Gynecological Exams
Annual GYN Exams
An annual Gynecologic (GYN) exam is a routine checkup to ensure that you’re healthy inside and out. It’s one of the most empowering things you can do for yourself because it can help detect certain health problems as well as prevent future ones from developing – building a foundation of health and wellness for all the stages of your life.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends:
A woman’s first reproductive health visit should take place between ages 13 and 15 (this first visit is often simply a discussion between patient and doctor)
Annual breast and pelvic exams should begin at age 19
Pap tests should begin at age 21
Despite your age, an annual GYN exams at The Diez Center includes:
An assessment of your current health status
A breast exam to check for lumps, skin changes, or nipple discharge
A pelvic exam to check your vulva, vagina, cervix, uterus, rectum, and pelvis, including your ovaries, for masses, growths or other abnormalities
A Pap test to screen for cervical cancer
Your annual wellness exam may also include information on which vaccinations are recommended based on your age and risks. These can include the flu shot, Tdap, and human papilloma virus (HPV).
Your doctor may also recommend you for your regular mammogram as part of your annual GYN exam.
Annual testing for chlamydia and gonorrhea is recommended for sexually active adolescents and young women up to age 25. Routine HIV testing is recommended for all sexually active women beginning at age 19 until 64.
Pap Smear
A Pap smear, also called a Pap test, is a procedure to test for cervical cancer in women. It involves collecting cells from your cervix — the lower, narrow end of your uterus that's at the top of your vagina.
Detecting cervical cancer early with a Pap smear gives you a greater chance at a cure. A Pap smear can also detect changes in your cervical cells that suggest cancer may develop in the future. Detecting these abnormal cells early with a Pap smear is your first step in halting the possible development of cervical cancer.
HPV Test
The Human Papillomavirus (HPV) Test detects the presence of human papillomavirus, a virus that can lead to the development of genital warts, abnormal cervical cells or cervical cancer.
Your doctor at The Diez Center may likely recommend the HPV test if:
Your Pap test was abnormal, showing atypical squamous cells of undetermined significance (ASCUS)
You're age 30 or older
The HPV test is available only to women; no HPV test yet exists to detect the virus in men. However, men can be infected with HPV and pass the virus to their sex partners.
Heavy / Irregular Bleeding
Abnormally heavy or prolonged menstrual periods is a common condition that affects about one-third of women. You may have heavy menstrual bleeding if you experience any of the following:
Menstrual periods that last longer than seven days
Soaking through one or more tampons or pads per hour for several hours
Getting up in the middle of the night to change tampons or pads
Periods with blood clots the size of a quarter or larger
Excessive blood loss during your period isn’t normal and may be a symptom of an underlying medical issue or a side effect of certain treatments and can negatively affect your quality of life.
Common causes of heavy menstrual bleeding may include:
Uterine fibroids or polyps
Endometrial cancer
Endometriosis
Ectopic pregnancy
Miscarriage
Pelvic inflammatory disease
Irregular ovulation
Polycystic ovary syndrome (PCOS)
Thyroid disorders such as hypothyroidism
Blood-thinning medications such as aspirin
Copper intrauterine device (IUD)
Vulvitis / Vulvar Rashes
Vulvitis is not a disease, but refers to the inflammation of the soft folds of skin on the outside of the female genitalia, the vulva. The irritation can be caused by infection, allergic reaction, or injury. The skin of the vulva is especially susceptible to irritation due to its moistness and warmth.
Any woman of any age can be affected by vulvitis. Girls who have not yet reached puberty or post-menopausal women may be at higher risk of vulvitis. Their lower estrogen levels may make them more susceptible to the condition due to thinner, dryer vulvar tissues.
What are the Symptoms ?
The symptoms of vulvitis can include:
Extreme and constant itching
A burning sensation in the vulvar area
Small cracks on the skin of the vulva
Redness and swelling on the vulva and labia (lips of the vagina)
Blisters on the vulva
Scaly, thick, whitish patches on the vulva
How is it Diagosed ?
Your doctor will begin with a medical history and full pelvic exam, looking for redness, blisters, or lesions that may indicate vulvitis. Doctor may also check for vaginal discharge, which can be tested for infections.
