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Your annual gynaecology exam is a time that allows you to stop and pause to make your personal healthcare a priority. This yearly visit allows the doctor to assess your general health, perform a physical exam, order indicated screening tests, and to make individual recommendations.
Saying yes to your healthcare is saying yes to your future self. Having an annual check-up with your physician invites the opportunity to have an expert pick up on areas that you may think are normal but need addressing.
What to expect at your annual gynaecology exam:
The gynaecological physical exam at BioConnect consists of a detailed conversation with Dr. Corona regarding your medical history and may include a physical exam with an emphasis on the breast and pelvic exam (depending on factors such as age). The pelvic exam includes the external exam that checks for disorders of the vulva, clitoris, vaginal opening and the area around the anus. This essential part of the pelvic exam is often missed by doctors and is an important way of discovering cancers, infections and even disorders such as diabetes.
A speculum is used for the internal pelvic exam to look for abnormalities of the vagina and cervix. The pap smear is taken of the cervix if indicated and is only used to detect cervical cancer and pre-cancer. Uterine tumours such as fibroids and ovarian cancers are suspected only with a bimanual pelvic exam. This is separate to a pap smear.
If you hear or read that a pap smear is not necessary yearly, this may be correct, but remember that a pap smear is only a small part of the pelvic exam. All women over the age of 18 should enquire about a complete breast and pelvic exam yearly and Dr. Corona will discuss it with you.
This is a good guide to know when to visit your doctor for your cervical screening.
Screening & Treatment for Sexually Transmitted Diseases
Any woman who is sexually active in a non-monogamous relationship needs to be screened for STDs. It is easier to be infected than you may think and STDs can cause infertility, cancer and life threatening illnesses without causing any significant symptoms. Dr. Corona will screen appropriately and treat as indicated by published guidelines.
STD (sexually transmitted disease) screening is important because many STDs don’t show symptoms and early detection and treatment are critical for preventing long-term health problems and the spread of the disease to others. Here are some general guidelines:
- Frequency of screening: The frequency of STD screening depends on an individual’s sexual behaviour and the types of sexual activities they engage in. Those who are sexually active with multiple partners or who engage in high-risk behaviours, such as unprotected sex or sex with someone who has an STD, may need more frequent testing. In general, it’s recommended to get tested at least once a year if sexually active.
- Types of tests: There are several types of tests used to screen for STDs, including blood tests, urine tests and swabs. The tests can detect a variety of STDs including chlamydia, gonorrhoea, syphilis, HIV and hepatitis.
- Treatment: If the results of the STD screening are positive, treatment will depend on the specific infection. Treatment may include antibiotics or antiviral medications, and in some cases, medication to manage symptoms. In addition to treatment it’s important to notify sexual partners so they can also get tested and treated if necessary.
- Prevention: The best way to prevent STDs is to practise safe sex by using condoms and other barrier methods during sexual activity. Additionally, it’s important to have open and honest communication with sexual partners about STDs and testing.
It’s important to note that STD screening may look different for each individual depending on their sexual behaviour and risk factors. Dr. Corona will recommend the best approach for your specific circumstances.
Many factors play a role in a woman’s choice of contraception including cultural and religious beliefs, health, age and personal preference. Dr. Corona will work individually with each patient to find her a suitable method of contraception from pills to patches, rings, Mirena IUDs, diaphragms, Natural Family Planning or sterilisation.
Dr. Corona’s focus and vigilance is on a thorough physical exam of the breast and pelvic organs with screening tests ordered based on age, family history, personal risk factors and physical findings. Her recommendations will be based on her evaluation and in collaboration with the patient.
Evaluation of Abnormal Bleeding
Any woman needs an evaluation of abnormal bleeding if it is persistent. While younger women may need only an exam and hormone adjustment, others may need more extensive testing to rule out serious disease and this can only be determined by an office visit. Once cancer or pre-cancer is ruled out, there are many options available for the treatment of heavy periods.
Some of the out-patient, minimally invasive procedures available are:
- Hysteroscopic removal of polyps and fibroids
- Endometrial ablation
- Placement of a Mirena IUD.
Dilation and Curettage (D&C)
Dilation and curettage is a procedure performed to evaluate the inside of the uterus and is a more extensive evaluation than an endometrial biopsy. Dilation is the widening of the cervix that allows instruments to pass into the uterus, while curettage is the scraping of the uterine walls. It is preceded by a hysteroscopy to visually evaluate the inside of the uterus prior to the D & C. The hysteroscopy with D & C is performed to diagnose uterine cancer, to remove uterine polyps or fibroids in the cavity and to treat heavy bleeding.
Missing periods recurrently require a gynaecological and hormonal evaluation. The 4 most common causes of missing periods are:
- Hormonal birth controlStress
More unusual causes are pituitary gland tumours, thyroid disease, PCOS and eating too few calories and/or over-exercising. While it is not dangerous or unusual to miss an occasional period, missing more periods may signify one of these problems.
