2. Who is eligible for hormonal contraceptives? Are there any limitations on the users for telehealth management at V.ARIA?
Combined hormonal contraceptives can be used safely in women with a range of medical conditions, including well-controlled hypertension, uncomplicated diabetes, uncomplicated heart disease, migraine headaches without aura, systemic lupus erythematosus (SLE) without antiphospholipid antibodies, human immunodeficiency virus (HIV) infection, thyroid disease, anemia, and uncomplicated kidney or liver disease.
However, with the limitations of telehealth management, V.ARIA takes extra precautions and has our own strict medical protocol when we evaluate treatment requests. For this reason, we do not provide hormonal contraceptive prescriptions via telehealth management for the following cases.
Any females under 18 or older than 50
Any patients who is pregnant, possibly pregnant or breastfeeding
Patients who have never taken hormonal contraceptives. V.ARIA prescribes refills only for those who have used the same medications before (For example, we do not prescribe NuvaRing or a patch to those who have never used this type of contraceptives).
Patients who previously had allergic reactions to hormonal medications with estrogen or progestin
Current active smokers or who recently quit smoking within the last 6 months
Patients with a history of Venous thromboembolism (VTE) such as blood clots in legs, in lungs or in brain (Stroke)
Patients with underlying liver disease, kidney disease or hypertension
Patients experiencing abnormal vaginal bleeding or has a history of abnormal vaginal bleeding
Patients who plan to take contraceptive medications for non-contraceptive purposes (such as regulated menses or dysmenorrhea). V.ARIA prescribes contraceptive medications for contraceptive measures only
3. Why do I need to provide my blood pressure information to get refills for birth control prescriptions?
Certain contraceptives contain estrogen that affects blood pressure. Exposure to estrogen consistently for a long time is linked to high blood pressure as well as other complications secondary to elevated blood pressures.
For this reason, our medical providers must know your baseline of blood pressure as well as the most recent blood pressure at least within the last 3 months to determine if you are suitable and eligible to get a prescription treatment through a telehealth management at V.ARIA. For your safety concerns, it is highly expected for you to disclose your medical information fully and honestly when you submit a request for birth control refills.
4. I do not know my blood pressure and it has been a while since I have checked them. What should I do?
Although it is always better to check your blood pressure in a clinical setting to have correct and consistent measurements on your baseline blood pressures, however, we fully understand your busy daily activities and life can be difficult to get into your doctors office to check your blood pressure.
If you do not carry an automatic blood pressure machine with a cuff at home, there are free blood pressure Kiosk stations located in local pharmacies (such as CVS or Walgreens) and retail stores and you can check your blood pressure free of charge at the stations in your area.
You can google and search for “Blood Pressure Kiosk map” in your area to find out Blood Pressure Health Station Locator. Retail pharmacies like CVS, Walgreens or Walmart have such free-standing blood pressure Kiosk stations. You can choose your chosen pharmacy of your choice and measure your blood pressure at the chosen station when you are available.
After you check your updated blood pressure, you can resume your treatment request at V.ARIA and provide the information to continue the questionnaire.
1. What is Genital herpes and how can I get diagnosed?
Genital herpes is one of the common sexually transmitted diseases. It is caused by herpes simplex virus type 2 and it is known to be lifelong infection and periodic recurrent infections.
2. What are the symptoms?
Outbreak consists of single or clustered vesicles on the genitalia, perineum, buttocks, upper thighs, or perianal areas that ulcerate with or without other symptoms of pain, burning, or sometimes itching before resolving. However, it can be asymptomatic for many patients.
3. How can genital herpes be transmitted? What are the causes?
It is known to be caused by type 2 herpes simplex virus. However, the incidence of primary genital infection with herpes simplex virus type 1 (which is a cause of oral herpes) is now as common as herpes simplex virus type 2 in the United States.
