Regular Tests

Gynaecological Examinations

Annual examinations usually consist of screening, laboratory tests, evaluation, counselling and immunisation.

Ages 13 to 18 years

Establish doctor-patient relationship

Age appropriate education of anatomy, body image, weight management and prevention of sexually transmitted diseases

  • Screening checks for you and your family’s medical history, menstrual and reproductive health, sexual development and history of sexual activities

  • Pelvic examination (includes examining the external genitalia, cervix and vagina), is generally not included unless there is related medical history or presenting symptoms that require further evaluation

  • Regular laboratory tests for sexually transmitted diseases such as chlamydia, gonorrhoea, HIV (human immunodeficiency virus), and Hepatitis B and C virus

Dr Alexander will advise you on your sexual health, sexual behaviour, preventing unintended pregnancies and contraceptive use.

You will be recommended immunization for human papillomavirus (HPV), and Hepatitis A and B vaccine.

Ages 19 to 39 years

Screening checks for your medical history, menstrual and reproductive health including sexual practices

  • Clinical breast examination every 1 to 3 years from the age of 20

  • Pelvic examination from 19 to 20 years if there is any related medical history and periodically if you are above the age of 21

  • Laboratory test such as cervical cytology ( to detect cancerous changes in the cervix) at age 21 to 29, every 3 years

  • Cervical cytology (Pap test) after 20 years of age, every 2 years

  • Pap test + HPV after 20 years of age, every 5 years

  • Laboratory test for sexually transmitted diseases such as chlamydia, gonorrhoea and HIV if you are 25 years of age or younger and sexually active

  • Colorectal cancer screening and mammography tests in high-risk groups

Dr Alexander may discuss sexuality, sexual behaviour, reproductive planning and contraceptives. Your visit will also include genetic counselling, preconception and protection against sexually transmitted infections.

Dr Alexander will also inform you about the importance of breast self-examination. You will be advised to vaccinate yourself against human papilloma virus, and Hepatitis A and B.

Ages 40 to 64 years

Screening checks for your medical history, menstrual, and reproductive history, sexual practices and menopausal symptoms.

  • Annual examination for pelvic prolapse (internal pelvic organ presses against the vagina), clinical breast examination and pelvic examination

  • Cervical cytology, every 2 years

  • Pap test + HPV, every 5 years

  • Colonoscopy (colorectal cancer screening) from age 50, or earlier if strong family history

  • Laboratory tests for HIV

  • Thyroid stimulating hormone test, every 1 years after the age of 45

  • Yearly mammography

Dr Alexander will advise you regarding sexually transmitted diseases, avoiding unwanted pregnancies, genetic counselling, preconception, hormone therapy, breast self-awareness and prophylaxis for breast cancer.

You will be advised to vaccinate yourself against Hepatitis A and B.

Ages 65 years and older

  • Screening checks for your medical history, reproductive health and menopausal symptoms.

  • Bone density scan especially with family history of osteoporosis

  • Annual examination for pelvic prolapse, breast examination and pelvic examination

  • Cervical cytology (can be stopped if prior tests have been negative)

  • Colonoscopy every 5 years or more frequently if family history.

  • Yearly mammography

  • Thyroid stimulating hormone testing every 1 years

You will be advised to perform self-breast examination tests, and can discuss sexual behaviours with Dr Alexander.

Regardless of your age, Dr Alexander will also examine your health with respect to nutrition, tobacco, alcohol and drug usage, physical activity and sexual practices.

PAP SMEARS

What is a Pap test?

The Pap test, also known as Pap smear, checks for changes in the cells of your cervix. The cervix is the lower part of the uterus (womb) that opens into the vagina (birth canal). The Pap test can indicate if you have an infection, abnormal (unhealthy) cervical cells, or cervical cancer.

During a Pap smear, Dr Alexander takes a sample of cells from your cervix to be tested and examined. A Pap test is safe with no known medical risks.

Why is a Pap test Performed?

A Pap test can save your life. Pap tests can

  • find the earliest signs of cervical cancer

  • detect infections and

  • abnormal cervical cells that can turn into cancer cells.

If diagnosed early, the chance of curing cervical cancer is very high as treatments can prevent most cases of cervical cancer from developing.

Getting regular Pap tests is the best thing you can do to prevent cervical cancer. In fact, regular Pap tests have led to a major decline in the number of cervical cancer cases and deaths.

Do all Women need Pap Tests?

It is important for all women to have annual Pap tests, along with pelvic examinations, as part of their routine health care. You need a Pap test if you are:

  • 21 years or older, and

  • Women under 21 years of age who have been sexually active for 3 years or more

There is no age limit for the Pap test. Even women who have gone through menopause need regular Pap tests.

Women aged 65 to 70 can talk to their doctor about stopping after at least 3 normal Pap tests and no abnormal results in the last 10 years.

How to prepare for a Pap test?

Many things can cause wrong test results by washing away or hiding abnormal cells of the cervix. So [doctor] suggest that for 2 days before the test you avoid:

  • Douching

  • Using tampons

  • Using vaginal creams, suppositories, and medicines

  • Using vaginal deodorant sprays or powders

  • Having sex

Make sure to empty your bladder just before your examination. [doctor] may suggest you schedule a Pap test when you do not have your period. The best time to be tested is 10 to 20 days after the first day of your last period.

How is a Pap test done?

