Gynecology – Common Questions

Dr. Inga Zilberstein consults a patient during an office visit

Dr. Inga Zilberstein consults a patient during an office visit

What is Preventive care?

Preventive care consists of the following clinical assessment activities:

  • Review of health changes
  • Review of lifestyle changes
  • Breast exam
  • Pap smear
  • early pelvic examSTD screen (if applicable)
  • Discussion of individual nutritional support

What is a PAP smear?

A PAP smear is a test used to examine the cells of the cervix to detect any microscopic abnormalities, including those leading to cervical cancer.

In the past two years, the American College of Ob/Gyn issued new guidelines regarding the frequency of Pap smears. The new recommendations takes into consideration many individual factors.

Is there anything new in contraception?

Yes: Nexplanon.

Nexplanon is a subcutatenous progesterone implant. It is invisible. The placement is quick and virtually painless.

  • Birth control pills. New, lower doses are available
  • Barrier contraception (condom, diaphragm)
  • IUD (intrauterine device) without hormones (Paraguard)
  • IUD with progesterone (Mirena, Skyla)
  • Progesterone shots (Depo Provera)

Modes of contraception have improved. Side effects are minimized with the new birth control pills. IUDs have become very safe, and are becoming increasingly popular.

What is HPV?

  • HPV stands for human papilloma virus; there are over 100 types
  • It is the most common sexually transmitted virus today
  • Men and women can both be carriers of the virus
  • Condoms usually do not protect an individual from contracting HPV
  • HPV is responsible for genital warts
  • It is widely prevalent among women and men of all races, ages and socioeconomic classes
  • It also causes cervical dysplasia or precancerous cells of the cervix, vagina and vulva in women
  • High risk HPV is responsible for the formation of precancerous cells
  • The most common types of high risk virus are 16, 18, 31, 33, 35, 39

Is there vaccine for HPV?

New Gardasil-9 vaccine is available, and is protective against 90% of cervical cancers.

  • Gardasil® isa vaccine against the most common 4 types of HPV (Low risk: 6 and 11; High risk: 16 and 18)
  • Cervarix is a vaccine against two most common high risk types of the virus: 16 and 18
  • It works best if given to sexually naïve women between the ages of 9 and 26
  • Simply receiving a vaccine, however, does not guarantee protection against HPV

How do I know if I have HPV?

A PAP smear and a test for HPV performed together are an excellent method for detecting HPV.

What if I have HPV?

When a woman has HPV, it means that the cells in her genital tract, usually in the cervix, have the virus inside them. However, it does not mean that she is sick. It does not necessarily mean that she has precancerous cells (also called "cervical dysplasia"). Therefore, when her PAP smear shows normal cells and evidence of the HPV virus (usually meaning "High risk" types), it is safe to repeat the PAP smear in 6 months.

What is an abnormal PAP?

There are a few abnormal PAP smear findings:

ASCUS stands for atypical squamous cells of undetermined significance. They are present when:

  • a woman has HPV
  • women have lower estrogen levels (for example, during menopause)
  • a cell repair process from various causes is occurring

LGSIL stands for low grade squamous intraepithelial lesion. It occurs when:

  • Cells are infected with HPV

HGSIL stands for high grade squamous intraepithelial lesion cells which became precancerous due to the influence of HPV.

  • Cells become pre-cancerous due to the presence of HPV
  • The condition usually requires treatment

What happens if I have an abnormal PAP smear?

A woman who has an "abnormal PAP" smear is advised to have another test called colposcopy.

What is Colposcopy?

  • Colposcopy is the evaluation of the cervix through a microscope.
  • Biopsies of cervix are often performed during this evaluation
  • Cervical cells are washed with acetic acid first to remove mucus and make the area with abnormal cells better seen
  • The entire evaluation lasts only 10-15 minutes
  • There is normally minimal discomfort. Usually women report menstrual-like cramping
  • Sexual intercourse should be avoided for 3 days after colposcopy