The V Zone: A Woman's Guide to Intimate Health Care

Overview

Everything You've Ever Wanted to Know About Intimate Health Care
The V Zone answers those difficult and embarrassing questions women often are unable to ask their own doctor. Colette Bouchez, an award winning medical journalist, explains important health information in easy-to-understand language, and offers women a clear, concise plan for dealing with the most common gynecological complaints. In addition to describing currently available medical treatments, The V Zone reports ...

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Overview

Everything You've Ever Wanted to Know About Intimate Health Care
The V Zone answers those difficult and embarrassing questions women often are unable to ask their own doctor. Colette Bouchez, an award winning medical journalist, explains important health information in easy-to-understand language, and offers women a clear, concise plan for dealing with the most common gynecological complaints. In addition to describing currently available medical treatments, The V Zone reports on natural and alternative solutions, and helps navigate the wide array of over-the-counter products, including menstrual aids, home test kits, and feminine hygiene products. Know instantly what's safe to use, what's not, when it's okay to self-treat, and when it's time to seek professional care. Also included is the latest information on:

  • vaginitis
  • painful sex
  • urinary tract infections
  • yeast infections
  • STDs
  • and much more!

With advice from over two dozen medical experts, The V Zone is the definitive guide women can turn to and rely on, today and for years to come.
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Editorial Reviews

From Barnes & Noble
The title might skirt the issue, but the rest of the book sure doesn't. This guide to feminine sexual and reproductive health is a frank, comprehensive source of information about the most intimate parts of a woman's body. Vaginal and breast care (including gynecological exams and self-exams); the functioning of the internal sexual and reproductive organs; menstruation and beyond; common problems and methods of treatment; types of cancer and warning signs; and sexually transmitted diseases are among the topics covered with knowledge and candor. This is an excellent reference to have around for any questions that may arise, but it is also an essential primer on feminine health that every woman should be familiar with.
From the Publisher
Christiane Northrup, M.D. author of Women's Bodies, Women's Wisdom and The Wisdom of Menopause The book that women have needed for decades is finally here! Every woman needs a copy of this practical, reassuring, and comprehensive guide to her most intimate, and often misunderstood, V Zone.

Caroline Myss, bestselling author of Why People Don't Heal and How They Can and Anatomy of the Spirit The V Zone is an absolutely essential book for all women interested in the intimate care of their bodies.

Library Journal
This is a wonderful, easy-to-read, comprehensive guide to all those questions women have regarding gynecological healthcare: from bumps and lumps to pain to vaginosis to yeast infections. Bouchez (coauthor, Getting Pregnant) encourages women to become familiar with their most intimate anatomy in a section titled "Your V Zone Road Map: Where To Begin." In sections titled "Mother Nature's Bounty," she then describes new diagnostic and treatment options for various gynecological problems and explores natural solutions. Bouchez also provides information on sexually transmitted diseases, painful sex, recurring urinary tract infections (UTIs), women and AIDS, new PAP smear technologies, and itches and rashes. A guide to a wide array of personal hygiene products includes indications of their safety and effectiveness. Throughout, there are clear guidelines on when to self-treat and when to seek professional help. Sidebars feature expert opinions. A resource list completes this instructive and helpful book. Highly recommended for all women's health collections. Jodith Janes, Cleveland Clinic Fdn. Copyright 2001 Cahners Business Information.
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Product Details

  • ISBN-13: 9780684870977
  • Publisher: Touchstone
  • Publication date: 6/1/2001
  • Edition description: Original
  • Pages: 256
  • Sales rank: 864,042
  • Product dimensions: 0.59 (w) x 5.50 (h) x 8.50 (d)

Meet the Author

Colette Bouchez is the coauthor of Getting Pregnant and the former medical writer for the New York Daily News. She has been honored by the American Cancer Society, the American Academy of Dermatology, NBCAM, and the National Multiple Sclerosis Society. She is currently a medical reporter for www.healthscout.com, and her weekly columns are distributed nationwide by The New York Times Syndicate. The author lives in New York City and can be contacted at www.thevzone.net.

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Read an Excerpt

Chapter One: Understanding Your V Zone
What You Need to Know About Your Intimate Health

If you're like most other women, it's likely you pay very little attention to your intimate anatomy until a problem occurs. Then you panic, as you begin to realize how little you really know about some areas of your body. Indeed, studies show that, by and large, most of us are far more familiar with the pores on our nose than we are with our V zone, the area between our belly button and our thighs. And that can be a big mistake.

Why? First, the more you know about your intimate anatomy, the greater is your chance of having not only a happier and more satisfying sex life but, more important, a healthier one, for you and your partner.

More important, not being familiar with how this area of your body functions can have some dire consequences. Indeed, the placement and structure of a woman's intimate geography is such that each of us is at risk for a variety of diseases and conditions, several of which carry some potentially serious complications. If you're not familiar with what's normal for you, then you may have a real problem figuring out when something goes wrong — at least early enough to get the kind of comprehensive treatment that offsets the risk of any of those serious health consequences from occurring.

What's that you say? You're counting on your doctor to provide you with all the V zone protection you need? Then you may be surprised to learn studies have shown that your gynecologist may not be offering you the care you deserve. Indeed, at least one new report, a 1999 survey of doctors conducted by the National Vaginitis Association, revealed that the majority of gynecologists sometimes bypass offering patients treatment for even potentially serious vaginal infections unless they themselves bring symptoms to their doctor's attention. And this can be the case even when the doctor notices problems during the exam. Perhaps the worst part is that the doctors surveyed didn't even provide a reason. They simply said they don't do it!

Indeed, if you are to be ensured the best, most progressive, most preventative health care possible, you must become an active participant in that health care. And ultimately that means knowing enough about your body to enable you to recognize when something does go wrong.

When it comes to learning about your V zone, the best place to start is with a little healthy self-exploration, done with a keen eye toward becoming familiar with form and function. In short, you need to know not only how your intimate anatomy looks and feels under normal conditions of optimum health, but also how it acts and reacts.

With that goal in mind, this book begins with a kind of personal road map — a "geography," if you will — of a woman's most intimate parts, with emphasis on helping you learn more about what's normal for you — and what's not.

If you already believe you know more about your body than you probably will ever need to, feel free to skim this chapter and proceed to the areas of the book that apply to your V zone health needs right now.

But if you're not really sure about how much you do or don't know, then I invite you to pay special attention to this chapter. If, in fact, you take only one message from this book, let it be that you can have power over your body and your health care — once you take the time to get to know yourself.

Your V Zone Road Map: Where to Begin

Your journey of self-exploration starts with the area just below your "bikini line" — the area of your V zone known as the vulva. For most of us, the portion we are most familiar with is the mons veneris, or mound of Venus, a wad of fatty tissue that lies just on top of the opening to the vagina. Usually covered with pubic hair, it acts as a protective cover particularly during vigorous intercourse, helping to absorb impact and sheltering the more delicate organs and bones in and around the pelvis. Not coincidentally, this section of your V zone is also among the most erotic areas of your body, highly sensitive to the touch. In fact, the pubic hair found here can be so responsive that even a light touch can cause a sensual, electric-like shock sensation that travels right to the inside of your vagina.

Following the mound of Venus downward, you will come to the labia majora, or outside vaginal lips. Also made up of pads of fatty tissue covered with pubic hair, these "lips" are also extremely sensitive to both touch and temperature. In fact, much like a man's testicles, which shrink and wrinkle in response to cold temperatures, so do a woman's labia. They also swell and become puffy and softer in warmer temperatures, particularly when you are bathing in a hot tub or sauna or when you are sexually aroused. For some women, simply stroking the outside of the labia majora can act as powerful foreplay.

Inside the labia majora is a second set of "lips," known as the labia minora. Composed of a thin tissue with an elastic quality, they work to protect the interior of your vagina. In some women the labia minora are hardly visible; in others they are large and protruding. Both types, and anything in between, are considered normal.

