Your Top OB-GYN Questions Answered What’s Up Down There?

The annual ob-gyn visit can lead to more questions than answers. Are you healthy? What's normal? Here are the 10 most common questions, and facts that may save your life... 1. What’s the difference between a yeast infection and bacterial vaginosis? Women normally have a healthy balance of bacteria in their vagina. But pregnancy, hormonal changes, douching, foreign bodies (including IUDs) and stress can disrupt the harmony and cause an overgrowth of bacteria, which can lead to infection, inflammation and discomfort. Yeast infections and bacteria vaginosis (BV) stem from too many of the wrong microbe in the vagina, and their symptoms are similar. Yeast infections are caused by an excess of candida fungus, which is common in low numbers in the vagina. Symptoms include: Redness, itching and burning around the vulva Foul-smelling, thick white discharge (may look like cottage cheese Pain during intercourse and urination With BV, the vagina’s bacterial balance is out of whack, though experts don’t know exactly why. It’s the most common vaginal infection among child-bearing women in the U.S., according to the Centers for Disease Control and Prevention (CDC). BV’s symptoms include redness, itching and pain, but its discharge tends to be thin, white or yellowish, and more uniform in appearance. 2. What does a routine Pap smear show? What other tests should I ask for? Pap tests, usually part of a regular pelvic exam, find abnormal cervical cells that may become cancerous or indicate the presence of cancer. Cells are collected from the cervix (the lower, narrow end of the uterus), and placed on a glass slide and sent to a lab for examination. It doesn’t test for human papillomavirus (HPV), although it may detect cellular changes due to HPV. Through regular Pap tests, cervical cancer can be prevented or detected at a very early stage. When the cancer is confined to the cervix, the five-year survival rate is more than 90%. If you're sexually active and have a new or multiple sexual partners or a non-monogamous sexual partner, you also should be screened for sexually transmitted diseases (STDs), including chlamydia, gonorrhea, syphilis and HIV. If an ob-gyn is your only doctor, get a complete physical exam annually, not just a pelvic and breast exam. If you're over 40, talk to your doctor about whether of not you should have a mammogram (see Question #10). Beginning at age 50, women should also get regular screenings for colon cancer, as well as lab tests for anemia, thyroid function, lipid levels and blood glucose. 3. How do I treat recurring UTIs? A urinary tract infection (UTI) is a bacterial infection of the urinary system, which includes the urethra, bladder, ureters and kidneys. UTIs can be caused by any trauma or chemical irritation to the urethral opening (perhaps from intercourse, manual stimulation or using diaphragms, catheters, douches, deodorant sprays or spermicides). Menopause or a weakened immune system can also make a woman more susceptible to UTIs. Simple UTIs can be treated easily with oral antibiotics, which should be taken as soon as symptoms develop. Most healthy women can occasionally treat themselves for recurrent UTIs without a doctor's visit, because a physician can prescribe and order prescriptions for you over the phone for pickup at a pharmacy. But women who get two or more UTIs within six months or three or more over a year may have to take preventive low-dose antibiotics for six months or longer. The treatment may reduce recurrent UTIs by up to 95%. 4. Can I get cancer from oral sex? STDs, including herpes, syphilis, gonorrhea and HIV, are linked to oral sex. In a study published in the New England Journal of Medicine, researchers established an association between oral sex, HPV infection and throat cancer. The oral cancer linked to HPV afflicts about 11,000 people in the U.S. annually – about the same number of new cervical cancer cases each year. Throat cancer associated with HPV typically involves the base of the tongue, tonsillar area or back of the throat. Studies show that infrequent condom use with a new oral or vaginal sex partner can increase the risk of throat cancer. To protect yourself, treat oral sex with the same caution as other forms of sexual contact. 5. How does the morning-after pill work? Is it safe? The “morning-after pill” is a form of emergency contraception to prevent pregnancy after sexual intercourse. It’s not like RU-486, the “abortion pill,” which uses hormones to terminate an early pregnancy. The morning-after pill prevents ovulation or fertilization and possibly blocks implantation of the embryo in the womb. Of nearly two dozen pills on the U.S. market today, only Plan B has FDA approval as an over-the-counter emergency contraceptive for women 17 and older. Ella, which contains ulipristal, a non-hormonal drug that blocks key hormones from allowing conception up to five days after sex, was approved in August 2010 for prescription-only. Plan B contains the progestin hormone levonorgestrel, which is in many birth control pills. Unlike birth control pills, however, it contains larger doses of levonorgestrel and no estrogen. The treatment includes two pills: one taken within 72 hours after unprotected intercourse and a second 12 hours after the first dose. But studies have shown that a single dose of 1.5 milligrams is as effective as the two-dose regimen. Although you have up to 120 hours (five days) after sex to take the first pill, the longer you wait, the less effective it is. If taken within 72 hours, Plan B reduces the risk of pregnancy by 75%-89%. The pill is considered safe and the risk of serious side effects is low. Around 25% of Plan B users experience nausea and vomiting. Other common side effects include abdominal pain, fatigue, headache, dizziness and breast tenderness. Most side effects resolve within 24 hours. 6. What are Kegel exercises? How do I do them? The floor of a woman’s pelvis contains muscles surrounding the openings of the urethra, vagina and rectum. The muscles can weaken from age, obesity and childbirth, leading to urinary incontinence. Kegel exercises strengthen them, thereby improving bladder control. The exercises also boost sexual gratification by strengthening the vaginal muscles, which can heighten sensitivity, arousal and orgasm. Kegel exercises affect the muscles normally used to stop urination. But don’t stop and start urine flow to practice your Kegels, because this may induce urinary reflux, which can lead to a UTI. To make sure you’re tightening the proper muscles, ask your doctor for help. She'll insert two fingers into your vagina during a pelvic examin and ask you to squeeze down as if you were stopping urination. (Be careful not to contract leg, abdominal or buttocks muscles.) To practice Kegels, tighten the pelvic muscles for 10 seconds and relax for 10 seconds. Try this lying down first. Once you become accustomed to the sensation, do them while sitting or standing. Build up to 10 reps, five times per day. Over-taxing your pelvic muscles can make incontinence temporarily worse. 