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Award-winning medical journalist Rita Baron-Faust demystifies the female reproductive system in this accessible resource for women of all ages. With emphasis on preventive care, Baron-Faust addresses common concerns, including fibroids, urinary tract infections, and PMS, as well as more serious health issues, including breast, ovarian, cervical, and uterine cancers, endometriosis, STDs, infertility and sexual dysfunction. She offers clear explanations of new tests and treatments, including hormone replacement ...
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Award-winning medical journalist Rita Baron-Faust demystifies the female reproductive system in this accessible resource for women of all ages. With emphasis on preventive care, Baron-Faust addresses common concerns, including fibroids, urinary tract infections, and PMS, as well as more serious health issues, including breast, ovarian, cervical, and uterine cancers, endometriosis, STDs, infertility and sexual dysfunction. She offers clear explanations of new tests and treatments, including hormone replacement therapy, fertility procedures and gynecologic surgeries. Amid increasing health care costs and the constant, confusing barrage of new medical information, Being Female gives women the knowledge they need to receive the best care.
"...demystifies the female reproductive system and addresses such common concerns as fibroids, urinary tract infections, endometriosis, and infertility...written with the physicians of the NYU Medical Center Women's Health Service."
There's no set age at which experts recommend a young girl see a gynecologist. An adolescent who is menstruating normally can be followed by a family physician or pediatrician. But a get-acquainted visit with a gynecologist may be a good idea sometime during the teenage years to discuss a girl's sexual maturation and gynecological health. A pelvic examination of a normal adolescent is rarely needed; progression through puberty can be assessed with standard measurements of breast and pubic hair development (Tanner staging).
'However, a pelvic examination is required every' six to twelve months for all sexually active teenage girls," stresses Dr. Charles Lockwood, chairman of the Department of Obstetrics and Gynecology at NYLJ Medical Center. A teenager who is sexually active should also see a gynecologist to obtain information on contraception and protecting herself from sexually transmit-ted diseases." One study found most teens are sexually active for six months to a year before they begin using contraceptives; often a teenager's first visit to a gynecologist is due to a suspected pregnancy.
In most states a parent must give consent for medical care of a minor until she is emancipated" or is eighteen years of age (unless it's an emergency). However, 49 states permit minors to obtain confidential testing and treatment for STDs, and many others allow access to contraception, pregnancy-related care, mental health and substance abuse counseling without parental consent. But some conservative groups are pushing for federal and state laws limiting access to confidentialhealth services for teens, saying it interferes with parents' rights to direct the upbringing of their children. At the same time medical organizations, led by the American Medical Association, are trying to improve teens access to confidential care, citing high rates of serious health problems among young people, including STDs, alcohol and cigarette use and illicit drug abuse as well as depression, suicide and teenage pregnancy.
While every parent desires good communication with his or her children, experts say a young person may confide more readily in a health care professional. So while you need to accompany your daughter to the gynecologist, it's a good idea to allow her a private conversation to discuss her personal concerns.
After age eighteen every woman should begin regular gynecological visits. All sexually active women should visit their gynecologists at least once a year for pelvic and breast exams," says Dr. Lockwood. STD testing should be performed if a woman has a new sexual partner, since some STDs are asymptomatic.
After menopause women may neglect gynecological checkups, wrongly believing that once their reproductive years are over they need not pay attention to their reproductive organs. But age is the single most important risk factor for gynecological cancers, which occur most often in women over sixty. Unfortunately up to 65 percent of older women do not have screening mammograms, and as many as 75 percent do not get regular Pap smears.
The American Cancer Society (ACS) and the American College of Ob-stetricians and Gynecologists (ACOG) recommend yearly Pap smears for all women eighteen and up who are (or have been) sexually active. The ACS also recommends that women have yearly clinical breast exams and begin screening mammography at forty. Many women do not receive needed preventive and medical care because they lack health insurance or other coverage. But other factors can interfere with a woman's getting good gynecological care: cultural attitudes against doctors, disability and fear of disclosing homosexual status. This chapter will discuss such issues of special concern and offer advice on managing your health care in an era of managed care.
If you are menstruating, the best time to visit your gynecologist is in the middle of your cycle. There's no need to take any special cleansing measures other than a shower or a bath. Never douche before a GYN visit since it could affect the results of your Pap smear and other tests.
Before the actual exam your physician may request a urine specimen to check for the presence of bacteria, excess sugar, protein or red blood cells (a sign of a bladder infection or Kidney disease). Even if you don't have to provide a urine sample, it's a good idea to urinate before your pelvic exam, as it will make the exam more comfortable, and if your bladder is not empty, its fullness could be mistaken for an abdominal mass, a pregnant uterus or an ovarian cyst during abdominal palpation, notes Louis A. Mucelli, M.D., a clinical instructor of obstetrics and gynecology at NYU Medical Center.
Before the physical, your physician should update your medical history or take a complete history if it is your first visit. Your weight and blood pressure will be checked, and your neck will be palpated for swollen glands (a sign of infection) and for any swelling or nodules in the thyroid (since thyroid disease may affect ovulation).
If you are using your gynecologist as a primary care physician, make sure you get a more complete physical, having your heart and lungs listened to and your eyes, ears, nose and throat examined. By the same token, if you are past menopause and relying on an internist for your routine care, make sure you receive a pelvic exam and a Pap smear," stresses Dr. Mucelli. Blood tests, including a complete blood count (CB C) to check for anemia and other problems, may be ordered. If this visit is serving as a general physical, blood tests to check your cholesterol and other blood fats should be done on a regular basis to help assess your risk of heart disease.
The physical part of the exam should include an external and internal examination of the genitalia and a clinical breast exam. In a clinical breast exam a visual examination is done as you sit upright, with your arms raised above your head, then with your arms on your waist pushing down and in. Each breast (along with the underarm area and the area above the collarbone) is palpated as you sit up with your arm lifted. Then each breast is examined while you're lying down, first with your arms at your side, then with your arm behind your head. If you have large breasts, you may be asked to roll in the opposite direction of the breast being examined and put your arm in back of your head, so the breast is flattened against your ribs. If you have questions about doing breast self-exams, now's the time to ask.
The gynecological examination is performed while you are lying on the examining table in what's called the litbotomy position with your buttocks extending over the end of the table, and your legs apart and elevated. The lithotomy position straightens the curvature of the lower spine and relaxes the abdominal muscles to aid the internal examination. Your legs will be raised either with foot or knee stirrups (preferably the latter, Dr. Mucelli advises, since this allows for maximum relaxation of the pelvic muscles and is more comfortable).
First, the doctor will palpate the abdomen and groin (where your thighs meet your pelvis), looking for lumps or tenderness; swelling or tenderness could indicate an infection. Then, donning latex surgical gloves, he or she will inspect the external genitalia, do an internal examination, perform a digital pelvic and rectal examination and take a Pap smear.<%END%>