Women's health issues can be complex. As women ourselves, and as Nurse Practitioners, we know that taking time to listen to a woman's health story is important.

We carefully diagnose your condition, and then we help you clearly understand it and your options. Whether it is premenstrual tension, menopausal issues, or polycystic ovary conditions, we will treat your condition with the best choices for you. We can help with annoying conditions such as incontinence, and debilitating conditions like fatigue. We do thorough exams and order appropriate tests, including hormone levels. We will look at the problem holistically and help you find the best solution.

Family Planning

We can help you with birth control choices including birth control pills, NuvaRing, Ortho Evra Patch, Depo Provera injections, diaphragm fitting, and IUD insertion or Implenon placement. We are among the few practitioners trained and approved to place and remove Implenon in Whatcom and Skagit county.  We can discuss natural family planning. We have pregnancy tests and can confirm your pregnancy and help refer you to obstetrical or midwifery care. We can test for STDs and treat them with prescriptions.

*Dee is one of the few Nurse Practitioners in the Whatcom, Skagit area
trained to place Implenon.

Implanon
Implanon is a thin, flexible plastic implant about the size of a cardboard matchstick. It is inserted
under the skin of the upper arm. It protects against pregnancy for up to three years.

Birth Control Patch
The birth control patch is a thin, beige, plastic patch that sticks to the skin. It is used to prevent
pregnancy. A new patch is placed on the skin once a week for three weeks in a row, followed by
a patch-free week.

The birth control patch is commonly called Ortho Evra, its brand name.

Birth Control Pills
Birth control pills are a kind of medication that women can take daily to prevent pregnancy. They
are also sometimes called “the pill” or oral contraception.

Vaginal Ring
The vaginal ring is a small, flexible ring a woman inserts into her vagina once a month to prevent
pregnancy. It is left in place for three weeks and taken out for the remaining week each month.
The vaginal ring is commonly called NuvaRing, its brand name.

Birth Control Shot (Depo-Provera)
The birth control shot is an injection of a hormone that prevents pregnancy. Each shot prevents
pregnancy for three months.
The shot is also known by the brand name Depo-Provera, or by the name of the medicine in the
shot, DMPA.

IUD
The letters IUD stand for “intrauterine device.” IUDs are small, “T-shaped” devices made of
flexible plastic. A health care provider inserts an IUD into a woman’s uterus to prevent
pregnancy.
There are two brands of IUD available in the United States — ParaGard and Mirena.

Fertility awareness-based methods (FAMs) or Natural Family Planning
Fertility awareness-based methods (FAMs) are ways to track ovulation — the release of
an egg in order to prevent pregnancy by charting your menstrual cycle, monitoring
vaginal mucus and in some cases taking your basal body temperature

Emergency Contraception--Is NOT a Birth Control Method
Plan B, Plan B Step-one or Next Choice

Emergency contraception (EC) is a safe and effective way to prevent pregnancy after
unprotected intercourse. It is MOST effective if taken within the first 24 hours when
needed and can be started up to five days (120 hours) after unprotected intercourse.
You may want Emergency Contraception if:

• The condom broke or slipped off, and he ejaculated in your vagina.
• You forgot to take your birth control pills, insert your ring, or apply your patch.
• Your diaphragm or cap slipped out of place, and he ejaculated inside your vagina.
• You miscalculated your “safe” days.
• He didn’t pull out in time.
• You weren’t using any birth control.
• You were forced to have unprotected vaginal sex, or were raped.

Men are sometimes reluctant to get the healthcare they need. If you are seeking screening or treatment for Sexually Transmitted Infections or information regarding birth control or information, diagnosis and treatment of genital warts, herpes or have questions about Sexually Transmitted Infections we will  treat your health care needs with the respect and attention you deserve.  All patient information is confidential.

 We will help you understand the importance of your treatment, and the options you have in managing your health. If you need treatment outside our clinic, we can help you navigate the medical system and connect with the specialists you need. We are here to help you take care of yourself, and your family.