7. Should I get the HPV vaccine? Gardasil, the HPV vaccine, protects against certain strains of it that cause cervical cancer and genital warts. HPV has infected around 20 million people in the U.S., with more than six million new cases occurring annually. There are more than 100 types of HPV. About 60 cause common skin warts (plantar, hand); around 40 affect the genital tissues and are sexually transmitted. Only a few genital types can cause cancer. Gardasil is effective against four types of HPV, including the two that cause 90% of all genital warts. The other two strains cause 70% of cervical cancer cases. The FDA approved Gardasil for females and males ages 9-26 years old, because inoculating them before they're sexually active ensures that they’re protected before HPV transmission or exposure. Although the vaccine may protect women older than 26, it hasn’t been sanctioned by the FDA. Why not? Older, sexually active women may have already acquired one (or all) of the four HPV strains the vaccine protects against, thus reducing its effectiveness. Condoms can't offer complete protection because they don’t cover all skin areas that may harbor the virus. 8. What are “shortened period” pills? Are they safe? The FDA has approved two oral, combined-hormonal contraceptive pills designed to give women four extended cycles each year – Seasonale and Seasonique. A third pill, Lybrel, approved in May 2007 by the FDA, is the first continuous birth control pill to stop periods for a full year. Studies have found no extra health risks from period-suppressing pills. Research on Lybrel shows that 99% of women returned to a normal menstruation cycle or became pregnant within 90 days of stopping the pills. Studies found similar spotting or bleeding as with traditional, cyclic birth control pills. And breakthrough bleeding decreased the longer women stayed on the regimen. With Seasonale, a pill with active ingredients is taken every day for three months (84 days for a 28-day cycle), followed by an inactive pill for seven days. Seasonique has the same dosing frequency, but the seven-day cycle includes a reduced estrogen dosage instead of a placebo. Using low-dose estrogen pills instead of a placebo limits the bloating and breakthrough bleeding experienced by some women taking Seasonale. 9. What are cervical or ovarian cancer symptoms to watch for? Cervical cancer By the time cervical cancer exhibits symptoms, it may be too late, because the disease may be at an advanced stage. It’s typically a slow-developing disease and can be detected early through routine pelvic exams and Pap tests. Symptoms include: Abnormal vaginal bleeding Unusual, heavy discharge that may be foul smelling and contain mucus Pelvic pain unrelated to the menstrual cycle Pain during urination Bleeding between periods, after sexual intercourse or after a pelvic examination Ovarian cancer Unlike cervical cancer, ovarian cancer doesn’t have a routine test to detect its presence. More than 75% of women diagnosed with the disease die from it. Among the early symptoms to look for: Difficulty eating or feeling full quickly while eating Abdominal bloating, pelvic or abdominal pain Frequent urge to urinate Advanced ovarian cancer symptoms include: Change in bowel movements Pain during sexual intercourse Persistent fatigue Abdominal weight gain Sudden weight gain or loss If you have any of these symptoms for more than two weeks, see a gynecologist. 10. What are the best methods to screen for ovarian and breast cancer? Ovarian cancer Women with potential symptoms (see Question #9) should get a manual pelvic/rectal exam in which the ovaries can be felt. The next step is a vaginal ultrasound, which can check the ovaries for abnormal growths. There’s also a blood test for a tumor marker that can be elevated with ovarian cancer, although it doesn’t provide a definitive diagnosis. If non-invasive testing fails to detect a tumor, the area may need to be biopsied. Breast cancer A mammogram is one of the most common methods of detecting breast cancer because it can detect the disease before you feel a lump through a breast exam. Approximately 25% of breast cancers are first detected on breast examination, about 35% are found through mammography alone, and 40% are detected with an exam and mammography. In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended that non-high risk women in their 40s not undergo routine mammography. Other controversial recommendations included cessation of teaching breast self-examination and stopping mammograms altogether for women over 74 years. The panel believes that the benefits of testing don’t justify the risks. These recommendations only apply to women with normal risk of breast cancer and not those with an established genetic predisposition. Breast ultrasound is recommended for women with dense breasts (with little fat). About half of women younger than 50 and a third of those older than 50 have dense breasts. Breast ultrasound is also advised for pregnant women (mammography radiation may be dangerous to the fetus) and those with abnormal mammograms. For women with dense breasts, one screening tool promises more accuracy in detecting breast cancer. Positron emission mammography (PEM) was equal to magnetic resonance imaging (MRI) in detecting malignancies, but PEM had fewer false positives, according to a 2008 study of 208 women conducted at Boca Raton (Fla.) Community Hospital. Researchers reported PEM had an 83% accuracy rate. Monthly self-exams can begin at age 20. Although the USPSTF dismissed the effectiveness of self-checks, women aren’t discouraged from doing them. After all, they're free, easy and may detect some cancers. Talk to your doctor to decide which screening is best for you. Are You in Perimenopause? Do you suspect you might be in perimenopause, the period of time leading up to menopause? It can occur as early as your late 30s. But remember, you can still be years away from menopause even if you're experiencing the symptoms.