Complete Gynecology Services
An annual exam is a once-a-year visit to your primary care provider for a general health check, including a breast exam and pap smear. An annual exam visit does not include discussion of new problems or detailed review of chronic conditions. Annual exams are also called routine checkup, yearly exam, annual pap, and preventive visit.
Please schedule a separate appointment if you have health concerns other than your routine physical exam.
- Examples are:
- A list of concerns or questions.
- New health care concerns or problems found at the time of your annual exam.
- Ongoing health problems that need more attention.
As part of your routine gynecologic exam, you will have a Pap test (also called a Pap smear). A Pap test is used to identify abnormal cell changes on your cervix and to screen for cervical cancer.
An abnormal Pap test indicates that cells on your cervix have changed. An abnormal Pap test is not uncommon because the cells of the cervix normally undergo constant change. About 5% to 10% of women who have a yearly Pap test will have an abnormal result, but only a small percentage of these abnormal results indicate changes that may progress to cervical cancer.
Many abnormal Pap tests are caused by viral infections, such as human papillomavirus (HPV) infection, or other types of infection, such as those caused by bacteria, fungi (yeast), or protozoa (Trichomonas). Natural cervical cell changes (atrophic vaginitis) related to menopause can cause an abnormal Pap test. Usually cells return to normal on their own, after an infection has been treated or has resolved on its own.
In some cases, untreated cervical cell changes that cause abnormal Pap tests may progress to precancerous or cancerous stages. Certain high-risk types of HPV, especially types 16 and 18, have been linked to the development of cervical cancer. However, changes in cervical cells usually progress slowly and take many years to become cancer cells.
Most cervical cell changes are the result of high-risk sexual behaviors by you or your partner, such as having multiple sex partners and not using condoms. These behaviors increase your risk of infections and sexually transmitted diseases (STDs). If you are in a single-partner (monogamous) relationship, an abnormal Pap result caused by HPV may not indicate current high-risk behavior. Since the HPV virus remains in body cells for many years, abnormal cervical cell changes can be a result of an HPV infection years earlier.
Smoking or having an impaired immune system also may increase your risk for cervical changes.
Having regular Pap test screening and follow-up evaluations of any abnormal results can reduce your risk of developing cervical cancer.
Abnormal cervical cell changes themselves do not cause symptoms. An HPV infection—the most common cause of abnormal cervical cell changes—usually does not cause symptoms. This is why regular Pap test screening is so important.
If an STD is the cause of your abnormal Pap test, you may have symptoms from the STD. STDs can have a variety of symptoms, including:
- Abnormal vaginal discharge, such as a change in the amount, color, odor, or texture.
- Pain, burning, or itching in the pelvic or genital area during urination or during sexual intercourse.
- Sores, lumps, blisters, rashes, or warts on or around the genitals.
Even though most abnormal Pap tests are caused by infections or inflammation that can be treated, you will need a follow-up evaluation to make sure your abnormal cell changes have resolved. Your treatment choices will vary depending on whether your abnormal cell changes are mild, moderate, or severe.
- If you have minor cervical cell changes, you may choose monitoring by your doctor (watchful waiting), an HPV test, or in some cases colposcopy.
- If you have moderate to severe cell changes, you will need further evaluation by colposcopy and possibly a cervical biopsy. Then treatment that specifically destroy or remove the abnormal cells may be recommended depending on the biopsy results.
Vaginal yeast infections (monilial vulvovaginitis) occur frequently in many women. They have a variety of causes. Pregnancy, birth control users, women who take antibiotics for any reason, frequent swimmers, certain type clothing, diabetics, and no obvious cause are some of the conditions associated with this problem. It is not dangerous but just inconvenient, irritating, and uncomfortable.
The infection usually has a itching and/or burning associated with a discharge. The discharge can be white, yellow, or greenish yellow. It frequently has the appearance of cottage cheese.
The treatment is quite simple. There is a variety of anti-yeast medications available over-the-counter. These include Monistat, Mycelex, Gynelotrimin and Femstat. Terazol, a medicine that requires a prescription, is also available. A pill, Diflucan, is also available in a one-dose strength.
If you purchase anti-yeast medication, you should use the cream. You should apply the cream to the lips of the vagina once or twice a day and insert the cream up inside the vagina once a day for three to five days. If intercourse is occurring, you should give the cream to your partner to apply on the penis and the area around the base of the penis. If oral genital sex is practiced, the mouths should be treated and this can be done by chewing a Mycelex vaginal suppository. This tastes like chalk and is not dangerous to swallow. Drying the area after bathing, even using a hair dryer, and avoiding tight-fitting, air-occlusive clothing are helpful to prevent yeast infections.
If after 24 to 48 hours no improvement occurs with these methods, another problem may exist and a doctor should be consulted.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is a condition of unknown cause. It is associated with problems such as irregular (usually less frequent) menstrual cycles, excessive hair growth, acne, obesity, infertility and the possible development of diabetes and osteoporosis. Treatment for PCOS depends on the associated problems and can include weight reduction, hormones or – in some cases – an operation.