Oral herpes caused by herpes simplex virus type 1 can spread from the mouth to the genitals through oral sex. Therefore, some cases of genital herpes are due to herpes simplex virus type 1.
It is usually spread by direct contact with someone who is positive for herpes simplex virus, through vaginal, anal, or oral sex.
It can be also transmitted through direct contact with someone who has
Visible sores/blisters by Herpes simplex virus Direct contact to skin in the oral area of a sexual partner with oral herpes Direct contact to skin in the genital area of a sexual partner with genital herpes Oral secretion/Saliva from a sexual partner with an oral herpes Genital secretion/discharge from a sexual partner with genital herpes Sexual partner who does not have a visible sore and is unaware of their infection.
4. What is the treatment for genital herpes? Does the medication cure genital herpes?
The treatment is antiviral medication such as Acyclovir, Valacyclovir or Famciclovir.
There is no cure for genital herpes. However, taking antiviral medication as a suppression plan with a daily antiviral medication prevents or shortens outbreaks. It can also make it less likely to transmit the infection on to your sex partner.
Even though the medication resolves the symptoms, the herpes virus stays in your body (hiding in nerve cells) even when you do not have genital herpes. If the virus becomes active again, it causes genital herpes to reactivate, causing recurrent genital herpes.
Here are some factors to contribute to such recurrence of genital herpes.
Any illness such as flu or cold extreme temperature changes either hot or freezing weather Stressful events in life Physical or psychological trauma, again causing stress or affecting immune system Too much sun exposure Weakened immune system
1. What are Cold sores and how can I get diagnosed?
Cold sores (oral herpes) are non-genital herpes simplex virus with type 1. Cold sores usually show up around the mouth (including lips) as a cluster of blisters with a red base. They are also called fever blisters.
The diagnosis is usually made clinically by the appearance of the lesions (grouped vesicles or ulcers on a red base) and patient history.
2. What are the symptoms?
They may be painful and feel itchy, dry or crusty. If the blisters recur later down the road as a recurrent infection, you may feel a tingling feeling without any visible blister before the blisters or sores appear on the skin.
3. How can cold sores be transmitted? What are the causes?
It is a common infection usually transmitted during childhood via nonsexual contact (such as kissing or sharing utensils/towels with a person who is positive with oral herpes. e.g, parents or siblings). Cold sores are caused by a type of virus called herpes simplex virus, which is contagious.
It is usually spread by direct contact with someone who is positive for herpes simplex virus type 1. Direct contacts include kissing or sharing eating utensils or towels. It is the most contagious when there are visible open, blister-like sores.
4. What is the treatment for cold sores? Does the medication cure cold sores?
The treatment is antiviral medication such as Acyclovir, Valacyclovir or Famciclovir.
There is no cure for oral herpes. However, taking antiviral medication as a suppression plan with a daily antiviral medication prevents or shortens outbreaks. It can also make it less likely to transmit the infection to close contacts.
Even though the medication resolves the symptoms, the herpes virus stays in your body (hiding in nerve cells) even when you don’t have oral herpes. If the virus becomes active again, it causes oral herpes to reactivate, causing recurrent oral herpes.
Here are some factors to contribute to such recurrence of oral herpes.
Any illness such as flu or cold
Extreme temperature changes either hot or freezing weather
Stressful events in life
Physical or psychological trauma, again causing stress or affecting immune system
1. What are the signs and symptoms of erectile dysfunction (ED)?
Erectile dysfunction (ED) stands as the most prevalent sexual issue among men, and its occurrence rises as men age, impacting up to one third of them during their lifetime. The most prevalent symptoms of erectile dysfunction include experiencing difficulty in achieving and maintaining an erection during sexual activities.
2. How is ED diagnosed?
Unlike some medical conditions, there isn’t a single preferred diagnostic test for ED, and standard screening isn’t advised. Instead, a thorough history and physical examination usually suffice to accurately diagnose ED in the majority of cases.
