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The Annual Women's Exam

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About the Annual Women's Exam

Routine women's or "gynecologic" exams are a very important part of health care for women. The annual exam provides an opportunity for your clinician to detect and test for abnormalities of the breast, vulva, vagina, cervix, ovaries, fallopian tubes, uterus, and colon. Listed are the basic things that may be included in your exam.

  • Screening for Sexually Transmitted Infections (STI's): STI testing will be done upon your request or your clinician may recommend testing. Testing for Chlamydia & Gonorrhea are done using a Q-tip to swab the cervix or by a urine test. Herpes and HPV can more easily be diagnosed if symptoms are present at the time of examination. HIV, Hepatitis B, Syphilis are detected by a simple blood test.

  • Abnormal growths: Infection with HPV (human papilloma virus) is a known precursor to dysplasia and cervical cancer. Most often HPV is not visible but when it is present your provider may see growths that are characteristic of HPV. An important part of your exam is palpation (examination by touch and/or pressure). Abnormal growths, including cancer of the breast, ovaries, and uterus are commonly found by palpation.

  • Pap smears: Pap smears detect cervical dysplasia (abnormal cervical cells) and cervical cancer. Routine Pap smears provide an opportunity for early detection and treatment of dyplasia and prevention of cervical cancer. Click here for new pap test guidelines.

  • Cancers: Breast, uterine, ovarian, and colon cancers are more common in women over age 50 but can occur in younger women.

Warning signs or indications to seek medical care include:

  • Abdominal pain or cramping
  • Abdominal lump, swelling or bloating
  • Abnormal vaginal bleeding, spotting or discharge
  • Pain with intercourse
  • Breast lump, pain or discharge
  • Fever
  • Abnormal bleeding or irregular menses
  • Unexplained weight loss
  • Persistent digestive problems

Breast Health

  • Breast self-exam: Although the risk of having breast cancer in your 20s and 30s is low, it can happen. Your 20s and 30s are a time in which to become familiar with your breasts and to develop the routine of a monthly breast self-exam. At the end of your menses each month, examine your breasts with a visual inspection in front of a mirror, checking for skin, nipple or symmetry changes. Then, lying down with opposite hand to breast, use your fingertips to go up and down across your breast in round circular motions, including the perimeter and the armpit. Report any changes or discrete lumps to your health care provider.
  • Mammography is an x-ray of the breast, which is used to help find breast cancer early along with the clinical breast exam and breast self-exam. If cancers are found when they are small, there is a higher rate of cure. The American Cancer Society recommends a baseline mammogram at age 40 and, depending on risk factors, every one to two years between ages 40 and 50, then yearly after age 50.

Menstrual Calendar

It is helpful to keep a calendar of the first day of each menstrual period. The length of your cycle is counted from the first day of one period (first day of bleeding) to the first day of the next. If you become pregnant, the date of the first day of your last menses is the basis of the timing of your due date and/or appropriate testing or procedures.

Emergency Contraception ("Morning-After Pill")

Emergency contraception (EC) is safe, legal and available at the Tang Center. It is helpful in decreasing your risk of pregnancy if you have unprotected intercourse (e.g., a condom breaks or slips off). EC should be taken as soon as possible, within 3-5 days. EC may contain progestin or a high-dose combination of estrogen and progestin (as in regular birth control pills). It is not a good routine form of contraception since it is only about 75% effective in preventing pregnancy and causes nausea for some women, but it can be helpful in emergency situations. You may ask for a prescription to have on hand, or you can call UHS if you need emergency contraception. For more information, also see Emergency Contraception.

Osteoporosis

Osteoporosis, or "thinning of the bones," is a leading cause of disability in older women. Postmenopausal women with osteoporosis are at higher risk of fractures leading to pain and immobility. Prevention begins in childhood and young adulthood by building "peak bone mass." We build bone until ages 22 to 28 and then by our mid-30s begin to lose it. To build bone, teenagers require 1200 to 1500 mg and women ages 25 to 50 need 1000 mg of elemental calcium a day. One cup of milk (skim or low fat) has about 300 mg of calcium, plain yogurt (1 cup) has about 415 mg, and 1/2 cup of tofu has 130 mg of calcium. Orange juice fortified with added calcium is another source. Calcium supplements such as Tums, Oscal or Caltrate are alternatives. Weight bearing exercises (walking, running, dancing) for lower body and spine, and upper body weight lifting are also important to keep your bones strong. Regular exercise is also important for physical and mental health; aim for 30 minutes 3 times per week as a start.

Viral Hepatitis

Hepatitis B is a sexually transmitted infection. Like HIV, you can get Hepatitis B from any contact with infected blood or body fluids. It can be present with no symptoms, or with jaundice (yellowing of eyes and skin), nausea, and fatigue. In many cases, there is often complete cure without treatment. A minority of cases can lead to chronic liver disease. Some people become silent "carriers" of the virus and can infect others for the rest of their lives; these individuals are also at increased risk of liver cancer. Some people are infected at birth if they were born to infected parents in an endemic area (including Asia, Africa, Alaska, Pacific Islands and the Amazon region). There is a safe vaccine series for Hepatitis B that can prevent you from getting this disease. Using condoms and practicing safer sex can also reduce your risk. The Hepatitis B vaccine series is now a routine pediatric vaccination and is available here at UHS. Hepatitis C is found by blood test (of those infected). Most people who get Hepatitis C carry the virus for the rest of their lives. There is no vaccine currently available to prevent Hepatitis C so avoiding risk factors such as IV drugs, sharing needles, and risky sexual behaviors is the only sure prevention.

HIV

HIV is a viral infection that infects white blood cells that manage the body's immune system. The virus is transmitted through contact with infected semen, blood, vaginal and cervical secretions, and breast milk. HIV is most likely to be transmitted by unprotected vaginal or anal intercourse, sharing needles, and/or blood transfusions. Using latex condoms properly substantially reduces the risk of HIV transmission. Many people infected with HIV have no symptoms. HIV testing indicates whether a person has developed antibodies to HIV, which takes 3-6 months after infection. Early treatment of HIV infection can preserve your health. Women should consider HIV testing before attempting pregnancy.

Rubella Vaccination

If you are considering pregnancy in the near future and are not sure whether you have an immunity to Rubella, consider checking it (with a blood test) and getting a Rubella vaccination if you find you are not immune. Rubella infection during a pregnancy can lead to serious birth defects.

Folic Acid

Taken before and immediately after becoming pregnant, folic acid reduces neural tube defects, a serious birth defect, by 50 to 70%. Because of the chance of unplanned pregnancy, the Food & Drug Administration recommends that all women of childbearing age take a multivitamin with 400 micrograms of folic acid daily. Folic Acid is found naturally in dark green leafy vegetables, oranges, yeast, liver, and fortified grains. It is difficult, however, to obtain 400 micrograms through diet alone. Most brands of daily multivitamins contain 400 mcg of Folic Acid.

Related services at the Tang Center

If you have further questions about anything you read today, or need referrals, you can make a follow-up appointment to discuss it with your clinician, or you can speak to an advice nurse. You can also find more information at the Self Care Resource Center located on the second floor of Tang Center.

  • Advice Nurse: (510) 643-7197
  • Appointments: (510) 642-2000
  • Self Care Resource Center: (510) 642-7202

Additional Online Resources

Related Topics

 

Disclaimer: The information provided here is not intended to diagnose, treat or provide a second opinion on any health problem or disease. It is meant to support, not replace, the relationship that exists between an individual and his/her clinician.

Last revised: August 2007

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