PCOS (Polycystic Ovarian Syndrome)
PCOS is an ovulation disorder common in pre-menopausal women. It may be associated with missed periods, difficulty in losing weight and/or abnormal hair growth. There is an association with more serious health problems in the future, such as type 2 diabetes, abnormal cholesterol values and uterine cancer. It is important that this syndrome is diagnosed early and treated appropriately. BioConnect will perform specialised hormonal testing for hormonal disorders including PCOS.
Dr. Corona has had decades of experience treating patients with endometriosis. She will discuss your symptoms and the management of the condition with you. She will perform an ultrasound to assist in her evaluation and take next steps as required in partnership with the patient.
Abnormal Pap Smear
Pap smears are done at the annual exam to screen for cervical cancer. The Pap smear does not screen for endometrial or ovarian cancer. Abnormal pap smears are usually, but not always, associated with an infection with the high risk HPV virus. If an abnormal pap smear is found, a colposcopy is recommended to carefully examine the cervix and upper vagina microscopically to detect cervical dysplasia (pre-cancer) or cervical cancer. Pap smears are screening tests and the colposcopy is the definitive test.
Most vaginal infections are easily treated or are self-limiting. Chronic infections, however, can be debilitating and embarrassing requiring the expertise of a gynaecologist skilled in the diagnosis of vaginal diseases.
Over-treatment with inappropriate over-the-counter medications and prescriptions are often part of the problem. The correct diagnosis and targeted treatment is key for optimal vaginal health.
Acute pelvic pain could be due to
- A ruptured or twisted ovarian cyst
- Pelvic infection
- Bladder pain
Chronic pelvic pain is often more difficult to diagnose. Pelvic adhesions from prior surgery or infection, endometriosis, interstitial cystitis, diverticulitis and tumours are all possibilities that must be investigated.
Decreased libido, sexual arousal disorders (difficulty having an orgasm) and painful sex are common complaints and deserve time and attention. There are many reasons for sexual problems and Dr. Corona will give the safe space to discuss this intimate issue. Hormonal testing and advanced examination of the vulva and vaginal disorders, that may lead to pain, will be investigated.
It is always advisable to get a second, independent opinion on any major surgical procedure or treatment protocols for serious disease. Dr. Corona has provided second surgical opinions in gynaecology for years and is happy to provide this service. She also provides second opinions on menopausal problems, hormonal dysfunction, the diagnosis of vulva skin lesions or symptoms or any other gynaecological problem.
Frequently Asked Questions
At your first visit an assessment is done by the nurse in order to have a baseline of your general health, eg. your blood pressure will be taken, your weight and urine. After seeing the nurse you will then proceed to the doctor’s office where you will confidentially go into more detail about your visit. By having this conversation with your doctor next steps can be established if needed.
At these visits pap-smears, pelvic examination and breast examinations are done.
An internal examination of the pelvis, vagina and cervix with the use of a speculum to look for any abnormalities. A pap-smear of the cervix is done to detect cervical cancer, pre-cancer, infections and inflammation.
- Pelvic Exam
This examination is done with two (2) gloved fingers inserted into the vagina by your doctor while using the other hand to gently but firmly simultaneously pressing on the abdomen. The size, shape and position of the vagina, cervix, fallopian tubes and rectum are checked during this exam.
- Breast Exam
Your doctor will use her hands and ultrasound if needed to evaluate your breasts. She will look for changes in size, shape and symmetry of your breasts. She will also examine your breast for any signs of rashes, dimpling or redness.
A visit is between 30-45 mins.
The cornerstone of great health care for women is having annual check-ups. At this visit you doctor is able to assess your physical and general health, compare past examinations and also make recommendations of tests or further investigations if needed.
The Nurse/medical assistant will place a small amount of gel on your pelvic area. Then they will record images on the ultrasound through moving the handheld device called the “wand” through the gel that was placed on your pelvic area.
Vaginal ultrasonography is an ultrasound where the transducer or probe is inserted into the vagina to visualize organs within the pelvic cavity. A trans-vaginal ultrasound is not typically painful, but some may find the insertion of the probe to be uncomfortable. Dr. Corona will be performing the scan. She will first cover the probe in a sheath condom and lubricating gel before inserting it slowly into the vagina to a depth of around 5–8 centimeters (cm). There is no need to shave for this procedure.
Similar to a pelvic ultrasound, gel is applied to the breast area to be examined and by using the “wand” on the ultrasound machine images are made of your breast. The wand sends out sound waves which bounce off the breast tissue and then picks back up the sound waves. This is how the images are provided. This procedure also should not be painful if so allow your technician to know. Whereas a mammogram uses two (2) plates where the breast tissue is compressed between using a low dose of radiation to take images of your breast.
A breast ultrasound can take approx. 15 mins.
If your pap-smear comes back irregular it doesn't mean you have cervical cancer, but your doctor will guide you through the next steps accordingly. Your doctor may speak to you about having a minor procedure called a colposcopy. This is a procedure where your doctor will do a visual examination of the cervix using a low-powered microscope to find and biopsy any abnormal tissues they may find.