For most women, the annual visit to their OB/GYN can lead to more questions than answers. Are you healthy? What is normal? Is the doctor checking everything he or she should? Here are 10 of the most commonly asked questions gynecologists hear, along with the answers you need…
1. What’s the difference between bacterial vaginosis and yeast infection?
Yeast infections are caused by an overgrowth of the Candida fungus that is often present in low numbers in the vagina. Pregnancy, antibiotics, moisture, and vaginal irritation can all lead to an overgrowth of these organisms.
Symptoms of yeast infections include: redness, itching and burning around the vulva; foul-smelling, thick white discharge (may look like cottage cheese); pain during intercourse and urination.
Bacterial vaginosis (BV) is the most common cause of vaginal infection. Women normally have bacteria in their vagina that are in healthy balance with their surrounding tissues. But that balance can be disrupted by a number of things, including pregnancy, hormonal changes, douching, foreign bodies (including IUDs), and stress. This imbalance can cause an overgrowth of bacteria, which can lead to infection, inflammation and discomfort.
The signs and symptoms of BV may be quite similar to yeast infections: redness, itching and pain. With BV, however, the discharge tends to be thin, white or yellowish, and more uniform in appearance.
2. What does a routine Pap smear test? What other tests should I ask for?
Getting a regular Pap test is the most important thing you can do to prevent cervical cancer. Pap tests detect abnormal cervical cells that can become cancerous or may indicate the presence of cancer. Tests for other STDs can also be obtained at the time of the Pap test.
In a Pap test, cells are collected from the cervix (the lower, narrow end of the uterus). The specimen is placed on a glass slide and sent to a laboratory for examination. The test is usually done during the course of a regular pelvic exam.
If an OB/GYN is the only doctor you visit, get a complete physical exam annually, not just a pelvic and breast exam. Women 40 and over should receive routine screenings for breast cancer. Beginning at age 50, women should also be screened regularly for colon cancer. Laboratory tests for anemia, thyroid function, lipid levels, and blood glucose are also suggested.
If you are sexually active and have a new sexual partner, multiple sexual partners, or a non-monogamous sexual partner, you should be screened for sexually transmitted diseases, including chlamydia, gonorrhea, syphilis, and HIV. The Pap test itself may detect the presence of cellular changes due to human papillomavirus (HPV).
3. How do I treat recurring UTIs?
A urinary tract infection (UTI) is a bacterial infection of the urinary system, including the urethra, bladder, ureters, and kidneys. Any trauma or chemical irritation to the urethral opening such as that caused by intercourse, use of diaphragms, catheters, douches, deodorant sprays, spermicides, or manual stimulation can lead to a UTI. Menopause or a weakened immune system can also make a woman more susceptible to UTIs.
Simple urinary infections of the bladder are easily treated with oral antibiotics. Most women who are otherwise healthy can intermittently self-treat recurrent UTIs without a doctor visit, since your doctor can prescribe and order prescriptions for you over the phone for pickup at your local pharmacy. Antibiotics are taken as soon as characteristic symptoms develop, as if treating an initial attack. There are effective single dose and 3-day antibiotic regimens.
However, women who experience two or more UTIs within six months or three or more over a 12-month period may require preventive antibiotics. Low-dose antibiotics are taken continuously for six months or longer, usually with excellent results. Such continuous, prophylactic treatment is reported to reduce recurrent UTIs by up to 95%.
4. Can I get cancer from oral sex?
A number of sexually transmitted diseases are linked to oral sex. These include herpes, syphilis, gonorrhea, and HIV. Studies have previously found a link between HPV and head and neck cancers. Now, in an article published in the New England Journal of Medicine, researchers have established a link between oral sex, the presence of the human papillomavirus (HPV) infection (the virus that causes cervical cancer), and throat cancer.
The type of oral cancer linked to HPV afflicts about 11,000 people in the U.S. annually – about the same number of new cervical cancer cases each year. Throat cancer associated with HPV typically involves the base of the tongue, the tonsillar area or the back of the throat.
The particular subtype of HPV that correlates with throat cancer is known as HPV16.
Condom use can reduce the risk of genital HPV infection. Moreover, other studies have shown that infrequent use of condoms with a new oral or vaginal sex partner increased the risk of throat cancer. To protect yourself, treat oral sex with the same caution as other forms of sexual contact.
5. How does the morning-after pill work? Is it safe?
The “morning-after pill” is a form of emergency contraception (EC) intended to prevent pregnancy after sexual intercourse. EC works by preventing ovulation or fertilization and possibly block post-fertilization implantation of the embryo in the womb.
Nearly two dozen brands of pills are used for EC in the U.S. today. However, Plan B is the only product specifically FDA approved and marketed as an emergency contraceptive. Plan B contains the progestin hormone levonorgestrel, an ingredient found in many birth control pills. Unlike birth control pills, however, Plan B contains much larger doses of levonorgestrel and no estrogen. Two pills total are required.
The usual treatment schedule for Plan B is one 0.75 milligram pill taken within 72 hours after unprotected intercourse, and a second 0.75 milligram pill 12 hours after the first dose. However, recent studies have shown that a single dose of 1.5 milligrams is equally effective as the two-dose regimen.
While you have up to 120 hours (five days) after sex to take the first pill, the longer initial treatment is delayed, the less effective the regimen. If taken within 72 hours after sex, EC reduces the risk of pregnancy by 75%-89%.
The morning-after pill is considered to be very safe and the risk of serious side effects is quite low. Around 25% of Plan B users experience nausea, with many complaining of vomiting. Other common side effects are: abdominal pain, fatigue, headache, dizziness, and breast tenderness. Most side effects resolve within 24 hours.
