Introduction to Women’s Health Care

1. Introduction to Women’s Health Care

2. Women’s HealthWhat does a teen girl need to know? • What in the world is a women’s health exam? • Why would anyone have one? • Do I need one?

3. Rachel Sieman, CNMCertified Nurse-Midwife

5. Nurse MidwifeMidwife: “with woman” Women’s Health Care Pregnancy and Birth

6. Women’s Health Care • Annual exams and PAP tests • Birth control • STD testing and treatment • Common problems • Pregnancy and Birth • Prenatal care • Birth

9. Everything you need to know(but were afraid to ask) • Why do I need an exam? • When do I need one? • Who will do my exam? • What will happen?

10. Why does anyone need an exam? • Screening for breast and cervical cancer • Common gynecologic problems • Family planning • STD testing and treatment

11. Why? Breast Cancer Screening • Lifetime risk is 12.8% • This is one out of every eight women! • Breast cancer is the second most common cancer among women (skin cancer 1st) • Lung cancer is leading cause of cancer death in women, breast cancer is second

12. Breast Cancer Risk Factors

14. Breast Cancer Facts • Early diagnosis is the key to surviving breast cancer • Nearly 97% of women who are diagnosed with breast cancer at an early stage survive for more than 5 years • Breast cancer occurs when there is erratic cell growth and proliferation in the breast tissue

15. Normal Breast Structure

16. Cancer vs. Non-cancer

17. Breast Cysts • Fluid-filled sacs within the breast • May become enlarged and tender just before your period • Not cancer, but any new lump should be checked out by a health care provider • Treatment: possibly decreasing caffeine

19. Early Detection Methods:3 ways to catch breast cancer early • Screening Mammogram • Yearly for women over 40 • Clinical Breast Exam • Performed by a doctor, nurse practitioner or nurse-midwife • Yearly for women >40 • Every 3 years for women 20-39 • Breast Self Exam (BSE) • Monthly

20. Mammogram • X-ray of the breast to detect breast cancer • Can detect a lump before it can be felt • Studies demonstrate that mammograms reduce the risk of dying from breast cancer

23. How to do a Self Breast Exam (SBE)

24. When to contact your health care provider • You feel a lump • There is a change in your skin • Dimpling • Retraction • Looks like an orange peel • Red, warm, swollen • Your breasts hurt, and it’s not related to your cycles • Nipple discharge when you are not pregnant or breastfeeding • There is anything that concerns you

25. A word about nipple piercing • Potential complications • Infection, can be severe • Nerve damage* • Blood-filled cyst • Scarring, including keloid formation • Can contract hepatitis B or C, or HIV (rare) • Allergic reaction to the metal • Damage to the nipple if pulled • Need to remove to breastfeed, may leak breast milk through piercing hole

26. Why? Cervical cancer screening Abnormal cells on the cervix that multiply out of control

27. Most cases of cervical cancer caused by HPV virus • Human Papillomavirus • Common virus: more than 100 subtypes • 30 of these sub-types are sexually transmitted • High-risk strains cause cervical cancer, cancer of the tonsils and throat** • Low-risk types cause genital warts

28. How common is cervical cancer? • Most common sexually transmitted infection • 11,000 new cases each year • 3,600 women die each year (that’s 10 per day in the U.S.) Worldwide, the 2nd most common type of female cancer

29. Cases of Cervical Cancerhave decreased 75% in last 50 years in the U.S.

30. Surviving Cervical Cancer: better screening is key • Overall 5-year survival rate for women diagnosed with cervical cancer, regardless of stage - 73% • Screening done with PAP test • Cells collected from cervix • Looked at under microscope

31. How common are abnormal PAP test results? • Abnormal Pap test results are quite common • They are usually only slightly abnormal • If followed up and treated early, you can prevent the abnormality from turning into cervical cancer

32. Whendo I need a PAP test? • Starting at age 21 • Every year until age 30 • After age 30, if you have had only normal results, you may have them every 2 to 3 years (after talking with your health care provider about your level of risk)

33. Why do I need to keep getting tested? • PAP testing is not a one-time test • New changes (abnormalities) can occur after you get tested, even if you have not had new partners • It could take many years for changes to develop or to be noticed • Your risk changes if you have new partners, or if your partner has other partners *

34. When should I have my first women’s health exam? • Age 21 • When sexually active (or considering it) • Women’s health problem

35. Women’s health problems • Abnormal vaginal bleeding • Periods more often than every 3 weeks • Periods less often than every 6 weeks • Bleeding between periods • Periods that last longer than a week • Very heavy periods (soaking a pad per hour) • Painful Periods • Cramps that interfere with your lifestyle • Headaches that occur with menstruation • PMS

36. Other reasons to see a health care provider • Breast lump or pain • Vaginal itching, burning, or odor • Painful urination, or blood in your urine • Testing for STDs • Family planning (birth control) • Pregnancy care

38. Who will do my exam? • Women’s health provider • Physician or physician’s assistant • Nurse practitioner • Nurse-midwife • Male or Female • Physicians and Midwives also deliver babies

39. The GYN exam and PAP test: What to Expect • First things first • Weight • Blood pressure

40. Lots of Questions(while you are still dressed) • Know the first day of your last menstrual period • Medical history (asthma, diabetes, etc.) • Surgical history (tonsils, etc.) • Menstrual history • Sexual history • Problems you want to address

41. General exam • Breast exam

42. Positioning for the PAP test and pelvic exam

43. The Pelvic Exam with PAP test External exam Examine external anatomy Internal exam: 2 parts 1. Speculum Exam Examine vaginal walls and cervix PAP test and testing for STD’s can be done 2. Bimanual Exam Feel uterus and ovaries

44. Instruments • Speculum • Collection devices and liquid medium

45. Speculum Exam

46. What is a PAP test? • Cells are collected from the surface of your cervix by a health care provider

47. Bimanual exam

48. What now?