 Just
about from the instant you were born, there has been a schedule -- or at
the very least guidelines -- to outline when you need to take care of certain
aspects of your heath. First, there were all those immunizations
for diseases almost no one around these days has ever heard of (thank goodness)
-- diphtheria, typhoid, whooping cough, polio. Then, like clockwork,
every few years or so, Mom would drag you back to the doctor’s office
for a whole new round of shots. They tried to convince you that all
of this was “for your own good,” but you weren’t buying it. You did
get the message, however, that trips to the doctor’s office often involved
pain and having to take your clothes off.
By the time you reached the important teen years, and successfully negotiated
the rites of becoming a “woman,” the doctor’s visit routine had been confirmed
numerous times. There were more surprises waiting for you, however,
when Mom decided it was time you had your first appointment with a gynecologist.
If you were lucky, the doctor was born in this century, had a good understanding
that his or her patients would rather be anywhere else, and who intuitively
knew that whether the patient was a teenager or a senior citizen, women
dislike carrying on a conversation when they are the only one undressed.
 Back
40 or 50 years ago, a woman made her first gynecological visit during her
20’s or in preparation for her wedding. Today, however, the American
College of Obstetricians and Gynecologists recommends that young women
make their first visit to a gynecologist by age 18 or earlier if she becomes
sexually active.
This initial visit provides a good opportunity to discuss changes that
are occurring to her body, and for her to learn about preventive measures
-- such as breast self-exams and diagnostic tests that should become part
of her health routine for life. Probably the first of these that
will be performed is the Pap Test.
The Pap Test
The Pap Test -- which, incidentally, has been around for sixty years,
thanks to a Dr. George Papanicolaou -- is credited with saving the lives
of hundreds of thousands of women, and as being the best early warning
system for cervical cancer available. In the 1950’s, for example,
about  20,000
women died each year from cervical cancer. Today, the annual mortality
rate for this disease is less than 5,000 -- a number that could be even
further reduced if more women would schedule the exam.
There has been significant progress over the past decade in our understanding
of cervical cancer. We know that cancers arising in the lining of
the cervix seem to be related to sexual behavior and exposure because women
who have been celibate rarely get this disease. Those who become
sexually active at a young age, however, and who have had multiple sex
partners are at a significantly higher risk of getting this cancer.
Research has also shown that certain viruses (of the herpes and papilloma
group) play a role in causing about 95 percent of the cases of this disease.
Scientific studies indicate that some combination of genetic susceptibility,
sexual exposure, and contact with some viruses may all be involved.
Fortunately, this is a cancer that can be detected in its earliest, pre-cancerous
stage and be cured. However, once symptoms occur -- vaginal bleeding
and discharge between periods and pain during intercourse -- the cervical
cancer is often advanced. This is why having regular Pap Tests is
so important.
The test is relatively simple, quick and painless, and is accomplished
in the doctor’s office. During a pelvic exam, the doctor gently removes
cells from the cervix (the narrow neck-like opening of the uterus) with
a cotton swab or similar instrument, and places them on a glass slide for
a microscopic analysis in a laboratory, where a specially trained technician
(cytotechnologist) examines the sample for abnormal cells. Traditionally,
this test has been performed manually, and has been compared to looking
for the proverbial needle in a haystack. Each sample may contain
as many as 300,000 cells that have to be examined under a microscope, from
which as few as a dozen might be pre-cancerous. Even so, the test
has been incredibly reliable through the years.
In the past decade, however, advanced computer technology has been introduced
that is designed to detect and display abnormal cells on a video monitor
for closer inspection. While this method does appear to provide a
closer, second look at abnormal cells, it is not foolproof, either.
None of the tests have a 100 percent accuracy record but, even with false-negative
and false-positive readings, this is still an important test that accurately
detects significant abnormalities about 90 to 95 percent of the time.
Back to the lifelong schedule again...women should schedule Pap Tests
according to their doctor’s recommendation. After three consecutive,
normal, annual Pap Tests less frequent testing may be considered, but not
less often than every three years...for life. Remember, the risk
for invasive cervical cancer increases with age; the disease is most likely
to occur between the ages of 30 and 55. For those who are at higher
risk for cervical cancer -- early sexual activity, multiple sex partners,
a history of sexually transmitted diseases, a history of abnormal Pap Tests,
genital warts, or women who smoke -- more frequent Pap Testing is appropriate.
