Why does Dr. Toubi use ultrasound guidance for IUD insertion?

Every uterus is different in shape, size, and position. Ultrasound guidance allows real-time visualization of the uterus during IUD placement - confirming correct positioning immediately, reducing the risk of complications, and significantly improving patient comfort. It is especially valuable for women with a tilted or unusually positioned uterus, a history of difficult insertions, or significant pain concerns.

Why does Dr. Toubi recommend yearly Pap smears when standard guidelines say every 3-5 years?

Standard guidelines are written for population-level screening programs. Dr. Toubi's approach is individualized - and for her patients, she recommends annual Pap testing as part of her proactive well-care philosophy. Cervical cell changes can develop between screenings. Catching them early - when they are minor and easy to manage - is always preferable to discovering them later.

What is a LEEP procedure and when is it needed?

A LEEP (Loop Electrosurgical Excision Procedure) removes a thin layer of abnormal cervical tissue using a wire loop with electrical current. It is typically recommended when colposcopy and biopsy reveal higher-grade cervical cell changes (CIN 2 or CIN 3) that require removal rather than observation. It is an in-office procedure performed under local anesthesia, and pain control including nerve blocks and nitrous oxide is available.

Gynecologic Procedures

Q: What happens if my Pap smear is abnormal?

An abnormal Pap result most often indicates low-grade cellular changes, not cancer. The next step is colposcopy - a closer examination of the cervix using a specialized magnifying instrument, during which a small biopsy may be taken from any suspicious area. Most abnormalities are easily monitored or treated. Dr. Toubi walks patients through each step and its significance clearly.

Q: Is IUD insertion painful?

It can cause cramping - the severity varies widely between individuals. Dr. Toubi takes pain management seriously for all procedures. She offers nerve blocks (paracervical block) and nitrous oxide (laughing gas) for IUD insertions, particularly for patients who are anxious, nulliparous, or have had painful insertions in the past. You should not be told to simply take ibuprofen and endure it.

Q: How does Nexplanon work and how long does it last?

Nexplanon is a small, flexible progestin-releasing implant placed just beneath the skin of the upper arm. It prevents pregnancy by suppressing ovulation, thickening cervical mucus, and thinning the uterine lining. It provides highly effective contraception for up to three years and is fully reversible - fertility returns quickly after removal. Insertion and removal are brief in-office procedures performed under local anesthesia.

Gynecologic procedures shouldn't feel like something to dread. Here's what Dr. Toubi offers - and how patient comfort is built into every step.

Pap smears. IUD insertions. Colposcopy. Biopsies. These procedures are essential tools for women's preventive health and contraceptive care. They are also procedures that have historically been performed without adequate attention to patient comfort - which has led to unnecessary anxiety, avoidance, and trauma.

Dr. Toubi's practice is built on the belief that pain management should be standard for in-office gynecologic procedures - not a luxury add-on or something you have to specifically request. Nerve blocks and nitrous oxide are available for every appropriate procedure.

Procedures offered

Cervical screening

Pap smear (annual)

Dr. Toubi recommends yearly Pap testing - even when guidelines suggest every 3-5 years - for the most consistent early detection of cervical cell changes. Quick, minimally invasive, integrated into your annual exam.

Follow-up evaluation

Colposcopy & cervical biopsy

A detailed examination of the cervix using a magnifying instrument when a Pap is abnormal. A small biopsy may be taken from suspicious areas. Performed with local anesthesia and nitrous oxide available.

Contraception

IUD insertion & removal (ultrasound-guided)

Real-time ultrasound guidance ensures accurate placement and confirms positioning immediately. Especially valuable for difficult anatomy or previous painful insertions. Paracervical block and nitrous oxide available.

Contraception

Nexplanon insertion & removal

A small, flexible arm implant providing up to 3 years of highly effective birth control. Quick in-office insertion and removal under local anesthesia. Fully reversible.

Uterine health

Endometrial biopsy

Collects a small sample of the uterine lining for lab analysis - recommended for postmenopausal bleeding, heavy or irregular periods, or suspected hormonal abnormality. Nerve block and nitrous oxide standard.

Cervical treatment

LEEP procedure

Removes abnormal cervical tissue when higher-grade changes are found on colposcopy/biopsy. Performed under local anesthesia with nerve block and nitrous oxide available.

Vulvar diagnosis

Vulvar biopsy

Small tissue sample taken under local anesthesia to diagnose skin conditions including lichen sclerosus, lichen planus, VIN, and others. Results guide targeted treatment.

Standard comfort measures for all in-office procedures: Dr. Toubi offers paracervical or local nerve blocks, topical anesthetic, and nitrous oxide (laughing gas) for all appropriate procedures. You will always be informed of your options - and your comfort matters.

Frequently asked questions

Why use ultrasound guidance for IUD insertion?

Every uterus is different in shape and position. Ultrasound guidance provides real-time visualization during placement - confirming correct positioning immediately, reducing complication risk, and significantly improving comfort. It is especially valuable for women with a tilted uterus, a history of difficult insertions, or significant pain concerns.

Why does Dr. Toubi recommend yearly Pap smears?

Standard guidelines are population-level recommendations. Dr. Toubi takes an individualized approach and recommends annual Pap testing for her patients as part of a proactive well-care philosophy. Cervical cell changes can develop between screenings, and catching them early - when they are minor and easily addressed - is always preferable to discovering them at the next scheduled interval.

What happens if my Pap smear is abnormal?

An abnormal Pap most often indicates low-grade cellular changes, not cancer. The next step is colposcopy - a closer examination of the cervix using a magnifying instrument, with a small biopsy from any suspicious areas. Most abnormalities are easily monitored or treated. Dr. Toubi explains each step and its significance clearly so you understand what's happening and why.

Is IUD insertion painful?

IUD insertion can cause cramping that varies from mild to significant. Dr. Toubi takes pain management seriously and offers paracervical nerve blocks and nitrous oxide for IUD insertions - particularly for patients who are anxious, nulliparous, or have had difficult insertions before. You should not have to simply endure unnecessary pain for a routine procedure.

How does Nexplanon work?

Nexplanon is a small flexible progestin-releasing implant placed just under the skin of the upper arm. It prevents pregnancy by suppressing ovulation, thickening cervical mucus, and thinning the uterine lining. It provides highly effective contraception for up to three years and is fully reversible - fertility returns quickly after removal.

Preventive procedures shouldn't be avoided out of fear of pain. They should be done well.

Dr. Toubi's Beverly Hills practice offers a full range of gynecologic procedures with precision, patient-centered communication, and genuine attention to your comfort. Schedule your visit today.

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Ultrasound-guided IUDNerve blocks & nitrous oxide availableBeverly Hills