We realize that many lesbian women neglect their sexual health due to fear of being ridiculed or discriminated against on the basis of their sexual orientation. WSW and bisexual women often experience the same kind of fear. The chances are that even if these women do go for medical checkups, they tend to keep important personal information to themselves. This can lead to mis-diagnosis and lack of proper health information given, because the health care provider has no proper sexual history of the woman. If you are one of those woman who find it difficult to disclose your sexual orientation or same sex sexual history, we suggest you call.
REGULAR CHECK UPS
BREAST SELF-EXAMINATION (BSE)
Breast self-examination is a procedure performed by oneself to physically examine yourself for any changes in your breasts and underarm areas of your body. BSE should used in addition to clinical breast examination and mammography for early detection of breast cancer.
How to examine your breasts
- Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
- Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
- Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.
- Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
- There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.
- While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
- Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.
A Mammogram is a low-powered x-ray technique that displays an image of the internal structure of your breast. Additional angles and magnified views are taken of suspicious areas. The function of a mammogram is to assist in early diagnosis of breast diseases, including cancer. A mammogram can detect cancer even before a lump is felt. It is recommended that women have baseline mammogram at age 40, followed by a mammogram every couple of years until age 50. Family history may require that women do mammogram’s earlier and more frequently. After the age of 50 years, women should have a mammogram done yearly.
What to expect during a mammogram
- At the radiology department, they would ask you to undress and only keep your panties on and the examination jacket provided. If you are wearing a neck less, also a remove that.
- The radiologist will ask you to remove the examination jacket and stand next to the X-ray machine.
- The radiologist will assist you to place one of your breasts between two compression plates to flatten the breast to a thickness of about 4-6 cm. It may be a little uncomfortable.
- Your breast will first be compressed horizontally and then obliquely. An X-ray will be taken of each position. The same procedure will be followed for your other breast.
PELVIC AND VAGINAL EXAMINATION
A pelvic exam is a simple procedure — although for many an embarrassing or uncomfortable one. Your doctor or health care practitioner will examine your vulva, vagina, uterus, rectum and pelvic and your ovaries for masses or growths. Often a pap smear is part of the procedure, but it is not always the case. Understanding what your doctor is looking for during a pelvic exam may put your mind at ease. Learn who the test is for, when you should have it done and what exactly happens during a pelvic exam.
Who needs a pelvic exam?
All women benefit from routine gynecologic screening, including a pelvic exam. Most experts agree that the first pelvic exam should take place within three years of the onset of sexual activity or by age 21, whichever comes first. Your doctor can recommend how frequently you need to be examined, but many women have a pelvic exam once a year.
How do you prepare for a pelvic exam?
No special preparation is required for a pelvic exam, though you may be advised to schedule the test on a day when you don’t have your menstrual cycle.
Where is the pelvic examination performed?
A pelvic exam is performed in your doctor or health care practitioner’s office and takes only a few minutes. The exam involves using a specialized technique to feel (palpate) your pelvic organs and maybe a visual inspection of your vagina by means of using a speculum. Your doctor is looking for signs that point to a problem that requires treatment, such as an infection, a sexually transmitted disease or early-stage cancer.
What can you expect during a pelvic exam?
- You’ll be asked to change out of your clothes and into an examination gown in privacy. This means that you will need to take of your bra and panties as well.
- Before performing the pelvic exam, your health care practitioner may listen to your heart and lungs and perform a breast examination.
- During the pelvic examination, you will lie on your back on an examination bed. To allow your health care practitioner to examine you more comfortable, you will have to bend your knees and place your feet on the corners of the bed for support. You’ll be asked to slide your body toward the end of the table and let your knees fall apart.
- To assist your health care practitioner, try to keep your legs as far apart as possible. This will allow your health care practitioner to examine you more thoroughly and this will cause less discomfort for you. The procedure is not painful, but may be uncomfortable due to the cold lubrication and the fingers that enter your vagina.
- First, your health care practitioner will visually inspects your external genitalia, looking for sores, swelling or any other abnormalities. He/She will then inspect your vagina using a speculum — a plastic or metal-hinged instrument shaped like a duck’s bill, which spreads open your vaginal canal. Before the speculum is inserted, it is lubricated with a water-base lubricant. Often, the speculum is cold, so this might be uncomfortable.
- Inserting and opening the speculum can cause pressure or discomfort for some women. Relaxing as much as possible may ease discomfort, but tell your health care practitioner if you experience pain. If your pelvic examination includes a Pap smear, a sample will be taken of your cervix before the speculum is removed.
