Annual Exam - Gynecological Health

Each year, we advise you to have an "annual exam" to evaluate your gynecological health by detecting changes from your previous evaluation. A thorough history is taken, concentrating on changes in your symptoms, a complete physical is performed to detect any new abnormalities and a Pap smear is conducted. Additional testing is ordered for mammography, ultrasound, and lab tests as indicated. Prescriptions are refilled or changed, and your chart is updated so telephone inquiries can be answered accurately during the ensuing year.

A "Thin-prep Pap" has been used in our office since 1998. The advantage of this liquid Pap, as opposed to the dried Pap smear, is that abnormalities may be detected earlier, at a less-advanced stage. Cervical dysplasia is graded as mild (CIN I), moderate (CIN II), severe/carcinoma-in-situ (CIN III) and reported to us in about two weeks. You are sent a self-addressed postcard if your Pap is normal. If your Pap is abnormal, we call you immediately. Usually we recommend you undergo further investigation with colposcopy/cervical biopsies in our office. Automatically, the abnormal Thin-prep Pap Smears are screened for Human Papilloma Virus (HPV), which can be present and cause a more rapid progression of your cervical disease. If present, the HPV is stratified into High or Low risk categories to help determine the best care for you.

We recommend mammograms annually if you are over 35, are on hormone replacement therapy or have had breast augmentation. If a close relative developed breast cancer at a young age, we deduct 5 years from the onset of that cancer and recommend screening for you.

High-definition vaginal ultrasounds, conducted in our office at the time of your exam, may be recommended if you are on hormone replacement therapy and have a uterus and/or ovaries. We want to detect abnormal thickening of the uterine lining, polyps or ovarian cysts, which may have malignant potential. We may order a Ca-125, a blood test to help detect ovarian malignancy.

Laboratory testing usually includes a test for thyroid, anemia, liver and kidney function, as well as a lipid check. The total cholesterol is assessed with the lipids fractionated into high and low density lipoproteins and triglycerides. For accuracy, it important that you are "fasting" with no food or drink after midnight the previous evening. We may order an ultrasenitive C-reactive protein, which if elevated, may be an indication of coronary artery inflammation, even though your cholesterol is normal. This potentially increases your chance of a heart attack and will be addressed.