This preventative exam is usually done yearly to access vital information such as weight, blood pressure, and height. An exam is done to access the thyroid, lungs, heart, breast, abdomen, and pelvis looking for signs of problems.
PAP SmearCells are scraped from the cervix and sent to a lab to detect cervical cancer and pre-cancer.
ColposcopyViewing the cervix with magnification to perform biopsies, looking for precancerous cells.
LEEPRemoval of a larger biopsy of the cervix with a wire loop and current. The sample is sent to the lab to rule out pre-cancer and cancer. This is the most common way of treating severely abnormal cells and is successful about 85-95% of the time with one procedure. It can be done with local or IV medication. It requires pelvic rest (no tampons or intercourse/sex) for 4-6 weeks and no aerobic activity for 2 weeks.
Endometrial BiopsyA Sampling of the tissue that lines the uterine cavity most often done to look for the cause of abnormal bleeding and help exclude cancer.
Hysteroscopy with Dilation and CurettageUsing a small scope to look inside the uterus and sample the lining to look for infection, polyps, cancer, and other pathology.
UltrasoundA non-invasive method of visualizing pelvic organs for masses, cysts, and other abnormalities. It can detect early pregnancies inside and outside of the uterus. Used in obstetrics to assess the baby inside the uterus.
Long-Acting Reversible ContraceptivesImplantation of birth control devices for that is removable. These may contain hormones but they are safer than birth control pills containing estrogen.
Hormone Replacement TherapyReplacing the hormones that are no longer produced when a woman goes through menopause. This is done to reduce symptoms. Breast and uterus cancer risks may be increased with their use, but they can usually be used safely in a small amount with great benefits and better quality of life.
Laparoscopic (with a small scope) or vaginal procedures that avoid large incisions and more painful recovery and scar formation. These procedures allow the diagnosis of gynecologic problems and surgical removal of organs, cysts, scar tissue, and biopsies of tissue. These include Diagnostic Laparoscopy, Operative Laparoscopy, Tubal Ligation, Cystectomy, and Hysterectomy.
SterilizationRemoval or clamping of the Fallopian tubes to prevent pregnancy. This may be done through a small scope and does not require a hospital stay. Also called Tubal Ligation.
CystectomyRemoval and most often testing of a cyst (fluid-filled structure) usually found on the ovaries. Most ovarian cysts are benign and do not require removal. Usually done through tiny incisions as an outpatient.
MyomectomyRemoval of a benign muscle and fibrous growths from the uterus, either through a scope or abdominal incision.
HysterectomyRemoval of the uterus. The tubes and ovaries may be removed at the same time depending on the circumstances. Often the tubes are removed at the time of the hysterectomy as they are a source of cancer and they have no function after childbearing. Ovaries may be retained if the patient desires them for hormones and if they appear normal. Hysterectomies are done through minimally invasive techniques unless the uterus is too large or other masses or complications require a larger incision. The preferred method, if possible, is to remove the uterus vaginally. Vaginal hysterectomy has been shown to have the lowest complication rate.
We can now test the cervix for HPV or Human Papillomavirus. This is a virus that can cause cervical cancer. It is very common and most females (about 80%) will have one of the strains of this virus at some time in their lives. Most of the time the infection goes away by itself. Testing for HPV can help provide further information on how to follow abnormal PAP smears. It can also be used in general screening in patients with normal PAP smears to lengthen the time between PAP smears from 1 to three or more years.
Abnormal PAP Smears/HPVA PAP smear is a scraping of skin-like cells from the cervix that are sent to a lab and evaluated for signs of precancerous or malignant cells. PAP smears should start at 21 years of age regardless of sexual activity, PAP smears are repeated depending on age and the results of the last PAP smear and are done every 1 to 3 years until at least the age of 65. Additional co-testing for HPV ( Human Papilloma Virus) after the age of 30, if neg, may allow up to 5 years between PAP smears.
PAP smears are abnormal if they show pre-cancer or cancerous cells. These abnormalities are caused by the Human Papilloma Virus. Abnormal cell types are separated into 3 main categories: Mild pre-cancer, Severe pre-cancer, and Cancer. Each category has different names that can be confusing but they all are the same category:
When abnormalities are found in gland cells, (Atypical Glandular Cells), it is more worrisome than the Squamous (skin-like) cells. Abnormal glands cells can progress to cancer more quickly.
The treatment or follow up of abnormal PAP smears is also less aggressive in women from 21 to 30 years of age as the immune system is so robust that the cells will most likely return to normal. Surgery to remove abnormal cells from the cervix can weaken the cervix and lead to pregnancy loss or premature delivery of an infant. In most cases, even in women over 30 years of age, these cells can be carefully watched with PAP smears and biopsies without any other intervention as long as they do not become severely abnormal.
When PAP smears are found to be abnormal, the cervix can be further evaluated with biopsies that are directed by the use of a magnifying device called a Colposcope. The biopsies feel like a pinch or a cramp and the sample is sent to pathology and evaluated for pre-cancer or cancer cells. Taking Motrin before the procedure makes it more comfortable.
