Women spend over one-third of their lives in the childbearing years, when they not only have to think about their own health but also the health of the precious lives they bring into this world and nurture with their love. There are many exciting challenges and wonderful experiences throughout these years.
Healthy living by women in their reproductive years can set a foundation for good maternal and infant health. Elements for a healthy life include healthy diet, regular exercise, adequate rest, avoiding obesity, avoiding tobacco or drug use, minimizing use of alcohol, and recognizing and seeking help with mental health or abusive relationships. Women may also lengthen their lives through regular screening for cancer and other illnesses. Women can promote their well-being and avoid unplanned pregnancies and sexually transmitted diseases. Healthy habits through the childbearing years improve birth outcomes, and life-long health.
Being proactive about your health is important. Many problems that affect women cannot be detected without thorough periodic examinations by a health care professional. Whether you are sexually active or not, good gynecological care can prevent illness and discomfort.
The American College of Obstetricians and Gynecologists recommends annual exams for every woman age 18 years and older. The gynecologic exam allows a health care provider to assess normal development of reproductive organs and screen for certain health problems. It also provides an opportunity to talk with a clinician about any sexual health concerns. This may include menstrual health, pregnancy prevention, concerns about sexually transmitted diseases, or menopausal concerns.
A yearly gynecology exam is important for women of all ages. At an annual appointment, a physical exam is performed assessing your heart, lungs, breasts, abdomen and pelvic anatomy. It is also a perfect time to touch base on special individual needs of women in different age groups and/or with a family history of specific illnesses.
During the women's health exam, the physician or advanced practitioner (nurse practitioner, midwife, physicians assistant) will:
The Pap smear is a screening test for detecting cancerous or precancerous changes of the cervix. The test was developed by Dr. George Papanicolaou in the 1940’s. Since its introduction over 50 years ago, a woman’s chance of dying from cancer of the cervix has decreased by over 75%. This makes the Pap smear one of the most effective cancer screening tests ever invented.
The cervix is the opening of the uterus (or womb). It is covered with a thin layer of tissue that is similar to skin; and just like the skin on your body, the cells that make up this tissue are constantly being shed to make room for the newer, healthier cells. It is these cells which have shed that are collected during the Pap smear and viewed under a microscope for abnormalities.
It is important to remember that although the Pap is a screening test for cancer of the cervix, cancer is not usually the cause of most abnormal smears. Before cervical cancer develops, there are usually several stages of abnormal cells called "dysplasia" (also known as "cervical intraepithelial neoplasia" or CIN). CIN changes take several years to develop and progress, which is why the Pap smear is so effective. When these abnormal cells are found, they can often be treated with procedures in your doctor's office which avoids hospitalization. Keep in mind that like any screening test, 10-20% of the time, a normal Pap result could be a "false-negative". This means that a normal result is reported even though abnormal cells are present. This reinforces the need for repeating Pap smears on a regular basis, which in the long run will cut down on the false-negative results.
Testing for the Human Papiloma Virus (HPV) has now become a routine part of Pap smear screening. Two types of HPV exist; low and high risk. It is the high risk subtypes which have been found to cause cervical dysplasia and cancer. Knowing that high risk HPV must be present in cervical cells to develop cancer and the ability to test for it, has allowed your physician to decrease how often a Pap smear must be performed.
Many women will be used to having Pap smears done yearly. Recommendations have changed and now allow Pap smear screening to be done every 3 years for women 21-29 and 5 years for women 30 years or older. The test for high risk HPV will now routinely be added for women 30 years and older as well as selectively for women 21-29.
If you have an abnormal Pap smear result, don’t panic. There is very low probability of finding invasive cancer, in fact most of the time only dysplasia (CIN) or nothing at all will be found. Your doctor will recommend what further action needs to be taken. Usually this will either be a repeat of the Pap smear in several months or a colposcopy.
Colposcopy means that your doctor will use an in-office magnification system to closely inspect your cervix and possibly to take a biopsy. If at any point in this process you are uncertain about the nature of your treatment, please discuss it further with your physician.
Recommendations for when to repeat a Pap smear after an abnormal result will very. Please follow your physician's individual recommendations closely.
What is GARDASIL?
GARDASIL is a cervical cancer vaccine that helps protect against 4 types of human papillomavirus (HPV): 2 types that cause 70% of cervical cancer cases, and 2 more types that cause 90% of genital warts cases. The duration of protection of GARDASIL has not been established. GARDASIL is given in 3 doses over 6 months.
Who should be vaccinated with GARDASIL?
GARDASIL is for girls and young women ages 9 to 26. Vaccination is recommended for girls as young as 9 because GARDASIL works when given before there is any contact with HPV Types 6, 11, 16, and 18.