Although most often we think of our intimate secretions and discharges as coming from the vagina, in fact, most come from the walls lining the outside and inside of the outer vulvar lips. Both the labia majora and labia minora contain an abundance of sweat, scent, and oil glands that continuously secrete the fluids that keep the vagina moist and healthy and provide the characteristic musky scent and extra "wet" sensation when you are sexually aroused. These secretions also help protect the vagina from acids and other irritating chemicals in urine and menstrual blood, as well as help block the passage of some bacteria into the reproductive tract.

Nestled neatly into the folds of the labia is your actual vagina. Although it is only about 3/4 of an inch wide and extends just 3 to 4 inches inward, it is composed of highly elastic tissue and stretches dramatically to many times its original size. This makes it possible not only to give birth but also to comfortably accommodate a penis of virtually any size. To help make intercourse easier and more pleasurable for both sexes, the inside of the vagina also has a pleated-like surface called rugae. Similar to the folds found in corrugated cardboard, the rugae help grip the penis and ease it deeper inside. After intercourse, as well as childbirth, your vagina contracts back to its normal size.

Located deeper inside the vagina is the hymen, a thin membrane that in the not too distant past was thought to function as a kind of archaic "virginity meter." As the myth went, on first intercourse the hymen would tear, causing bleeding to occur. If that characteristic bloodshed didn't take place, a woman's virginity was put into question. Today we know just how foolish (if not insulting) this myth really is. Indeed, so many factors can cause the hymen to tear, including most sporting activities, that even a doctor can't tell if a woman is a virgin simply by looking to this membrane for clues.

Although its shape and size is as individual as the woman herself (hymens can range from a thin, wispy membrane to a tough, fibrous layer), in some women it can be so thick that it won't break even during sex, which can cause any attempt at intercourse to be extremely painful. In fact, if you have always experienced pain or discomfort during intercourse, one of the first areas your doctor should check is your hymen. Should it be exceptionally thick, your gynecologist can remove it by a relatively fast and simple in-office procedure.

More V Zone Anatomy:

What Else You Need to Know

In addition to your vulva, your intimate anatomy also involves the following areas:

Urethra — Located just below your clitoris, this is the passageway for urine. About 3 inches long, it extends inward and is connected to your bladder. Containing mucus-secreting glands, it also helps produce a fluid that keeps your bladder opening moist and less likely to become irritated.

Perineum — A short piece of skin that stretches from the bottom of the vagina to the anal opening. Because the perineum can tear during childbirth, some obstetricians recommend cutting the skin just before the baby is ready to leave the birth channel. This, however, is considered controversial, and not all physicians agree it's necessary.

Bartholin's glands — Located on either side of the vaginal opening, these tiny glands produce small amounts of lubricating fluid, particularly during sex. Sometimes these glands can become inflamed, causing pain and swelling and, ultimately, infection (see Chapter 4).

Cervix — Located at the end of the vagina and composed of smooth muscle and collagen fibers, the cervix acts as the gateway to the uterus. Its size can range from 1 to 3 millimeters (between 0.04 and 0.12 inches), changing in response to various stages of a single menstrual cycle. Although it is technically part of the vagina, the cells lining the inside of the cervix look and grow differently, making them much more susceptible to infection.

Uterus — Shaped much like a small pear and about the same size, the uterus is the main organ of your entire reproductive system (see illustration). It is lined with layers of cells, one of which responds to hormonal stimulation. This stimulation causes the lining to grow thick during each menstrual cycle and be shed in the form of menstrual blood each month. Should pregnancy occur, the lining becomes the spongy nest where your fertilized egg implants and where your baby grows and develops.

Ovaries — Attached to the uterus by strong but thin ligaments are the ovaries, the main producers of the primary female hormone estrogen. In addition, the ovaries also play host to some 400,000 egg follicles — or "fertility seeds" — one of which develops into a fertile egg and is ovulated, usually every month during the childbearing years.

Fallopian tubes — Just 3 to 4 inches in length and a delicate 1/3 of an inch in diameter, these slender tubes jut out from either side of the uterus and slope gently downward toward the ovary. The finger-like ends, which resemble the open petals of a flower, reach out to catch an ovulated egg. The fallopian tubes also act as the transport lane for sperm, which swim toward the egg in anticipation of fertilization. If fertilization does occur, tiny hairs (called cilia), which line the inside of the tube, help shuttle the fertilized egg into the uterus, where it can implant and begin to grow.

Your Healthy Body: Know the Signs

When it comes to a healthy V zone, there are three major factors to look for. They include the way your vulva looks and feels to the touch, how it smells, and the quality of your intimate secretions or discharge. All three factors, alone or together, can help you determine if your V zone is healthy or if you are in need of medical attention and care. Here's what to look for.

Factor #1: Discharge

Medically known as leukorrhea, many women believe that a noticeable vaginal discharge is always an indication of a problem. In reality, however, it's one of the most important signs of good vaginal health. Indeed, the vagina is a self-cleaning organ, and discharge is one way it rids itself of old cells, bacteria, and other microorganisms that might otherwise cause harm.

What's Normal: According to experts at the McKinley Health Center at the University of Illinois, look for a discharge that is milky, cloudy white, or clear. If it dries on your panties, it may take on a yellow tinge or contain white flecks. Since the amount of discharge is different for every woman — and it changes from week to week in direct response to the menstrual cycle — it's difficult to say what's normal in this respect. That said, for the most part, discharge should be visible but not so abundant as to make you feel you are wetting your panties all day long. You should know, however, that stress can affect vaginal discharge (increasing or decreasing it), as can birth control pills. Sexual arousal will almost always increase production (that's normal!), while just after pregnancy and during breast-feeding, discharge often decreases, making your vagina feel somewhat drier.

Red Flags: Problems include discharge that appears grayish-white or yellow-green in color; is clumpy or "cheesy" looking; a frothy or foaming discharge of any color; and exceptional amounts of discharge, particularly if it is runny, watery, or very thin.

What This Means to You: For the large majority of women these particular red flags usually signal the presence of any number of simple vaginal infections — and you'll learn more about what they are and how they are treated later in this book. In a few rare instances, however, they could signal the presence of more complicated and serious problems, including pelvic inflammatory disease or even cancer. However, as with all other medical problems, the faster you are diagnosed, the more likely it is that you will suffer no permanent consequences. So don't panic — but don't avoid seeing your doctor.

Factor #2: Vaginal Odors

Every woman has a personal intimate scent unique to her, and it's generally magnified during sexual arousal as well as during ovulation and sometimes menstruation. In fact, some studies have shown that it is this natural scent of "reproduction" that throws a man back to his most primal mating instincts, causing him to feel more "turned on" to a woman when she is the most fertile.

What's Normal: Under healthy circumstances, a vagina should have no offensive odor — but that doesn't mean you won't smell something. In addition to your personal biochemical scent, most healthy women will also notice a faint salty or slightly musky odor.

Red Flags: Look for a "fishy" or foul odor — sometimes described as a bitter or sour smell. Also note any pungent smell that seems obvious, such as overly salty or oily, or any disturbing odors that appear directly after intercourse. All can signal the beginnings of a vaginal infection. Also be on the lookout for what can only be described as a vague smell of freshly baked bread. It could signal a yeast infection. At the same time, remember that what may seem like an intimate odor could actually be coming from an area outside the vagina, such as the groin, where many women tend to sweat profusely during warm weather. In addition, certain foods can change the scent of your urine (sometimes making it smell stronger or more ammonia-like), which may make it seem as if your vagina is emanating an odor when it's not. These smells do not indicate a vaginal problem and should not be confused with true, intimate odors.

