Well Woman Exam
At South Orange OB/GYN, we believe that Well Woman Exams are the foundation for health promotion, disease identification and wellness throughout your life. It is no secret that healthy living and early detection of disease increases not only your length of life but, more importantly, your quality of living.
A periodic well woman exam (usually once a year) for all ages is not just about good medical care; it also gives you the opportunity to learn about beneficial health habits, counseling and community support services. It also provides an overall view of the best ways to take care of yourself and your family for a lifetime.
The well women exam is performed in three parts: the health history, breast exam, pelvic exam - as well as an assessment for other health issues. Always remember to discuss all healthcare concerns with Drs. Dresdner or Simon—your best source for advice on healthy living.
The Health History
If this is your first visit at South Orange OB/GYN & Infertility Group, your visit may be longer and more involved than later office visits. Since we are not yet familiar with you, a detailed medical, family, obstetric, gynecologic, genetic and psychosocial history is done to develop a complete plan of care. This is called the health history. It is important to know your family medical and genetic history, if possible. Some issues you will need to discuss include...
- Have you ever been pregnant and, if so, did you have any problems?
- Are you planning a pregnancy?
- When was your last Pap Smear and was it normal?
- Your menstrual history: This includes the age that your period started, and the frequency and duration of your periods.
- When was your last Mammogram?
- Have you ever had any type of surgical procedures?
- Are you experiencing any health problems now?
- Your daily habits such as diet, smoking, and exercise and a detailed sexual history.
It always is a good idea to bring any medical records and a list of medications that you may already be taking to your first health visit. Remember to include any use of alternative treatments such as herbal preparations or acupuncture.
The well woman exam is a good opportunity to discuss any concerns that you may not feel comfortable talking about with friends or family such as infection, drug and alcohol use, depression and domestic violence. You can also feel free to discuss any sexual issues such as frequency of sexual activity, libido, and pain during sexual intercourse. Any health information you reveal is kept confidential, by law, so be sure to ask about any concerns. It always is a good idea to write down any questions you have and bring your list with you. Remember, no question is stupid. At South Orange OB/GYN we want to make sure you receive a complete plan of care in order to help you be healthy in every way.
The well-woman exam is a good time for Dr. Dresdner to screen you for potential reproductive health problems, to answer your questions, and to discuss your concerns. The well woman exam typically includes a basic history and physical. The Annual Exam will include...
- A Pap smear which is an evaluation of the outer cells of your cervix (the neck of your uterus/womb). If you are 30 years old or greater, the sample will also be tested for the Human Papilloma Virus (HPV). Some strains of this virus are responsible for genital warts and others may be pre-cancerous. It is important to detect this early and follow instructions provided by your doctor.
- Each of our patients will have blood work performed (complete blood count) to check for anemia. This can be performed at our on-site lab.
- If you are greater than 40 years of age (or high risk), you will be given a prescription for a mammogram and breast ultrasound to evaluate you for breast changes. An ultrasound is often indicated if you have dense breasts.
- If you are greater than 65 years of age (or high risk), you will be given a prescription for a bone mineral density scan (DEXA) to evaluate for osteoporosis
- Occasionally you will be asked to come back every 6 months i.e. birth control follow-up.
Clinical Breast Exam
A Breast Exam, performed by your provider, is a very important part of the annual well woman exam. It should be done for women of all ages to detect any evidence of breast disease. A good exam starts by sitting up with arms above the head for any signs of abnormality to the breast such as dimpling, nipple inversion (where the nipple turns in, not out), an orange peel appearance or any redness, soreness, rash or swelling. Your provider will touch each breast with the pads of the three middle fingers for evidence of lumps or thickening from the bottom of the breast to the collar bone and up under each arm pit. This area is all breast tissue and needs to be checked.