If you're already sexually active, you may still benefit from GARDASIL. That's because even if you have been exposed to HPV, it's unlikely that you have been exposed to all the types of the virus covered by this cervical cancer vaccine. That means GARDASIL could still help guard you against HPV types you haven't been exposed to.
What are the possible GARDASIL side effects?
The most common GARDASIL side effects are:
Sometimes fainting is accompanied by falling with injury, as well as shaking or stiffening and other seizure-like activity.
Tell your health care professional if you have any of the following problems because these may be signs of an allergic reaction:
Tell your health care professional if you have:
Who should not get GARDASIL?
You should not get GARDASIL if you have, or have had:
Tell your health care provider if you:
Your doctor or health care professional will help you decide if you should get the vaccine.
Adult Immunization Schedule
9-18 Yrs. Immunization Schedule
You often hear about the importance of physical health, mental health and spiritual health, but feeling confident about your sexual health also is very important. Achieving sexual health allows for healthy relationships, planned pregnancies, and disease prevention.
Getting answers about your sexual health is important. If you have questions about women's sexual health, talk openly with your health care provider. There's no reason to be embarrassed about sexual problems. Your doctor can effectively treat a wide variety of sexual problems, including genital herpes, HPV, HIV or other sexually transmitted diseases (STDs). He or she can also discuss sexual changes that may occur due to other health conditions or menopause.
Safe sex means taking steps before and during that can prevent you from getting an infection, or from giving one to your partner.
The only safe sex is no sex. Abstinence may be the only true form of “safe” sex, as all forms of sexual contact carry some risk. Abstinence is a personal decision to refrain from all sexual intercourse: vaginal, anal, or oral. It is possible to get a STD even without having intercourse through skin-to-skin contact. However, certain precautions and safe behaviors can minimize a person’s risk of contracting a sexually transmitted disease (STD) and preventing an unwanted pregnancy.
Birth control refers to any activity, medication, or equipment used to prevent pregnancy. There are many types of birth control available for women who do not wish to become pregnant. The decision on which method is right for you should be made with your health care provider, as well as with your partner.
Birth control methods work in different ways to prevent pregnancy, including:
Some methods that do not require a prescription from your health care provider include:
Some methods that require a visit to your health care provider for an examination and a prescription include:
This birth control method provides either 5 or 10 years of contraception depending on the device used. It is 99% effective. It may be used in women who have had children and also those who have not. Both types of IUDs prevent fertilization of the egg by damaging or killing sperm. It also effects the uterine lining (where a fertilized egg would implant and grow).
There are two types of IUDs:
The Copper IUD - The copper IUD, Paragard, contains copper which kills sperm. It can stay in place for up to 10 years. Periods may be heavier or slightly longer with the use of Paragard.
The Hormonal IUD - The hormonal IUD, such as Mirena and Skyla, releases progesterone. This thins the uterine lining and helps make periods lighter with less cramping. The hormonal IUD appears to be slightly more effective at preventing pregnancy than the copper IUD. The hormonal IUD is effective for 3-5 years.
Surgery that results in the inability to become pregnant includes:
Methods that have been suggested as preventive, but may actually present a high risk for pregnancy include:
What is bacterial vaginosis?
A bacterial infection is caused by an overgrowth of certain types of bacteria that normally live in the vagina. The normal environment of the vagina may get out of balance and the infection cause bacteria to multiply faster than they normally would while other types of bacteria that normally keep them in check do not.
What are the symptoms of a bacterial infection?
The most common symptoms are an increased vaginal discharge with a strong fishy odor. The discharge is usually thin and dull or dark gray but may have a greenish color.
What may increase my risk of getting a bacterial infection?
The balance and acidity level of the vagina can be changed by many things. Douching, sexual activity, and even pregnancy may increase the occurrence of infection for some women but often a particular cause cannot be determined.
What medication will I receive if I have bacterial vaginosis?
Bacterial infections can be treated by antibiotic medications placed in the vagina or by taking medications by mouth. It is very important that you use these medications for the entire time the physician recommends.
Metrogel (metronidazole gel) and Cleocin (clindamycin cream or ovules) are inserted into the vagina at night using an applicator. These are not often used during pregnancy since they have not been found to be as effective in treating the infection during that time. The length of time these medications are used vary depending on what medication is prescribed.
Antibiotics taken by mouth, such as Flagyl (metronidazole tablets) or clindamycin, are usually taken twice a day for seven days. Many women find oral medication more convenient but while taking Flagyl (metronidazole) you should not consume alcohol. Drinking alcohol while taking this medication often results in severe vomiting.
It is common to delay giving oral antibiotics for bacterial infection to pregnant women until after the first trimester unless symptoms are bothersome. This allows the doctor to use the most effective treatment. Safe treatment is available during the first part of pregnancy but may not be as effective in curing the infection.
