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 Northwest Women's Consultants 

Gynecology

Q. I missed one or two of my birth control pills.  What should I do?
If you’ve missed one pill, go ahead and take 2 pills that day (the pill you missed plus the pill for that day).  If you’ve missed two pills, take 2 pills the next 2 days.  If you have missed two or more pills, you MUST use a back-up birth control method (i.e. condoms) for the remainder of the month.  Missing birth control pills may cause breakthrough bleeding or spotting.  If you are late for your period after missing pills, you should check a pregnancy test.

Q. I have my period…can I still come in for my pap smear?
If you are bleeding heavily, we recommend that you reschedule.  If your bleeding is light or just spotting, you should keep your scheduled appointment.

Q. I think I might have a yeast infection, what should I do?
If you have had a yeast infection diagnosed by a doctor in the past, and your symptoms are the same, you may try an over the counter yeast infection medicine, such as Monistat.  If your symptoms do not improve within a week taking the medication, please make an appointment to see us.
If you have never had a yeast infection before, it is best to call our office for an appointment so that we can make sure you have the correct diagnosis and are treated with the correct medicine.  
Our nurses are also available to answer your questions regarding vaginal infections.

Q. If the condom breaks or I have unprotected intercourse, is there any way to prevent pregnancy?
Yes.  Emergency contraception is now available over the counter.  It is called Plan B.  You must take this within 72 hours of the unprotected intercourse.  It works by interrupting or delaying ovulation (release of an egg) so that fertilization and pregnancy cannot occur.  This should not be used as a long term birth control method and cannot work once a fertilized egg has implanted into the uterus (i.e. when someone is already pregnant).  Plan B will come with extensive instructions.  You are welcome to call our office if you have questions.

Q. What is HPV?
Human papilloma virus is a very common infection that can be transmitted from person to person.  The type of HPV that we worry about is the kind that is sexually transmitted.  There are many strains of the virus that are sexually transmitted.   Some cause genital warts and some cause abnormal pap smears and even cervical cancer.  Studies show that at least 3 out of 4 sexually active people will contract HPV at some time in their lives.  The Pap smear is a test used to screen for cervical cancer and any lesions that could someday lead to cervical cancer.

 Q. Is there a medicine I can take to get rid of my HPV?
Unfortunately, there is no cure for HPV.  Your body’s immune system can sometimes fight the virus with time; and your pap smear can return to normal on its own in some cases.  There are things you can do to decrease your risk of getting HPV:

Limit your sexual partners.  The higher your number of sexual partners the greater your risk of being exposed to HPV.
Get vaccinated.  Gardasil is currently available in our office for patients 9-26 years old.  It protects women against the 2 most common strains of HPV that cause genital warts and the 2 most common strains that cause abnormal pap smears and cervical cancer.   www.gardasil.com/  

Use condoms.  This can decrease your risk of contracting HPV (although not 100%).
Quit smoking—smoking can worsen the effects of the HPV virus.

Q. Do I get an HPV (human papilloma virus) test with my pap smear?
In all our patients aged 30-64, an HPV test is done with your pap smear.  We do this test because it has been shown that an HPV test is more sensitive than a pap alone in detecting pre-cancerous lesions of the cervix.  If both your pap and HPV test are negative, you can have peace of mind that you do not have a high grade (pre-cancerous) cervical lesion or cervical cancer.

Q. What if I have a positive HPV test?
The current recommendation for a normal pap smear but positive HPV test is a repeat pap and HPV test in 6-12 months.  If your HPV is still positive at your repeat exam, it will be recommended that you have a colposcopy (microscope exam of cervix with biopsies).
If your HPV test is positive, you should not blame your partner.  There is no way to tell when or where you were exposed to the virus.  Exposure could have been many years ago.

If you have atypical cells on your pap smear and a positive HPV test, the recommendation will be for you to have a colposcopy.

Q. What is a colposcopy?
This is a test which allows us to view the cervix with a microscope.  Usually biopsies of the cervix are done with this test.
The test only takes about 15-20 minutes.  You may have some slight discomfort or cramping with the test but should be able to return to work or school the next day.
You should not have sex for at least 1-2 weeks following the test.

This test is for patients with abnormal pap smears or 2 positive HPV tests in a row.
You may have spotting, light bleeding, or dark colored discharge after the test.
Your doctor will have results within 1-2 weeks.

Q. I’ve been told I need a LEEP…what should I expect?

A LEEP (loop electrosurgical excisions procedure) uses a loop connected to an electrical current to remove a thin cone-shaped area of your cervix where abnormal cells are located.
A speculum is used like when you have a Pap smear.  We then inject numbing medicine into the cervix.  Once the loop is used to remove the abnormal area, we will control the bleeding with an instrument connected to the electrical current (cautery) or a special paste (“liquid band-aid).

Bleeding after the procedure can be normal but call us if you are soaking through a large pad in one hour for 2 consecutive hours.

Risks:
Infection—call us if fever >101.
A LEEP will NOT affect your ability to become pregnant in the future.
You may return to work/school after the procedure.  You may not have sex for at least 2 weeks after the procedure.

There is a very small risk that after having a LEEP that in the future, when you decide to have children, that your cervix may start to dilate too early (cervical incompetence).  We carefully monitor our patients for this complication, which happens VERY RARELY.  There is also a risk that scar tissue may form in your cervix making it difficult for your cervix to dilate during labor.

Q. I’m thinking of trying to get pregnant…what recommendations do you have?
If you have not already talked to your doctor about this, we would be happy to see you for a “pre-conceptual consult” to discuss recommendations and order any necessary lab work.  One thing that is very important is to make sure you are taking a vitamin containing folic acid.  The current recommendation is at least 400 micrograms (mcg) of folic acid daily for all women of reproductive age.  This will decrease your chance of having a baby with a neural tube defect (i.e. spina bifida).

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