First of all, to lay the foundations of good awareness, let’s recall what they are…
Prevention – a complex of measures and activities to prevent the occurrence, development and spread of diseases of the female genital organs.
Prevention – includes the early diagnosis and treatment of diseases in gynecology.
In the following lines, I will offer basic guidelines and information related to prophylaxis and prevention in gynecology. The topical areas that I have focused on are actually the most frequent questions that patients ask me.
HOW OFTEN SHOULD WE VISIT A GYNECOLOGIST?
The first visit to an obstetrician-gynecologist of sexually mature girls, without complaints, for the purpose of prevention, should take place by the third year after starting sexual life.
In the absence of complaints and good results from previous preventive examinations, visits are made once a year.
However, there are many conditions for which appointments with a gynecologist should be more frequent. These may include the following symptoms: pelvic pain or menstrual cramps; unusual, profuse and prolonged bleeding during or outside the menstrual period; unusual vaginal discharge accompanied by itching, discomfort or pain; conditions associated with spontaneous leakage of urine or leakage with little need during usual and minimal physical efforts, as well as frequent urinary infections, etc. All the listed symptoms can be a sign of a medical condition that is subject to diagnosis and timely treatment.
HOW DOES THE MEETING WITH THE GYNECOLOGIST GO?
A preventive examination at a gynecologist usually includes an anamnesis and an objective examination.
The gynecological anamnesis begins with the patient’s data and a subsequent extensive conversation about available complaints, concomitant and past diseases, medication intake, family history of chronic and malignant diseases, drug allergies and past surgeries.
A specific part of the gynecological history is information about sex life, date of last regular menstruation, duration, cyclicity and strength of bleeding, specifying the number of pregnancies, if any, their course, sterility and abortions. This information is always confidential and based on mutual trust!
After clarifying the gynecological status through the patient’s eyes, we move on to the actual examination. He begins with a general view of the patient’s constitution – tone, color of skin and mucous membranes, swellings and pathological secretions. Then we proceed to the gynecological examination on a gynecological chair. The examination begins with inspection and palpation of the abdomen – shape, level, participation in breathing, presence of surgical scars, pigmentation, hair growth. The palpation or examination with light pressure with the palm of the hand is done in order to establish soreness, swellings, sizes and mobility of organs and formations in relation to the surrounding structures.
I also carry out a careful examination of the external genitalia with the naked eye or with a colposcope – a microscopic examination. Only after that I proceed to inspect and examine the vagina and cervix. For this purpose, an instrument called a speculum is used, which opens the walls of the vagina and allows, if necessary, to take a sample for microbiology and examination of the cervix.
Cervical screening includes a naked-eye exam, Pap smear to prevent pre-cancer and cervical cancer in women who have been sexually active for at least 3 years. It is recommended that cytological examination be followed by colposcopy.
In the prevention of precancerous and cancerous diseases during a gynecological examination, if necessary, material is taken for HPV typing and for other sexually transmitted diseases. Taking materials for research is followed by removal of the speculum and bimanual palpation or examination of the internal genital organs – uterus and ovaries, by means of pressure between the palms of both hands of the examiner.
All information obtained from the history and gynecological status is described in an outpatient sheet, a copy of which is provided to the patient, together with the medical documentation from the specialized examinations (eg, colposcopy with biopsy slip and ultrasound examination document).
The review concludes with specific recommendations and guidelines for maintaining and protecting women’s health.
WHAT ARE THE POSSIBLE DIAGNOSTIC METHODS?
Taking a pap smear (PAP test) is a painless, recommended method for cervical cancer screening and prevention. Thanks to the introduction of the prophylactic pap smear, cervical cancer has significantly decreased in developed countries. During the examination, a speculum is inserted, which opens the vagina to view the cervix. With a special brush, the outer part of the cervix and the cervical canal are rubbed, thereby taking surface cells, which are applied to a glass slide.
A smear is taken when the patient is not on her period. The best time is 10-20 days from the start of menstruation. It is good to avoid sex, tampons, vaginal douche, creams or vaginal globules two days before the test. These agents could wash away or hide some pathological cells.
It is recommended that a smear be done once a year, as part of the annual preventive examination, if there are no risk conditions that require more frequent follow-up. It is a recommended prophylactic measure for women aged 21 and under this age for all women who have been sexually active for more than 3 years. The examination is also necessary after hysterectomy, if the cervix is preserved (subtotal hysterectomy). In women over 65 years of age, the frequency may be once every three years, and 3 consecutive normal pap smears may stop this type of prophylaxis.
Colposcopy – a specialized, safe, non-invasive method for microscopic examination of the cervix, which complements the prevention of cervical cancer. Colposcopy makes it possible to observe suspicious structures and changes in the cervix, the so-called “sores” and in the presence of colposcopic atypism or pathologically changed structures, to offer the patient the taking of a small piece of tissue by means of a biopsy. The manipulation is absolutely painless, does not require anesthesia, hospitalization and preliminary preparation, lasts seconds and in most cases there is no bleeding. It is possible, of course, a slight spotting bleeding after the manipulation.
When performing a colposcopy with a biopsy, a colposcopy slip must be filled out, on which the colposcopy finding is reflected with the corresponding abbreviation and the location of the biopsy. In this way, the patient receives comprehensive information about the current state of the cervix. For a return visit or a visit to another location, it is recommended that this type of medical information be presented as a comparative analysis.
Ultrasound examination (ultrasound) – a specialized, non-invasive, routine diagnostic method for diagnosing a number of diseases of the uterus and ovaries – fibroids, polyps, ovarian cysts, tumor formations, congenital uterine anomalies. It is usually combined with the actual gynecological examination to give a complete picture and maximum information about the patient’s status.
Finally, I would like to note that every gynecological examination in my office proceeds differently. It depends on the condition of the patient – emotional and physical. Sometimes important aspects of a health condition require a longer discussion. Therefore, when planning your annual preventive examination, I would recommend that you allow enough time in your schedule. This is how we guarantee mutual trust!
The article was prepared by Dr. Silvia Orucheva, obstetrician-gynecologist and head of the “Obstetrics-gynecology and aesthetic gynecology” department at the Aestheline clinic.