Dr Alexander can do a Pap test during a pelvic examination. It is a simple and quick test. While you lie on an examination table, [doctor] puts an instrument called a speculum into your vagina opening to see the cervix.

When [doctor] performs the procedure what is being examine is:

  • lumps, sores, inflammation, or other abnormalities of the external genitals..

  • using a metal or plastic instrument called a speculum into the vagina, and

  • a small disposable swab, wooden spatula, brush, or soft-bristled "broom" to remove cells from the entrance to the canal that connects the cervix with the uterus.

  • the cell sample on a glass slide, which is sent to a laboratory for examination under a microscope.

While usually painless, a Pap test is uncomfortable for some women.

What do abnormal Pap test results mean?

Abnormal Pap test results usually do not mean you have cancer. Most often there is a small problem with the cervix. Some abnormal cells will turn into cancer if left untreated for a long period of time, but early cell changes can revert back into normal in most of the cases.

By treating these unhealthy cells, almost all cases of cervical cancer can be prevented. If you have abnormal results, then consult with Dr Alexander about what they mean.

Although every effort is made to educate you on PAP TEST and take control, there will be specific information that will not be discussed. Talk to Dr Alexander about any concerns you have about PAP TEST.

ABNORMAL PAP SMEAR

Pap smear or Pap test is conducted as part of a woman's routine health examination, after the age of 21 years. It is not a diagnostic test, but is a screening tool used to detect any abnormal cells in the cervix. The cervix is the lower part of the uterus that opens into the vagina.

Pap smears help in early detection of any serious medical conditions such as cervical cancer.

Abnormal Pap smears may indicate the presence of infection or abnormal cells called dysplasia. An abnormal Pap smear may not necessarily denote cancer. These results highlight the requirement of supplementary testing to identify and confirm an underlying problem.

Causes of abnormal Pap smears

An abnormal pap smear may indicate any of the following:

  • Dysplasia (abnormal cells that may be precancerous)

  • Atrophy or vaginal dryness especially after menopause

  • An infection or an inflammation

  • Herpes

  • Trichomoniasis

  • Recent sexual activity

  • HPV (Human Papillomavirus) infection; also called genital warts

Symptoms Associated with Abnormal Pap Results

Usually, abnormal cells do not produce any symptoms. Moreover, even the presence of HPV in an abnormal Pap smear is asymptomatic. Therefore, a regular Pap smear is beneficial in early detection of any abnormalities.

An abnormal Pap smear secondary to a sexually transmitted infection may induce the following symptoms:

  • Abnormal discharge from the vagina, such as change in the amount, colour, odour or texture

  • Abnormal sensations such as pain, burning, or itching in the pelvic or genital area during urination or sex

  • Sores, lumps, blisters, rashes or warts on or around the genitals

Further Tests after Abnormal Pap Results

Following an abnormal Pap smear, the next step is further testing to confirm the cause of the abnormal cells. A repeat Pap smear or test for human papilloma virus (HPV), a major risk factor for cervical cancer, may also be recommended.

Depending on the age of the patient and the type of abnormal cells, [doctor] may recommend the following treatment options:

  • Loop electrosurgical excision procedure (LEEP): In this procedure, a triangular segment of cervical tissue including abnormal cells is removed by specially designed instruments for evaluation.

  • Cone biopsy, same as above but usually reserved for deeper lesion. Dr Alexander will make the choice usually depending type and location of abnormality.

WHAT IS COLPOSCOPY?

Colposcopy is a procedure in which a special magnifying instrument called a colposcope is used to look into the vagina and into the cervix. The colposcope gives an enlarged view of the outer portion of the cervix.

Why would a Colposcopy be necessary?

Colposcopy is done when there are abnormal changes in the cells of the cervix as seen on a Pap test. Further, it may be done to assess problems such as genital warts on the cervix, inflammation of the cervix, benign growths or polyps, pain and bleeding.

How is the Colposcopy procedure done?

During a colposcopy, you will lie on your back with feet raised just as you do when you have a regular pelvic examination. [doctor] uses an instrument called a speculum to hold the walls of the vagina apart. Then the colposcope is placed at the opening of your vagina.

A mild solution may be applied to the vagina and cervix with a cotton swab. This makes abnormal areas to be seen easily.  [doctor] will look inside the vagina to locate any problem. If there are any abnormalities, [doctor] may take a small tissue sample called a biopsy.

You may feel a mild pinch or cramp while the biopsy sample is taken. The tissue is then sent to a laboratory for further study.

What to expect after the Colposcopy procedure?

Your gynaecologist will talk to you about any problems detected during colposcopy. If a sample of tissue was taken from your cervix (biopsy), the laboratory results should be ready in 2 to 3 weeks.

Most women feel fine after colposcopy. You may feel a little lightheaded and if you have had a biopsy, you may have some mild bleeding. Talk to your gynaecologist about how to take care of yourself after the procedure and when you need to return for a check-up.

What are the risks of colposcopy?

There may be a risk of infection when you have a colposcopy. Mild pain and cramping during the procedure and mild bleeding afterwards are common. This most often happens when a biopsy is done. If there is heavy bleeding, fever, or severe pain after the procedure, contact your gynaecologist immediately.

Abnormal Pap smear during pregnancy

A Pap smear during pregnancy is very safe. In case of an abnormal Pap smear, a colposcopy can be performed during pregnancy. However, further treatments are delayed until the birth of the baby. Often, the birth process washes away the abnormal cervical cells.