Visiting The Gynecologist

The regular gynecologic exam is a key part of your health care. Routine gynecologic exams are important to a woman's total health and well-being. From the start of menstruation (menarche) through the end of the time when menstrual periods end (menopause) and beyond, any number of problems can occur that involve the reproductive organs. The healthy condition of these organs is essential to sexual satisfaction, normal fertility, uncomplicated pregnancy and childbirth, and the health of any future infants.

By performing exams on a routine basis, your doctor can detect problems and treat them before they become worse. This is especially important with cancer of the cervix, which can be detected in an early stage with a simple, quick test, called a Pap test, that can be done in your doctor's office. Your ob-gyn can also give you preventive care-guidelines and advice to help you stay healthy-in areas such as nutrition and sexually transmitted diseases.

When your reproductive organs are healthy, there is less risk of problems during pregnancy and childbirth. It is ideal for obstetric care to begin when a woman first decides to have a baby-before she becomes pregnant. A woman and her doctor need to know about her overall health so they can plan in advance for a healthy pregnancy and a healthy baby.

When Should You Have an Exam ?

You should have your first gynecologic exam by age 18 or earlier if:

• You are or may soon become sexually active

• You have menstrual problems, such as unusual pain or abnormal bleeding

• You have a vaginal discharge that has a foul odor or is causing irritation

• You are planning to become pregnant

• You have not had a menstrual period but have developed breasts and pubic hair

How often your visits should be depends on the care plan that you and your doctor prepare. In most cases, you should see your doctor once a year. Of course, if you have a health problem, notice any changes in your body, or become ill, you should contact your doctor right away.

Health History

One of the first things your doctor does on your first visit is ask you for a personal and a family health history . Your personal history tells the doctor specifically about you. The family health history gives him or her a general view of your family's health. It also provides information on diseases that may be inherited (passed on) from your parents to you or from you to your future children. It is important to give answers that are honest and as complete as possible during the health history. Don't let fear or embarrassment keep you from giving your doctor important information about your health. Keep in mind that these discussions between you and your doctor are strictly confidential.

Physical Examination

The physical exam by your ob-gyn usually involves your entire body, including your reproductive organs. It usually begins with a check of your weight, nutritional status, and blood pressure.

An examination of the chest and abdomen may also be performed. Your blood pressure should be checked on a regular basis. A person can have high blood pressure and still feel fine and have no symptoms. High blood pressure overworks the heart and circulatory system and, if not treated, can lead to kidney damage or stroke.

During the exam, your doctor checks your breasts for signs of cysts or lumps. This is done in addition to the monthly breast self- examination you should be doing on your own.

What Is the Exam ?

A routine exam lets the doctor evaluate you as a total person. It also provides clues in finding the causes of problems such as abnormal uterine bleeding or vaginal discharge, urinary or bowel problems, pain in the abdomen or lower back, infertility, or sexual problems. The exam consists of a personal and family health history, a physical exam, lab tests, and education and counseling.

Pap Test

During the internal exam, your doctor may perform a Pap test. In this test, a few cells are taken from the cervix and vagina with a cotton swab or applicator. This is not painful. The cells will be examined in a lab for early signs of abnormal cells. Such abnormal cells could signal cancer in an early stage. Although abnormal calls are sometimes found on the cervix, as long as 10 years may pass before cancer develops. A Pap test can detect cancer when it is in an early stage, before it invades deeper tissues. At this early stage, there is a greater chance that the cancer can be treated with success.

A Pap test done on a regular basis is a key part of your overall reproductive health care. You should have your first Pap test by age 18 or when you begin having sex. Most doctors feel that women should have a gynecologic exam, including a Pap test, every year. If any of your tests shows abnormal results, your doctor may advise you to have a Pap test more often than once a year. Other lab tests, along with the Pap test, are also part of a periodic gynecologic exam. These may include several tests of both blood and urine. Special tests, such as X-rays, tests for infections, or mammograms (X-rays of the breasts), may also be needed.

The Pap test or pap smear is most effective, early cervical cancer detection method available today. It is a simple procedure that involves swabbing a small sample of cells from a woman's cervix and transferring them to a slide. The cells are then examined and evaluated by a certified laboratory.

Done regularly, Pap smears make it possible for doctors to find early evidence of cervical cancer. This can be done before any visible symptoms are present, when the disease is easier to cure.

Cervical cancer is one of the most common female cancers in the United States. It is diagnosed in an estimated 13,500 women yearly. About 4,400 women die each year from the disease. For those women diagnosed early, the survival rate is 89 percent. If the disease hasn't spread, the survival rate is virtually 100 percent.

Your Doctor's Advice

After taking your history and doing a physical exam, your doctor will discuss results with you and answer any questions you may have. If the lab tests that have been ordered show anything unusual, you will be informed later.

Your doctor and the office staff can discuss with you such topics as:

You probably will have specific questions about these matters. Feel free to ask your doctor any questions you have.

Source: American College of Obstetrics and Gynecology - Patient education material

Pap Test or Pap Smear

Cervical cancer is nearly 100 percent preventable, yet according to the American Cancer Society, an estimated 13,000 new cases of invasive cervical cancer will be diagnosed in 2002 and about 4,100 women will die of the disease. The good news is that cervical cancer is preventable and curable if it is detected early; in fact, the occurrence of deaths from cervical cancer has declined significantly over the last 20 to 30 years.

Cervical cancer rates are higher among older women; however, cervical intraepithelial neoplasia (or CIN), the precursor lesion to cervical cancer, most often occurs among younger women. Screening younger women using the Papanicolaou (Pap) test is an important strategy that can actually prevent cervical cancer from developing almost 100 percent of the time.

Minority populations and persons of low socioeconomic status are affected disproportionately as well. For more information on cervical cancer and specific populations

Cervical Cancer and Specific Populations

Studies that have identified risk factors associated with cervical cancer have shown that cervical cancer is closely linked to:

• Failure to receive regular Pap test screening

• Human papillomavirus (HPV) infection

• Certain sexual behaviors (see paragraph below)

• Immunosuppressive disorders such as HIV/AIDS

Experts agree that infection with certain strains of the HPV is one of the strongest risk factors for cervical cancer. The sexual behaviors specifically associated with greater risk are intercourse at an early age, multiple male sexual partners, and sex with a male partner who has had multiple sexual partners. Experts also agree that one of the most important things women can do to reduce their risk of cervical cancer is to receive regular screening with a Pap test.

• Pap testing should begin with the onset of sexual activity.

• Pap testing should be repeated at least every 3 years.

• There is insufficient evidence to recommend for or against an upper age limit for Pap testing, but recommendations can be made on other grounds to discontinue regular testing after age 65 in women who have had regular previous screenings in which the smears have been consistently normal.

There is insufficient evidence to recommend for or against routine screening with cervicography, routine screening with colposcopy, and screening for human papilloma virus infection, although recommendations against such screening can be made on other grounds.

Many organizations, including the American Cancer Society, National Cancer Institute, American College of Obstetricians and Gynecologists, American Medical Association, American Academy of Family Physicians, and others also recommend that Pap testing should

• Begin annually at the onset of sexual activity or at age 18 and

• Ccontinue less frequently at the discretion of the doctor and patient after three or more annual tests have been normal.

• Women who are past menopause (change of life) still need to have regular Pap tests. However, women who have undergone a hysterectomy in which the cervix was removed do not require Pap testing, unless the hysterectomy was performed because of cervical cancer or its precursors.

Source: Cancer Facts and Figures 2002, American Cancer Society, 2002.