What This Means to You: Most often a vaginal odor that does not disappear with good hygiene is usually the sign of some type of infection. (You'll learn more about what those infections are in upcoming chapters.) In the meantime, you should also check the presence of any accompanying discharge (see Factor #1 above), as this can help narrow down the possible causes of the odor itself.

But with or without discharge, do bring the odor to your doctor's attention. Important note: When you see your doctor (and all abnormal odors and discharges should be checked firsthand and not diagnosed over the telephone), do not attempt to cover up the smell by using a scented body wash or talc before your visit. Instead, wash with plain, warm water and dry well. Remember, you want your doctor to smell what you smell.

Factor #3: Genital Skin Condition and Color

Sometimes the earliest signs of V zone infection are indicated by how your vulva looks and feels, particularly in regard to itching or significant changes in texture or color.

What's Normal: The area on the inside and the outside of your vagina should be smooth, free of bumps, dark or light spots, blisters, or rashes. The color on the inside of the outer lips should be a fairly uniform shade of light pink, or, in women of color, a slightly darker, salmon-color pink. The deeper inside you go, the darker the skin looks, up to a medium red.

You should also check the area just outside your vagina, particularly at your panty line, where your thighs meet your groin. It should be free of any swelling as well as bumps or lumps.

Red Flags: Look for bumps; rashes; redness; itching; lumps; lesions; white or light patches, particularly inside the vulva; dark patches or areas of very red or reddish-purple tissue; areas that burn or are painful to the touch; and significant changes in pubic hair, such as obvious thinning.

What This Means to You: For most women, these red flags are usually the result of simple dermatological-type problems, often caused by any number of environmental factors such as the fabric or style of your panties or even your laundry detergent (see Chapter 4). In a few instances these same symptoms could also be the sign of minor infection or even a biochemical imbalance such as a thyroid disorder — and even more rarely, a more complicated disease such as genital warts or even rare forms of cancer. The key here is not to try to diagnose these problems yourself. Later in this book you will learn more about how and why many of these conditions develop. Use that information to open a dialogue with your doctor — and be certain always to mention any changes in genital skin, color, and condition during your exam.

The V Zone Self-Exam

Now that you're familiar with how your V zone should function during optimal health, it's time to find out if indeed it is functioning this way now. The best way to tell that is by some self-exploration, in the form of a vulvar self-exam. Indeed, experts advise that checking yourself on a regular basis (some say as often as you do a monthly breast exam) is one of the best ways to catch most health problems before they go on to become catastrophic problems.

Getting Started

To begin your exam you need only two things: a hand mirror and a good source of light. According to the Center for Vulvar Disease, before every exam be certain to wash your hands thoroughly, lathering with soap for 15 to 20 seconds and then rinsing in warm water. Since you will be touching the inside of your body, it is imperative that you don't skip this important step.

That done, you must position your body in a way that makes the exam fast and easy to do. There are several ways in which this can be done, depending on what's most comfortable for you. You can sit or lie down on your bed, squat or kneel on the floor, or stand up.

Most important is that you are comfortable, in a position that allows you to see the clearest and the most comprehensive view of your V zone in your hand-held mirror. Often this is best accomplished by sitting on your bed with your feet up and your body in a slightly reclined position, using a pillow to prop up your back.

Once you have positioned yourself, you are ready to begin. According to the Center for Vulvar Disease, here are the steps you should take:

Step 1. Viewing your vulva in the hand mirror, separate the outer lips with your fingers. A normal vulva should be pink to medium red in color, with no obvious discolorations or very light areas. You should also be on the lookout for any dark red areas, swelling (the tissue may look or feel bloated), blisters, bumps, lesions, sores, unusual colors, and particularly any unusual odors. Certainly make note of any pain you feel when touching any area of your vulva.

Step 2. Now look a little deeper inside. For this you will need to locate and then separate your inner lips. Look for the same signs mentioned in step 1. In addition, also check the entrance to your vagina for those signs.

Step 3. Examine your clitoris, located just under a hood or fold of skin just below the urinary opening. It should resemble a small, fleshy mound. It is soft to the touch and pink in color. Some say it resembles a tiny penis.

Step 4. Check the area outside your V zone: the urethra, perineum, anus, and the outside of the labia majora and mons veneris (see previous illustration). In addition to redness, swelling, or discolorations, check for soreness or irritation as well as itching. Certainly, pay special attention to signs of bleeding (such as dried or moist blood) other than that which is associated with your monthly cycle.

Protection Plus:

How Your Doctor Can Help

If during a vulvar self-exam you discover anything that seems even a bit unusual, you should bring it to your doctor's attention, and usually the sooner, the better. In many instances, he or she will simply reassure you that everything is all right. Nevertheless, if things seem abnormal to you, ask for an explanation as well as what you should look for as a sign of trouble.

Even if your body continues to check out okay, however, it's still important that you don't skip regular gynecological exams. Indeed, while performing monthly self-exams is important, there are some instances when, despite the fact that everything looks and feels okay, something is terribly wrong. And that's where your doctor can play a major, sometimes life-saving, role. In fact, even when you seemingly have no problems, seeing your doctor at least once a year allows you to give yourself the gift of preventative care, and in doing so, help preserve not only your V zone health but your overall good health, as well as your sexual vitality.

Your Annual Gynecological Exam:

What It Must Include

Most experts agree that the first, most important step of any gynecological exam is the consultation — a talk between you and your doctor that should take place while you are still fully dressed. Here you should bring up any symptoms you may have discovered on your own, as well as any complaints you may have about your V zone, as well as your overall health. This is an especially important step if you see a gynecologist only once a year, for an annual exam.

This is also the time when you should ask your doctor any potentially "embarrassing" V zone questions you may have. Indeed, most women find that they feel less intimidated about asking questions when they are fully dressed, rather than undressed and in a compromising exam position. If you give it a try you may be surprised to discover how much easier it is to talk to your doctor during this preexam consult.

Once this discussion takes place and you are satisfied with the answers your doctor provides, you will proceed to the physical portion of your exam. It should include at least the following four steps:

1. The General Health Check. This should include listening to your heart and lungs and feeling your neck. You may be asked to give a urine sample, which will be tested for sugar (a sign of diabetes) or blood (a sign of infection). If your gynecologist is also your primary care doctor (and you must make a point of discussing this with your doctor, as not all feel comfortable in this total-care role), your exam should include a check of any general health concerns you mention during your consult.

2. The Breast Check. This should take up to two minutes. Your doctor should feel each breast, usually using a circular motion, examining the nipples, as well as the area under each armpit (see illustration). Since research shows that up to 25 percent of all gynecologists skip this step, it may be necessary for you to ask for this portion of the exam — and you must take the initiative. It's that vital to your health. In addition, if you haven't been doing self-breast exams, now is the time to 'fess up. Your doctor must know if this is the case for you.

3. The Pelvic Exam. This should begin with a check of the outside portion of your V zone. Here your doctor is looking for the same factors you look for in your vulvar self-exam: lumps, bumps, discolorations, redness, or swelling.

The next step is an internal exam. It begins with inserting the speculum, which should only cause minimal discomfort. If you experience pain, talk to your doctor about using a smaller instrument. Also, relaxing your pelvic muscles as much as possible will help make the exam more comfortable. Once your vagina is held open, your doctor will examine the inside of the vaginal walls and take a Pap smear. This is the screening for cervical cancer and a test that is mandatory at least every other year for all sexually active women (see "The New Pap Smear" below). This test should be followed by the bimanual exam. Here, your doctor will place the fingers of one hand inside your vagina and the other on your stomach, and then gently feel your pelvic organs. In this way he or she can feel the shape, size, and position of your cervix, ovaries, and uterus and check for any growths such as fibroid tumors or cysts.

