Women’s Health Questions You are Too Embarrassed to Ask!

Dr. Shahim tackles topics from the first appointment through menopause. He will also discuss procedures such as Thermiva and Tempsure Vitalia.
Women’s Health Questions You are Too Embarrassed to Ask!
Featured Speaker:
Abe Shahim, M.D.
Dr. Abe Shahim is a practicing board-certified obstetrician-gynecologist in New York City.

Dr. Shahim graduated with a Bachelor of Arts degree in Psychology and Middle Eastern Studies from Columbia University. He earned a medical degree from the University of Tel Aviv; Sackler School of Medicine.

He completed his internship in Ob/Gyn at Sinai/Grace Hospital in Detroit, Michigan and then completed training in OB/GYN at Lenox Hill Hospital in New York City.

Dr. Shahim received the Dr. Marvin P. Zuckerman Award for excellence in surgery and the Lenox Hill Hospital Excellence in Research Award.
He is a Fellow of the American College of Obstetrics and Gynecology and also an active member of the American Medical Association, the Medical Society of the State of New York and the New York County Medical Society.

He has held many leadership roles in ob/gyn including being Vice-Chairman and Director of Obstetrics at Mount Sinai West and Director of Patient Safety and Quality at Lenox Hill Hospital/Northwell Health.

Dr. Shahim has a special interest in minimally invasive surgery, particularly hysteroscopy. He has been recognized by his peers with election into New York Magazine's Top Doctors, Castle Connoly's Top Doctors, New York Superdoctors and NY Top Docs.

Maggie McKay: When it comes to visiting the gynecologist, there are often awkward questions to ask that many women just find too embarrassing to ask. So today, with the help of board-certified obstetrician gynecologist, Dr. Abe Shahim will tackle some of those questions.

Welcome to Top Docs. I'm Maggie McKay.

It's so good to have you here, Dr. Shahim. I can't wait to hear what you do. But first, can you please introduce yourself?

Abe Shahim, MD: Hi, Maggie. It's a pleasure being on with you. My name's Abe Shahim. I'm an obstetrician gynecologist, as you mentioned, in New York City. I've been doing this for 20 plus years at this point. And I enjoy what we're doing.

Maggie McKay: I know you believe that forming relationships with patients is a key part of good healthcare. Tell us a little more about why that's so important.

Abe Shahim, MD: So, I think that there's a multitude of things that go on when you have a doctor-patient relationship. There's one thing to treat a disease and treat a problem that a patient is having, but the reality of the relationship is that each patient is really an individual and what will work for one person doesn't necessarily work as well for somebody else. I've been very lucky in my career that I have patients who've been with me for a long time and a wonderful part about that is, as you get to know each other over the years, when something does come up, you kind of have a baseline of how each person is going to approach that, and you can help make it a more comfortable environment for that person. Beyond that, it also allows the patient to feel comfortable talking about some of the more difficult questions that you don't always feel comfortable bringing up in public or with other people. And so, I think that that relationship is the most important part of the interaction.

Maggie McKay: And what are some of the other ways you put patients at ease when you know that they have questions, but they're just too shy to ask them?

Abe Shahim, MD: I think it depends on the person, as we said. I think sometimes it's just hinting at it and seeing if that'll open up the conversation. But really, I think it's allowing the patient to feel comfortable at being in a comfortable setting where they don't feel judged or pushed too much and just being willing to listen and see what comes out. One of the problems we have in medicine these days is that a lot of times things are being rushed, because patients aren't given enough time to speak because of just the way our medical system has changed over the years. And that's really one of the things I try and stay away from as much as possible.

Maggie McKay: And when women come in after they've had a baby and they ask you, will their body ever get back to the way it was before? How do you answer that one?

Abe Shahim, MD: Well, look, I think there's got to be some truth-telling. The body does change after you have a baby. There's nothing you can do about that, that is par for the course. But at the same time, if you're fit beforehand, you take good care of yourself during the pregnancy, we limit the weight gain during pregnancy to what's expected, those things will be less. Beyond that, a lot of things that happen can be improved over time, but there will be some things that'll just be part of having had a child.

Maggie McKay: Right. And that's the price, but it's well worth it, right?

Abe Shahim, MD: Absolutely. I think most people are comfortable with a give and take.

Maggie McKay: What do you tell patients who ask you about vaginal dryness? What can they do about that?