6. What are Kegel exercises? How do I do them?
The floor of the female pelvis contains muscles that surround the openings of the urethra, vagina and rectum. Those muscles may weaken due to age, obesity and childbirth, leading to urinary incontinence. Kegel exercises are intended to strengthen these muscles, thereby improving bladder control.
The exercises are also used to increase sexual gratification. Kegels strengthen the vaginal muscles, which can heighten sensitivity, arousal and orgasm.
Kegel exercises use the muscles normally used to stop urination. However, it is not recommended that you stop and start the flow of urine to practice your Kegels, as this may induce urinary reflux which can lead to a urinary tract infection.
To make sure you’re tightening the proper muscles, you can ask the assistance of your healthcare provider. The provider will insert two fingers into the vagina during a pelvic examination and ask you to squeeze down as if you were stopping urination. (Be careful not to contract leg, abdominal, or buttocks muscles.)
To practice Kegel exercises, tighten the pelvic muscles for 10 seconds, and relax for 10 seconds. Try this lying down at first, and then once you become accustomed to the sensation, you can do these while sitting or standing. Repeat this sequence 10 or so times, for five times per day. Build up to this amount over time. Over-taxing your pelvic muscles can make incontinence symptoms temporarily worse.
7. Should I get the HPV vaccine?
Gardasil, the HPV vaccine, protects against certain strains of human papillomavirus (HPV) that cause cervical cancer and genital warts. HPV has infected around 20 million people in the United States to date, with more than six million new cases occurring annually.
There are over 100 different types of HPV: About 60 cause common skin warts (plantar, hand); around 40 affect the genital tissues and are sexually transmitted. Only a few of the genital types are considered high risk and can cause cancer. Gardasil is effective against four types of HPV: Two of the types cause 90% of all genital warts; the other two strains cause 70% of cervical cancer cases.
Gardasil is approved for females ages 9-26 years old. While Gardasil may offer protection for women older than 26, the vaccine has not yet been approved for their use. One reason may be that older, sexually-active women may already have acquired one (or all) of the four HPV types the vaccine protects against, reducing its effectiveness.
Reaching pre-teen girls before they are sexually active ensures that they are protected prior to HPV exposure. Once sexually active, they are at high risk of contracting the infection. Condoms do not offer complete protection because they don’t cover all skin areas which may harbor the virus.
8. What are “shortened period” pills? Are they safe?
The FDA has approved two oral combined hormonal contraceptive pills designed to give women four extended cycles each year – Seasonale and Seasonique. Now a third pill called Lybrel has been approved by the FDA. Lybrel is the first continuous birth control pill to stop periods for one full year.
With Seasonale, a pill with active ingredients is taken every day for three months (84 days for a 28-day cycle), followed by an inactive pill for seven days. Seasonique has the same dosing frequency, but the 7-day cycle includes a reduced estrogen dosage instead of a placebo. Using low-dose estrogen pills instead of a placebo limits the bloating and breakthrough bleeding experienced by some women taking Seasonale.
Studies have found no extra health risks caused by period-suppressing pills. Research on Lybrel shows that 99% of women either returned to a normal menstruation cycle or became pregnant within 90 days of stopping the pills. Studies found similar spotting or bleeding as with traditional, cyclic birth control pills. And breakthrough bleeding decreased the longer women stayed on the regimen.
9. Are there symptoms for cervical or ovarian cancer I can watch for?
Cervical cancer is typically a slow-developing disease that can be detected early through routine pelvic examinations and Pap tests. Since cervical cancer can be found before it exhibits any signs, the presence of symptoms may indicate that the disease is at an advanced stage.
Cervical cancer symptoms:
Abnormal vaginal bleeding
Unusual, heavy discharge that may be foul smelling and contain mucus
Pelvic pain unrelated to the menstrual cycle
Pain during urination
Bleeding between periods, after sexual intercourse or after a pelvic examination
Ovarian cancer doesn’t have a routine test that can detect its presence. Because ovarian cancer is hard to detect early, more than 75% of women diagnosed with it die from the disease. However, there are symptoms to watch for.
Ovarian cancer symptoms:
Difficulty eating or feeling full quickly while eating
Abdominal bloating, pelvic or abdominal pain
Frequent urge to urinate
Advanced ovarian cancer symptoms:
Change in bowel movements
Pain during sexual intercourse
Persistent fatigue
Abdominal weight gain
Sudden weight gain or loss
If a woman experiences any of these symptoms for more than two weeks, she should see her gynecologist for evaluation. This is particularly important if the symptoms are new and different from her normal state of health.
10. What are the best methods to screen for ovarian, cervical and breast cancer?
Ovarian cancer
There are no routine tests that can detect the presence of ovarian cancer. Women with potential symptoms (see Question 9) should be screened with a pelvic/rectal examination in which ovaries can usually be manually palpated (felt). If there is a question of a tumor after physical examination, an ultrasound can check the ovaries for abnormal growths. There is also a blood test for a substance known as a tumor marker that can be elevated with ovarian cancer, although it doesn’t provide a definitive diagnosis. If still unresolved after non-invasive testing, the suspicious areas may need to be biopsied.
Cervical cancer
Routine pelvic examinations and Pap tests are the most effective way to detect cervical cancer. When the cancer is confined to the cervix, the 5-year survival rate is greater than 90%. With regular Pap tests, cervical cancer can be prevented or detected at a very early stage.
Breast cancer
Breast cancer is most reliably detected through a mammogram. Because mammography can detect breast cancer before it can be felt as a lump, it is considered more sensitive than breast examination. About 25% of breast cancers are first detected on breast examination, about 35% are found through mammography alone, and 40% are detected using a combination of examination and mammography.