4. The Recto-Vaginal Exam. This is by far the most overlooked part of the exam — many doctors don't like to do it, and most women avoid it as well. Still, many experts agree it's a vital way for your doctor to check the internal area behind your vagina and uterus, which can often reveal problems not felt during the bimanual exam, including cysts and tumors, as well as endometriosis, tubal infections, and even polyps. For this portion of the exam, which should take less than a minute, your doctor will insert one gloved finger into your rectum. Don't be alarmed if you feel a momentary sensation of having to have a bowel movement. You won't. It's just a normal sensation.

5. The Conclusion. Every exam should conclude with a talk, where you and your doctor can discuss any problems discovered during your exam, as well as any additional tests you may need and any self-care treatments you need to do. You should also use this time to bring up any additional questions you have and discuss any treatment options. It's also a good idea to ask your doctor when you should call for test results, particularly your Pap smear. If your doctor suggests a follow-up exam for anything he or she would like to watch (such as a cyst or even an irritation), don't take the suggestion lightly, and make an appointment before you leave.

The New Pap Smear:

How It Can Save Your Life

Among the most important V zone screening available today is the Pap smear. Developed in the 1940s as a way of looking for cell changes that can, if not treated, result in cervical cancer, it has been credited with saving the lives of hundreds of thousands of women throughout the years.

More recently, the Pap smear has become an even more important tool. Doctors now know that at least one sexually transmitted virus (certain strains of the human papilloma virus, or HPV — see Chapter 9) can cause cell changes that lead to cervical cancer. With the advent of the sexual revolution and the social acceptance of multiple sex partners, now, more than ever before, women have become vulnerable to contracting this virus and developing cervical cancer.

The important news is that the Pap smear is a highly effective method of discovering those who are at high risk — often early enough to save a life. And the test is getting better, with important improvements in both the way the actual screening is done and how the cells are analyzed.

Why is it important for you to know these details? In many instances, the use of the newer technologies is not automatic. Indeed, many of you will have to request some of these new technologies specifically before your doctor will comply. Sometimes you may even need to consider a different doctor since, unfortunately, not all physicians routinely keep up with the latest advances, including the newest ways to save your life. Additionally, since some doctors are coerced by managed care companies to restrict suggestions of what can be a more costly procedure, they neglect to mention all that's available to their patients.

That said, here's a rundown of the newest, most important technologies in the area of cervical screening. Remember, depending on your insurance coverage, you may have to foot the bill for the difference in cost over and above a regular Pap smear. Usually, however, this nominal expense is well worth it.

Technology: Thin Prep Test

What It Is: A new way of collecting and preparing Pap smear samples for analysis.

How It's Done: Instead of swabbing your cervix and placing the cells on a slide before sending it to the laboratory, the traditional swab or brush is replaced by a special wand that goes directly from your cervix into a vial of fluid, which is sent to the laboratory. This ensures that the entire cell sampling, and not just a small portion, is submitted for analysis. Once it reaches the lab, your sample is put through a declumping process, which makes it easier to see each of the sampled cells, and then a filtering procedure, to separate out the blood and mucus. The remaining cervical cells are then spread in a thin layer onto the glass slide for analysis. The end result is a slide that is clearer and easier to read and a diagnosis that is ultimately more accurate.

Improved Accuracy: A study of some 7,000 women conducted by the manufacturer revealed Thin Prep was able to pinpoint abnormalities 65 percent more often than the traditionally prepared Pap smear slide.

A second study on some 50,000 women published in the Medical Journal of Australia found Thin Prep was not only more efficient at identifying severe levels of cell abnormality, it found these abnormalities more often than the traditional Pap smear. In certain instances, Thin Prep found high-grade lesions, indicating an advanced form of cervical disease, while no such cells were seen on the traditional Pap smear, even with a second review.

Additional Cost: About $20 over and above the cost of a traditional Pap smear. Most insurance companies won't pick up the extra tab.

Technology: PapSure Test

What It Is: An on-site visual cervical exam performed at the same time as a traditional Pap smear.

How It's Done: Immediately after taking your Pap smear, your doctor will "wash" your cervix with a diluted solution of white table vinegar, which will adhere to abnormal cells. Then, by exposing the cervix directly to a harmless, disposable, low-glare, blue-white chemiluminescent light source (the process is called speculoscopy), any abnormal cells become immediately apparent to the eye. Normal cells look bluish in color; abnormal cells are distinctly white. So, your doctor can immediately tell if abnormal cells are present and where they are located.

Most often, when the PapSure test results are negative — meaning no abnormal cells are seen — the Pap smear portion of the test is negative as well, and it's a result you can comfortably believe is true. If, in rare instances, PapSure is negative but the Pap smear is positive, then your condition is considered positive until proven otherwise.

Improved Accuracy: When performed along with a traditional Pap smear, the PapSure test has been shown to be more than twice as accurate in identifying cervical abnormalities before they progress to cancer — a 90 percent rate for PapSure compared to a 40 percent rate with Pap smear alone. Perhaps more important, it is equally effective in ruling out cancer, meaning you can now feel highly confident about a negative Pap smear result.

Although using PapSure technology is not considered "required," the Food and Drug Administration (FDA) has allowed PapSure inventors (the Trylon Corporation) to say that the exam is indicated in all women undergoing a pelvic exam and Pap smear — meaning that there is enough evidence to show it's worth the extra effort. Another bonus for you is that PapSure offers an immediate diagnosis, meaning there's no waiting for test results.

pardAdditional Cost: About $25 over and above the cost of your regular Pap. Most insurance companies do not pay.

Technology: AutoPap and PAPNET

What It Is: Automated methods of analyzing Pap smear slides.

How It's Done: In both tests computers are used to read the Pap smear slides, helping to decrease the margin of human error. In PAPNET the slides are reread by the computer after first being seen by a cytologist. In AutoPap, the slides are read by computer analysis first, and those that indicate an abnormality are reread by a cytologist.

Improved Accuracy of PAPNET: Studies comparing positive PAPNET test results with those obtained by the traditional manual screening method were similar in number. The PAPNET, however, was faster. Additionally, studies conducted in 1997 on some 21,000 women and reported in the journal Lancet found that PAPNET was able to identify negative smears 77 percent of the time versus 42 percent using traditional manual reading techniques. A 1998 American study published in the journal Obstetrics and Gynecology found PAPNET useful as a second analysis when Pap smears were classified as containing atypical squamous cells of undetermined origin (often identified on test results as "ASCUS"). Specifically, PAPNET was able to determine which women needed treatment to obliterate their abnormal cells and which were likely to experience a regression back to normal cell status on their own — all without a biopsy.

Improved Accuracy of AutoPap: Data from a large-scale clinical study of Pap smears taken from more than 25,000 patients from five different laboratories found that AutoPap achieved greater accuracy in early diagnosis of cervical disease and reduced incidence of both false-positive and false-negative results.

Added Cost: Both PAPNET and AutoPap add about $35 each to the cost of a Pap smear. Most insurance plans don't cover it.

How You Can Make Every

Pap Test Count

Regardless of what your doctor may do to help increase the accuracy of your Pap smear, there are steps you can take as well to ensure a more accurate test result. According to the American Society of Clinical Pathologists (ASCP) — the folks that read your Pap smear tests — and experts from the Virginia Mason Medical Center in Seattle, here's what to do:

  • Schedule your gynecologic exam at the optimum time, usually two weeks after the first day of your last menstrual cycle. Estrogen levels are highest at this time, making the cell samples easier to read and interpret. Never have a Pap smear during a menstrual period.
  • Don't put anything in your vagina for at least twenty-four hours (ASCP suggests seventy-two hours) prior to your Pap smear. This includes vaginal medications, creams, contraceptive foams or jellies including spermicide, douches, and tampons. You should also abstain from intercourse for twenty-four hours prior to your test.
  • Never have a Pap smear when you are experiencing signs of a vaginal infection, such as unusual discharge or itching. A yeast infection can be particularly disruptive since it often causes an increase in inflammation and cell changes that make the test difficult to read.
  • Ask your doctor where he or she is sending your sample for analysis — and make certain the laboratory is accredited, employing nationally certified cytotechnologists and board certified pathologists.
  • Have a Pap smear every year, beginning as soon as you are sexually active, or at least by age eighteen. Despite common misconceptions, all women, including lesbians and those who are not involved in any kind of sexual relationship, need an annual Pap smear.

