An annual exam can be performed at any age, but we usually recommend starting at age 21. The annual gynecologic exam involves a breast exam and a pelvic exam. A pap smear may or may not be performed.
A pap smear is a screening test for cervical cancer. Your provider will use a speculum to look at your cervix and use a brush to collect some cells to send to the lab. It may feel a little uncomfortable and scratchy but should not hurt. The American Society for Cervical Cancer Screening and Prevention (ASCCP) recommends starting pap smear screening at age 21. From the age of 21 to 29 pap smears are recommended at least every 3 years. From age 30 to 65 it is recommended at least every 5 years if you have the HPV test as well. If you have an abnormal pap smear it does not mean you have cervical cancer, but it may mean you need more frequent pap smears or additional testing that your provider will go over with you.
A mammogram is an x-ray test to screen for breast cancer. The American College of Obstetrics and Gynecology (ACOG) recommends starting mammogram screening at age 40 and performing them every year. This is what we recommend as well. If you have a strong family history of breast cancer or ovarian cancer, talk to your provider to see if you need to have screening starting earlier than age 40 or if you qualify for genetic testing.
Birth control refers to ways of preventing pregnancy. Here is a list of some common methods. Talk with your provider to see which one would be best for you.
Oral contraceptive pills (OCPs): Otherwise known as birth control pills. This is a pill that you must take at the same time every day. This is a good option if you will be good about taking pills daily. There are A LOT of different types of birth control pills, so talk to your provider about which one may be best for you.
Contraceptive patch: This is a patch you put on your skin once every week for 3 weeks. On week 4 you do not put a patch on, and you have your period this week. This is good if you want something that is a bit easier to remember than taking a daily pill.
Vaginal ring: Also known as the NuvaRing. This is a flexible ring that you insert and leave in the vagina for 3 weeks. On week 4 you remove it and you have your period this week. This is good if you want something that is a little lower maintenance than the pill or the patch.
Depo provera shot: This is a shot that you get every 3 months.
Long acting reversible contraceptives: Also known as LARC. This is a term that is used for types of birth control that can last many years such as the intrauterine devices (IUDs) and Nexplanon. These are the most effective (over 99%) forms of birth control.
Intrauterine device (IUD): An intrauterine device is small T shaped device that is inserted into the uterine cavity (where a baby would grow) to prevent pregnancy. There are a few different types of IUDs as listed below:
Mirena: This contains a hormone called progesterone to help thin the lining of the uterus. Many people do not have a period or have light periods with this IUD. This type of IUD is good for 5 years.
Kyleena: This also contains a hormone called progesterone but is a significantly lower dose of progesterone than the Mirena. This IUD is also smaller in size compared to the Mirena, so is especially good for teens or patients who have not had a baby. This type of IUD is good for 5 years.
Paragard: This is also known as the copper IUD. It is the most effective non-hormonal method for birth control. This type of IUD is good for 10 years.
Nexplanon: The Nexplanon is an implant that is placed under the skin in your upper arm. This contains a hormone called progesterone to help thin the lining of the uterus. Many people do not have a period or have light periods with this in place. The Nexplanon is good for 3 years.
Infertility is defined as no pregnancy after 1 year of regular intercourse without birth control. If you are 35 years old or over then evaluation should start after 6 months of trying. Usually work up for infertility includes blood work, imaging, and a semen analysis depending on your history and risk factors. Most infertility is unexplained, which means all your testing was normal and no obvious reason for infertility was found. Female infertility can be treated with medication, injectable hormones, intrauterine insemination, or in vitro fertilization (IVF). Higher level treatments such as IVF are done by a specialist called a reproductive endocrinologist and your provider can recommend one if they think this is necessary. Check with your insurance company regarding infertility evaluation and treatment because these expenses may or may not be covered.