When, you lie down, the exam is performed again, looking for the same abnormal findings. Nipple discharge is important to access and a gentle squeeze on each nipple is done for this purpose. Even though you may have a negative clinical breast exam, you should continue monthly breast self-exams, performed the same way, in order to give yourself the best protection against breast cancer.
The pelvic exam specifically determines if the outer sexual parts (vulva and labia) and the inner organs (vagina, cervix, uterus and ovaries) are healthy. A Pap smear is done as part of a gynecological exam. To do this, your doctor will look at the outer area for any problems then gently insert a sterile instrument called a speculum into the vagina, in order to see the entire vagina and the lower part of the uterus called the cervix. This allows your care provider to observe any abnormal discharge or appearance to the vagina and cervix. Try to relax. You should feel some pressure during the procedure, but no pain.
An annual pap smear is done to detect abnormal cell changes of the cervix that could lead to cancer. This involves scraping the outer and inner area of the cervix with a small instrument called a palate, brush or broom. The cervix does not have a lot of pain sensation so this should not hurt, but you can feel it. Once the speculum is removed, your care provider will make sure the uterus and both ovaries feel normal in size and you have no pain in this area. They do this by gently inserting two gloved and lubricated fingers into the vagina and using the other hand to feel these organs by pressing on your lower abdomen. Rectal examinations are not routinely done by most care providers unless there is a problem. Women over age 40 may be more likely to have rectal exams. Be sure to let your doctor know if you have never had a pelvic or rectal exam or if you ever have had problems during an exam.
Sexually Transmitted Illnesses (STI) Screening
Sexually transmitted illnesses can be characterized by abnormal vaginal discharge, bleeding, genital sores, or pelvic pain. They also can show no symptoms early on. If untreated, a patient may spread the illness to another sexual partner and there could be severe consequences later in life i.e. infertility, organ failure.
All sexually active patients 35 years old or younger are tested annually for sexually transmitted diseases. Patients may also request more frequent testing or screening as needed i.e. a new partner.
Examples of sexually transmitted diseases that we regularly test for...
- Gonorrhea – a bacterial infection of the cervix. Patient often presents with abnormal yellow, green discharge and pain on exam. The test is performed via vaginal swab. The infection is treated with an intramuscular antibiotic injection at your local urgent care, emergency room, or department of health. You and your partner should be treated to prevent reinfection. If untreated, it can lead to pelvic inflammatory disease and infertility.
- Chlamydia – a bacterial infection of the cervix. Patient often presents with heavy clear discharge and can have pain on exam. The test is performed via vaginal swab. Chlamydia is treated with a one-time dose of antibiotic pills. You and your partner should be treated to prevent reinfection. If untreated, it can lead to pelvic inflammatory disease and infertility.
- Trichomoniasis – a parasitic infection of the cervix. Only about 30% of patients show symptoms of abnormal, frothy discharge. It is often picked up on routine Pap smears. It is treated with a one-time dose of antibiotic pills. You and your partner should be treated to prevent reinfection.
- Herpes Simplex Type 2 – a virus spread through unprotected intercourse or direct contact. Herpes is very common and contagious. Some patients show signs of exposure in their blood but never have an outbreak. If you develop painful sores on your genitalia, an antiviral medication can be provided to you and you should abstain from intercourse until the lesions resolve. The symptoms are treatable but the virus is not curable.
- Syphilis – a parasite/spirochete infection which results in a painless “chancre” (lesion) on the genitalia. A primary infection is treated with the antibiotic penicillin. It is highly treatable, but if a patient does not receive treatment, it can result in dangerous, life long complications.
- Hepatitis B – a virus spread by blood and other bodily fluids which can seriously affect a patient’s liver over time. Many patients in the U.S. are immunized against the Hepatitis B virus with a three–vaccine series as children.
- Human Immunodeficiency (HIV) – a virus spread through blood and other bodily fluids. This is a very serious illness which requires special care and medications prescribed by an Infectious Disease doctor. The symptoms of the virus often are treatable but the virus is not curable.
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