3. Which demographic group is most frequently affected by this condition?
Erectile dysfunction (ED) can affect men of various demographic backgrounds, including age, race, and ethnicity. However, the risk of ED tends to increase with age. It is more common in older men, with prevalence rates generally rising as men get older. Other factors that can contribute to ED risk include underlying medical conditions, such as diabetes and heart disease, lifestyle factors like smoking and excessive alcohol consumption, and psychological factors like stress and anxiety.
4. What is the approach to treatment of ED?
The initial approach to treating erectile dysfunction (ED) focuses on making lifestyle adjustments and potentially modifying medication regimens that could be linked to ED. A sedentary lifestyle, which poses a considerable risk for cardiovascular disease, can also be a factor that can be modified to reduce the risk of ED. Additionally, it’s important to note that obesity significantly increases the likelihood of experiencing ED, almost doubling the risk.
For pharmacotherapy options, Phosphodiesterase type 5 (PDE5) inhibitors, which include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), are recognized as the most effective oral medications for the treatment of erectile dysfunction (ED) and are often the initial choice of therapy. There is no substantial evidence indicating that one PDE5 inhibitor surpasses the others in effectiveness. Typically, PDE5 inhibitors are well-tolerated, and they may lead to mild and temporary side effects such as headaches (the most commonly reported), facial flushing, indigestion, nasal congestion, and changes in vision (e.g, bluish-tinted vision).
1. What are the signs and symptoms of premature ejaculation (PE)?
Premature ejaculation (PE) occurs when a man reaches orgasm and ejaculates (releases semen) earlier than desired during sexual intercourse or inability to delay ejaculation for longer than three minutes after penetration. Premature ejaculation is estimated to affect between 4% to 39% of men in the general population.
2. How is PE diagnosed?
The diagnosis of premature ejaculation is typically based on the timing of ejaculation, whether it occurs too early, too late, or not at all, as determined through a patient’s history. Laboratory testing is generally only required if a healthcare provider identifies any specific issues during the physical examination.
3. Which demographic group is most frequently affected by this condition?
Generally, the risk of PE is known to decrease with age. Premature ejaculation can affect men across various demographic groups. However, it is more commonly reported among younger men, particularly those in their 20s and 30s. It can also occur in older age groups, but the prevalence tends to be higher among younger individuals. It’s important to note that premature ejaculation is a widespread issue, and its occurrence is not limited to a specific demographic.
4. What is the approach to treatment of PE?
Common treatment options for premature ejaculation encompass behavioral techniques, medications, and counseling. Additionally, topical numbing agents and oral medications can be employed.
Some medications have the potential to delay orgasm, although it’s important to note that these drugs are not specifically approved by the Food and Drug Administration for treating premature ejaculation. Some of these medications include antidepressants, pain relievers, and drugs used for erectile dysfunction. These medications may be prescribed for either on-demand use or daily use, depending on the individual’s needs and preferences.
Urinary tract infection (UTI) is the most common bacterial infection in women, with one-half of all women experiencing at least one UTI in their lifetime.
The most common causative bacteria for most UTIs in women are Escherichia coli up to 86% and the rest of them are made up of Staphylococcus saprophyticus, Klebsiella, Proteus species, Enterobacter species, Citrobacter species, or Enterococcus species as the least causative bacteria.
2. What are the common symptoms?
Symptoms include the following:
Burning pain when urinating (Dysuria)
Increased urination (Urinary frequency)
Increased urges to urinate, but not urinating as much (Urinary urgency) and/or
Pain or discomfort over lower abdominal pain (bladder pain or suprapubic pain)
3. How can we make a diagnosis? Can you make a diagnosis without labs?
Yes, Because of the predictable nature of the causative bacteria as listed above, urine culture is not indicated for the majority of urinary tract infection diagnosis. However, urinalysis is recommended and appropriate, especially for patients who fail initial treatment.