The HPV Test and Cervical Cancer

Many doctors believe that the most accurate way of detecting cervical cancer is to test for something else entirely: HPV, the human papilloma virus. The reason? Studies now show that certain strains of the virus are present in virtually 100 percent of all cases of cervical cancer. While the latest study — a January 2000 report in the Journal of the American Medical Association — reveals that testing for HPV has a higher false-positive rate than the traditional Pap smear, many believe that in time the test will be refined enough to become the gold standard for cervical cancer, particularly in women over age thirty-five. One factor that certainly makes the HPV test attractive is that it involves only a simple swabbing of the vagina, which a woman can easily do on her own. The tissue is then analyzed for DNA from thirteen different types of suspect strains of HPV. (For more information on HPV, cervical cancer, and this test, see Chapter 8.)

Becoming a Savvy Medical Consumer:

What You Must Do Now

Now that you know a little something about how your V zone functions, you will be well prepared to understand and act on the information that is found in the remainder of this book, much of which you will need to maintain optimum intimate health. In many instances, I hope you will also find answers to your intimate care questions — subjects that for a variety of reasons you may have found difficult to discuss with your own doctor. Indeed, whether it is simple shyness on your part that's kept you in the dark or, as is more often the case, your doctor is simply not as approachable about intimate care subjects as you would hope he or she would be, if you're not getting the answers you need, your health care can suffer.

Just having all this information, however, isn't quite enough. You must put it to use by becoming the single most proactive element in your health care. Indeed, if you are to obtain and maintain the best V zone care, you must become involved — not only in selecting the doctor who will care for you but also in deciding on the types of treatments you will receive throughout the course of that care. The information you find in this book can help you achieve that. By sharing what you learn with your own gynecologist, you can open a dialogue about your V zone health that will be of value not only today but also far into your future.

The bottom line is this: Only when you and your doctor work together as a team will you be assured of getting the best care possible. And this V zone guide will help you become the best team player possible!

Copyright © 2001 by Colette Bouchez

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First Chapter

Chapter One: Understanding Your V ZoneWhat You Need to Know About Your Intimate Health


If you're like most other women, it's likely you pay very little attention to your intimate anatomy until a problem occurs. Then you panic, as you begin to realize how little you really know about some areas of your body. Indeed, studies show that, by and large, most of us are far more familiar with the pores on our nose than we are with our V zone, the area between our belly button and our thighs. And that can be a big mistake.

Why? First, the more you know about your intimate anatomy, the greater is your chance of having not only a happier and more satisfying sex life but, more important, a healthier one, for you and your partner.

More important, not being familiar with how this area of your body functions can have some dire consequences. Indeed, the placement and structure of a woman's intimate geography is such that each of us is at risk for a variety of diseases and conditions, several of which carry some potentially serious complications. If you're not familiar with what's normal for you, then you may have a real problem figuring out when something goes wrong — at least early enough to get the kind of comprehensive treatment that offsets the risk of any of those serious health consequences from occurring.

What's that you say? You're counting on your doctor to provide you with all the V zone protection you need? Then you may be surprised to learn studies have shown that your gynecologist may not be offering you the care you deserve. Indeed, at least one new report, a 1999 survey of doctors conducted by the National Vaginitis Association, revealed that the majority of gynecologists sometimes bypass offering patients treatment for even potentially serious vaginal infections unless they themselves bring symptoms to their doctor's attention. And this can be the case even when the doctor notices problems during the exam. Perhaps the worst part is that the doctors surveyed didn't even provide a reason. They simply said they don't do it!

Indeed, if you are to be ensured the best, most progressive, most preventative health care possible, you must become an active participant in that health care. And ultimately that means knowing enough about your body to enable you to recognize when something does go wrong.

When it comes to learning about your V zone, the best place to start is with a little healthy self-exploration, done with a keen eye toward becoming familiar with form and function. In short, you need to know not only how your intimate anatomy looks and feels under normal conditions of optimum health, but also how it acts and reacts.

With that goal in mind, this book begins with a kind of personal road map — a "geography," if you will — of a woman's most intimate parts, with emphasis on helping you learn more about what's normal for you — and what's not.

If you already believe you know more about your body than you probably will ever need to, feel free to skim this chapter and proceed to the areas of the book that apply to your V zone health needs right now.

But if you're not really sure about how much you do or don't know, then I invite you to pay special attention to this chapter. If, in fact, you take only one message from this book, let it be that you can have power over your body and your health care — once you take the time to get to know yourself.


Your V Zone Road Map: Where to Begin

Your journey of self-exploration starts with the area just below your "bikini line" — the area of your V zone known as the vulva. For most of us, the portion we are most familiar with is the mons veneris, or mound of Venus, a wad of fatty tissue that lies just on top of the opening to the vagina. Usually covered with pubic hair, it acts as a protective cover particularly during vigorous intercourse, helping to absorb impact and sheltering the more delicate organs and bones in and around the pelvis. Not coincidentally, this section of your V zone is also among the most erotic areas of your body, highly sensitive to the touch. In fact, the pubic hair found here can be so responsive that even a light touch can cause a sensual, electric-like shock sensation that travels right to the inside of your vagina.

Following the mound of Venus downward, you will come to the labia majora, or outside vaginal lips. Also made up of pads of fatty tissue covered with pubic hair, these "lips" are also extremely sensitive to both touch and temperature. In fact, much like a man's testicles, which shrink and wrinkle in response to cold temperatures, so do a woman's labia. They also swell and become puffy and softer in warmer temperatures, particularly when you are bathing in a hot tub or sauna or when you are sexually aroused. For some women, simply stroking the outside of the labia majora can act as powerful foreplay.

Inside the labia majora is a second set of "lips," known as the labia minora. Composed of a thin tissue with an elastic quality, they work to protect the interior of your vagina. In some women the labia minora are hardly visible; in others they are large and protruding. Both types, and anything in between, are considered normal.

Although most often we think of our intimate secretions and discharges as coming from the vagina, in fact, most come from the walls lining the outside and inside of the outer vulvar lips. Both the labia majora and labia minora contain an abundance of sweat, scent, and oil glands that continuously secrete the fluids that keep the vagina moist and healthy and provide the characteristic musky scent and extra "wet" sensation when you are sexually aroused. These secretions also help protect the vagina from acids and other irritating chemicals in urine and menstrual blood, as well as help block the passage of some bacteria into the reproductive tract.

Nestled neatly into the folds of the labia is your actual vagina. Although it is only about 3Ž4 of an inch wide and extends just 3 to 4 inches inward, it is composed of highly elastic tissue and stretches dramatically to many times its original size. This makes it possible not only to give birth but also to comfortably accommodate a penis of virtually any size. To help make intercourse easier and more pleasurable for both sexes, the inside of the vagina also has a pleated-like surface called rugae. Similar to the folds found in corrugated cardboard, the rugae help grip the penis and ease it deeper inside. After intercourse, as well as childbirth, your vagina contracts back to its normal size.

Located deeper inside the vagina is the hymen, a thin membrane that in the not too distant past was thought to function as a kind of archaic "virginity meter." As the myth went, on first intercourse the hymen would tear, causing bleeding to occur. If that characteristic bloodshed didn't take place, a woman's virginity was put into question. Today we know just how foolish (if not insulting) this myth really is. Indeed, so many factors can cause the hymen to tear, including most sporting activities, that even a doctor can't tell if a woman is a virgin simply by looking to this membrane for clues.