- After removal of the speculum, your health care practitioner will examine your other pelvic organs for any signs of abnormalities. Because your pelvic organs, including your uterus and ovaries, can’t be seen from outside your body, your health care practitioner needs to feel (palpate) your abdomen for this portion of the exam. To do this your health care practitioner inserts two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. This is to check the size and shape of your uterus and ovaries and identify any tenderness or unusual growths. Sometimes after the vaginal examination — especially if you’re older than 40 — your doctor also inserts a gloved finger into your rectum to check for tenderness, growths or other irregularities.
- Usually your health care practitioner will tell you exactly what he or she is doing next so that nothing comes as a surprise to you.
During a pelvic exam, your doctor uses a speculum to hold your vaginal walls apart. If your pelvic exam also includes a Pap test, your doctor collects a sample of cells from your cervix, using a small cone-shaped brush and a small plastic spatula (1 and 2). Your doctor then transfers the cells onto a glass slide (3) for examination under a microscope. Or your doctor may rinse the brush in a liquid-filled vial (4) and send the vial to a laboratory for testing.
After the pelvic exam
- When the pelvic examination is completed, you may get dressed.
- Your health care practitioner will inform you if he/she discovered anything unusual during your pelvic examination. If you had a pap smear, the results will be available within a few days.
- Your health care practitioner will discuss any necessary next steps, including your health care practitioner’s recommendation on your follow-up or the timing of your next pelvic examination.
Having regular pelvic examinations can help to ensure that any problems that you might have, are detected at an early and treatable stage.
VAGINAL PAP SMEAR
A pap smear, also called a pap test, is a procedure to test for cervical cancer in women. A pap smear involves collecting cells from your cervix — the lower, narrow end of your uterus.
Detecting cervical cancer early with a pap smear gives you a greater chance for treatment and curing of cervical cancer. A pap smear can also detect changes in your cervical cells that suggest cancer may develop in the future. Early detection of these cells is your first step in stopping the possible development of cervical cancer. Furthermore, a pap smear can also detect any infection that you may or may not have. A pap smear can be done in conjunction with a pelvic examination.
Who should have a pap smear?
Women should have her first pap smear about three years after first having sexual relations or at age 21, whichever comes first. Pap smears are not only for heterosexual women, Lesbian women should also abide by this rule. In general it is safer to have a pap smear annually, although some medical professionals say if you had 3 negative results in a row, then you can do it every 2-3 years. If you have any of the following risk factors then you should go annually for a pap smear, regardless of your age:
- Any previous diagnosis of a cervical cancer or a result showing precancerous cells;
- Family history of cervical cancer;
- HIV infection;
- Weakened immune system due to organ transplant, chemotherapy or chronic corticosteroid use.
Who can consider stopping Pap smears?
Discuss your screening options with your doctor. In certain situations a woman and her doctor may decide to end Pap testing, such as:
- After total hysterectomy. After a total hysterectomy (surgical removal of the uterus including the cervix) ask your doctor if you need to continue having Pap smears. If you had hysterectomy due to noncancerous conditions, you may be able to discontinue routine pap smears. If your hysterectomy was for a precancerous or cancerous condition, you should have an annual vaginal pap smear.
- Older age. There is not enough evidence to determine an age at which it’s safe to stop testing. Some health care professionals believe that if you are 70 years of age and had 3 negative results in the last 10 years, you can stop having pap smears. Discuss your options with your health care professional and together you can decide what’s best for you based on your risk factors.
A pap smear is a safe and easy way to screen for cervical cancer. However, a pap smear isn’t always foolproof. It’s possible to receive false-negative results, meaning that the test indicates no abnormality, even though you do have abnormal cells.
The liquid-based Pap smear test, in which the sample of cells is preserved in liquid rather than smeared on a microscope slide, provides fewer false-negative results. With either test, false-positive results, when the test indicates an abnormality when there really isn’t one, are extremely rare. To eliminate the changes of false negative and false positive, 2 microscope slides are examined, to be able to compare.
A false-negative result doesn’t mean that a mistake was made. Many factors can cause a false-negative result, including:
- An inadequate collection of cells;
- A small number of abnormal cells;
- An inaccessible location of the lesion;
- A small lesion;
- Abnormal cells mimicking benign cells;
- Blood or inflammatory cells obscuring the abnormal cells.
Although it’s possible for abnormal cells to go undetected, time is on your side. Cervical cancer takes several years to develop, and if one test doesn’t detect the abnormal cells, the next test most likely will. Therefore it is best to go annually for a pap smear.
