A newsletter from the office of Dr Mary Kirk
March 2017
Let's talk about what your gynecological exam covers
and why it's so very important.
Did you know that your Annual Gynecologic Exam may no longer include a cervical or vaginal Pap smear? New research and guidelines from the American College of Obstetricians and Gynecologists now say that Pap smear testing may be conducted every three to five years in a low risk population. In an effort to provide our patients the most current and compassionate care available, we are adopting these new guidelines in 2017. In fact, starting in 2017, we will be doing far fewer Pap tests during Annual Well Woman Exams.  I know this new development may sound very strange and new to those of you who have been told for years that a Pap smear every 12 months is a necessity.  In fact, many women have come to believe that the Annual Well Woman Exam (WWE) is synonymous with a Pap smear.  An annual WWE, however, is only comprised of a clinical breast exam and a pelvic exam in which a clinician checks your breasts, uterus, cervix, vagina, and ovaries for any abnormalities. 

Your annual WWE is the best time to have a face to face conversation 
with your provider regarding any personal questions or health 
concerns you may be experiencing.

An annual WWE also provides the perfect opportunity to discuss any general health screening questions you may have with your provider.  Topics such as sexual dysfunction, female incontinence, osteoporosis, cholesterol screening, thyroid disease, diabetes, and anemia testing are very frequently discussed.  The WWE also provides an opportunity to prescribe and monitor contraceptives and to screen for STDs.  

We will be happy to answer any additional questions that you may have concerning our new policies.... and we will see you at your next Gyn examination!

Mary C Kirk, MD

Guidelines that we will be following in the office:
Of course, your provider will have to discuss your individual screening risks and determine the routine that best suits your healthcare needs!  Below is a basic summary for most healthy, non-smoking women.

  • Pap smear testing will begin at 21 years of age unless high risk sexual behavior is present prior.
  • Routine Pap smears in healthy, non-smoking women with no underlying chronic medical conditions will be performed every three years.  
  • Women over age 30 yrs. will have a Pap smear and HPV testing performed.  If both screening tests are negative, then testing will be repeated every 5 years.
  • Women over age 65 years of age will no longer need a Pap smear screening unless they have had an abnormal Pap smear in the past or have a concurrent chronic medical condition.
  • Women who have had a hysterectomy with removal of the cervix for non-cervical cancer indications NO LONGER NEED PAP SMEAR SCREENINGS.

What exactly does the Pap Smear screen for?
A Pap smear is a screening test for any recent changes in the outer cells of your cervix that may be caused by an exposure to the Human Papilloma Virus (HPV).  These changes, if severe enough, can be a sign of an early cervical cancer.  The Pap smear may be suggestive of changes from HPV exposure, but it does not routinely test for the actual presence of the HPV DNA.

Is there a test for HPV DNA?
YES!  We can screen for the presence of certain "high risk" strains of the HPV virus, which are the ones that we know are more likely to progress to cervical cancer or vulvo-vaginal condyloma.  In some situations, the laboratory will automatically perform this test for High Risk HPV (HRHPV) and in others it must be requested specifically.  In women over 30 years of age we will now routinely request the HPV testing.  If both the Pap smear and the HPV testing are negative, then the testing does not need to be performed as frequently.

Why did the guidelines change for Pap Smear Testing?
There has been a tremendous amount of research performed in the past five years about the HPV virus and its correlation with cervical cancer.  This medical research combined with our current Pap smear's ability to detect the lowest levels of HPV DNA have made the screenings much more accurate.  Here are some highlights of the new information that we have learned.
  • Normal, healthy, non-smoking women are at very low risk for developing cervical cancer.
  • The changes caused by HPV in the cervix are very slow growing and indolent.  Most changes will resolve before they ever become cancerous.
  • The wide spread usage of the Gardasil vaccine which has now been administered to both boys and girls ranging in age from 11 years old to 25 years old has drastically reduced the number of cervical cancer diagnoses made annually.  Gardasil has now been FDA approved for over 10 years with a well-documented safety profile.   If you qualify for the Gardasil vaccination (age 11-25 years) and have not had it administered, please contact the office to begin the three-injection series.  
  • Having a Pap smear every year can increase the risk of an abnormal false positive Pap smear reading.  This may lead to additional unnecessary testing and worry.

What if I've had the Gardasil (HPV) vaccination series?
You will still need to follow the age appropriate guidelines:
  • Pap smear testing to begin at age 21.
  • Routine Pap smear testing + HPV testing every 3 years.
  • Women over age 65 no longer need Pap testing.
  • Women with a hysterectomy no longer need Pap testing.

If I don't need a Pap smear every year, then why do I need to come in for an Annual Examination?
Your Annual WWE is very important to your overall health and well-being.  A breast examination and review of your breast cancer risk factors will be assessed annually.  Appropriate screening tests for Mammography, Breast Ultrasound, or MRI will be ordered.  Birth control, contraceptives and hormonal management need to be assessed annually as well. Your vulva, vagina, cervix, uterus and ovaries will be examined and assessed for any other developing problems related to menstruation, menopause, or sexual activity.  Screening for sexually transmitted diseases is still recommended annually for sexually active women.  Certainly, different age groups will require different laboratory or screening tests.

If I've had a hysterectomy do I still need an Annual Examination?
If you have had your ovaries removed at the time of surgery for benign disease, NO you do not need an annual examination.  You DO still need annual mammography screening over the age of 40.  If your ovaries remain you do NOT want to forget about them!  You should have a pelvic examination once every two to three years to make sure things continue to go well.

Fun Fact:
Some of the earliest named doctors were women.

Merit Ptah, the first female doctor known by name lived in Egypt around 2,700 BC.

About 200 years later, Peseshet was described as 'overseer of female physicians'.

Not much is known about the practices of Merit Ptah or Peseshet but female doctors appear to have been a respected part of ancient Egyptian society.

Dr Mary C Kirk | 918-508-2200 | www.kirkobgyn.com