Womens’ Health & Gynecology Services

Meridian, Boise, Eagle & Nampa Womens’ Health & Gynecology Physician Services

CERVICAL CANCER SCREENING:

Routine medical care is an important part of staying healthy.  For women, this includes gynecologic (female) examinations and testing.

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Current guidelines recommend Pap smear testing beginning at 21 years old, and continue through the age of 65. Pap smears are specifically for cervical cancer screening ONLY, not for ovarian cancer. Not every time a woman receives an exam in stirrups necessarily means that a cancer screening was done; some vaginal exams are for urinary complaints, discharge evaluations or to rule out infection.

• For women aged 21 to 29 years old, Pap smears should be done every 3 years.
• For women 30 to 65 years old, Pap smears should be done every 5 years with Pap and co-testing (if both are both normal you can go 5 years before repeating). Co-testing involves screening with a Pap smear & HPV testing (HPV virus causes most cervical cancer).
• Women over 65 may stop screening for cervical cancer as long as the testing was normal.
• Women who have had a hysterectomy may also stop screening for cervical cancer as long as the surgery was for treatment of issues other than high-grade pre-cancer abnormalities on Pap smear.
• If the Pap smear or HPV testing is not normal, additional testing such as colposcopy or more frequent Pap smears (with or without HPV testing) may be required.
• Of note, performing a bimanual screening pelvic exam (physician’s two hands) in non-pregnant, adult women without any symptoms is NOT recommended.

ENDOMETRIAL BIOPSY (EMB)

Endometrial (uterine) biopsy is an office procedure where a small sample of endometrial tissue is obtained for review by the pathologist.  It replaces the traditional D+C (dilatation & curettage) performed in the hospital operating room. An EMB may be recommended for evaluation of abnormal menses, postmenopausal bleeding, or if the Pap smear shows certain types of abnormal cells. It is primarily helpful to rule out uterine cancer.

Patients are positioned as if a Pap smear were to be performed.  The cervix is cleaned with antibacterial solution and stabilized to allow passage of a small straw-like instrument (endometrial pipelle) to examine the uterine tissue.  The sample is sent for biopsy review.

CONTRACEPTION

A woman has the choice to determine the contraception method that is best for her; we are able to help and provide various treatments.

One underutilized option is the Intrauterine Device (IUD). IUDs are an excellent contraceptive choice for many women and are very convenient (you don’t have to remember to take a pill every day).  Fifty percent of women working in the health care field select the IUD for their personal needs.

Two categories of IUD are available:  Hormonal and Non-hormonal.

1. Hormonal:  Some intrauterine devices contain a small amount of progesterone (a naturally occurring hormone) which reduces bleeding and cramping. The most common product is Mirena, which last six years.
   Mirena
2. Non-hormonal:  Other types of intrauterine devices contain no hormones and have no impact on bleeding or cramping. The most common type is the Copper-T ParaGard, which lasts for 10 years.
   Paragard

Insertion of an IUD is straightforward and can be quickly done in the office. It is an affordable and reliable method of contraception covered by most insurance payers.  Our doctors can help you make a decision that would fit your lifestyle and concerns.

Visiting Your Family Doctor for Women’s Health & Gynecology

Optimal female well-being includes having your physical, mental, and social health all at peak performance. The family medicine specialists at Treasure Valley Family Medicine (TVFM) are comprehensive primary care experts and manage nearly all women’s health conditions, to include vaginal infections or bleeding, urinary tract infections, cancer screenings, early pregnancy detection and management, and family planning.

We focus on prevention and care of the reproductive system as a critical part of the whole person. We believe in proactively offering yearly exams which are generously covered by most insurance companies. Many common female health conditions are preventable and/or treatable. For example, we recommend that all women over 21 years age have regular interval Pap Smears and those over the age of 40 talk with their doctor or PA about mammograms. We also discuss and recommend immunizations and lifestyle medicine during these yearly exams. Blood and urine tests are usually ordered to screen for other common conditions such as diabetes and heart disease. TVFM clinicians are experts in managing contraception whether you’re interested in an intrauterine device (IUD), an implantable device such as Nexplanon, or birth control pills. We also perform endometrial (uterine) biopsies when necessary for abnormal bleeding.

What Does A Women’s Health & Gynecology Visit Look Like?

The American Congress of Obstetricians and Gynecologists (ACOG) recommends that reproductive health visits for young women should begin at age 13. Regular Pap smears are recommended at age 21 despite the age at which a woman becomes sexually active. Pap smears for cervical cancer screening have technologically advanced such that Pap smears are done every three years until age 30, then every five years until age 65 years for average-risk women. Pap smears are distinctly different than screening for sexually transmitted infections (STI) which can also be performed. Ensure that 24 hours before your appointment, you avoid engaging in sex or using any feminine hygiene products.

Here is what you can expect during a TVFM women’s health & Gynecology check-up:

1. General exam – After a medical assistant takes vital signs and collects your history, your doctor or PA will review the gathered information and discuss any concerns you may have regarding overall health and specifically women’s health concerns. When a Pap smear or STI examination is indicated, you will then be given a gown and/or sheet to keep you completely covered after you remove your clothing, often only from the waist down. The clinician will then start with a general check-up and examine your eyes, ears, nose, throat, heart, lungs, skin, lymph nodes, etc.
2. Examination of your reproductive system – If you have any concerns about your breasts, care will be taken to expose only one breast at a time. The clinician will examine the breast and nipple as well as the axilla or armpit looking for any masses, skin or nipple changes. The American Cancer Society (ACS) no longer recommends routine clinical breast exams for women without specific concerns, so talk to you provider if you have questions. You’ll then be helped into stirrups, or footrests, and your lower half will be uncovered. The clinician will begin by examining the external surfaces of the vulva (the name given to the female genitals). A properly sized speculum is lubricated and used to examine the internal surfaces of the vagina and cervix (the bottom portion of the uterus). A soft rubber brush is used to collect cells from the cervical mucus to rule out cervical cancer — this procedure is known as the Pap smear. You should expect some pressure and perhaps a pinching sensation but no pain. There is occasionally some spotting afterwards. If you have any concerns for sexually transmitted diseases, an additional sampling from the cervix will be taken at this time. The microscopic cervical cells collected during the Pap smear are then sent to a lab to look for any abnormalities, usually caused by the human papillomavirus, or HPV, which is transmitted sexually. The American College of Physicians (ACP) no longer recommends a bimanual exam in women without any symptoms for cancer detection (using the hands and fingers internally to detect masses in the pelvis). Talk to your provider about any concerns you may have.If you are wondering why clinical breast exams and internal bimanual pelvic examinations are no longer routine, it is because very large studies have shown that these examinations FAIL to significantly detect cancer and save lives, despite their intuitive appeal to improve health.

A Few Last Words

We have both male and female clinicians who are well-trained and experienced in caring for a woman’s reproductive health & gynecology matters. We take your comfort and privacy seriously. Female medical assistants are also present during all exams. You should always ask questions if you are unsure about something. Don’t be embarrassed—we’ve likely heard it before! At Treasure Valley Family Medicine, we want to partner with you to help you live your best life and that includes offering comprehensive women’s health care.