Screening & Tests- 04

1- Your 20s and 30s: Jumpstart Healthy Living
2- Medical Tests in Your 20s and 30s
3- Your 40s and 50s: Managing Health Changes
4- Exams for Women Over 40

5- Health Checklist for Women Over 40
6- Your 60s and Up: Healthy Body, Sharp Mind
7- Testosterone and Estrogen Levels in Women
8- Estrogen Test

9- Progesterone Test
10- Breast Biopsy
11- What to Expect From an Ob-Gyn Visit
12- Hysteroscopy

13- Pelvic Exam
14- Pap Smear
15- What If My Pap Test Results Are Abnormal?
16- Vaginal Wet Mount
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13- Pelvic Exam

The Pelvic Exam

A pelvic exam is a way for doctors to look for signs of illness in certain organs in a woman's body. The word "pelvic" refers to the pelvis. The exam is used to look at a woman's:

• Vulva (external genital organs)
• Uterus (the womb)
• Cervix (opening from the vagina to the uterus)
• Fallopian tubes (tubes that carry eggs to the womb)
• Ovaries (organs that produce eggs)
• Bladder (the sac that holds urine)
• Rectum (the chamber that connects the colon to the anus)

When Are Pelvic Exams Done?

Pelvic exams are performed:

• During a yearly physical exam
• When a woman is pregnant
• When a doctor is checking for an infection (such as chlamydia, vaginosis, trichomoniasis, and others)
• When a woman is having pain in her pelvic area or low back

Do I Need to Do Anything to Prepare for a Pelvic Exam?

Because a Pap test is typically performed during a routine pelvic exam, you should schedule the exam when you are not having your period.

In addition, for 48 hours prior to the exam, you should not:

• Douche
• Use a tampon
• Have sex
• Use birth control foam, cream, or jelly
• Use medicine or cream in your vagina

What Can I Expect During a Pelvic Exam?

You can expect to feel a little discomfort, but you should not feel pain during a pelvic exam. The exam itself takes about 10 minutes. If you have any questions during the exam, be sure to ask your doctor.

How Is a Pelvic Exam Performed?

During a typical pelvic exam, your doctor or nurse will:

1. Ask you to take off your clothes in private (You will be given a gown or other covering.)
2. Talk to you about any health concerns
3. Ask you to lie on your back and relax
4. Press down on areas of the lower stomach to feel the organs from the outside
5. Help you get in position for the speculum exam (You may be asked to slide down to the end of the table.)
6. Ask you to bend your knees and to place your feet in holders called stirrups
7. Perform the speculum exam. During the exam, a device called a speculum will be inserted into the vagina. The speculum is opened to widen the vagina so that the vagina and cervix can be seen.
8. Perform a Pap smear. Your doctor will use a plastic spatula and small brush to take a sample of cells from the cervix (A sample of fluid also may be taken from the vagina to test for infection.)
9. Remove the speculum.
10. Perform a bimanual exam. Your doctor will place two fingers inside the vagina and uses the other hand to gently press down on the area he or she is feeling. Your doctor is noting if the organs have changed in size or shape.
11. Sometimes a rectal exam is performed. Your doctor inserts a gloved finger into the rectum to detect any tumors or other abnormalities.
12. Talk to you about the exam (You may be asked to return to get test results.)

What Tests Are Taken During the Pelvic Exam?

A sample of cells may be taken as part of regular test called a Pap smear, or Pap test, to screen for cervical cancer or cells that look like they might lead to cancer. The sample is placed in a solution and sent to a lab where it is examined. Tests also may be taken to screen for sexually transmitted diseases.

How Often Should I Get a Pelvic Exam?

A Pap smear is recommended starting when women reach 21 years of age. Women ages 21-65 should have routine screening with Pap test every three years.

Combining a Pap test with a human papillomavirus ( HPV ) test can safely extend the interval between cervical cancer screenings from three years to five years in many women between the ages of 30-65, according to the U.S.Preventive Services Task Force (USPSTF).

Also according to USPSTF guidelines, HPV testing is not recommended for women in their 20s, because people in that age group can have HPV infections that resolve without treatment.

Women over age 65 can stop getting screened if they’ve had at least three consecutive negative Pap tests or at least two negative HPV tests within the previous 10 years, according to the guidelines. But women who have a history of a more advanced precancer diagnosis should continue to be screened for at least 20 years.

14- Pap Smear

What Is a Pap Test?

A Pap test, also called a Pap smear, is an exam a doctor uses to test for cervical cancer in women. It can also reveal changes in your cervical cells that may turn into cancerlater.

What Happens During the Test?

It’s done in your doctor’s office or clinic and takes about 10 to 20 minutes.

You’ll lie on a table with your feet placed firmly in stirrups. You’ll spread your legs, and your doctor will insert a metal or plastic tool (speculum) into your vagina. He’ll open it so that it widens the vaginal walls. This allows him to see your cervix. Your doctor will use a swab to take a sample of cells from your cervix. He’ll place them into a liquid substance in a small jar, and send them to a lab for review.

The Pap test doesn’t hurt, but you may feel a little pinch or a bit of pressure.

What Do the Results Mean?

Your doctor will get them within a few days. They’ll come back either negative or positive.

A negative result is actually a good thing. That means your doctor didn’t find any strange-looking cells on your cervix. You won’t need another Pap until you’re due for your next scheduled one.

If your results come back positive, it doesn’t mean you have cancer. You could have slight inflammation. Or, you might have minor cell changes (doctors call this “dysplasia”). These often clear up on their own, so your doctor may take a “wait and see” approach. He’ll likely suggest you have another Pap test in a few months. If the abnormal cells haven’t cleared up by then, your doctor may order more tests. These might include a procedure called a colposcopy.