Ovarian CystsCysts are fluid-filled sacs and often occur naturally on the ovary before it releases an egg. Sometimes the cysts become enlarged and can cause pelvic pressure or sudden and prolonged pain. They can even cause the ovary to twist, lose its blood supply, resulting in damage or the loss of an ovary. They are very common in childbearing years.
Cysts are benign about 99% of the time before menopause. They are usually diagnosed by imaging such as an Ultrasound or CT scan. They usually resolve on their own. If they are not causing symptoms, it is safe to watch them most of the time. Often, we recommend repeating an ultrasound every few months to see if it is getting smaller. If the cyst requires removal, it can usually be done through small incisions with a scope, as an outpatient.
Abnormal Vaginal BleedingVaginal bleeding is abnormal if it occurs more frequently than every 21 days, lasts longer than 8 days, occurs between normal monthly periods or after intercourse. Women should not soak more than 30 maxi-pads in a cycle or more than a maxi pad an hour, for two hours in a row.
Abnormal bleeding may be caused by hormonal irregularities such as PCOS (Polycystic Ovarian Syndrome) or peri-menopause as well as other hormonal irregularities. It can be caused by abnormal pregnancies. It may be due to trauma.
Abnormal Vaginal Bleeding can be caused by clotting abnormalities. Irregularity of periods should always be reported to your doctor so that an appropriate investigation can be recommended if indicated. Labs and Ultrasound are the most common types of evaluation, but biopsies may be required, especially as a woman gets nearer to menopausal and has a greater chance of pre-cancer and cancer of the uterus.
All bleeding that occurs after menopause should be reported as the chances of malignancy are greater when bleeding occurs.
Menstrual Cramps(DYSMENORRHEA): Cramping with periods can be normal if it is mild and resolves with Motrin. If it is not controlled with over the counter medications, it should be investigated. This condition is treated with hormonal birth control to prevent ovulation, such as birth control pills or Depo-Provera (birth control shot). If this is not effective and the pain is becoming worse and accompanied by pain with intercourse (DYSPAREUNIA), further investigation with laparoscopy or other prescription medications may be indicated. Most women can be treated effectively and not have their lives disrupted by severe cramps.
Pelvic PainA symptom that requires further investigation. It may be as simple as a new work out routine that has strained a muscle or a serious life-threatening disease such as appendicitis. Most often it is a self-limited diagnosis such as an ovarian cyst that has leaked fluid, that will dissolve on its own. If the pain is severe and persistent and not relieved in a short time or with over the counter medications, it will probably require further investigation at the office or in the emergency room if it is severe. It is most important to seek urgent care if you could be pregnant.
It is very important to notice as many details about the pain as possible and report them to your provider. Such as, when did the pain occur, how long has it been present, is it related to the menstrual cycle or intercourse and are there any associated symptoms such as fever, chills, vaginal discharge, or bleeding. If you have had a new sexual partner it is important to let us know. It is also important to know what makes it better or worse. This information along with an exam, lab test and sometimes and ultrasound can diagnose most causes and allow effective treatment to relieve your pain
InfertilityA woman is considered infertile if she has had unprotected intercourse (no birth control) for a year and has not conceived. Women over 35 years old should seek help if they have not conceived in 6 months. Fertility decreases with age.
Fertility can be improved in obese women by weight loss. Which helps improve ovulation. This is also true for weight gain in very thin women or women who exercise vigorously.
A workup usually involves lab tests of hormones and a semen analysis to rule out malefactors which are found in 40% of infertile couples. A test to confirm that the Fallopian tubes are open should also be performed. Treatment often involves taking medication to improve ovulation or sperm count and motility.
Intrauterine insemination of sperm can also be performed. If a tube is obstructed, surgery may be performed. In-Vitro fertilization (IVF), in which the egg and sperm are brought together and fertilization takes place outside the woman's body can be performed to bypass obstructed tubes. The fertilized egg or embryo is then placed back inside the woman's body. IVF can also be used to improve fertility if less invasive treatments are not successful.
Uterine FibroidsFibroids are muscle and fibrous growths in the uterus. They usually do not cause symptoms and are almost always benign. They may cause heavy menstrual cycles, pelvic pressure, including urinary frequency and constipation. They can also make it difficult to get pregnant.
If there are no symptoms, they may not require any treatment. Treatment may be as easy as hormonal therapy to control bleeding or as extreme as removal of the fibroid if childbearing is desired or hysterectomy if not. They can also be treated by radiologists who place beads to obstruct their blood supply or destruction (ablation) of the uterine lining to decrease menstrual bleeding. The treatment is tailored to the individual's needs and symptoms.
Sexually Transmitted DiseasesThese infections are spread during sexual activity of any type.
These infections can be present even if you have no symptoms. Screening is recommended for sexually active young women every year when they are 25 years old or younger for gonorrhea and chlamydia and older women who have more than one partner or do not use condoms. Screening is recommended for Hepatitis B if you have more than one partner. Check for Hepatitis C if you were born between 1945 and 1965. Pregnant women should be screened during pregnancy for Syphilis, Chlamydia, Gonorrhea, HIV, and Hepatitis B.