Although its shape and size is as individual as the woman herself (hymens can range from a thin, wispy membrane to a tough, fibrous layer), in some women it can be so thick that it won't break even during sex, which can cause any attempt at intercourse to be extremely painful. In fact, if you have always experienced pain or discomfort during intercourse, one of the first areas your doctor should check is your hymen. Should it be exceptionally thick, your gynecologist can remove it by a relatively fast and simple in-office procedure.


More V Zone Anatomy:
What Else You Need to Know

In addition to your vulva, your intimate anatomy also involves the following areas:

Urethra — Located just below your clitoris, this is the passageway for urine. About 3 inches long, it extends inward and is connected to your bladder. Containing mucus-secreting glands, it also helps produce a fluid that keeps your bladder opening moist and less likely to become irritated.

Perineum — A short piece of skin that stretches from the bottom of the vagina to the anal opening. Because the perineum can tear during childbirth, some obstetricians recommend cutting the skin just before the baby is ready to leave the birth channel. This, however, is considered controversial, and not all physicians agree it's necessary.

Bartholin's glands — Located on either side of the vaginal opening, these tiny glands produce small amounts of lubricating fluid, particularly during sex. Sometimes these glands can become inflamed, causing pain and swelling and, ultimately, infection (see Chapter 4).

Cervix — Located at the end of the vagina and composed of smooth muscle and collagen fibers, the cervix acts as the gateway to the uterus. Its size can range from 1 to 3 millimeters (between 0.04 and 0.12 inches), changing in response to various stages of a single menstrual cycle. Although it is technically part of the vagina, the cells lining the inside of the cervix look and grow differently, making them much more susceptible to infection.

Uterus — Shaped much like a small pear and about the same size, the uterus is the main organ of your entire reproductive system (see illustration). It is lined with layers of cells, one of which responds to hormonal stimulation. This stimulation causes the lining to grow thick during each menstrual cycle and be shed in the form of menstrual blood each month. Should pregnancy occur, the lining becomes the spongy nest where your fertilized egg implants and where your baby grows and develops.

Ovaries — Attached to the uterus by strong but thin ligaments are the ovaries, the main producers of the primary female hormone estrogen. In addition, the ovaries also play host to some 400,000 egg follicles — or "fertility seeds" — one of which develops into a fertile egg and is ovulated, usually every month during the childbearing years.

Fallopian tubes — Just 3 to 4 inches in length and a delicate 1Ž3 of an inch in diameter, these slender tubes jut out from either side of the uterus and slope gently downward toward the ovary. The finger-like ends, which resemble the open petals of a flower, reach out to catch an ovulated egg. The fallopian tubes also act as the transport lane for sperm, which swim toward the egg in anticipation of fertilization. If fertilization does occur, tiny hairs (called cilia), which line the inside of the tube, help shuttle the fertilized egg into the uterus, where it can implant and begin to grow.


Your Healthy Body: Know the Signs

When it comes to a healthy V zone, there are three major factors to look for. They include the way your vulva looks and feels to the touch, how it smells, and the quality of your intimate secretions or discharge. All three factors, alone or together, can help you determine if your V zone is healthy or if you are in need of medical attention and care. Here's what to look for.


Factor #1: Discharge

Medically known as leukorrhea, many women believe that a noticeable vaginal discharge is always an indication of a problem. In reality, however, it's one of the most important signs of good vaginal health. Indeed, the vagina is a self-cleaning organ, and discharge is one way it rids itself of old cells, bacteria, and other microorganisms that might otherwise cause harm.

What's Normal: According to experts at the McKinley Health Center at the University of Illinois, look for a discharge that is milky, cloudy white, or clear. If it dries on your panties, it may take on a yellow tinge or contain white flecks. Since the amount of discharge is different for every woman — and it changes from week to week in direct response to the menstrual cycle — it's difficult to say what's normal in this respect. That said, for the most part, discharge should be visible but not so abundant as to make you feel you are wetting your panties all day long. You should know, however, that stress can affect vaginal discharge (increasing or decreasing it), as can birth control pills. Sexual arousal will almost always increase production (that's normal!), while just after pregnancy and during breast-feeding, discharge often decreases, making your vagina feel somewhat drier.

Red Flags: Problems include discharge that appears grayish-white or yellow-green in color; is clumpy or "cheesy" looking; a frothy or foaming discharge of any color; and exceptional amounts of discharge, particularly if it is runny, watery, or very thin.

What This Means to You: For the large majority of women these particular red flags usually signal the presence of any number of simple vaginal infections — and you'll learn more about what they are and how they are treated later in this book. In a few rare instances, however, they could signal the presence of more complicated and serious problems, including pelvic inflammatory disease or even cancer. However, as with all other medical problems, the faster you are diagnosed, the more likely it is that you will suffer no permanent consequences. So don't panic — but don't avoid seeing your doctor.


Factor #2: Vaginal Odors

Every woman has a personal intimate scent unique to her, and it's generally magnified during sexual arousal as well as during ovulation and sometimes menstruation. In fact, some studies have shown that it is this natural scent of "reproduction" that throws a man back to his most primal mating instincts, causing him to feel more "turned on" to a woman when she is the most fertile.

What's Normal: Under healthy circumstances, a vagina should have no offensive odor — but that doesn't mean you won't smell something. In addition to your personal biochemical scent, most healthy women will also notice a faint salty or slightly musky odor.

Red Flags: Look for a "fishy" or foul odor — sometimes described as a bitter or sour smell. Also note any pungent smell that seems obvious, such as overly salty or oily, or any disturbing odors that appear directly after intercourse. All can signal the beginnings of a vaginal infection. Also be on the lookout for what can only be described as a vague smell of freshly baked bread. It could signal a yeast infection. At the same time, remember that what may seem like an intimate odor could actually be coming from an area outside the vagina, such as the groin, where many women tend to sweat profusely during warm weather. In addition, certain foods can change the scent of your urine (sometimes making it smell stronger or more ammonia-like), which may make it seem as if your vagina is emanating an odor when it's not. These smells do not indicate a vaginal problem and should not be confused with true, intimate odors.

What This Means to You: Most often a vaginal odor that does not disappear with good hygiene is usually the sign of some type of infection. (You'll learn more about what those infections are in upcoming chapters.) In the meantime, you should also check the presence of any accompanying discharge (see Factor #1 above), as this can help narrow down the possible causes of the odor itself.

But with or without discharge, do bring the odor to your doctor's attention. Important note: When you see your doctor (and all abnormal odors and discharges should be checked firsthand and not diagnosed over the telephone), do not attempt to cover up the smell by using a scented body wash or talc before your visit. Instead, wash with plain, warm water and dry well. Remember, you want your doctor to smell what you smell.


Factor #3: Genital Skin Condition and Color

Sometimes the earliest signs of V zone infection are indicated by how your vulva looks and feels, particularly in regard to itching or significant changes in texture or color.

What's Normal: The area on the inside and the outside of your vagina should be smooth, free of bumps, dark or light spots, blisters, or rashes. The color on the inside of the outer lips should be a fairly uniform shade of light pink, or, in women of color, a slightly darker, salmon-color pink. The deeper inside you go, the darker the skin looks, up to a medium red.

You should also check the area just outside your vagina, particularly at your panty line, where your thighs meet your groin. It should be free of any swelling as well as bumps or lumps.

Red Flags: Look for bumps; rashes; redness; itching; lumps; lesions; white or light patches, particularly inside the vulva; dark patches or areas of very red or reddish-purple tissue; areas that burn or are painful to the touch; and significant changes in pubic hair, such as obvious thinning.

What This Means to You: For most women, these red flags are usually the result of simple dermatological-type problems, often caused by any number of environmental factors such as the fabric or style of your panties or even your laundry detergent (see Chapter 4). In a few instances these same symptoms could also be the sign of minor infection or even a biochemical imbalance such as a thyroid disorder — and even more rarely, a more complicated disease such as genital warts or even rare forms of cancer. The key here is not to try to diagnose these problems yourself. Later in this book you will learn more about how and why many of these conditions develop. Use that information to open a dialogue with your doctor — and be certain always to mention any changes in genital skin, color, and condition during your exam.