Urine cultures are recommended in women with suspected kidney infection, women with symptoms that do not resolve or that recur within two to four weeks after completing the antibiotic treatment, and women who present with atypical symptoms.
4. Diagnosis of Urinary tract infection by Telehealth
There have been studies that woman who have previously had uncomplicated urinary tract infection are usually accurate in determining when they are having another recurrent infection. Another randomized controlled trial compared outcomes of uncomplicated urinary tract infection in healthy women managed by telehealth setting versus in the office setting and made a conclusion that there were no differences in symptom score or satisfaction in treatment results between the two groups.
Vaginal yeast infections are common and about 75% of women will have one episode of vaginal yeast infection at some time in their lifetime. It is caused by overgrowth of yeast organisms that normally live in small numbers on normal skin and inside vagina.
2. What causes this imbalance of acidity in your vagina?
The acidity of the vagina helps keep the yeast from growing. If this pH balance is affected and the vagina loses its acidity, yeast can outgrow and take over, causing a vaginal infection.
The following are potential contributing factors to vaginal yeast infection.
Certain medications like antibiotics, steroids or birth control pills
Irritation of the vagina
3. What are the symptoms?
Symptoms include the following:
Itching and burning in the vagina and around the vulva (the skin that surrounds your vagina)
A thick, white colored cottage cheese like or curdy discharge
You may have pain during sexual intercourse
Swelling of the vulva
4. How can I keep from getting another infection?
Avoid vaginal douching
Avoid non-breathable or tight-fitting underwear or clothing
Avoid using any chemical hygiene products including deodorant sanitary pads, feminine hygiene sprays, tampons, or bubble bath
Build a habit to wipe from front to back after using the toilet, preventing bacteria that normally live in your rectum from getting into your vaginal area
Consider a suppression plan that you take daily for a few weeks to months to prevent recurrent episodes of yeast infection if you have frequent recurrent infections
Bacterial vaginosis is another common vaginal infection in women. It is caused by disrupting the normal balance of bacteria in the vagina when there is too much of certain bacteria in the vagina.
The common causative bacteria for this condition are anaerobic bacteria including Prevotella, Mobiluncus, Gardnerella vaginalis, Ureaplasma or Mycoplasma.
2. What causes this imbalance of bacteria in vagina, causing Bacterial vaginosis?
It is not completely known how BV spreads. However, the following are commonly known contributing factors to imbalance the number of normal bacteria in vagina.
– Vaginal douching, not using condoms, or having new or multiple sex partners can increase the risk for getting Bacterial vaginosis.
3. What are the symptoms of BV?
Symptoms include the following:
Thin and homogeneous discharge that may worsen after intercourse
Fishy odor in vaginal discharge
Itching or discomfort in vagina or vulva may present
Pain during sexual intercourse
Pelvic discomfort may present
4. How can BV be treated?
First-line therapy includes either oral or intravaginal treatment. We can choose oral metronidazole (Flagyl), or intravaginal treatment with either metronidazole (Metrogel) or clindamycin vaginal gel.
In addition to address resolving symptoms of BV, treating BV is also important to reduce the risk of sexual transmitted disease such as Chlamydia, Neisseria gonorrhoeae, Trichomonas, human immunodeficiency virus (HIV), and herpes simplex virus type 2 infections because imbalances and shifts in vaginal flora that BV has caused have been associated with increased risk of these infections as well.
Chlamydia is the most frequently reported bacterial sexually transmitted infection (STI) in the United States.
In 2019, there were 1,808,703 million reported cases among both men and women, with an incidence rate of 552.8 cases per 100,000 individuals. The year 2018 saw approximately 4 million reported cases.
Chlamydia is more widespread than gonorrhea, with around 600,000 reported cases of gonorrhea in the same year. This infection is primarily transmitted through sexual intercourse, including vaginal, anal, or oral sex with a partner who has gonorrhea. While Chlamydia can often be asymptomatic, some individuals may experience symptoms such as painful urination (dysuria), genital discharge (in males and females), discomfort during sexual intercourse, abdominal pain, testicular pain (in males), and breakthrough vaginal bleeding (in females).
