Patient Information
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| Gynecologic Phases in a Woman's Life |
Pre-pubertal
We are usually asked to evaluate females under the age of 13. Generally this involves concerns regarding vaginal irritation possibly related to bicycle injury, yeast infections or foreign bodies. Unfortunately, we have seen a number of females ages 12-14 who are pregnant. These patients are extremely high risk. They are followed very closely during the pregnancy. The risk of premature labor, poor growth of the fetus, and toxemia are all significantly greater in young girls.
Girls 13-21
Current recommendations are to do the Pap smear at age 21 or 3 years after onset of sexual activity. The majority of females that we see in this age category present to contraceptive counseling, pregnancy, or treatment for sexually transmitted diseases. The other primary concern would be menstrual bleeding disorders, particularly with a very heavy menstrual flow.
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Women 21-45
This is the largest category of women in our practice. This includes a wide variety of conditions including obstetrical, or pregnancy concerns, STD testing and therapy, menstrual disorders, anatomic abnormalities such as benign ovarian cysts, benign fibroid tumors, cancer of the cervix. Counseling regarding breast cancer at young age, particularly if there is a strong family history. Perimenopausal, or premenopausal changes which occur generally between the ages of 42 and 49. We would like to see the patient on an annual basis. We now do Pap smears every two years. Pelvic exams, breast exams, heart and lung exams are always performed, as well as vital sign determination, such as blood pressure, pulse and weight. We do dietary counseling with our obese patients, as well as the very thin patient. Lab work is minimal at this point. We usually check a blood count and a urine, which can be done in the office. Occasionally, we do have to send patients out of the office for more extensive testing, such as thyroid functions, liver functions, kidney functions and other hormonal disorders.
Women 45+
This age group brings us into the menopausal era. We do much hormone replacement counseling, menopausal counseling, vaginal relaxation disorders, bleeding abnormalities and now have to deal with cancer onset. The risk of cervical cancer is between the ages of 30 and 40. The risk of uterine cancer is between 45 and 60. Ovarian cancer occurs in women ages 60 to 80. Breast cancer is also during the ages of 60 to 80. Therefore, entering this era, we recommend mammograms be done on an annual basis. We initiate mammograms at age 40, unless there is a family history (if a mother or sister have had breast cancer), then we initiate mammograms at age 35. Mammograms should be done every two years between the ages of 40 and 50, and is generally done yearly after that. We begin doing testing for colon cancer by testing for blood in the stool after age 50. It is also recommended that colonoscopies be done at least once between the ages of 50 and 60. Pap smears can begin to be spaced out, as cervical is less risky in this age group. We generally do pap smears on women over 50 between 2 and 3 years apart, however, the patient still needs to come in every year for a pelvic exam to determine if there is any enlargement or masses associated with the uterus or ovaries. Generally, we stop doing Pap smears at age 70. The risk of cervical cancer is a 0% at that point. We also deal with general health issues, such as hypertention, diabetes, thyroid conditions, obesity and other miscellaneous medical problems.
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