During a colposcopy, your doctor will insert a speculum into your vagina, just like he did for the Pap test. This time, he’ll look at the cervix with a colposcope. That’s a tool that has a lens and a bright light that allow your doctor to get a better look at your cervix. Your doctor will swab your cervix with vinegar or some other liquid solution. It’ll highlight any suspicious-looking areas. Your doctor will be able to see them through the lens on the colposcope.

If he finds areas that don’t look right, he’ll take sample (“biopsy”). He’ll send the sample to a lab for further testing. He may swab your cervix with a chemical solution to limit bleeding.

How Often Should I Have a Pap Test?

Doctors recommend you begin Pap testing at age 21. You should have the test every 3years from age 21 to 65. If you’re age 30 or over, you can have a Pap test every 5 years if you’re tested at the same time for the Human Papilloma Virus (HPV). That’s the most common sexually transmitted infection (STI), and it’s linked to cervical cancer.

If you have certain health concerns, your doctor may recommend you have a Pap more often. Some of these include:

• Cervical cancer or a Pap test that revealed pre-cancerous cells
• HIV infection
• A weakened immune system due to organ transplant, chemotherapy, or chronic corticosteroid use
• Having been exposed to diethylstilbestrol (DES) before birth

Talk to your doctor if you have questions or concerns. He’ll let you know for sure.

15- What If My Pap Test Results Are Abnormal?

What If My Pap Test Results Are Abnormal?

If the results of your Pap test come back positive, that means your doctor found abnormal or unusual cells on your cervix. It doesn’t mean you have cervical cancer.

Most often, the abnormal test result means there have been cell changes caused by the human papilloma virus (HPV). That’s the most common sexually transmitted infection (STI), and can be linked to cervical cancer. Changes to your cervical cells caused by HPV can be mild, moderate, or severe.

Will I Need More Tests?

Your doctor will review your test results and let you know. His answer will depend on what type of abnormal cells are found in your cervix. The most common ones are listed below.

Atypical squamous cells of undetermined significance (ASCUS). Thin, flat cells called squamous cells grow on the surface of a healthy cervix. ASCUS occurs when these cells are slightly abnormal. Your doctor will do a test with a special liquid to see if HPV is present. If it’s not, there’s probably no need for concern.

Squamous intraepithelial lesion. These cells may be pre-cancerous. Doctors call changes to them “low-grade” or “high-grade.” If they’re low-grade, a pre-cancerous cell may not turn to cancer for many years. If it’s high-grade, the cells could turn to cancer much sooner. Your doctor will likely order more tests, whether he finds low-grade or high-grade changes to these cells.

Atypical glandular cells. These cells make mucus. They grow in the opening of your cervix and inside your uterus. If they appear to be abnormal, your doctor will order more tests to find out for sure if it’s cancer.

Squamous cell cancer or adenocarcinoma cells. This means the cells on your cervix are so abnormal, your doctor is almost certain it’s cancer.

To be sure, your doctor will likely order two other tests -- a colposcopy and a biopsy.

During a colposcopy, your doctor will insert a speculum into your vagina, just like he did for the Pap test. This time, he’ll look at the cervix with a colposcope. This is a tool that has a lens and a bright light that allows your doctor to get a better look at your cervix. He will swab your cervix with vinegar or some other liquid solution. It’ll highlight any suspicious-looking areas. Your doctor will be able to see them through the lens on the colposcope.

If your doctor finds areas that don’t look right, he’ll take a sample, called a biopsy. He’ll send the tissue to a lab for further testing.

16- Vaginal Wet Mount

What Is a Vaginal Wet Mount?

If you think you have vaginal infection, your doctor will probably perform a test called a vaginal wet mount, or vaginal smear.

It’s not the same as a Pap test, which is a regularly scheduled exam that looks for cancerous or precancerous cells in the cervix. But you could have a vaginal wet mount and a Pap smear at the same appointment.

Most often, your doctor will do a vaginal wet mount to find the cause of vaginitis, an inflammation of the vagina. She’ll usually order the test if you’re having symptoms like itching, discharge or pain.

What Causes Vaginitis?

A few different things. There are three main types of vaginitis:

• Bacterial vaginosis . This is the most common type of vaginitis. It occurs when bacteria replace healthy vaginal cells.
• Candida vaginitis. This is better known as a yeast infection. It’s the second most common type of vaginitis, and is caused by a fungus.
• Trichomonas vaginitis. Also known as “trich,” this is actually a sexually transmitted disease (STD). It accounts for about 5% of all cases of vaginitis.

Your doctor might also do a vaginal smear to test for vulvitis. That’s an inflammation of the vulva -- the folds of skin just outside the vagina.

How Is the Test Done?

Your doctor or nurse will examine your vagina. If there’s obvious discharge, she may know what it is right away. For example, a yeast infection produces white, lumpy discharge. But with a bacterial infection, the discharge is thin and smells like fish. Still, your doctor might do a vaginal wet mount to be sure the culprit is what she thinks it is.

During the test, you’ll lie on your back with your feet above your hips, usually in stirrups. Your nurse or doctor will use a thin cotton swab to collect cells from the vaginal wall. She’ll smear the cells on a small microscope slide and mix them with a saline solution. She’ll view the slide under a microscope.

Before the test, don’t have sex, douche, or use tampons. If you’re having your period, wait until it’s over to have a vaginal wet mount. Blood can make it hard to get clean test results.

Your doctor will know what type of vaginitis you have, based on what she sees on the slide.

But What If I’m Embarrassed?

A gynecological exam of any kind can be a little awkward. You may also feel embarrassed if you have symptoms like a smelly discharge. But keep in mind that these types of infections are common. And remember that a vaginal infection can lead to serious complications if it’s not treated right away.