The doctor may also check for Sexually Transmitted Diseases (STDs) or collect a urine sample for analysis in order to rule out more serious causes of genital irritation.
How is Vulvitis treated?
The first treatment is to immediately stop the use of any products that may be causing the irritation and to wear loose-fitting, breathable white cotton undergarments. Over-the-counter anti-itch products should be avoided, as they can make the condition worse, or last longer.
Your doctor may also prescribe the use of an over-the-counter cortisone ointment on the affected area several times a day. This can help reduce the irritation and itching.
Sitz baths and the use of a topical estrogen cream may also be prescribed to deal with the itching and other symptoms of vulvitis.
If these treatments do not reduce the irritation, further tests may be prescribed to rule out more serious underlying conditions such as vulvar cancer. Luckily, vulvar cancer is rare.
Pelvic Pain
Pelvic pain is a general term to describe pain in the area between the hips and below the navel.
If a woman has had pelvic pain (whether constantly or on-and-off) for six months or longer, it is considered chronic pelvic pain.
A wide range of problems in the reproductive, urinary, and/or digestive systems can cause pelvic pain, as well as a history of physical or sexual abuse. For some women, a specific cause of pelvic pain may not be identified.
Treatment for pelvic pain depends on the cause of the pain. If no specific cause is identified, the pain is still treatable.
Managing chronic pelvic pain may require a combination of medication, therapy, and stress reduction.
Causes of pelvic pain
Pelvic pain can be caused by a variety of conditions in the lower abdominal region, including the reproductive, urinary, and digestive organs.
Some common causes of pelvic pain include:
Pelvic floor muscle spasms/tension
Chronic pelvic inflammatory disease
Adenomyosis and/or endometriosis (conditions where the tissue that lines the uterus grows into the walls of the uterus or in other parts of the lower abdomen)
Ovarian remnants (a small piece of ovary left behind after a complete hysterectomy)
Uterine fibroids (non-cancerous growths in the uterus)
Irritable bowel syndrome
Interstitial cystitis (chronic inflammation of the bladder)
A history of physical or sexual abuse, depression, or chronic stress
Neuropathic pain, when damaged nerves continue to send pain signals after a disease or an injury has healed, may also be a cause of pelvic pain.
Determining the cause of pelvic pain can be challenging and in some cases a physician will not be able to pinpoint a specific cause. Nevertheless, pelvic pain is a valid concern that affects a woman’s well being, and can be treated even if a cause is not identified.
Pelvic Pain Symptoms
The symptoms of pelvic pain may differ from one woman to another. Some women experience pain that is so severe that everyday responsibilities are difficult to manage, while others feel a mild irritation. Pelvic pain may be:
A dull ache
A sharp, cramping sensation
Intense and constant
On-and-off (intermittent)
The discomfort may also feel like heaviness, fullness, or pressure in the lower abdomen. Symptoms of pelvic pain may worsen during Intercourse, Bowel movements or urination, Long periods of standing or sitting
Sudden Pelvic Pain
See a health care provider immediately if you have sudden, severe pelvic pain. This may be a sign of a serious health emergency.
Treatment for Pelvic Pain
Treatment for pelvic pain depends on the woman’s symptoms and underlying conditions.
For most women with chronic pelvic pain, a combination of treatments, medications, and pain management techniques will be the most effective source of relief from their symptoms. It may take a process of trial and error to discover the combination that works best.
Some methods of treatment for pelvic pain include:
Pain medication (over-the-counter and/or prescription)
Birth control pills or other hormonal medications
Antidepressants
Antibiotics
Transcutaneous electrical nerve stimulation (TENS)
Trigger point injections
Physical therapy
Laparoscopic surgery to remove pelvic adhesions or endometrial tissue.
Counseling can provide techniques for managing the stress, depression, and/or anxiety of living with chronic pain as well.
HPV Counseling
Anogenital HPV infection is very common. It usually infects the anogenital area but can infect other areas including the mouth and throat. Most sexually active people get HPV at some time in their lives, although most never know it.
Partners who have been together tend to share HPV, and it is not possible to determine which partner transmitted the original infection. Having HPV does not mean that a person or his/her partner is having sex outside the relationship.
