Health and Wellness Summary

A yearly pelvic exam can provide very helpful information regarding your gynecologic health.

The pelvic exam consists of three parts: 

• First, the provider inspects the external anatomy to look for redness, rashes, ulcers, and growths. 
• Second, the speculum is inserted to examine the cervix and deeper portion of the vagina. This is often when the Pap test and HPV test are taken. The Pap test and HPV test do not have to be performed with every pelvic exam.  It is common for women to assume that a Pap test / HPV sample is being done with every pelvic examination. However, we only do the Pap test and HPV test on the schedule listed in the section below. (For example, a Pap test and HPV test will never be performed in the emergency room.)
• The final part of the pelvic exam occurs when the provider presses on the uterus and ovaries through the vagina. The proper location, size, and texture of the organs are confirmed with this third part of the exam. 

There are times when performing a routine pelvic exam when diseases or problems can be identified that either the patient wasn’t aware of or that they were too uncomfortable to discuss.

Examples include:

• Vaginal Atrophy – a thinning and dryness of the vaginal skin that can lead to irritation and painful intimacy.
• A bulge in the vagina is caused by a condition called pelvic organ prolapse. This condition can be associated with leakage of urine.
• Signs of infection can be detected that could lead to testing and treatment before the symptoms occur.

All of the above can be treated but may have gone undiagnosed without a pelvic exam.

Other reasons to perform a pelvic exam include:

• Women have problems such as menstrual period changes, vaginal discharge, and pelvic pain.
• Women who experience heaviness, bloating, change in appetite or change in how their clothes fit.

Cervical cancer screening has improved significantly over the last two decades.  As our understanding of cervical cancer and testing technology has improved, we are now able to safely test at different intervals to maximize detection of precancerous changes of the cervix and minimize false-positive results. There are two tests to detect cervical cancer, the Pap test, and the HPV test. (HPV stands for human papillomavirus – a virus that causes >90% of cervical cancers.) With both tests, cells are taken from the cervix and tested. The Pap test looks for abnormal cells that may develop into cancerous cells over time. The HPV test looks for the strains of HPV that are most likely to cause cancer.

Guidelines are regularly updated, and we review them and adjust our recommendations based on those. The current guidelines specify that we start screening at age 21. Your provider will let you know if you are having a Pap test, HPV test or both.  Women between 21 and 29 years old are tested every 3 years. Women over 30 years old are tested every 5 years. If you have had any abnormal results on your Pap test or HPV test in the past, then you may need more frequent testing.  After age 65, you can stop having cervical cancer screening tests IF you have no history of precancerous changes on the cervix in the last 25 years, no history of cervical cancer ever in the past, and 2-3 consecutive negative tests in the past 10 years.

Your provider will inform you if you are due for cervical cancer screening at your visit.

HPV (human papillomavirus) is a virus spread through any type of sexual contact with someone who has HPV. Intercourse is the most common way people get HPV but it can occur with any skin-to-skin contact. HPV often has no signs or symptoms. People can get the virus and pass it on without even knowing it. HPV is VERY common. ~79 million males and females in the U.S. are currently infected with HPV. ~14 million people become newly infected with HPV each year with 50% occurring in people ages 25 and over.

• GARDASIL 9 (HPV vaccine) is the only vaccine that helps protect individuals ages 9 to 45 against the following diseases caused by 9 types of HPV: cervical, vaginal, vulvar, and anal cancer; genital warts
• GARDASIL 9 does not treat cancer or genital warts – it is for prevention, not treatment
• GARDASIL 9 may not fully protect everyone, nor will it protect against diseases caused by other HPV types
• Patients under age 15 will require a 2-dose injection schedule while patients over age 15 will require 3 doses
• Most common side effects:
• Pain, swelling, redness, itching, bruising, bleeding, and a lump where the injection was administered
• Headache, fever, nausea, dizziness, tiredness, diarrhea, abdominal pain, sore throat, fainting
• For most, HPV clears on its own – but for others who don’t clear the virus, HPV could cause cancer. There is no way to predict who will or will not clear the virus.

If you have not received the HPV vaccine – talk with your healthcare provider at your visit to see if GARDASIL 9 is right for you.

Did you know that females who are smokers die 12 years earlier than female nonsmokers?  Tobacco use dramatically increases your risk of lung cancer and heart disease.  Heart disease is the number one cause of death in women.  Lung cancer is now causing more deaths in women than either breast cancer or ovarian cancer.  If that’s not enough motivation to think about quitting, let’s not forget that smoking makes you look older by causing more wrinkles and darkening your teeth.  There are a lot of great tools to help you stop smoking.  There are support groups, nicotine replacement items like gum or patches, and prescription medications to help control your cravings.  There is a great hotline that can help you too:  1-800-QUIT-NOW.

