Introduction to

Women’s Health Care

Women’s HealthWhat does a teen girl need to know? What in the world is a women’s

health exam?

Why would anyone have one?

Do I need one?

Rachel Sieman, CNMCertified Nurse-Midwife

Nurse MidwifeMidwife: “with woman”

Women’s Health CarePregnancy and

Birth

Women’s Health CareAnnual exams and PAP testsBirth controlSTD testing and treatmentCommon problems

Pregnancy and BirthPrenatal careBirth

Everything you need to know(but were afraid to ask) Why do I need an exam? When do I need one? Who will do my exam? What will happen?

Why does anyone need an exam? Screening for breast and cervical

cancer Common gynecologic problems Family planning STD testing and treatment

Why? Breast Cancer Screening Lifetime risk is 12.8%

This is one out of every eight women!

Breast cancer is the second most common cancer among women (skin cancer 1st)

Lung cancer is leading cause of cancer death in women, breast cancer is second

Breast Cancer Risk FactorsNon-Modifiable ModifiableBeing femaleAgingFamily historyGenetic RisksPersonal historyCertain types of breast cancerMenstrual historyRace

Reproductive historyOral contraceptivesHormone replacementAlcoholWeight

*Injury to the breast is NOT a risk factor

Breast Cancer Facts Early diagnosis is the key to

surviving breast cancerNearly 97% of women who are

diagnosed with breast cancer at an early stage survive for more than 5 years

Breast cancer occurs when there is erratic cell growth and proliferation in the breast tissue

Normal Breast Structure

Cancer vs. Non-cancerMalignant(cancer)

Non-malignant(not cancer)

Invades, compresses and destroys normal tissue

80% of breast lumps

Cells may break away to form new tumors

Do not invade or spread

Life-threatening Not life-threatening

Breast Cysts Fluid-filled sacs within the breast May become enlarged and tender just

before your period Not cancer, but any new lump should

be checked out by a health care provider

Treatment: possibly decreasing caffeine

Early Detection Methods:3 ways to catch breast cancer early Screening Mammogram

Yearly for women over 40 Clinical Breast Exam

Performed by a doctor, nurse practitioner

or nurse-midwifeYearly for women >40Every 3 years for women 20-39

Breast Self Exam (BSE)Monthly

Mammogram X-ray of the breast to detect breast

cancer

Can detect a lump before it can be felt

Studies demonstrate that mammograms reduce the risk of dying from breast cancer

How to do a Self Breast Exam (SBE)

When to contact your health care provider You feel a lump There is a change in your skin

DimplingRetractionLooks like an orange peelRed, warm, swollen

Your breasts hurt, and it’s not related to your cycles

Nipple discharge when you are not pregnant or breastfeeding

There is anything that concerns you

A word about nipple piercing Potential complications

Infection, can be severeNerve damage*Blood-filled cystScarring, including keloid formationCan contract hepatitis B or C, or HIV (rare)Allergic reaction to the metal Damage to the nipple if pulledNeed to remove to breastfeed, may leak

breast milk through piercing hole

Why? Cervical cancer screening

Abnormal cells on the cervix that multiply out of control

Most cases of cervical cancer caused by HPV virus

Human Papillomavirus Common virus: more than 100

subtypes 30 of these sub-types are sexually

transmittedHigh-risk strains cause cervical cancer,

cancer of the tonsils and throat** Low-risk types cause genital warts

How common is cervical cancer? Most common sexually transmitted

infection 11,000 new cases each year 3,600 women die each year

(that’s 10 per day in the U.S.)

Worldwide, the 2nd most common type of female cancer

Cases of Cervical Cancerhave decreased 75% in last 50 years in the U.S.

Surviving Cervical Cancer: better screening is key

Overall 5-year survival rate for women diagnosed with cervical cancer, regardless of stage - 73%

Screening done with PAP testCells collected from cervixLooked at under microscope

How common are abnormal PAP test results?

Abnormal Pap test results are quite common

They are usually only slightly abnormal

If followed up and treated early, you can prevent the abnormality from turning into cervical cancer

When do I need a PAP test?

Starting at age 21 Every year until age 30 After age 30, if you have had

only normal results, you may have them every 2 to 3 years (after talking with your health care provider about your level of risk)

Why do I need to keep getting tested?

PAP testing is not a one-time test

New changes (abnormalities) can occur after you get tested, even if you have not had new partners

It could take many years for changes to develop or to be noticed

Your risk changes if you have new partners, or if your partner has other partners *

When should I have my first women’s health exam? Age 21 When sexually active (or considering

it) Women’s health problem

Women’s health problems Abnormal vaginal bleeding

Periods more often than every 3 weeksPeriods less often than every 6 weeksBleeding between periodsPeriods that last longer than a weekVery heavy periods (soaking a pad per hour)

Painful PeriodsCramps that interfere with your lifestyleHeadaches that occur with menstruation

PMS

Other reasons to see a health care provider Breast lump or pain Vaginal itching, burning, or odor Painful urination, or blood in your

urine

Testing for STDs Family planning (birth control) Pregnancy care

Who will do my exam? Women’s health provider

Physician or physician’s assistantNurse practitionerNurse-midwife

Male or Female

Physicians and Midwives also deliver babies

The GYN exam and PAP test: What to Expect First things first

WeightBlood pressure

Lots of Questions(while you are still dressed) Know the first day of your last

menstrual period Medical history (asthma, diabetes,

etc.) Surgical history (tonsils, etc.) Menstrual history Sexual history Problems you want to address

General exam

Breast exam

Positioning for the PAP test and pelvic exam

The Pelvic Exam with PAP testExternal exam

Examine external anatomyInternal exam: 2 parts

1. Speculum ExamExamine vaginal walls and cervixPAP test and testing for STD’s can be done

2. Bimanual Exam Feel uterus and ovaries

Instruments Speculum

Collection devices and liquid medium

Speculum Exam

What is a PAP test?

Cells are collected from the surface of your cervix by a health care provider

Bimanual exam

What now?