Topics Your OB/GYN Wants You to Know
No one likes to come to the gynecologist… in fact, we usually vie for last place on the popularity scale (along with dentists)! Many women struggle with body image, and going to the gynecologist forces women to expose even her most private parts. We get it. But you must remember, we see women of all shapes and sizes. We do not judge. We want you to be as comfortable as possible (and if that means leaving your socks and shoes on… we don’t mind one bit!)
There are no silly questions. We want to know what’s on your mind. We are used to talking about all those taboo topics such as, bleeding, leaking, sex, etc. So, take a deep breath, and ask those questions that you’ve been meaning to ask.
Gardasil can protect you (or your daughter). Gardasil, the vaccine to protect against HPV (Human Papillomavirus) and cervical cancer, is licensed for girls and boys, age 9 to 26. The American Congress of Obstetricians and Gynecologists recommends routinely vaccinating all girls (and boys) age 11 to 12. It is a series of three shots, over the course of 6 months. Most common side effects include pain or swelling at the injection site, fever, nausea, or fainting.
Pap smear guidelines have changed. Pap smears are screening tests for cervical cancer and should start at age 21 (unless a woman is immunocompromised). If a woman is low-risk, she can be screened every 2 years while in her twenties. “Co-testing”, or testing for HPV in addition to a Pap smear, is indicated for women aged 30 and above, and can allow Pap smears to be spaced out to every 3 to 5 years. Pap smears may be discontinued at age 65 or 70 for low-risk women. And, most women who have had a hysterectomy for non-cancerous reasons and have no history of high grade cervical dysplasia, no longer need Pap smears, regardless of her age.
A Pap smear and a pelvic exam are not the same thing. A pelvic exam consists of a speculum exam (yes, that metal duck-shaped thing) with inspection of the vagina and external genitalia and a bimanual exam. A Pap smear is the collection of cells from the cervix, which is the outer portion of the uterus. A brush or swab is used to collect those cells. While a Pap smear may not be necessary every year, a pelvic exam is recommended annually, as well as, a breast exam and complete physical exam. Annual mammograms should begin at age 40.
Break-through bleeding while taking birth control pills can be common, especially during the first three months of use. If a pill is missed or taken off-schedule, that can lead to spotting or bleeding. Smokers also tend to have higher rates of break-through bleeding. Extended cycle packs are more prone to break-through bleeding, as well. There are lots of different formulations of the Pill - low, medium, and higher doses of estrogen; low, medium, and higher potency progesterone; monophasic (which means the estrogen and progesterone is one, level dose throughout the pill pack), biphasic (the estrogen or progesterone levels change),or triphasic (three levels of estrogen or progesterone in each pack). If break-bleeding continues to be a problem, talk to your doctor about the options for trying to find one that will work better for you.
Folic acid, a B vitamin, is recommended for all women of childbearing age. Folic acid can decrease the rate of birth defects, especially neural tube defects, and can reduce the incidence of prematurity. The routine dose of folic acid is 400mcg (this is found in most multivitamins and prenatal vitamins). For women who have had a pregnancy affected by a neural tube defect, the dose should be increased to 4mg. Folic acid can also be found in many foods including vegetables, beans, fruits, whole grains, and in fortified breakfast cereal.
Pregnancy is a long journey! All those crazy things that happen to your baby… normal! We know that the vast majority of women do get tired of being pregnant - very tired! However, elective induction of labor requires a serious discussion with your physician about the risks and benefits, and is not recommended before 39 weeks. The last weeks of your pregnancy are critical in the development of your baby’s brain, lungs, and digestive system.