If you still have symptoms several days after finishing the treatment recommended by your doctor it is important to call and let them know.
Do I need to see the doctor anytime I have a bacterial infection?
There are no over the counter medications currently available to treat bacterial infections. In order to be sure that the symptoms you are having are from a bacterial infection and should be treated with antibiotics the doctor or other healthcare provider must examine you and collect a sample for testing by the laboratory.
What is yeast infection?
A yeast infection is usually caused by a fungus called Candida. A small amount of yeast and bacteria are normally present in the vagina. The bacteria and yeast sometimes get out of balance and the yeast overgrows.
What are the symptoms of a yeast infection?
The most common symptoms are itching and burning in the area around the opening of the vagina. This area may become red and swollen. Vaginal discharge is usually white and lumpy but does not have a strong odor.
What may increase my risk of getting a yeast infection?
The balance between yeast and bacteria can be changed by many things. Taking some types of antibiotics, pregnancy, and diabetes increase the likelihood that a woman will get a yeast infection.
What medication will I receive if I have a yeast infection?
Yeast infections can be treated by medication placed in the vagina or by taking a pill by mouth.
The cream (usually Terazol, also known as Terconazole) is placed in the vagina with an applicator at night for 3 to 7 days and is safe to use during pregnancy. Most women find that symptoms are relieved sooner by using the cream and a small amount can be used around the outside of the vagina to help decrease itching and irritation through the day. It is very important that you use the medication for the entire time it is prescribed even if your symptoms go away in order to make sure the infection is completely treated.
The pill (Diflucan or Fluconazole) is often just one pill taken one time. In some cases more than one pill may be prescribed by your doctor to be taken 3 days apart. Symptoms may not go away for a few days after taking the pill.
If you still have symptoms several days after finishing the treatment recommended by your doctor it is important to call and let us know.
Do I need to see the doctor anytime I have a yeast infection?
There are some treatments available without a prescription to treat yeast infections that work very well for most women. We suggest that anyone who has never before had a yeast infection, isn’t absolutely sure that the problems they are having are a yeast infection, or has tried these treatments without the symptoms going away completely make an appointment. It is important that we make sure that the symptoms you are having are really caused by yeast and not another type of vaginal infection. Medications to treat yeast when the symptoms have another cause, like bacteria, can make symptoms worse.
Screening tests are available for many of the most common sexually transmitted diseases (STDs). You may request screening tests or your physician may offer these tests at your appointment based on a number of risk factors and current recommendations. Some common STDs are Gonorrhea, Chlamydia, Trichomoniasis, Syphilis, Human Immunodeficiency Virus (HIV), and Hepatitis B.
Screening tests for Chlamydia are routinely performed at the time of a pelvic exam for women sexually active and age 25 or under. At the time of the exam, a small swab may be used to collect a sample from the cervix to determine if Gonorrhea, Chlamydia, and/or Trichomoniasis are present. A small amount of your blood may be drawn and sent to the laboratory for testing in order to screen for Syphilis, HIV, and Hepatitis B. Results from these tests are usually available within a week to ten days.
HPV is a common virus. In 2005, the Centers for Disease Control and Prevention (CDC) estimated that 20 million people in the United States had this virus. There are many different types of HPV; some cause no harm. Others can cause diseases of the genital area. For most people the virus goes away on its own. When the virus does not go away it can develop into cervical cancer, precancerous lesions, or genital warts, depending on the HPV type.
In 2005, the CDC estimated that at least 50% of sexually active people catch HPV during their lifetime. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk. Many people who have HPV may not show any signs or symptoms.
Recent studies have shown that HPV may also cause cancers in the mouth or throat. Ask your provider about the HPV vaccine, Gardasil.
What is infertility?
Infertility refers to the inability of a couple of child-bearing age to conceive a child after one year of regular sexual activity without contraceptive use. Infertility is very common, affecting about 6 million Americans. Infertility can be due to health issues in the male partner, female partner, or both. In one-third of cases the cause is unknown. Both men and women are about equally affected by infertility.
What causes infertility?
The most common male infertility factors include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.
The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, which can occur when a woman has had pelvic inflammatory disease or endometriosis (a sometimes painful condition causing adhesions and cysts). Congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids may be associated with repeated miscarriages.
What are infertility tests?
Infertility tests are done to help find out why a couple cannot become pregnant. The tests help find whether the problem is with the man, the woman, or both. Tests usually include a physical exam, semen analysis, blood tests, and special procedures.
When to see the doctor
If you are under 35 and have been trying to get pregnant without success for a year, see your doctor. Women 35 and older should see their doctor after six months of trying.
