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Making the Most of Your Annual OB-GYN Appointment

Monday, April 21st, 2014

Too often, women have a list of questions or concerns in their heads in the days leading up to an appointment with their doctors, only to forget most or all of them once in the exam room. Or, they leave the doctor’s office without feeling they received all of the information they needed. You don’t get a lot of time with your gynecologist, so it’s a good idea to be aware of some strategies for making sure you get as much as you can out of the visit. Here are some tips for making sure you and your doctor communicate well and that you get what you need out of your visit.

1. Know when your last period was. Mark it on a calendar and know the date – your gynecologist needs to know this. If you are experiencing irregular bleeding, a calendar tracking your periods as far back as possible is preferable.

2. For a couple of days before your visit, do not douche (which you should not be doing anyway) or have sex. Both of these things can interfere with the results of your pap test.

3. Bring a written list of all medications you are taking, including herbal supplements and vitamins. Know the doses and names of all of them.

4. Bring a list that you have prepared ahead of time of all questions you want to ask or concerns you want to bring up. Even if there are only a few items on the list, write them down – it’s too easy to forget them during the visit.

5. Ask for clarification. If the doctor says something you don’t fully understand, speak up. If you aren’t sure, repeat it back to the doctor in your own words to make sure you get it. Also ask if he or she can recommend any books or other resources for information on any condition you may have.

6. Be completely honest. Never lie about drug or alcohol use, your sexual history, or any other issues your doctor asks about, no matter how embarrassing the conversation may feel. Not being truthful can lead to a wrong diagnosis or the wrong advice.

7. If you need to discuss a specific problem you are having, take some time to make some notes before your appointment and know the answers to questions such as: When did the problem begin? What have you tried to improve your symptoms? What worked and what didn’t? Has any other doctor seen you for the condition; have any tests been done? What were the results? What makes the problem worse and what alleviates it? Include any information you can think of that might be relevant.

Most women don’t look forward to their annual gynecologic checkup, but it is one of the most important things you will do all year. Following these tips for making the most of your visit can ensure you get the highest quality care possible.

– Yvonne S. Thornton, M. D., M. P. H

What Is a Pap Test Used For?

Thursday, March 20th, 2014

The term  “Pap test” or “Pap smear” is known by almost every woman in the United States.  However, over the past few years, its annual frequency has been questioned and the actual manner in which it is performed has been enhanced in many gynecologists’ offices. One of the components of a gynecologic exam that you have undoubtedly undergone is the Pap test (or Pap smear).  As stated in my health book for women and many times before on this blog, A Pap smear is NOT a pelvic exam.  The purpose of a pelvic (gynecologic exam) is to check all of your reproductive organs, which includes uterus, ovaries, vagina and vulva.  The Pap test is only to check for cellular changes in your cervix (the mouth of the womb) that may signal cancer or precancer. This is why regular appointments with your gynecologist are so important – because a precancerous condition can be treated before it becomes invasive cervical cancer, but the only way to detect a condition like this is with a Pap test.

Make no mistake – a Pap test can save your life. The chances of treating cervical cancer successfully are far, far higher when it is caught in its early stages. In most cases, precancerous cell changes can be treated before they ever become cancer at all. If you are wondering why you need a Pap test, or have been putting off making an appointment for your annual visit to the gynecologist, remember: a Pap smear is the absolute best way to prevent cervical cancer.

With that said, a Pap test is not recommended for women less than 21 years of age.  However, between the ages of 21 and 65, most women need an annual Pap test. Even though the American Cancer Society recommends Pap tests every three years, the American College of Obstetricians and Gynecologists recommends this screening test every year, because three years is a long time for cancer to grow and spread. Why wait three years when your cervical cancer could have been caught in its precancerous stage two years earlier?

Even if a woman has had a hysterectomy, she still needs a Pap test if her cervix is still in place, which is the case with certain types of hysterectomies (known as subtotal or supracervical hysterectomies). Either way, she still needs an annual pelvic exam; you can find more information on this in my book, Inside Information for Women.