Genital Warts Human papilloma virus or HPV

Genital warts also known as Condyloma, Condylomata acuminata, or venereal warts,
anal wart or anogenital wart and is a sexually transmitted infection. It is spread through
direct skin-to-skin contact during oral, genital, or anal sex with an infected partner.

Genital warts are the most easily recognized sign of genital HPV infection. Anybody
who has had more than one sexual partner in a life time has been exposed to any one
or more of the 100 strains of HPV. Long term, mutually monogamous partnerships and
time can allow the immune system to clear the papilloma virus from your system.

Genital warts may be small, flat, flesh-colored bumps or tiny, cauliflower-like bumps. In
men, genital warts can grow on the penis, near the anus, or between the penis and the
scrotum. In women, genital warts may grow on the vulva and perineal area, in the
vagina and on the cervix. Genital warts vary in size and may even be so small that you
can’t see them. They can lead to cancer of the cervix in women or cancer of the penis in
men.

Treatment with liquid nitrogen, acid cauterization, topical creams and more natural
methods are very successful. Once treated effectively genital warts may never appear
again. New sexual partners increase the risk of re-exposure.

Herpes Simplex Type I and Type II

Herpes type I is also called fever blisters or cold sores.
Herpes type I can also be located on the genitals often through having oral sex with
someone who has cold sores. The herpes virus remains in the body along nerve
pathways for life. Herpes type I is a milder form of herpes. The lesions can be difficult
to identify as a result.

The most consistent symptoms for Herpes type I:
* a sore of some type which can be a minor as a paper cut
* which itches, stings or burns
* returns to the same location
* lasts more than two days.

Herpes virus can be shed or transmitted even without lesions. The frequency of this
shedding is not known and the belief is that it is less when it is herpes type I. Shedding
of the virus is more likely during the prodromal phase which can be missed by the
person affected. Generally the prodromal phase has an itching tingling quality to it
before the bumps or lesions appear.
Someone who has had fever blisters or cold sores in the past is very unlikely to get
Herpes type I on their genitals. They can however contact Herpes type II, most
frequently known as genital herpes.

Herpes type II generally known as genital herpes.

The herpes virus remains in the body along nerve pathways for life. Herpes type II is a
more aggressive form of herpes, especially the first two years after the initial outbreak.
Generally as time passes the outbreaks become less frequent.

In a classical case of herpes type II
* the lesions (prodromal phase, bumps, blisters, ulcers, scabs) affect both sides of the body
* appear 2 to 10 days after exposure and last 2-3 weeks.
* This is the most aggressive outbreak and often is accompanied with flu symptoms and
enlarged lymph nodes.

However, this is not always the case. Symptoms can be different in each person and
less aggressive if that person has oral herpes already. Herpes type II virus can be shed
without lesions. The amount and frequency of this shedding is not know exactly. This
puts a partner without herpes at risk because there is no identifying lesion. Because of
this risk some affected person elect to suppress their herpes outbreaks with a daily
dose of an anti-viral medication which is believed to decrease this shedding by half.
There are blood tests to indicate whether a person has Herpes type I or II. A positive
blood test for Herpes type I does not indicate the site. It could be oral or genital.
Generally herpes type I is oral but not all the time. Herpes lesions can also be cultured
and type identified which does indicate the location of the herpesHerpes and pregnancy.
In the past women with herpes had C/sections. Now, unless there are active lesions,
women can give birth vaginally. It is common practice to use an anti-viral medication in
pregnancy to suppress herpes outbreaks and protect the child from exposure to the
herpes virus.

TREATMENT for herpes includes
1. Suppressive therapy with an anti-viral medication taken daily
2. Treatment of an outbreak with an anti-viral medication taken for 2 days
3. Alternative treatment with supplements, vitamins and homeopathy
There is no cure for Herpes type I or type II

Parents need to use very good hand washing technique if they have cold
sores when handling a child. Touching a herpatic blister or kissing a child when you
have a cold sore can transmit the virus to your child.