Well woman gynaecological check-ups

There are several tests that a woman should have as part of a well woman gynecological routine. In this article we discuss some of these tests.

Pap smear

The Pap smear is perhaps the test that most women have heard of; it screens for cervical cancer.

Screening guidelines vary between countries. According to the American College of Obstetricians and Gynecologists women should have their first Pap test three years after their first sexual intercourse or by age 21, whichever comes first.

Women up to the age of 30 should have an annual Pap test as they have a higher likelihood of acquiring high-risk types of human papilloma virus that may cause pre-cancerous cervical changes.

Women aged 30 and older can discuss with their doctor having a combined Pap test and HPV DNA test. If their Pap test is normal and their HPV test is negative they may be able to wait three years before having to repeat the combined test. Women who are older than 30, who choose to have a Pap test only should discuss screening intervals with their doctor.

There are two types of Pap test available. Both tests require a woman to undress from the waist down and lie down. They both require the doctor or nurse collecting the sample to insert an instrument called a speculum into the vagina to widen it and collect a sample of cells from the cervix with a special brush or wooden spatula-like instrument.

A woman should avoid scheduling the test when she has her period and should avoid sexual intercourse and the use of tampons, douches and vaginal creams for 48 hours prior to the test.

The conventional and less expensive way of handling the sample is to place it on a glass slide and look at the slide under a microscope but there are some limitations to this method.

A newer but more expensive way of handling the sample is to place it in a liquid solution. The advantage to this method is that the sample can also be used to test for HPV.

HPV DNA test

HPV is the virus that causes cervical cancer and almost all sexually active beings has been exposed to a sexually transmitted strain of this virus at some point in their life. Testing for the virus can identify if a person has an active infection at the time of the test but it cannot identify which strain of the virus a person is infected with. HPV testing is recommended for women over the age of 30.

It is important to understand that the Pap smear tests for pre-cancerous changes to the cells of the cervix and cervical cancer only whereas the HPV test checks for HPV infection only.

Pelvic Exam

Like the Pap smear and HPV test, the pelvic exam requires a woman to be undressed from the waist down and be in a lying position. During the pelvic exam, the medical practitioner will check the organs of the reproductive system, particularly the ovaries and uterus (womb) for any abnormality in their size or shape. This is done by inserting two gloved fingers into the vagina while feeling from the outside for lumps or tenderness. The pelvic exam is usually done when a woman visits the doctor for a Pap smear. It is usually considered as a ‘screening’ tool for ovarian and endometrial cancer.

However, it is not recommended as an independent screening method for either ovarian or endometrial (uterine) cancer. It should also be remembered that a pelvic exam is not a test for cervical cancer.

CA-125 blood test

Many women ask for a CA-125 blood test when they visit their doctor for a gynecological check-up as they believe it to be a non-invasive and reliable way to screen for ovarian cancer. CA-125 is a protein that is a so-called tumour marker which is a substance that is found in greater concentration in tumor cells.

However there are a number of medical conditions that can cause a woman to have elevated CA-125 levels such as endometriosis and other types of cancer.

There are also circumstances in which this test can appear to be normal and cancer is indeed present. For these reasons, the CA-125 test is not recommended as a screening test for women. It is however useful if a woman presents herself to the doctor with symptoms of ovarian cancer as a part of the diagnostic work-up or to evaluate how a woman diagnosed with ovarian cancer is responding to treatment.

For more information on these tests and a well woman gynecological check-up contact the Cayman Islands Cancer Society at 949-7618 or email [email protected]

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