Blood, urine, and imaging tests can be done to discover why you are having trouble getting pregnant. A semen analysis can be done to check a man's sperm count and the overall health of the sperm.
Your doctor may refer you to a reproductive endocrinologist, a doctor who specializes in infertility. Infertility treatment is available, but it can be quite costly and physically and emotionally challenging.
Springfield Clinic ultrasound services are accredited by the American Institute of Ultrasound in Medicine (AIUM), an association dedicated to promoting the safe and effective use of ultrasound.
Accreditation means our practice has met nationally accepted standards and has demonstrated consistent excellence in patient care. Actual cases and reports have been reviewed by the AIUM and show that both the performance and the interpretation of ultrasound examinations offered by physicians and meet or exceed nationally accepted standards.
Our team of Registered Diagnostic Medical Sonographers has many years of experience in the areas of Obstetric and Gynecologic Ultrasound. They have all achieved a level of competency in both technical procedures and patient care. Both the physicians and sonographers in the practice receive continuing medical education in ultrasound to enhance their knowledge and keep their skills current. Effectively and safely meeting the growing needs of our patients is our number one priority.
Pelvic ultrasound may be performed to assist the physician in evaluating pelvic pain, abnormal bleeding, masses felt on exam, intrauterine device placement, or for comparison to prior imaging studies to evaluate changes. Obstetrical ultrasound may be used for initial confirmation of pregnancy, evaluating the thickness of the cervix, in combination with select genetic tests to assess risk, careful measurement and evaluation of all viewable organ systems, and to check on the well-being of your baby when medically indicated later in pregnancy.
Both 3 dimensional imaging and Doppler imaging to assess blood flow can be utilized if medically indicated to assist with evaluating a suspected or known medical condition.
Routine care is the best way to keep you and your breasts healthy. Although detecting breast cancer at its earliest stages is the main goal of routine breast care, other benign conditions, such as fibrocystic breasts or cysts, are often discovered during routine care.
Awareness of your own body and routine visual examination, combined with monthly breast self- exams can aid in the detection of breast changes or serious breast conditions
The following information and links provide an educational overview of common benign breast findings. You should always discuss any changes in the appearance, shape or color of your breasts with your physician to determine if appropriate testing should be performed.
Breast problems or changes may occur in women at any age. Most causes of breast changes are benign, but some changes may be due to serious conditions such as breast cancer.
Breast symptoms can include:
Breast symptoms can vary in character and intensity depending on the underlying cause and individual factors. They can be constant, or may only be felt when you examine or massage your breast. Breast symptoms can gradually build over weeks or months, or they can appear suddenly, such as breast symptoms of premenstrual syndrome (PMS) or mastitis. They can occur in one or both breasts at a time.
Your breasts will undergo normal changes over the course of your life as far as size, shape, consistency and appearance. Hormonal changes are a common cause of breast symptoms. Hormonal changes can occur at the onset of puberty; during menstrual cycles, pregnancy, breastfeeding, perimenopause, and menopause; and with the use of hormone medications.
Breast symptoms can be caused by physical changes, such as weight fluctuations, or other causes such as breast injury and breast surgery. Breast symptoms can occur as a result of breast cancer and other diseases, disorders or conditions, such as breast infections, breast adenosis, and cysts.
Seek prompt medical care if you have unexplained breast symptoms in one or both breasts. Left undetected and untreated, some underlying causes of breast symptoms, such as breast cancer, can lead to serious or life-threatening complications. Seeking regular medical care throughout your life improves your chances of discovering some serious diseases at their earliest, most curable stages.
A breast exam is generally done by your health provider at your “annual exam.” The physician, nurse practitioner, or physician’s assistant has been trained to notice abnormalities during your breast exam.
If you have felt something on your exam, or have questions about your breast exam, please let your practitioner know.
The combination of your self-exam and your provider’s exam as well as recommended mammograms gives you the best chance for early detection of breast abnormalities.
Breast cancer is the most common type of cancer among women in the United States, other than skin cancer.
According to the National Cancer Institute, when breast cancer is found early and is still localized (restricted to the site of origin, without evidence of spread), the relative survival rate, when measured at five years, is around 98 percent. When breast cancer is found at a late stage (cancer that has spread to distant parts of the body), the survival rate at five years is about 23 percent.
Although the incidence of breast cancer is beginning to decrease, one out of eight women will develop breast cancer at some point in her life. Mortality rates have decreased over the past several years because of early detection and improved treatment.
If you are diagnosed with breast cancer, the most important thing for you to remember is that it is not a hopeless condition. Early detection and modern therapy with a combination of surgery, radiation, drugs, or hormones can help many patients.
Springfield Clinic Breast Health Center
Common Breast Conditions
Breast Health: Three-Step Plan for Preventive Care - Health Library
Mammogram Procedure - Health Library
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