Factors that increase the risk of Chlamydia infection include being sexually active and under the age of 25, inconsistent or infrequent condom use, having multiple sexual partners, and a history of other sexually transmitted diseases.
Gonorrhea is a common sexually transmitted disease that can lead to infections in the genitals, rectum, and even the throat, depending on the nature of direct contact. It is particularly prevalent among young individuals.
This infection is primarily transmitted through sexual activity, including vaginal, anal, or oral intercourse with a partner who has gonorrhea. Additionally, a pregnant patient with a positive gonorrhea diagnosis can transmit the infection to her baby during childbirth.
The symptoms of Gonorrhea are similar to those of Chlamydia. However, in Gonorrhea, the discharge may have a yellow or greenish color, which distinguishes it from Chlamydia.
Much like Chlamydia, Gonorrhea can also be entirely asymptomatic. Nevertheless, patients may experience symptoms such as painful urination (dysuria), genital discharge (in males and females), discomfort during sexual intercourse, abdominal pain, testicular pain (in males), and breakthrough vaginal bleeding (in females).
Trichomoniasis is another prevalent sexually transmitted disease caused by an infection with a protozoan parasite known as Trichomonas vaginalis.
According to CDC data, there were more than two million reported cases of trichomoniasis in the United States in 2018.
Transmission of this infection occurs through sexual intercourse with a partner who is infected with Trichomoniasis. Symptoms of Trichomoniasis are often asymptomatic in up to 70% of cases. However, patients may also experience symptoms such as genital discharge (in both males and females), painful urination (dysuria), discomfort during sexual intercourse, abdominal pain, testicular pain (in males), breakthrough vaginal bleeding (in females), itching, and redness or soreness in the genital area.
1. What is vaginal atrophy? What is the cause of the condition?
Vaginal atrophy is also known as Atrophic vaginitis. It is seen in postmenopausal women up to 40% on average.
It is caused by estrogen deficiency with postmenopause, therefore it can also be seen in pre-menopausal women who take antiestrogenic medications such as selective estrogen receptor modulators (SERMs) like tamoxifen with an underlying condition of breast cancer or who have medical or surgical conditions that result in reduced levels of estrogen.
2. What are the symptoms?
One of the common symptoms is reduced vaginal lubrication. With this condition, other symptoms of atrophic vaginitis include vaginal dryness, vulvar or vaginal itching, burning, or pain during sexual intercourse.
Some patients may report urinary symptoms such as burning pain with urination, urinary frequency, or incontinence secondary to reduced levels of estrogen can also cause increased vaginal pH, putting them at a risk of developing vaginal and urinary tract infection.
For this reason, some patients with vaginal atrophy (or atrophic vaginitis) report other vaginal and urinary symptoms that may be aggravated by coextensive infection.
3. How is it treated? What are the treatment options?
Hormone replacement therapy is the main therapy to treat the condition and to resolve symptoms. Since the underlying cause of vaginal atrophy is reduced or lack of estrogen hormone in the system, estrogen replacement restores normal pH levels and thickens vaginal epithelium, addressing the concerning symptoms from reduced levels of estrogen.
At V.ARIA, we only provide transvaginal delivery of estrogen in the form of vaginal creams. We prescribe estradiol vaginal cream 0.01%.
Treatment with a low-dose transvaginal estrogen has proved effective in relieving symptoms without causing systemic or other complicated side effects including decreased risk of endometrial carcinoma compared to oral systemic hormonal treatment.
4. How much am I expected to pay for estradiol vaginal cream at a local pharmacy?
The lowest price with a coupon for the most common version of estradiol vaginal cream is around $27.84, about 86% off the average retail price of $205.33.
