Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
When should women start and stop having Pap smears, and how often should Pap
smears be performed?
The table summarizes the consensus of all the major
organizations regarding these important questions. The key points of the table
are as follows:
All the guidelines agree that Pap smears should be started
within 3 years of first sexual activity or age 21, whichever comes first.
There
are minor differences in the recommendations for the frequency and age at which
to stop Pap smears.
Older women who have had many normal Pap smears in a row and
have been regularly screened are highly unlikely to have an abnormal Pap smear.
These findings point to stopping Pap smears in older women, as reflected by
several of the guidelines in the Table.
Women who have had a total hysterectomy
for a benign condition no longer have a cervix, and thus do not derive any
benefit from screening for cervical cancer.
In contrast, women who have had a subtotal hysterectomy still
have a cervix, and thus should be screened according to the recommendations of women
who have not had a hysterectomy.
Women who have had a hysterectomy for abnormal
Pap smears have their own special recommendations.
Special situations may impact the frequency of screening. For example, women who have had cervical cancer, exposure to diethylstilbestrol, or a compromised immune
system (as with HIV infection, for example) should continue annual screening as
long as they are in reasonably good health. Women who have had a hysterectomy
for CIN2 or CIN3 (a type of abnormal Pap smear) should be screened until they
have had three normal Pap smears, (and if no abnormal Paps show up in 10 years, they
can stop having Pap tests).
What is the current status of the newer Pap smear technologies?
New technologies have been developed to try to circumvent the problem of
false-negative Pap smears. False-negative results occur when a disease or
condition is present but the test does not detect it. False-negative Pap smears
(slides with abnormal cells judged to be "normal") are estimated to be between
5% and 30%.
The new techniques consist of alternative ways to prepare and read Pap smears.
In one new preparation method known as liquid-based cytology, cervical cells are obtained as usual but a new
technique is used to prepare the slides for analysis. The physician puts the
cell sample into a vial of liquid preservative. The cells are then sent to the
laboratory where they are filtered and spread on glass slides. This method
removes any contamination from blood or mucous.
Prepared slides are usually read by cytotechnologists who examine thousands of
slides under a microscope every day. This exhausting process may be subject to
human error. Computer systems are now being developed to assist by providing an
automated analysis of slides. Slides containing abnormally appearing cervical
cells can first be automatically identified and then subjected to a second,
manual re-screening.
Recent guidelines are conflicting as to whether to recommend the new
technologies because sound scientific research is not available on which to base
a thoughtful recommendation. Besides being more expensive, the underlying
problem is that the new technologies (such as liquid-based cytology) have never
been proven to decrease mortality from cervical cancer as compared to
conventional Pap testing. In addition, even if future research shows that more
cases of cervical cancer are detected with the new technologies versus the
conventional Pap testing, there may be too many "false positive" cases in which
women are labeled to have abnormal Pap smears when they are perfectly normal.
This last point is critical. The information must be gathered before rational
recommendations can be widely instituted.
Yeast vaginitis is a yeast infection of the vagina. Symptoms include itching, burning, soreness, pain during intercourse and urination, and vaginal discharge. Yeast infections can be treated with over-the-counter and prescription medications.
There are many types of ovarian cancer, epithelial carcinoma is the most common. Women with a family history of ovarian cancer have an increased risk of developing the disease. Some ovarian cancer symptoms include abdominal pain, nausea, diarrhea, constipation, and abnormal vaginal bleeding, however, they usually do not present until the disease has progressed. Early diagnosis is important for successful treatment.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Cervical cancer is cancer of the entrance to the womb (uterus). Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding.
Menopause is the time in a woman's life when menstrual periods permanently stop, also called the “change of life." Menopause symptoms include hot flashes, night sweats, irregular vaginal bleeding, vaginal dryness, painful intercourse, urinary incontinence, weight gain, and emotional symptoms such as mood swings. Treatment of menopausal symptoms varies, and should be discussed with your physician.
Chlamydia, a type of bacteria that causes an infection, is spread through sexual contact. Most of the time, women with chlamydia have no symptoms. Antibiotics are an effective treatment for chlamydia.
Cervical dysplasia is a condition in which the cells of the inner lining of the cervix have precancerous changes. There are two types of cervical dysplasia; 1) squamous intraepithelial lesion, and 2) cervical intraepithelial neoplasia. Cervical dysplasia is caused by infection of the cervix with HPV (human papillomavirus). There are various diagnostic measures for cervical dysplasia. Treatment generally depends upon the progression of the dysplasia, mild, moderate, or severe.
Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the U.S. HPV is primarily transmitted by sexual contact. While some people develop warts in the genital region after infection, others experience no symptoms. Though genital warts can be removed, there is no cure for HPV infection. There is a vaccine to prevent infection from four common HPV types.
Vaginal cancer is fairly uncommon. There are two types of vaginal cancer: squamous cell carcinoma and adenocarcinoma. Risk factors include being 60 or older, exposure to DES while in the womb, HPV infection, and having a history of abnormal cervical cells. Painful intercourse, pelvic pain, vaginal lumps, and abnormal vaginal bleeding or discharge are all symptoms of vaginal cancer. Treatment depends upon the stage of the vaginal cancer and may involve surgery, radiation therapy, chemotherapy, and the use of radiosensitizers.
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include: abdominal pressure, pelvic pain, and pain during intercourse. Diagnosis and treatment of benign uterine growths depends upon the type of growth.
Syphilis, a sexually transmitted disease, is caused by a microscopic, wormlike bacterial organism called a spirochete. There are three stages of syphilis. The first involves the formation of the chancre. The second stage often includes hair loss, a sore throat, white patches in the nose, mouth, and vagina, fever, headaches, and a skin rash. The third stage can cause extensive damage to the internal organs and the brain, and can lead to death. Though early infection often resolves on its own, treatment usually varies based on the stage of the infection at the time of diagnosis.
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Sexual health information including birth control, impotence, herpes, sexually transmitted diseases, staying healthy, women's sexual health concerns, and men's sexual health concerns. Learn about the most common sexual conditions affecting men and women.
When you are pregnant, many sexually transmitted diseases (STDs) can be especially harmful to you and your baby. These STDs include herpes, HIV/AIDS, genital warts (HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis. Symptoms include bumps, sores, warts, swelling, itching, or redness in the genital region. Treatment of STDs while pregnant depends on how far along you are in the pregnancy and the progression of the infection.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
Womens Health RSS
Healthy Living Tips
