The Annual Gyn Exam
The annual exam is the cornerstone of good healthcare for women. This yearly visit allows the doctor to assess the patient’s general health, perform a physical exam, order indicated screening tests and to make individual recommendations.
The gynecological physical exam consists of a basic physical exam with emphasis on the breast and pelvic exam. 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 tumors such as fibroids and ovarian cancers are suspected only with the bimanual pelvic exam, and have nothing to do with the pap smear.
If you hear or read that a pap smear is not necessary yearly, this may be correct, but the pap smear is only a small part of the pelvic exam. All women, over the age of 18, need a complete breast and pelvic exam yearly.
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 one may think and STDs can cause infertility, cancer and life threatening illness. Dr. Hall will screen appropriately and treat as indicated by published guidelines.
Many factors play a role in a woman’s choice of contraception including cultural and religious beliefs, health, age, and personal preference. Dr. Hall will work individually with each patient to find her a suitable method of contraception, including pills, patches, rings, Mirena IUD, Paragard IUD, diaphragm, Natural Family Planning or sterilization.
Dr. Hall’s goal is to never miss a cancer. This may seen obvious, but the physician must always be vigilant when caring for a patient. Dr. Hall’s focus 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. Dr Hall does not “over screen” and bases her recommendations on her personalized 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 of fibroids, endometrial ablation including Novasure , or placement of the Mirena IUD.
An endometrial biopsy is a diagnostic procedure that involves examination and removal of tissue samples from the uterus due to abnormal bleeding or abnormal findings on a pelvic sonogram. The doctor may remove one or more tissue samples for further examination. Biopsy is helpful in detecting endometrial (uterine) cancer or hyperplasia (overgrowth of cells) that can lead to uterine cancer if not treated early.
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. It is performed under general or local anesthesia.
Missing periods recurrently requires a gynecological and hormonal evaluation. The most common causes are pregnancy, hormonal birth control methods, stress, medications and menopause. More unusual causes are pituitary gland tumors, 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 a 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.
We do specialized hormonal testing for hormonal disorders including PCOS. This often includes 24 hour urine testing to determine the best treatment protocol for treatment of this disorder.
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.
Colposcopy is a procedure used to magnify certain areas of the body and help diagnose abnormalities. A vulvar colposcopy typically examines lesions on the vulva and is often used to identify cancer or HPV. The procedure is done with a colposcope, a microscope that can help identify malignant lesions on the vulva.
A colposcopy is performed to evaluate an abnormal pap smear. The exam itself is similar to a pap smear in that a speculum is inserted into the vagina to visualize the cervix. The colposcope is then placed to view the area at 10 to 40 times its normal size. If any abnormal cells are found, a biopsy of the tissue may be done. A colposcopy is a very safe procedure with few complications. Light bleeding or discharge for up to a week after the exam is normal.
Most vaginal infections are easily treated or are self-limiting. Chronic infections, however, can be debilitating and embarrassing, requiring the expertise of a gynecologist 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 may be due to a ruptured or twisted ovarian cyst, pelvic infection, bladder pain, or even appendicitis. Chronic pelvic pain is often more difficult to diagnose. Pelvic adhesions from prior surgery or infection, endometriosis, interstitial cystitis, diverticulitis, and tumor are all possibilities that must be investigated.
If no pregnancy has occurred after a year of no birth control, an evaluation is advised. This will include testing for “ovarian reserve” or the ability to produce a healthy egg, testing to make sure ovulation occurs at the proper time and that the hormones are produced in adequate amounts, tests to make sure the fallopian tubes are open and that the uterine cavity is normal and of course, a semen analysis for the male partner. After the completion of these tests, the doctor will discuss the options for treatment and/or for referral to a specialist in fertility problems.
Decrease 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. Hall will spend several office visits in hormonal testing and advanced examination of the vulva and vaginal disorders that may lead to pain. We have successful treatments for sexual disorders once we explore the psychological, hormonal and anatomical issues that can contribute to this problem.
It is always advisable to get a second, independent opinion on any major surgical procedure or treatment protocols for serious disease. Dr. Hall has provided second surgical opinions in gynecology 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 gynecological problem.
Dr. Hall has been my gynecologist for the past 15 years. She is a wonderful doctor who listens closely to your problems. She is clinically the most astute diagnostician that I have ever used. Her experience and insights into peri-menopause and menopause can’t be beat and she will work with you to help you feel like yourself again. I recommend her to anyone without hesitation. – M.R.
Contact our office to learn more about our Gynecology services or to make an appointment.