The V Zone Self-Exam

Now that you're familiar with how your V zone should function during optimal health, it's time to find out if indeed it is functioning this way now. The best way to tell that is by some self-exploration, in the form of a vulvar self-exam. Indeed, experts advise that checking yourself on a regular basis (some say as often as you do a monthly breast exam) is one of the best ways to catch most health problems before they go on to become catastrophic problems.

Getting Started

To begin your exam you need only two things: a hand mirror and a good source of light. According to the Center for Vulvar Disease, before every exam be certain to wash your hands thoroughly, lathering with soap for 15 to 20 seconds and then rinsing in warm water. Since you will be touching the inside of your body, it is imperative that you don't skip this important step.

That done, you must position your body in a way that makes the exam fast and easy to do. There are several ways in which this can be done, depending on what's most comfortable for you. You can sit or lie down on your bed, squat or kneel on the floor, or stand up.

Most important is that you are comfortable, in a position that allows you to see the clearest and the most comprehensive view of your V zone in your hand-held mirror. Often this is best accomplished by sitting on your bed with your feet up and your body in a slightly reclined position, using a pillow to prop up your back.

Once you have positioned yourself, you are ready to begin. According to the Center for Vulvar Disease, here are the steps you should take:

Step 1. Viewing your vulva in the hand mirror, separate the outer lips with your fingers. A normal vulva should be pink to medium red in color, with no obvious discolorations or very light areas. You should also be on the lookout for any dark red areas, swelling (the tissue may look or feel bloated), blisters, bumps, lesions, sores, unusual colors, and particularly any unusual odors. Certainly make note of any pain you feel when touching any area of your vulva.

Step 2. Now look a little deeper inside. For this you will need to locate and then separate your inner lips. Look for the same signs mentioned in step 1. In addition, also check the entrance to your vagina for those signs.

Step 3. Examine your clitoris, located just under a hood or fold of skin just below the urinary opening. It should resemble a small, fleshy mound. It is soft to the touch and pink in color. Some say it resembles a tiny penis.

Step 4. Check the area outside your V zone: the urethra, perineum, anus, and the outside of the labia majora and mons veneris (see previous illustration). In addition to redness, swelling, or discolorations, check for soreness or irritation as well as itching. Certainly, pay special attention to signs of bleeding (such as dried or moist blood) other than that which is associated with your monthly cycle.


Protection Plus:
How Your Doctor Can Help

If during a vulvar self-exam you discover anything that seems even a bit unusual, you should bring it to your doctor's attention, and usually the sooner, the better. In many instances, he or she will simply reassure you that everything is all right. Nevertheless, if things seem abnormal to you, ask for an explanation as well as what you should look for as a sign of trouble.

Even if your body continues to check out okay, however, it's still important that you don't skip regular gynecological exams. Indeed, while performing monthly self-exams is important, there are some instances when, despite the fact that everything looks and feels okay, something is terribly wrong. And that's where your doctor can play a major, sometimes life-saving, role. In fact, even when you seemingly have no problems, seeing your doctor at least once a year allows you to give yourself the gift of preventative care, and in doing so, help preserve not only your V zone health but your overall good health, as well as your sexual vitality.

Your Annual Gynecological Exam:
What It Must Include

Most experts agree that the first, most important step of any gynecological exam is the consultation — a talk between you and your doctor that should take place while you are still fully dressed. Here you should bring up any symptoms you may have discovered on your own, as well as any complaints you may have about your V zone, as well as your overall health. This is an especially important step if you see a gynecologist only once a year, for an annual exam.

This is also the time when you should ask your doctor any potentially "embarrassing" V zone questions you may have. Indeed, most women find that they feel less intimidated about asking questions when they are fully dressed, rather than undressed and in a compromising exam position. If you give it a try you may be surprised to discover how much easier it is to talk to your doctor during this preexam consult.

Once this discussion takes place and you are satisfied with the answers your doctor provides, you will proceed to the physical portion of your exam. It should include at least the following four steps:

1. The General Health Check. This should include listening to your heart and lungs and feeling your neck. You may be asked to give a urine sample, which will be tested for sugar (a sign of diabetes) or blood (a sign of infection). If your gynecologist is also your primary care doctor (and you must make a point of discussing this with your doctor, as not all feel comfortable in this total-care role), your exam should include a check of any general health concerns you mention during your consult.

2. The Breast Check. This should take up to two minutes. Your doctor should feel each breast, usually using a circular motion, examining the nipples, as well as the area under each armpit (see illustration). Since research shows that up to 25 percent of all gynecologists skip this step, it may be necessary for you to ask for this portion of the exam — and you must take the initiative. It's that vital to your health. In addition, if you haven't been doing self-breast exams, now is the time to 'fess up. Your doctor must know if this is the case for you.

3. The Pelvic Exam. This should begin with a check of the outside portion of your V zone. Here your doctor is looking for the same factors you look for in your vulvar self-exam: lumps, bumps, discolorations, redness, or swelling.

The next step is an internal exam. It begins with inserting the speculum, which should only cause minimal discomfort. If you experience pain, talk to your doctor about using a smaller instrument. Also, relaxing your pelvic muscles as much as possible will help make the exam more comfortable. Once your vagina is held open, your doctor will examine the inside of the vaginal walls and take a Pap smear. This is the screening for cervical cancer and a test that is mandatory at least every other year for all sexually active women (see "The New Pap Smear" below). This test should be followed by the bimanual exam. Here, your doctor will place the fingers of one hand inside your vagina and the other on your stomach, and then gently feel your pelvic organs. In this way he or she can feel the shape, size, and position of your cervix, ovaries, and uterus and check for any growths such as fibroid tumors or cysts.

4. The Recto-Vaginal Exam. This is by far the most overlooked part of the exam — many doctors don't like to do it, and most women avoid it as well. Still, many experts agree it's a vital way for your doctor to check the internal area behind your vagina and uterus, which can often reveal problems not felt during the bimanual exam, including cysts and tumors, as well as endometriosis, tubal infections, and even polyps. For this portion of the exam, which should take less than a minute, your doctor will insert one gloved finger into your rectum. Don't be alarmed if you feel a momentary sensation of having to have a bowel movement. You won't. It's just a normal sensation.

5. The Conclusion. Every exam should conclude with a talk, where you and your doctor can discuss any problems discovered during your exam, as well as any additional tests you may need and any self-care treatments you need to do. You should also use this time to bring up any additional questions you have and discuss any treatment options. It's also a good idea to ask your doctor when you should call for test results, particularly your Pap smear. If your doctor suggests a follow-up exam for anything he or she would like to watch (such as a cyst or even an irritation), don't take the suggestion lightly, and make an appointment before you leave.

The New Pap Smear:
How It Can Save Your Life

Among the most important V zone screening available today is the Pap smear. Developed in the 1940s as a way of looking for cell changes that can, if not treated, result in cervical cancer, it has been credited with saving the lives of hundreds of thousands of women throughout the years.

More recently, the Pap smear has become an even more important tool. Doctors now know that at least one sexually transmitted virus (certain strains of the human papilloma virus, or HPV — see Chapter 9) can cause cell changes that lead to cervical cancer. With the advent of the sexual revolution and the social acceptance of multiple sex partners, now, more than ever before, women have become vulnerable to contracting this virus and developing cervical cancer.

The important news is that the Pap smear is a highly effective method of discovering those who are at high risk — often early enough to save a life. And the test is getting better, with important improvements in both the way the actual screening is done and how the cells are analyzed.

