroids?"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/what-are-uterine-fibroids">What are Uterine Fibroids?</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>An article from Dr. Steven R. Goldstein M.D, a top <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">Gynecologist in NYC</a>. What are uterine fibroids?</p> <p>Fibroids are the most common benign pelvic tumors. They are hormonally responsive to estrogen and, thus, they are not seen prior to women getting their first period and they will shrink in size after <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">menopause</a> when no more estrogen is produced. By age fifty, approximately 70% of Caucasian women and 80% of Black women will have some uterine fibroids. Most will be asymptomatic and incidental, although between 25-50% of women can experience symptoms especially heavy menstrual bleeding, iron deficiency with or without anemia, painful pressure symptoms, increased urinary frequency, and also reproductive issues.</p> <p>Many women, however, seem to be unaware of their fibroids and their impact on their health. Recent study suggested that the average woman does not seek treatment for a mean of 3.6 years and 41% saw at least two healthcare providers before being properly diagnosed.</p> <p>However, one must be extremely careful because fibroids are so common and so easily visualized on <a href="https://www.goldsteinmd.com/services/gynecologic-ultrasounds/" target="_blank" rel="noopener">transvaginal ultrasound</a> that understanding the difference between <u>incidental</u> and <u>significant</u> fibroids is paramount. I have a slide in my lecture that says, “fibroids are like fingerprints, no two are ever alike.”</p> <p>In addition, fibroids are much like real estate: “LOCATION, LOCATION, LOCATION.” Even small fibroids that impinge on the endometrial cavity (lining) can cause significant bleeding and fertility issues even when they are relatively small whereas, sometimes, rather large fibroids originating in the muscle and growing outward may have no impact whatsoever on bleeding, fertility, and patients may be totally unaware until examined.</p> <p>In my practice I use transvaginal ultrasound liberally in the examination of my patients. I perform these transvaginal ultrasounds personally and do not rely on the findings of a technician. If you have symptoms of fibroids, been told you have fibroids, or need a second opinion before surgery, feel free to schedule a consultation.</p> <p>Dr Steven R. Goldstein M.D is considered one of the nation’s top doctors in gynecology.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/what-are-uterine-fibroids">What are Uterine Fibroids?</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> </item> <item> <title>Information about Polycystic Ovarian Syndrome (PCOS)</title> <link>https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome</link> <comments>https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Thu, 12 Jan 2023 17:43:47 +0000</pubDate> <category><![CDATA[Fertility]]></category> <category><![CDATA[Screenings]]></category> <category><![CDATA[Ultrasounds]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=5626</guid> <description><![CDATA[<p>Recently, I have had a run of several young women who have presented (accompanied by their mothers) having received a diagnosis elsewhere of polycystic ovarian syndrome (PCOS). They have looked this up online and they are relatively distraught having learned about issues of infertility, insulin resistance, and a predilection later in life for diabetes. None … <a href="https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome" class="more-link">Continue reading<span class="screen-reader-text"> "Information about Polycystic Ovarian Syndrome (PCOS)"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome">Information about Polycystic Ovarian Syndrome (PCOS)</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>Recently, I have had a run of several young women who have presented (accompanied by their mothers) having received a diagnosis elsewhere of polycystic ovarian syndrome (PCOS). They have looked this up online and they are relatively distraught having learned about issues of infertility, insulin resistance, and a predilection later in life for diabetes. None of these recent cases truly had the entity itself. What they had was not unusual for late adolescence (women in their teens and even early twenties) whose menstrual cycle is still slightly irregular because of the fact that the hypothalamic-pituitary-ovarian axis has not yet matured, and someone performed an ultrasound and they had multiple small follicles in their ovary, and thus, were told they had polycystic ovarian syndrome. </p> <p>The original description of the entity was called Stein-Leventhal syndrome and, basically, these patients looked a little like Humpty Dumpty – they were obese, they had male-pattern hair growth (chin especially), and blood work showed increased androgens (testosterone and an entity know as DHEA-S). The problem began in 2003 when an international conference in Rotterdam produced what was known as The Rotterdam Criteria for the Diagnosis of PCOS. At that time the consensus was if a women had two of the following three characteristics she could be labeled as having PCOS. They were 1) irregular menses, 2) increased androgens (either in their blood or clinical manifestations), and 3) more than twelve follicles in their ovary on ultrasound. The problem is, however, that many young women, as stated above, will be having slight irregularity to their menses as the cycle “matures,” and as the resolution of transvaginal ultrasound has increased, as many as 50% of women will have more than twelve follicles in their ovary. These recent patients that I saw were 1) not obese, 2) had no evidence of increased androgens, either clinically or in their blood, and 3) were extremely healthy. They have what I have now referred to as “multicystic ovaries,” which are common and not abnormal in younger women. It has been my experience that the overwhelming majority of such patients, as they get into their mid- and later twenties, ultimately have very normal menstrual cycles, normal fertility, and no increased risk of insulin resistance or diabetes. </p> <p>Too many healthcare providers are still functioning under these misconceptions. However, some papers have called for using a threshold of more than twenty-five follicles per ovary. Other groups have recommended a threshold of greater than twenty follicles per ovary. It is also, in my opinion, important as to how the follicles are arranged in the ovary. In the original description of polycystic ovarian syndrome, the follicles were all very peripheral and often were referred to as a “string of pearls,” as opposed to just an increased randomly distributed number of follicles. </p> <p>Furthermore, there is a group known as the Androgen Excess and PCOS Society that has gone on record as saying that women who have irregular menses and multiple follicles, but no evidence of increased androgens should not be labeled as PCOS. Finally, an NIH workshop in 2012 recommended that the name “PCOS” be changed to “metabolic reproductive syndrome” because PCOS focuses on the polycystic ovarian appearance, which, as described in detail above, is the least sensitive factor for making such a diagnosis. However, it is highly unlikely that this “name change” will take hold. </p> <p>If you or a daughter or a niece or someone you know has received the diagnosis of polycystic ovarian syndrome, hopefully this information will be helpful. As always, I am available for consultation. </p> <p>Dr Steven R. Goldstein is a leading <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">gynecologist in NYC</a>, a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">menopause specialist in NYC</a>, <a href="https://www.goldsteinmd.com/services/best-obgyn-manhattan/" target="_blank" rel="noopener">obgyn Manhattan</a> and <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">NYC Gyn</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome">Information about Polycystic Ovarian Syndrome (PCOS)</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> </channel> </rss>