Normally the ovary produces large amounts of the female hormone estrogen, lesser amounts of the male hormone testosterone, and the pregnancy hormone progesterone (which is only produced in greater amounts after ovulation and during pregnancy). In PCOS, testosterone levels may be mildly increased.
The causes of PCOS are unknown. In some cases, it seems to run in the family; for other women, the condition only occurs when they are overweight. Recent research suggests that PCOS is related to insulin resistance and the development of diabetes, especially in women who are overweight.
Irregular menstrual cycles: menstruation may be less frequent due to less frequent ovulation, and may be either heavier or lighter than average.
Amenorrhea: some women with PCOS do not menstruate, in some cases for many years.
Obesity: the cause of this is unclear.
Excessive hair growth: may be due to increased testosterone.
Acne: the cause is unclear.
Infertility: related to less frequent or absent ovulation.
There may also be long-term health risks. Some women with PCOS develop diabetes, especially if overweight. Women with infrequent periods are at risk of osteoporosis.
PCOS is usually diagnosed based on the woman’s history and an examination. It may be confirmed by ultrasound and by measuring hormone levels in the blood. Early diagnosis is important, as it will allow symptoms to be managed and may prevent long-term health problems from developing.
It is important that a broad approach (by a general practitioner with interest or expertise in this area or perhaps involving several specialists – for example, an endocrinologist or a gynecologist) be used to manage and treat PCOS. If only one or two symptoms are addressed on a short-term basis, the woman may be left with long-term clinical problems.
The treatment for PCOS will depend on the problems the woman has. For example, if the woman is suffering from irregular, heavy periods, the oral contraceptive pill is often prescribed to regulate the cycle and prevent the lining of the womb from overgrowing. If the woman has infrequent periods, the oral contraceptive pill is used to reduce the risk of osteoporosis. Weight loss is very important, as it will reduce the risk of diabetes developing and can reduce other symptoms. An operation called ovarian drilling can be used to treat women with PCOS who want to become pregnant and are not ovulating.
Endometriosis is a condition where the innermost layer of the uterus, the endometrium, grows in locations outside the uterus. Endometriosis may cause adhesions on the uterus. The uterus can become stuck to the ovaries, fallopian tubes and bowel. Although many patients experience extreme pain, some women with endometriosis do not experience any symptoms (asymptomatic). Usually it causes pain around the time of the menstrual period but, for some women, the pain is almost constant.
The symptoms of endometriosis vary widely from woman to woman and the severity of symptoms is not necessarily related to the severity of the endometriosis. Symptoms depend on the extent and location of the endometrial implants and the affected structures. While some women have few or no symptoms, others experience severe and incapacitating pain that recurs each month for many years. Many women think that painful periods are normal. If you have bad period pain, you should see your doctor.
- Period pain (dysmenorrhoea)
- Pain during sexual intercourse (dyspareunia)
- Pelvic and abdominal pain outside of menstruation
- Abnormal bleeding – including heavy bleeding, clotting, prolonged bleeding, irregular bleeding, premenstrual spotting Bowel disturbances – including painful bowel motions, diarrhea, constipation, bleeding from the bowel
- Difficulty in getting pregnant
- Painful urination
- Lower back, thigh and/or leg pain
- Premenstrual syndrome
The anticipation of recurrent pain or discomfort each month may also lead to feelings of anxiety, stress and depression. It is important to acknowledge these emotional difficulties that may arise from endometriosis.
The tests used to help diagnose endometriosis are:
- Laparoscopy – a medical instrument with a video camera attached is used to examine your uterus.
- Ultrasound – an instrument which uses sound waves to create a video image.
- Colonoscopy – a medical instrument with a video camera attached is used to examine your bowel. This is done if it is thought that the endometriosis could also be affecting your bowel.
- The severity of symptoms
- The extent of the endometriosis
- The woman’s age and
- Her outcome requirements (e.g. reduction in pain, improved fertility)
No treatment can absolutely prevent endometriosis from recurring but a combination of regular medical follow-up, hormone medication and/or surgery can control the condition.
Having a baby may improve the condition. While endometriosis is suppressed during pregnancy, symptoms may recur in time, even as early as a few months after giving birth.
Medical treatment is essential for this condition. Hormones can usually treat endometriosis; sometimes surgery may be indicated.
- The oral contraceptive pill (occasionally)
- Anti-inflammatory medications
- Hormonal treatments (for example, Danazol, Lupron, Provera and Zoladex. Side effects of these drugs may include depression, hot flushes, mood swings, night sweats, loss of libido and headaches.)
- Laparoscopic surgery – is performed to diagnose endometriosis. Laser surgery may be used to try and remove the adhesions. This may be done to reduce pain and to improve the chances of you becoming pregnant.
- Laparotomy – is used to cut out or burn tissue, or remove cysts
- Bowel resection – for example, if the bowel has also developed endometriotic adhesions
- Hysterectomy – may be an option if endometriosis prevents you from having a normal life and other treatments have not worked