Why is it important for you to know these details? In many instances, the use of the newer technologies is not automatic. Indeed, many of you will have to request some of these new technologies specifically before your doctor will comply. Sometimes you may even need to consider a different doctor since, unfortunately, not all physicians routinely keep up with the latest advances, including the newest ways to save your life. Additionally, since some doctors are coerced by managed care companies to restrict suggestions of what can be a more costly procedure, they neglect to mention all that's available to their patients.

That said, here's a rundown of the newest, most important technologies in the area of cervical screening. Remember, depending on your insurance coverage, you may have to foot the bill for the difference in cost over and above a regular Pap smear. Usually, however, this nominal expense is well worth it.

Technology: Thin Prep Test

What It Is: A new way of collecting and preparing Pap smear samples for analysis.

How It's Done: Instead of swabbing your cervix and placing the cells on a slide before sending it to the laboratory, the traditional swab or brush is replaced by a special wand that goes directly from your cervix into a vial of fluid, which is sent to the laboratory. This ensures that the entire cell sampling, and not just a small portion, is submitted for analysis. Once it reaches the lab, your sample is put through a declumping process, which makes it easier to see each of the sampled cells, and then a filtering procedure, to separate out the blood and mucus. The remaining cervical cells are then spread in a thin layer onto the glass slide for analysis. The end result is a slide that is clearer and easier to read and a diagnosis that is ultimately more accurate.

Improved Accuracy: A study of some 7,000 women conducted by the manufacturer revealed Thin Prep was able to pinpoint abnormalities 65 percent more often than the traditionally prepared Pap smear slide.

A second study on some 50,000 women published in the Medical Journal of Australia found Thin Prep was not only more efficient at identifying severe levels of cell abnormality, it found these abnormalities more often than the traditional Pap smear. In certain instances, Thin Prep found high-grade lesions, indicating an advanced form of cervical disease, while no such cells were seen on the traditional Pap smear, even with a second review.

Additional Cost: About $20 over and above the cost of a traditional Pap smear. Most insurance companies won't pick up the extra tab.

Technology: PapSure Test

What It Is: An on-site visual cervical exam performed at the same time as a traditional Pap smear.

How It's Done: Immediately after taking your Pap smear, your doctor will "wash" your cervix with a diluted solution of white table vinegar, which will adhere to abnormal cells. Then, by exposing the cervix directly to a harmless, disposable, low-glare, blue-white chemiluminescent light source (the process is called speculoscopy), any abnormal cells become immediately apparent to the eye. Normal cells look bluish in color; abnormal cells are distinctly white. So, your doctor can immediately tell if abnormal cells are present and where they are located.

Most often, when the PapSure test results are negative — meaning no abnormal cells are seen — the Pap smear portion of the test is negative as well, and it's a result you can comfortably believe is true. If, in rare instances, PapSure is negative but the Pap smear is positive, then your condition is considered positive until proven otherwise.

Improved Accuracy: When performed along with a traditional Pap smear, the PapSure test has been shown to be more than twice as accurate in identifying cervical abnormalities before they progress to cancer — a 90 percent rate for PapSure compared to a 40 percent rate with Pap smear alone. Perhaps more important, it is equally effective in ruling out cancer, meaning you can now feel highly confident about a negative Pap smear result.

Although using PapSure technology is not considered "required," the Food and Drug Administration (FDA) has allowed PapSure inventors (the Trylon Corporation) to say that the exam is indicated in all women undergoing a pelvic exam and Pap smear — meaning that there is enough evidence to show it's worth the extra effort. Another bonus for you is that PapSure offers an immediate diagnosis, meaning there's no waiting for test results.

Additional Cost: About $25 over and above the cost of your regular Pap. Most insurance companies do not pay.

Technology: AutoPap and PAPNET

What It Is: Automated methods of analyzing Pap smear slides.

How It's Done: In both tests computers are used to read the Pap smear slides, helping to decrease the margin of human error. In PAPNET the slides are reread by the computer after first being seen by a cytologist. In AutoPap, the slides are read by computer analysis first, and those that indicate an abnormality are reread by a cytologist.

Improved Accuracy of PAPNET: Studies comparing positive PAPNET test results with those obtained by the traditional manual screening method were similar in number. The PAPNET, however, was faster. Additionally, studies conducted in 1997 on some 21,000 women and reported in the journal Lancet found that PAPNET was able to identify negative smears 77 percent of the time versus 42 percent using traditional manual reading techniques. A 1998 American study published in the journal Obstetrics and Gynecology found PAPNET useful as a second analysis when Pap smears were classified as containing atypical squamous cells of undetermined origin (often identified on test results as "ASCUS"). Specifically, PAPNET was able to determine which women needed treatment to obliterate their abnormal cells and which were likely to experience a regression back to normal cell status on their own — all without a biopsy.

Improved Accuracy of AutoPap: Data from a large-scale clinical study of Pap smears taken from more than 25,000 patients from five different laboratories found that AutoPap achieved greater accuracy in early diagnosis of cervical disease and reduced incidence of both false-positive and false-negative results.

Added Cost: Both PAPNET and AutoPap add about $35 each to the cost of a Pap smear. Most insurance plans don't cover it.


How You Can Make Every
Pap Test Count

Regardless of what your doctor may do to help increase the accuracy of your Pap smear, there are steps you can take as well to ensure a more accurate test result. According to the American Society of Clinical Pathologists (ASCP) — the folks that read your Pap smear tests — and experts from the Virginia Mason Medical Center in Seattle, here's what to do:


The HPV Test and Cervical Cancer

Many doctors believe that the most accurate way of detecting cervical cancer is to test for something else entirely: HPV, the human papilloma virus. The reason? Studies now show that certain strains of the virus are present in virtually 100 percent of all cases of cervical cancer. While the latest study — a January 2000 report in the Journal of the American Medical Association — reveals that testing for HPV has a higher false-positive rate than the traditional Pap smear, many believe that in time the test will be refined enough to become the gold standard for cervical cancer, particularly in women over age thirty-five. One factor that certainly makes the HPV test attractive is that it involves only a simple swabbing of the vagina, which a woman can easily do on her own. The tissue is then analyzed for DNA from thirteen different types of suspect strains of HPV. (For more information on HPV, cervical cancer, and this test, see Chapter 8.)


Becoming a Savvy Medical Consumer:
What You Must Do Now

Now that you know a little something about how your V zone functions, you will be well prepared to understand and act on the information that is found in the remainder of this book, much of which you will need to maintain optimum intimate health. In many instances, I hope you will also find answers to your intimate care questions — subjects that for a variety of reasons you may have found difficult to discuss with your own doctor. Indeed, whether it is simple shyness on your part that's kept you in the dark or, as is more often the case, your doctor is simply not as approachable about intimate care subjects as you would hope he or she would be, if you're not getting the answers you need, your health care can suffer.

Just having all this information, however, isn't quite enough. You must put it to use by becoming the single most proactive element in your health care. Indeed, if you are to obtain and maintain the best V zone care, you must become involved — not only in selecting the doctor who will care for you but also in deciding on the types of treatments you will receive throughout the course of that care. The information you find in this book can help you achieve that. By sharing what you learn with your own gynecologist, you can open a dialogue about your V zone health that will be of value not only today but also far into your future.

The bottom line is this: Only when you and your doctor work together as a team will you be assured of getting the best care possible. And this V zone guide will help you become the best team player possible!

Copyright © 2001 by Colette Bouchez

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  • Anonymous

    Posted May 24, 2002

    An excellent resource guide for women

    I found this book extremely helpful - it was easy to understand and helped me a great deal, particularly the chapters on recurring urinary tract infections and yeast infections. I checked out some of the suggestions with my doctor and she said they were the latest information - and plus they really worked. She is now recommending the book to other patients. If you have any gyn problems, this book might help you find the answers.

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  • Anonymous

    Posted April 30, 2009

    No text was provided for this review.

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