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Safeguarding women's health

For most young girls, the first physician who administers vaccinations and treats illness is a pediatrician or family practitioner. Unless there are concerns about irregular menstrual periods or medical problems affecting the reproductive system, most girls continue to see their primary care doctor past puberty. Today, pre-teen girls may receive the Gardasil® vaccine at their pediatrician’s office to prevent future infection with human papillomavirus, which causes 70 percent of all cervical cancers and 90 percent of all genital warts.

But in the late teen or young adult years, most women begin to receive regular care from OB/GYNs who specialize in women’s healthcare. Their education includes medical school followed by a four-year residency, during which they are trained to diagnose and treat complex gynecologic problems, manage the care of healthy and at-risk pregnant patients and perform surgery and other procedures that other primary care doctors don’t do. After residency, they may choose to practice general obstetrics and gynecology or specialize solely in either obstetrics or gynecology independently. Other OB/GYNs continue their training in two- to four-year fellowships in the subspecialties of gynecologic oncology, maternal-fetal medicine (perinatology), reproductive endocrinology and infertility, or urogynecology.

Establishing a relationship with your OB/GYN

“The teenage years are an ideal time for some girls to begin seeing an OB/GYN in addition to their pediatrician or family practitioner,” says Monique Regard, M.D., an attending pediatric OB/GYN at Maria Fareri Children’s Hospital at Westchester Medical Center and an assistant professor of clinical obstetrics and gynecology at New York Medical College.

“The American College of Obstetricians and Gynecologists recommends that girls ages 13 to 15 consider coming in for an introductory visit with a gynecologist, just a meet- and-greet with no pelvic exam,” she says. “By the time they are 16 to 19, we suggest they have private time with us, because they may already be sexually active. By age 19, young women should begin regular gynecologic well-care. Being able to confide comfortably in your OB/GYN is critical to your healthcare, and that’s why it is best to establish that relationship while you are young, before you have any gynecologic problems or become pregnant.”

Your yearly visit

Starting in young adulthood, an annual gynecologic checkup with your OB/ GYN should be a priority. This doctor will measure your weight, height and blood pressure, and review your health status and your family’s health history. He or she will perform a pelvic exam, which consists of looking at and feeling your reproductive organs. You may also undergo a Pap test to screen for cervical cancer, an HPV test to screen for the human papillomavirus, an HIV test for the human immunodeficiency virus that causes AIDS and a clinical breast exam to examine your breasts for lumps or other abnormalities.

If you are over age 40, your OB/ GYN will write you a prescription for a mammogram, and if you are over 50, a prescription for a colonoscopy to screen for colon cancer. Your OB/ GYN will discuss and may prescribe contraception. In your 30s or 40s, your conversations may include a look ahead toward menopause, and if you’re over 50, menopause and osteoporosis risk are important topics to discuss.
Your yearly OB/GYN checkup is also the time to discuss any gynecologic problems you may be experiencing, such as irregular menstrual periods and abnormal vaginal bleeding, discharge or irritation.

“In providing the full spectrum of women’s healthcare, we also address primary care issues such as tobacco use, high blood pressure, diabetes, nutrition, sexually transmitted diseases, depression and cancer prevention,” says Michael Kessler, M.D., chief of the Division of General Obstetrics and Gynecology at Westchester Medical Center and an assistant professor of obstetrics and gynecology at New York Medical College. Dr. Kessler and four other Westchester Medical Center OB/GYN generalists see patients at the offices of Advanced OB/ GYN Associates in Hawthorne, N.Y.

“We also spend time on preconception counseling,” adds Dr. Kessler. “The ideal time to discuss pregnancy is before it happens, so that a woman can lose or gain weight if she is over or underweight, control any chronic diseases she may have and treat any gynecologic problems that can cause infertility, such as endometriosis, uterine fibroids or blocked fallopian tubes. When a woman is ready to conceive or has become pregnant, we begin prenatal care in the first trimester and follow her through delivery, postpartum care at the hospital, and at her six-week checkup after the baby is born.”

Gynecologic care for the youngest girls

Though the typical oB/gyn treats female patients who are past puberty, a small minority see babies and children. most major children’s hospitals throughout the united States—including Maria Fareri Children’s Hospital at Westchester Medical Center—have a pediatric gynecologist on staff to care for girls from birth through the teen years.

Problems encountered by very young girls can include ovarian cysts, twisted ovaries, vaginal bleeding and labial adhesions, says Monique Regard, M.D., a pediatric gynecologist at the children’s hospital. many of these minor conditions usually can be treated with antibiotics or steroidal or estrogen creams.
“in toddlers and children, we tend to see girls with vulvar rashes or vaginal discharge infections. vulvar rashes are often secondary to mild eczema on the outer skin, and vaginal discharge may be due to a little bacteria from the anus, especially in girls who are constipated,” says Dr. Regard.

Dr. Regard’s pre-teen or young teenage patients tend to be brought in by their mothers for irregular, painful or absent menstrual periods; anatomic problems such as a vaginal blockage, or ovarian hormonal cysts or ovarian benign tumors. one of the most common reasons for irregular menstrual periods is polycystic ovary syndrome, which affects 1 in 15 girls and women in the united States. The ovaries of these patients make too much of the male hormone androgen, which impedes the development and release of eggs during ovulation. patients with polycystic ovary syndrome sometimes also make too much insulin, which can be a pre-diabetes condition. Treatment may include dietary modifications, anti-androgen medications, birth-control pills for those who do not wish to become pregnant, and insulin-lowering medication.

Recommended cancer screenings for women

Breast cancer:

• Breast self-exam: Should be explained by OB/GYN, and each woman must decide, with her physician, whether to perform it regularly.
• Clinical breast exam: at least every three years in the 20s and 30s, every year after age 40
• Mammogram: yearly after 40

Colorectal cancer:

  • Colonoscopy: every 10 years starting at 50
  • Fecal occult blood test or fecal immunochemical test: yearly after 50
  • Flexible sigmoidoscopy (to check lower end of colon): every five years starting at 50
  • Double-contrast barium enema: every five years starting at 50

Cervical cancer:

  • Pap test: beginning three years after vaginal intercourse but not later than age 21. done every year with a conventional pap test or every two years with a liquid pap test. after 30, if three consecutive paps have been normal, can be done every three years. after 70, if three consecutive paps have been normal and there have been no abnormal paps in 10 years, can be stopped. If total hysterectomy was done for reasons other than cancer, pap can be stopped—but if cervix is intact after surgery, follow other guidelines for continued paps.

Endometrial cancer:

  • At menopause, all women should be informed about the risks and symptoms of endometrial cancer and encouraged to report any bleeding or spotting to their OB/GYN.

Other cancers:

  • During a periodic checkup, all women should be examined for cancers of the thyroid, ovaries, lymph nodes, oral cavity and skin, and should be counseled about sun exposure, tobacco, diet and nutrition, sexual practices, and environmental and occupational exposures.

Source: American Cancer Society

To learn more about adult OB/GYN care at Westchester Medical Center, please call 914-493-2250, or call 1-877-WMC-DOCS to learn more about PEDIATRIC GYNECOLOGY. You can also visit our website at www.worldclassmedicine.com

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