Pap smear is a screening test done to detect cervical cancer. The most recent recommendation is that your 1st Pap smear be done 3 years after your first sexual intercourse, but no later than 21 years of age. The most common abnormalities are discussed below. For complete information, visit the National Cancer Institute’s webpage concerning Pap smears.

Abnormal Pap Smears-
ASCUS- Atypical Squamous Cells of Undetermined Significance is a low-grade abnormal pap smear. Sometimes having intercourse close to your Pap smear being done, an infection, or even menopause can cause your Pap smear to come back “abnormal”. We usually recommend that the first time you have an ASCUS Pap that it be repeated in 3-6 months. Two ASCUS results in a row will usually lead to a recommendation for colposcopy.

LSIL - Low-Grade Squamous Intraepithelial Lesion (sometimes referred to as CIN-I, which stands for Cervical Intraepithelial Neoplasia) is still considered a low-grade abnormality, but warrants further investigation. A repeat Pap smear in 3-4 months or a colposcopy is recommended. This type of abnormality is usually caused by the HPV virus. A vaccination against HPV is very close to being released, but it is meant as a preventative for those who are currently unaffected rather than a cure.

HGSIL – High-Grade Squamous Intraepithelial Lesion (also known as CIN-2 or CIN-3) requires colposcopy with biopsy within 30 days which may demonstrate a need for LEEP (loop electosurgial excision procedure) or cryotherapy (freezing of the cervix). Follow-up Pap smears after the LEEP or cryotherapy are frequent to make sure new high-grade growth does not return. The schedule is usually to perform “Re-Paps” every 3-4 moths for a year then every six months for a year. The annual exam schedule can be resumed when all of these Pap smears have been normal (or no more than one ASCUS).

Risk Factors for Cervical Cancer
• Tobacco use
• Long-term HPV infection
• Multiple sex partners, especially partners who engage in risky behaviors
• Exposure to HPV, especially high risk strains
• Failure to receive treatment at an early stage, when cervical cancer may be curable
• Knowing a partner for less than 8 months before engaging in sexual intercourse
• Sexual activity before age 20

Contraceptive counseling
As health care providers we know that there are a great many options out there for a woman to choose from when deciding a birth control method. At your visit we will discuss the options available and assist you in choosing the contraception method that best fits your medical history and lifestyle. You can look for information before your visit on the web at locations such as: PlannedParenthood.org or Womenshealth.gov

Sexually Transmitted Infection Screening, Treatment and Counseling
Sexually transmitted infections are very common; however, some people consider sexually transmitted infection a moral issue. The resulting discomfort and shame associated with this issue can get defy common sense and prevent proper care for yourself and your partner, including practicing safer sex and getting annual sexual-health checkups with their health care providers. We realize that many people find it very difficult to talk about their sexual health, but urge you to keep yourself healthy by speaking frankly and openly with your clinician about your sex life and your sexual health concerns.
Remember, testing, examination, and treatment for sexually transmitted infections are always confidential. We offer testing for sexually transmitted infections during your annual checkup regardless of marital status and sexual preference.

If you have been diagnosed with an STI, you may choose to read more information from the CDC or Planned Parenthood.

Preconception Counseling
Preconception counseling is an essential recommended element in attaining the goal of a healthy pregnancy and birth outcome. Seeking out preconception counseling and making lifestyle changes can help you get ready for the challenges of becoming pregnant and carry that new life for the following months. It is recommended that you start taking a vitamin with at least 400mcg of Folic Acid before you start trying to conceive. Most women don’t realize that they are pregnant until they are a few weeks along and this essential nutrient can help prevent birth defects during the critical first eight weeks of fetal formation. It is also recommended that you have your immunity for Rubella, Varicella (Chicken Pox) and Hepatitis B checked. If you are not immune to either Rubella or Varicella, you should receive these injections and wait three months before attempting conception. If you are not immune to Hepatitis B, you can receive the series at any time and no waiting period is required before you try to expand your family. Find out more at Preconception.com!

Pelvic Ultrasounds
If an ultrasound is ordered to help diagnosis a gynecological related problem, it can either be conveniently scheduled to be done on a Tuesday or Thursday with Bonnie, our office ultrasonographer, or it can be ordered to be completed at the hospital. You may be asked to schedule a follow-up appointment to discuss the results and plan of care after your ultrasound has been read by one of the clinicians.

Breast Health: Mammograms & Ultrasounds
The American Cancer Society recommends screening mammography annually for women aged 40 years and older. It is recommended that you get a mammogram at age 40, unless you have a strong family history of breast cancer then you would start getting yearly mammograms 5 years before the age of the family members cancer diagnosis. So, in other words, if your mother was diagnosed with breast cancer at age 40 then you would start your mammograms at age 35 years. A baseline mammogram is no longer recommended. All women should have clinical breast examinations as part of the physical examination.

We strongly encourage women to know and understand their bodies. Knowing what is normal for you and what is not normal in terms of your health is very important. We recommend that you wash your breasts with your bare hands and utilize a monthly visual inspection of your bare breasts in the mirror to detect breast changes. Some important signs to look for are:

• Lumps: Breast cancer lumps vary and may be hard or soft and have rounded or uneven edges.
• Swelling of part of the breast
• Skin irritation or dimpling
• Nipple pain or the nipple turning inward
• Red or scaly appearance of the nipple or breast skin
• Nipple discharge other than breast milk
• A lump in the underarm area

REMEMBER: These signs and symptoms do not necessarily mean that you have breast cancer. However, you should tell your doctor right away about any lump in the breast or underarm area and any changes in the skin of the breast, nipple, or areola (the area around the nipple).