The body mass index (BMI) is a tool often used to measure body fat. A healthy BMI is between 18.5 and 24.9. If you are interested in knowing yours, it can be found in your visit summary.  If your BMI is 25 or above, consider weight loss to reduce your risk of high blood pressure, diabetes, heart disease, arthritis, and several types of cancer.  Losing weight depends on a balance of healthy nutrition choices and exercise.  To help limit calories, try to eat fewer foods that are high in carbohydrates/fats.  Look for foods that are high in protein instead to help you feel full.  As for exercise to create weight loss, we recommend 60-90 minutes of moderate-intensity activity that gets your heart rate up at least 4 times per week.  For more information on dietary control, you can look at www.choosemyplate.gov. 

If you are interested in a medically-supervised weight loss program, visit Christie Clinic Transformations Medical Weight Loss Program. 

Women have a 5 times higher risk of osteoporosis than men.  Once we hit 30 years of age, our bones will start to get thinner and thinner leading to osteoporosis.  Worldwide 1 in every 3 women will have a broken bone related to osteoporosis.  Even though we can’t totally stop our bones from getting thinner, we can slow the process.  The American College of Obstetrics and Gynecology (ACOG) recommends 1000mg of calcium per day for women under 50 years of age and 1200mg per day for women over 50 years of age.  ACOG also recommends 800 IU per day of vitamin D.  It is also important to get 30 minutes of weight-bearing exercise at least 3 times per week for bone health.  Women over 65 should have a bone density test performed to evaluate for osteoporosis.  You can calculate your risk of a broken bone by going to www.shef.ac.uk/FRAX.

Breast cancer affects 1 in every 8 women. Women should understand what their breasts normally look and feel like (breast self-awareness). Then, if a change occurs you can call your healthcare provider. We also perform yearly breast exams on women over the age of 21 to screen for lumps. Women 40 years or older should get yearly mammograms to detect lumps that can be too small to feel. Mammograms are not perfect tests. They can detect about 78% of women who have breast cancer. On the other hand, mammograms can also raise concern for cancer in a woman who has a noncancerous lump: this is called a false-positive test. If women get 10 yearly mammograms, the chance of getting a false-positive test is 50%. Still, the benefits of finding early and treatable cancers outweigh the risks of a false-positive test. 

The estimate for how many people will die each year of colon cancer is about 50,000. To help reduce your risk of getting colon cancer increase the number of fruits, vegetables, and whole grains that you eat each day. Also, avoid tobacco and excessive alcohol consumption. Sometimes colon cancer can run in families so be sure to tell your healthcare provider about any relatives diagnosed with colon cancer. ACOG recommends screening with colonoscopy starting at age 45 for African Americans and at age 50 for all other ethnicities. If you have no family history of colon cancer, you may be a candidate for the Cologuard test. This is a stool sample test that you collect at home that detects the abnormal cells shed by colon cancer.  Talk to your provider to see if you are a candidate for this test.

One in three women are or have been victims of domestic violence. Abuse can take many forms including pushing, hitting, kicking, forced sexual activity, threatening harm, or using degrading/insulting language against another person. No one deserves this treatment and we encourage you to share what has happened to you with your healthcare provider. We can help you make a safety plan. Click here  for community resources & services.

1.7 million people were diagnosed with Chlamydia in the US in 2018. It is very important to try to reduce your risk of a sexually transmitted infection(STI). Not only can these infections cause abnormal discharge, pain, and bleeding while you have the infection, but they also can have long-term consequences as well.  STIs are a cause of chronic pelvic pain which is pain that lasts longer than 6 months at a time. They are also a leading cause of infertility. Use condoms to prevent exposure to an STI with any new intimate partner. Anyone who has had a new intimate partner in the last year should be screened for infection during their annual exam. 

The best way to take care of your skin is to prevent sun damage and wear SPF. With repeated sun damage, the skin starts to look dry, wrinkled, discolored, and leathery. Although the skin appears to be thicker, it actually has been weakened and as a result, it will bruise more easily. However, the sun's most serious threat is that it is the major cause of skin cancer, which is now the most common of all cancers with 3-4 million people being diagnosed each year. Most skin cancers can be avoided by preventing sun damage. We recommend wearing sunscreen every day and reapplying frequently during days with heavy sun exposure. Schedule an appointment with a Christie Clinic dermatologist for an annual skin check and to develop a skin care regimen that's right for you. 

A few recommendations to help you reduce your risk of accidental death:

1. Always, always, always wear your seatbelt.
2. Avoid having your cell phone in your hand for any purpose during driving.
3. Designate a driver when you drink more than one alcoholic beverage in the two hours before you will be driving.

• Dental exams every 6 months.  
• Annual eye doctor visits. 
• Patients over 65 years old should be having a glaucoma screening.