 Sexually
Transmitted Diseases
There is growing concern about the prevalence of pelvic inflammatory
disease (PID) and sexually transmitted diseases (STD) among
the country’s teen population. Granted, it is hard to get teenagers
to think in any tense but the present; however, these infections can alter
the course of their adult lives dramatically.
PID is basically an infection in the pelvic region and upper genital
tract caused by an of a group of infectious agents or microorganisms.
Each year, about a million women in this country are diagnosed with this
condition. In many cases, PID is caused by untreated sexually transmitted
diseases, making young women and those who have multiple sex partners the
most vulnerable.
Sexually transmitted diseases initially cause infection in the cervix
and vagina and, when not promptly treated, the microorganisms can spread
to infect the uterus and fallopian tubes, as well. Gonorrhea and
chlamydia are often the culprits, but in many cases, there is more than
one organism to blame.
Chlamydia is transmitted sexually, and may cause symptoms such
as painful urination and lower abdominal pain, or it may cause no symptoms
at all. Screening for this condition is simply accomplished from
a urine test and it is treated with antibiotics. The problem is that
far too many young women overlook the symptoms and don’t get medical attention,
so they run the risk of a more serious infection developing. There
has been such a high incidence of chlamydia that many physicians recommend
screening for sexually active young women every six months. The Centers
for Disease Control and Prevention recommends annual screenings.
Gonorrhea is a highly contagious STD and is, in fact, one of
the top 10 reported diseases in this country (about a half million cases),
with hundreds of thousands more cases undetected. Gonorrhea is caused
by a bacteria, transmitted through unprotected sex, and is most common
in people between the ages of 15 to 29. This disease causes a few
mild symptoms, and can easily go undetected. The infection usually
affects the cervix and reproductive organs, and well as the urethra, and
may cause frequent, urgent and painful urination. The bacteria that
causes gonorrhea can spread throughout the body and cause joint pain and
stiffness -- and other “remote” symptoms that the sufferer may not immediately
relate to an STD. Once diagnosed, antibiotic therapy can begin, however,
it is critical to abstain from sexual activity until the infection is eliminated,
and for the sexual partner to be treated, too.
The symptoms of PID include lower abdominal pain (sometimes severe),
a heavy discharge, irregular bleeding, fever and general malaise.
There is no single test for PID, so a number of factors in addition to
a physical exam are taken into account in making the diagnosis. One
of the most important of these is to consider the patient’s sexual history
and risk factors. There are many other conditions which can produce
the same symptoms, so the doctor must rule out appendicitis, ectopic pregnancy,
an ovarian cyst or any other condition which might require immediate surgery
or prompt treatment. When these other serious disorders cannot be
ruled out, a laparoscopy may be recommended to allow a visual inspection
of the upper genital area. This is a minimally invasive, outpatient
procedure that involves inserting a fiberoptic scope into the abdomen through
tiny incisions.
Many cases of PID go undiagnosed and untreated because the symptoms
are never particularly serious and are easily ignored. Consequently,
it is one of the leading causes of infertility for women in their childbearing
years. Most cases can be treated with a broad spectrum antibiotic
and a follow up visit. For the best results, however, the patient’s
partner should be treated with antibiotics, as well.
Breast Care
During a woman’s first gynecological visit -- or perhaps earlier with
her family physician -- she will have her first clinical breast exam where
her  doctor
will examine her breasts and armpits, feel for lumps and swollen lymph
nodes, and get a general overview of breast “geography.” This is
an ideal time for the doctor, physician’s assistant or nurse to teach the
young woman how to perform a breast self exam (BSE) which should become
a regular routine for the rest of her life. Breast cancer does occur
in young women in their 20’s and the sooner the habit of BSE is established
the more likely she will discover any suspicious lump in the earliest stage
when there is the best chance for a cure.