1. What is Tretinoin and how does it work to reduce wrinkles or dark spots?
Tretinoin, generic medication of Retin-A, is a topical cream to use for acne treatment. However, with its benefits to fade and soften aging or dark spots, even out hyperpigmentation, and helping to boost turnover of superficial skin cells, topical tretinoin has been widely used for anti-aging treatment as well to address fine lines and wrinkles by increasing the production of collagen.
2. How soon can I expect to see the results from Tretinoin?
The results from the treatment are not expected immediately. It takes up to 6 months to 1 year of consistent routine use before seeing positive differences.
3. What are the dosage options and how do I know which dosage is appropriate for my condition?
There are 3 different dosages of Tretinoin cream, starting from 0.025%, then 0.05%, up to 0.1% as a maximum dosage. Each dosage comes with either 20 grams or 45 grams tubes.
0.025% is the lowest dosage and is recommended for those with mild acne or those who are looking for improving overall skin complexity without any active concerns on wrinkles. Since the dosage is the least in strength, the risk of side effects are the minimal compared to the other two dosages.
0.05% is recommended for those with moderate acne or those who want to address their starting aging signs such as reducing fine lines.
0.1% is the highest in strength and this is recommended for those with severe acne or those who are looking for intense treatment for wrinkles/fine lines. Since it is the highest dosage, the risks of developing side effects are greater compared to the other dosages.
All dosages come with a size of 20 g tube with extra 5 monthly refills.
4. What are the expected side effects from Tretinoin?
Since it is a topical cream, the common side effects from Tretinoin are skin irritations including skin dryness, redness, burning, itching, or exfoliating.
5. How much am I expected to pay for Tretinoin cream at a local pharmacy?
The lowest price with a coupon for the most common version of generic Retin-A (Tretinoin) 0.025% is around $16.46, about 82% off the average retail price of $92.99.
The lowest price with a coupon for the most common version of generic Retin-A (Tretinoin) 0.05% is around $29.44, about 69% off the average retail price of $96.73.
The lowest price with a coupon for the most common version of generic Retin-A (Tretinoin) 0.05% is around $34.06, about 71% off the average retail price of $121.25.
1. What is Latisse (bimatoprost ophthalmic solution) and how does it work to lengthen eyelashes?
Latisse (bimatoprost ophthalmic solution) is the first FDA-approved treatment to lengthen eyelashes for people with inadequate or not enough eyelashes. It is used on the upper eyelashes to increase their growth.
V.ARIA provides a prescription for generic Latisse (called bimatoprost) to give you the most cost-effective option, however if you are okay with the price for brand Latisse on the market and you prefer a branded Latisse over the generic option, then we can provide a prescription for brand Latisse upon the request.
2. What is the dosage option for Latisse (bimatoprost ophthalmic solution)?
For lengthening eyelashes treatment, there is only 1 dosage option with 0.03%.
3. I see there are two different sized bottles of Latisse. What size should I choose?
There are two sizes of bottle available – 3 mL and 5 mL.
3 mL is the regular sized bottle and it is used for a monthly supply for daily use. Generally, 5 mL sized Latisse is used for maintenance treatment since you do not require to use it daily after the first 16 weeks treatment and once you start the maintenance phase.
4. What are the known side effects from Latisse?
Some of the known side effects from Latisse are irritations of eyes or eyelids including redness, itching, swelling, tearing, or dryness. Dark skin discoloration on skin around eyes or iris can be seen in some cases as well.
5. How much am I expected to pay for the generic Latisse (Bimatoprost) at a local pharmacy?
The lowest price with a coupon for the most common version of generic Latisse (3 mL bottle) is around $31.60, about 77% off the average retail price of $139.26.
The lowest price with a coupon for the most common version of generic Latisse (5 mL bottle) is around $50.00, about 72% off the average retail price of $180.90.
What does V.ARIA mean? It means helping patients sing in victory.