Most persons who acquire HPV clear the infection spontaneously and have no associated health problems. When the HPV infection does not clear, genital warts, precancers, and cancers of the cervix, anus, penis, vulva, vagina, head, and neck might develop.
The types of HPV that cause genital warts are different from the types that can cause cancer.
Many types of HPV are sexually transmitted through anogenital contact, mainly during vaginal and anal sex. HPV also might be transmitted during genital-to-genital contact without penetration and oral sex. In rare cases, a pregnant woman can transmit HPV to an infant during delivery.
Having HPV does not make it harder for a woman to get pregnant or carry a pregnancy to term. However, some of the precancers or cancers that HPV can cause, and the treatments needed to treat them, might lower a woman’s ability to get pregnant or have an uncomplicated delivery. Treatments are available for the conditions caused by HPV, but not for the virus itself.
No HPV test can determine which HPV infection will clear and which will progress. However, in certain circumstances, HPV tests can determine whether a woman is at increased risk for cervical cancer. These tests are not for detecting other HPV-related problems, nor are they useful in women aged<25 years or men of any age.
Prevention of HPV / Gardasil Vaccines
Two HPV vaccines can prevent diseases and cancers caused by HPV. The Cervarix and Gardasil vaccines protect against most cases of cervical cancer; Gardasil also protects against most genital warts. HPV vaccines are recommended routinely for boys and girls aged 11–12 years; either vaccine is recommended for girls/women, whereas only one vaccine (Gardasil) is recommended for boys/men (https://www.cdc.gov/vaccines/vpd-vac/hpv). These vaccines are safe and effective.
Condoms used consistently and correctly can lower the chances of acquiring and transmitting HPV and developing HPV-related diseases (e.g., genital warts and cervical cancer). However, because HPV can infect areas not covered by a condom, condoms might not fully protect against HPV.
Limiting number of sex partners can reduce the risk for HPV. However, even persons with only one lifetime sex partner can get HPV.
Abstaining from sexual activity is the most reliable method for preventing genital HPV infection.
Pessary
The pessary is a device that is placed into the vagina to support the uterus or bladder and rectum. It is a firm ring that presses against the wall of the vagina and urethra to help decrease urine leakage. The type and size of the pessary should be fitted to meet your individual needs and anatomy. A properly fitted pessary is not noticeable when it is in place.
If you have sensations of pressure or rubbing with continued wear of the pessary, or if you notice any unusual vaginal bleeding or spotting, call your health care provider immediately. It is not unusual to have to change the shape or size of the pessary after the initial fitting or even after continued wear. This is why it is important to keep your regularly scheduled clinic appointments.
You may notice an increase in vaginal discharge or secretions with pessary use. However, the pessary is made of silicon rubber and does not absorb odors or secretions. The Center for Urogynecology and Women's Pelvic Health recommends only external cleansing. Do not douche or use vaginal products unless they are specifically given to you by your health care provider.
Caring for a pessary is easy. Pessaries can be left in place for up to a week and removed for periodic easy cleaning. Some women choose to remove the pessary nightly before bed and replace it in the morning. It can be left in during intercourse if this is comfortable for you.
Inserting the Pessary
Wash your hands.
The notches inside the open ring and the openings in the ring-with-support are the flexible points. Grasp the device midway between these points and fold the pessary in half. The curved part should be facing the ceiling, like a taco. Put a small amount of water-soluble lubricant, such as KY Jelly, on the insertion edge.
Hold the folded pessary in one hand and spread the lips of your vagina with the other hand. Gently push the pessary as far back into the vagina as it will go. You can do this squatting, standing with one foot propped on the tub or toilet, or sitting with your feet propped up.
Removing the Pessary
Wash your hands.
Find the rim of the pessary just under the pubic bone at the front of your vagina. Locate the notch or opening and hook your finger under or over the rim.
Tilt the pessary slightly, to about a 30 degree angle, and gently pull down and out of the vagina. If you can fold the pessary somewhat, it will ease the removal.
Bearing down as if you are having a bowel movement can help push the rim of the pessary forward so you can grasp it more easily.