An ectopic pregnancy is a pregnancy that is growing in the wrong place. The most common place for an ectopic pregnancy to form is in the fallopian tube. Sometimes this resolves on its own, but sometimes this needs medication or surgery to fix. Your provider will let you know what they recommend if you are diagnosed with an ectopic pregnancy. An ectopic pregnancy can be dangerous because it can cause the tube to burst, which can cause internal bleeding and is a life-threatening emergency. If you have had an ectopic pregnancy in the past you are at risk of having another one, so if you have a positive pregnancy test let your provider know as soon as possible.
Endometriosis is a condition where the lining of the uterus called the endometrium grows where it is not supposed to such as on the outside surface of the uterus, the lining of your abdomen, the tubes, ovaries, bladder, bowel, etc. This can be the cause of pelvic pain, painful periods, and painful intercourse. Although we probably will get a pelvic ultrasound to look for causes of pain, endometriosis is not usually seen on ultrasound. Endometriosis is definitively diagnosed with surgery, but usually we try different treatments such as NSAIDs, hormones, birth control, or other medications first to see if they will help before resorting to surgery. If needed, surgical treatments include removing as much of the endometriosis implants as possible and clearing up any scar tissue or adhesions that formed. Even though surgery can treat endometriosis it can still come back so medical treatment or future surgical treatment may be necessary to keep your symptoms at bay. Ultimately, a bilateral salpingo-oophorectomy (removal of both of your tubes and ovaries) may be necessary to treat your symptoms once and for all if you are diagnosed with endometriosis.
Pelvic organ prolapse is a condition in which the connective tissue in the vagina becomes loose and the vaginal walls start to bulge into or out of the vagina. Even though it sounds and can feel scary, it is not life threatening and is a common condition that can happen as you age. Having a vaginal delivery is the most common risk factor for this. There are different types of prolapse:
Cystocele: This is the most common type of prolapse. It is when the top of the vagina that holds the bladder up starts to sag. Some people describe it as their “bladder is falling down.
Rectocele: A rectocele is when the back part of the vagina towards your rectum starts to bulge.
Uterine prolapse: This is self-explanatory and is when the uterus and cervix start to collapse into the vagina and towards the opening.
Vaginal vault prolapse: This occurs in someone who has had a hysterectomy when the end of the vagina where the uterus and cervix used to be starts to collapse towards the opening.
There are different grades or stages of pelvic organ prolapse that your provider will assess for. In general, if you are not having any symptoms from it and it is not bothering you then you do not need treatment. If you are having symptoms of prolapse that are bothersome then treatment includes a pessary or surgery.
A pessary is a silicone device that is inserted into the vagina to hold up the prolapse so it is not protruding out of the opening of the vagina. There are many types and sizes of pessaries and your provider will fit you for a pessary according to your body and your specific symptoms. It might seem strange how putting in a pessary would help with your symptoms but think of it like when people use tampons and do not feel them in there. After finding the pessary that is right for you, you can either take care of it yourself at home or come back to the office every few months to have it removed, cleaned, and replaced.
Surgery is performed in the hospital operating room while you are asleep. It is generally a same day procedure or overnight stay depending on what needs to be done and provider preference. This procedure uses dissolvable stiches to put together damaged connective tissue and trims the extra skin from the vagina. If you have uterine prolapse your provider might recommend a hysterectomy as well. ***Link to prolapse repair surgery section***
Vaginal dryness is a common issue in women who have low estrogen levels which usually occurs during the peri- or post-menopausal years. You may have this is you have painful intercourse or irritation around the vagina or vulva. Usually we recommend trying a water based (Astroglide) or silicone based (Uberlube) lubricant, or even using a natural oil such as coconut oil. If this is not working then talk to your provider about prescription medications, creams, or Mona Lisa treatment.
There are many different reasons your provider may recommend an ultrasound for you. A pelvic ultrasound is usually performed to evaluate the uterus, cervix, ovaries, and bladder. This is achieved through an abdominal or vaginal approach. Common reasons for ultrasound imaging include: Pelvic pain, evaluations of ovarian cysts or uterine fibroids, heavy or irregular periods, locating an IUD, bleeding after menopause.