To help ensure accurate Pap test results, you should not douche for a couple of days beforehand. That was a trick question, you should not be douching in the first place!!). Also avoid sex, vaginal creams or suppositories, deodorant sprays or powders in the vaginal area before a pelvic exam and Pap test.  Although some gynecologists prefer that the patient is not menstruating, a Pap test can be performed during your menses and they are not mutually exclusive.  If there are cancer cells present, they will be present whether you are menstruating or not.

What Does a Pap Test Involve?

The Pap test is done as part of the pelvic exam, and is very quick. The doctor places a bi-valved instrument called a speculum (hopefully warmed) in the patient’s vagina, which allows the cervix to be visualized.  The word “speculum” comes from the Latin “to see”. The doctor then uses a special brush (cytobrush) or swab (similar to a Q-tip) to collect cells from the cervix. These cells are placed on a slide and examined in the lab under a microscope. That is the traditional Pap smear.  Recently, liquid-based Pap tests have essentially replaced the conventional Pap smear.  In this test, after the cytobrush or the Q-tip has collected the cells from the cervix, it is submerged into a small vial of liquid preservative for transport to the laboratory, where it is then processed and smeared on the slide.  The presence of Human Papilloma Virus (HPV) can also be tested with this technology.  Some spotting is not unusual after a Pap test, but the test does not hurt. If the test shows a potential problem, your doctor will let you know that further testing is needed. Although this can be scary, remember that abnormal test results do not necessarily mean you have cancer.

Most insurance plans cover Pap tests as part of the gynecologic visit. However, if you are uninsured and not participating in the coverage afforded by the Patient Protection and Affordable Care Act, there are facilities that offer free or low-cost Pap tests

– Yvonne S. Thornton, M. D., M. P. H.

There’s much more to an annual pelvic exam than a Pap smear

Tuesday, October 25th, 2011

You might have read that the U.S. Preventive Services Task Force now recommends that most women have Pap smears just once every three years instead of once per year.

Does that mean you can skip the OB-GYN appointment until 2014?

No, no, no, and no.

You must have a pelvic exam every year. Pelvic examinations save lives. A Pap smear, which can help identify cervical cancer, is just one part of that examination. Your OB-GYN does much more during your annual. She also looks for any evidence of ovarian cancer, vaginal cancer, myoma (fibroids) and other abnormalities of the reproductive tract.

And while it’s true that cervical cancer is typically a slow-growing cancer that takes an average 10 years to spread, sometimes these cancers “don’t read the books” and spread in a shorter period of time.

In my new health book, INSIDE INFORMATION FOR WOMEN, I tell you in greater detail what to expect when you have a gynecologic examination.

Don’t take risks with your health. Your “annual” is called that for a reason. Make sure you see your OB-GYN for your pelvic examination every year.

– Yvonne S. Thornton, MD, MPH

Why you MUST get a gynecological exam every year. Period.

Monday, November 23rd, 2009

You may have heard that the American Congress of Obstetricians and Gynecologists (ACOG) has just come out with new guidelines for how often women should get Pap smears. Rather than discussing the details of the guidelines, I want to stress one essential fact:

A Pap smear is not an annual pelvic exam. It’s just one small segment. If you’re over 21, you must still get a pelvic examination each year, every year, for as long as you live. Some years the Pap test will be part of the examination and some years, it may not be. Whether you get a Pap has nothing to do with whether you need to be examined.

You do. Here’s why.

During your annual pelvic exam, your physician evaluates you for many diseases and disorders that have nothing to do with Pap smears or cervical cancer. Among the most critical that your doctor checks for are ovarian cancer, uterine cancer, and vulvar cancer.

If caught early, such cancers are highly treatable. If left undetected for years, as I fear might happen should women skip pelvic exams in years when they don’t get Pap tests, such cancers can be killers.

So, no matter what you’ve heard about the change in the guidelines for Pap smears, the take-away is that this change should not affect your behavior in any way; it’s merely guidance for your doctor.

Get your annual pelvic exam as you have in the past. Let your doctor decide whether the Pap should be part of it every two years or three years or if that particular test is necessary after age 70.

Remember that you’re not going to the doctor for just one test that detects just one type of cancer. You’re going to ensure that you’re in good gynecological health, and to get treated promptly if your doctor finds anything wrong.

– Yvonne S. Thornton, MD, MPH