How to prepare for your pap smear
To ensure that your pap smear is most effective, follow the following guidelines:
- Avoid penetration intercourse, douching or using any vaginal medicines or spermicidal foams, creams or jellies for two days before having a pap smear, as these may wash away or obscure abnormal cells; and
- Try not to schedule a pap smear during your menstrual period. If you recently menstruated, you should at least have stopped for two days. Although the test can be done, it’s best to avoid this time of your cycle cause the blood will prevent the cytologist to see the cells clearly under a microscope.
What can you expect during the pap smear?
- You’ll be asked to change out of your clothes and into an examination gown in privacy. This means that you will need to take of your bra and panties as well. Depending on the procedure, if it is only a pap smear or in combination with pelvic examination, your health care practitioner might even ask you just to take off your clothes from the waist downwards.
- During the pap smear, you will lie on your back on an examination bed. To allow your health care practitioner to examine you more comfortable, you will have to bend your knees and place your feet on the corners of the bed for support. You’ll be asked to slide your body toward the end of the bed and let your knees fall apart.
- To assist your health care practitioner, try to keep your legs as far apart as possible. This will allow your health care practitioner to examine you more thoroughly and this will be less uncomfortable for you.
- Your health care practitioner will gently insert an instrument called a speculum into your vagina. The speculum holds the walls of the vagina apart so that your health care practitioner can easily see your cervix. Inserting the speculum may cause sensation of pressure in your pelvic area. The procedure is not painful, but may be uncomfortable due to the cold lubrication and the speculum that is inserted in your vagina.
- Then your health care practitioner will take two samples of your cervical cells using a soft brush and/or a flat scraping device called a spatula. This doesn’t hurt and you may not even feel the sample being taken.
- The sample is then spread onto two microscope slides and sprayed with fixation spray to keep the cells in place. He/she might also transfer the cells collected into a container containing a special liquid to preserve the sample and this is called a liquid-bases pap smear test.
- After removal of the speculum, your health care practitioner might perform or continue with a pelvic examination.
After the Pap smear
After your pap smear, you can continue with your day as normal without any restrictions about your day without any restrictions.
The samples are transferred to a laboratory where a cytologist (a person trained to detect abnormal cells) will examine your sample. The cytologist work in cooperation with a pathologist (a doctor who specializes in cellular abnormalities). The pathologist is responsible for the final diagnosis.
Ask your health care practitioner when you can expect the results of your pap smear. In some cases, your health care practitioner will only contact you if something of concern is found or if it’s determined that you need further testing.
- Normal results
If only normal cervical cells were discovered during your pap smear, your test will then be negative for presence of cancer cells. You won’t need any further treatment or testing until you’re due for your next pap smear and pelvic examination.
- Abnormal results
If abnormal or unusual cells were discovered during your pap smear, this means that you have a positive result or the presence of cancer cells were noted.
Here are some terms your doctor might use and what your next course of action might be:
- Atypical squamous cells of undetermined significance (ASCUS). Squamous cells are thin and flat and grow on the surface of a healthy cervix. In the case of ASCUS, the pap smear reveals slightly abnormal squamous cells, but the changes don’t clearly suggest that precancerous cells are present. With the liquid-based test, your health care practitioner can reanalyze the sample to check for the presence of viruses known to promote the development of cancer, such as some types of human papillomavirus (HPV). [see: STI’s > Genital Warts) If no high-risk viruses are present, the abnormal cells found as a result of the test aren’t of great concern. If worrisome viruses are present, you’ll need further testing.
- Squamous intraepithelial lesion. This term is used to indicate that the cells collected from the pap smear may be precancerous. If the changes are low-grade, the size, shape and other characteristics of the cells suggest that if a precancerous lesion is present, it’s likely to be years away from becoming a cancer. If the changes are high-grade, there’s a greater chance that the lesion may develop into cancer much sooner. Diagnostic testing is necessary.
- Atypical glandular cells. Glandular cells produce mucus and grow in the opening of your cervix and within your uterus. Atypical glandular cells may appear to be slightly abnormal, but it’s unclear whether they’re cancerous. Further testing is needed to determine the source of the abnormal cells and their significance.
- Squamous cancer or adenocarcinoma cells. The cells collected from the pap smear appear so abnormal that the pathologist is almost certain a cancer is present in the vagina, cervix or, occasionally, the uterus. Squamous refers to cancers arising in the flat surface cells of the vagina or cervix. Adenocarcinoma refers to cancers arising in glandular cells. If such cells are found, your health care practitioner will recommend additional examinations.
If your pap smear is abnormal, your doctor may perform a procedure called colposcopy using a special magnifying instrument (colposcope) to examine the tissues of the cervix, vagina and vulva. He or she may take a tissue sample (biopsy) from any areas that appear abnormal. The tissue sample is then sent to a laboratory for analysis and for a definitive diagnosis.