While there is an ongoing discussion about when women should begin annual
mammograms, the general consensus is certainly at or before age 40, and
we recommend a baseline mammogram at age 35. (See
All Breasts Are Lumpy...) We welcome the opportunity to discuss
this important topic with our patients and, perhaps more importantly, we
understand how anxious you might be waiting for results of your mammogram.
so we minimize this wait as much as possible.
Women and Heart Disease...
Today, most people realize that heart disease can affect both men and
women. What they may not realize is that coronary heart disease is
the number one killer of American women. Of the over half million cardiovascular
disease fatalities that occur each year, almost half are women. Unfortunately,
studies show that women are less likely to survive heart attacks than men;
and at older ages, women who have heart attacks are twice as likely as
men are to die from them within a few weeks.
Ideally, by age 35 women should have regular blood pressure and cholesterol
level checks. If either parent had a history of heart disease, your
physician may also recommend a base-line electrocardiogram or stress test.
Then, based on the results of these tests, preventive measures may be recommended
-- including modifications in diet and lifestyle, stress management, and
certainly smoking cessation -- to minimize risk factors for cardiovascular
disease.
After menopause, women’s risk of heart attack and stroke continues to
rise with age. Researchers generally agree that loss of estrogen is a significant
contributor to women developing heart disease after menopause, so as that
time approaches, hormone replacement therapy is something you will want
to discuss with your gynecologist. (See
Women’s Heart Health Test)
Avoiding Osteoporosis
Approximately 22 million people in the United States have or are at
risk of developing osteoporosis, a bone-thinning condition in which bones
slowly lose mass and deteriorate. The disease, which mostly
affects older women, is credited with causing about a million fractures
each year and
can cause chronic and acute pain, and a stooped posture.
Osteoporosis is not, as previously thought, an inevitable consequence
of aging. Some people are at higher risk for developing the condition
and there are new options to prevent and treat the disease -- even if its
early signs and symptoms have been detected. The risk factors include:
gender (women are twice as likely to get osteoporosis as men); age (risk
increases with age); an immediate family member with the disease; race
(Caucasians are at greatest risk); early menopause; extended use of steroid
medications (for treating asthma, arthritis, etc.); and cigarette smoking.
A baseline bone densitometry scan should be done at menopause, with
additional scans done at the recommendation of your physician. This
is a painless, non-invasive scan of the lower back or hip that takes only
a few minutes to complete. If the disease is detected in its early
stages, exercise, calcium supplements, estrogen replacement therapy and/or
medications may be recommended.
Ovarian Cancer
Ever since Gilda Radner of Saturday Night Live fame died of ovarian
cancer a decade ago, women have been even more worried about this potentially
deadly disease. Since then, considerable progress has been made in
the diagnosis and treatment of this cancer. We now know, for example,
that about 7 percent of ovarian cancers are linked to a genetic predisposition
for both breast and ovarian cancer. While it now has a 90
percent five-year survival rate when detected early, ovarian cancer can
still be lethal if undetected and left untreated. The problem is
that ovarian cancer is difficult to diagnose before the tumor has spread
beyond the ovaries.
Each year, about 25,000 women are diagnosed with ovarian cancer and
more than 14,000 die of it. Most of the cases are in women over age
50, but it occurs in younger women, too. There are few early symptoms;
however, as the tumor grows it puts pressure on organs in the lower abdominal
cavity, which can cause changes in bowel or bladder habits, abdominal swelling,
indigestion, gas, bloating, pain, as well as weight gain or loss.
The enlarged ovaries may be detected during a pelvic exam and there are
now genetic blood tests that can be helpful, but a laparotomy is necessary
to reach a definitive diagnosis. If cancer is confirmed during the
laparotomy, surgery to remove the ovary or ovaries may be recommended.
Unfortunately, there are also other equal opportunity cancers that increasingly
affect women: lung cancer and colon cancer are on the rise in this
country. As the years pass, discuss which tests and screening measures
are important and be alert for changes in the way your body functions and
feels. Sometimes, the first signs of what could potentially be serious
illness start with a minor symptom that’s easy to ignore. Don’t.
If something doesn’t feel just right, make an appointment for a check up
or call your physician to share your concerns. Remember, the best
chance to cure or successfully treat even a potentially serious illness
is right at the outset, so don’t procrastinate...make the call. |
