A visit to the Gynecologist
Most women will rather see a dentist then to go to the gynaecologist. As daunting as it may be, it is a necessary evil. The aim of this piece is to prepare you and give insight to the importance of this consultation.
The first factor to consider is who to see, and it is likely the most critical of all the decisions that will follow. Most women tend to see doctors recommended by family and friends, but the recent trend is actually to research the doctor using Google or social media sites. In 2014 the choices have dramatically improved where you have almost equal numbers of female and male gynaecologist, young and eager and older and wise, generalists and super-specialists, making the choice more difficult.
The reason for regular consultations include making a diagnosis when you have symptoms, but also to screen for potentially serious conditions, to ensure good reproductive and post reproductive health and to prevent conditions that can impact on quality of life.
When we screen, the idea is to look for common conditions that can be easily tested for and have a known treatment and as a result prevent serious disease and improve quality of life. Screening look to diagnose early disease that can be treated, but also to investigate for causes preventing the ability to conceive, normal development and variations to such development.
Common screening tests include the Pap smear, mammograms, ultrasound examinations, certain blood tests and in later life bone density scans.
Pap smear is a light scrapping from the cervix to test for early changes that may lead to cancer with a poor prognosis and usually significant suffering. The unfortunate situation is that it may go unnoticed for many years and only have symptoms in the advanced stages when treatment options are limited. In its progress cervical cancer can cause renal failurem severe nerve pain, bladder and intestinal involvement with later spread to the liver, lungs and rarely bones. As per the World Health Organisation Pap smears should be done at age 30, 40, and 50 years in countries with limited resources. To decrease the impact of cervical cancer 70% of women need to be tested.
We know that it is caused by a virus (Human Pappiloma Virus) and with recent developments there is a vaccine available to decrease the risk of developing cervical cancer. Personally I recommend more regular pap smears - at least every 3-5 years as long as they stay normal.
Women with a family history of uterine cancer, breast, stomach, intestinal and ovarian cancers require closer follow up, even in the face of very poor screening tests. They may have a genetic predisposition and can be advised accordingly.
Screening can also prevent long term complications in conditions like polycystic ovarian syndrome (PCOS), hyperprolactinaemia, thyroid disease and risks associated with bone mass density.
General Gynae Health
With the Pap smear out of the way, a complete physical examination needs to be done. This will include a breast examination, abdo-pelvic exam and an internal assessment. Special tests include a look at vitals (blood pressure, pulse, respiratory rate, and temperature), urine test to exclude or confirm pregnancy, and look at a urinalysis. An ultrasound is then done to ensure normal gynaecological structures and to exclude pathology like fibroids, ovarian cysts, and pregnancy. When abnormalities are found, further investigations are done to get to a diagnosis and plan treatment.
Discussions will include disease prevention like HIV or STI’s, prevention of unwanted pregnancies/ family spacing. In the women during their reproductive years contraception will be assessed, and in the women who are peri-menopausal, prevention of menopausal symptoms, and its complications.
Unfortunately most women only present when pregnant or if there is a problem, in that way we are treating pathology and seldom get to do health education and preventative gynaecology.
Lastly : ‘all women are pregnant and all pregnancies are ectopic pregnancies until proven otherwise’.
It is always wise to consult even your house doctor if there are concerns and get referred appropriately.