Abe Shahim, MD: So, vaginal dryness is an interesting topic because it depends at what point you are in your life and what's causing that vaginal dryness. Sometimes people talk about vaginal dryness when they mean vaginal irritation, so that could be a yeast infection or a vaginitis or something like that that's just making the area very inflamed and so they feel uncomfortable and dry. So, that's one type of vaginal "dryness" or discomfort. Then, there's patients who have just had a child who are breastfeeding and their hormonal production decreases and they end up having a lot of discomfort and dryness vaginally. And then, there's patients who are in menopause whose body's no longer producing its own estrogen, and that causes decreased secretions in the vagina and it also changes the tissue in the vagina that it loses some of that flexibility and suppleness that the vaginal mucosa usually has. Each one of those things can be addressed differently. It can be with local estrogen therapy or it can be with some of the newer techniques that we have in vaginal rejuvenation, and those aspects can help improve the symptoms that the patient is having.

Maggie McKay: That's hopeful, because it sounds like it's not just at one time during their life, it's a few different times. So, that's good to know.

Abe Shahim, MD: Well, especially in a menopause, you're absolutely right. Until recently, vaginal dryness and vaginal discomfort in menopause was a very difficult thing for obstetrician-gynecologists to handle. There were very few options. There was over-the-counter lubricants and there was estrogen therapy. And estrogen therapy has its detractors and has its concerns. There's patients who can't get hormones. So, we didn't have a lot of options. In the last five to 10 years, we've come up with new technologies that have been able to give us a little bit more flexibility on what we can do in the "vaginal rejuvenation" world.

Maggie McKay: That's good news. Tell us about the procedure, ThermiVa, and what that helps with.

Abe Shahim, MD: So, it's a nice flow from what we were talking about. So, ThermiVa is one of the vaginal rejuvenation modalities. The way it works is it uses radiofrequency to develop a degree of heat to be used inside the vagina to allow the blood vessels in the vagina to open up and allow more blood flow and more reactions in the vagina to rejuvenate that tissue. The nice part about it is that it's really non-invasive in that there is no damage done or burning done or anything to the vagina itself. What I like to say to patients is it's basically a hot tub for the inside of the vagina.

It raises near body temperature. It goes to about a temperature of 47 degrees. And so, it doesn't burn. It's not uncomfortable. But just like when you sit in a hot tub and you see how your skin becomes all red and it does a similar effect of the vagina. That redness that you get on your skin is all your blood vessels opening up and getting more blood flow to the skin, we're doing the same thing to the

Maggie McKay: How new is ThermiVa?

Abe Shahim, MD: ThermiVa's, I think, been around between five and 10 years. It's been around for a little while. It's very well tolerated. The treatments usually work as a treatment once a month for three months, and then usually a followup every nine to 12 months. And patients particularly who have vaginal dryness have gotten a lot of benefit from it over the years.

It's also used on and off for patients who have some mild urinary continence. But it has been a really nice addition to our options for patients who are having trouble with vaginal dryness. Once in a while, it's also used in the other group that we were talking about, the pregnant patients who are breastfeeding or have a lot of vaginal dryness, it also has been used in that group as well.

Maggie McKay: And a lot of women complain about losing urine when they exercise. So, is that reserved just for women who have had babies or all ages?

Abe Shahim, MD: It's for all women. Usually, as people get older men and women, things don't hold up as well over time. So, what happens, there's a weakness in the support of the bladder, and what happens is when you put strain on your body, whether it is coughing, sneezing, lifting, you get more pressure on the bladder. And when there's that weakness, you end up leaking a little bit and losing urine. It happens in menopausal patients, without having children. But it can also happen with patients who've had kids where those muscles have been strained because of carrying a pregnancy and potentially delivering a large baby. So for those patients, often sometimes it can start even prior to menopause.

Maggie McKay: Any way to prevent that? Kegels? I don't know.

Abe Shahim, MD: Kegels and pelvic floor exercises are great. It keeps those muscles as strong as possible. But once it starts to occur, we still do recommend those things. But over time, usually those exercises won't be adequate.

Maggie McKay: Dr. Shahim, thank you so much for sharing this information. Is there anything else you would like patients listening to take away from this?

Abe Shahim, MD: Yeah, I think just to keep in mind that your GYN is there to be a support person and to help you through things. If there's concerns, if you're worried about something, talk to them. You know, things change over time. If you've had the conversation once and you didn't get the answers you were looking for, sometimes there are new modalities like we have now and we may be able to help when we couldn't in the past.

Maggie McKay: This has been so helpful and I'm sure a relief to many women to have some new tools to navigate their next appointment with their gynecologist, so thank you. If someone would like to make an appointment with you, how would they do that?

Abe Shahim, MD: They can come onto our website, manhattanwomenhealth.net. Yes, it's not com, it's net. Or they can call the office at (212) 744-6700.

Maggie McKay: Great. Again, that's manhattanwomenshealth.net. If you found this podcast helpful, please share it on your social channels. And please check out our entire library of podcasts for topics of interest to you. This is Top Docs Podcast. I'm Maggie McKay. Thank you so much for joining us and be well.

Abe Shahim, MD: Thank you, Maggie.