Gynecological Care (Pap smears and breast exams)
As part of routine gynecological care, breast and cervical cancer screening is offered. The best defense against these cancers is early detection and treatment.

Breast Exams:
Starting at age 20, breast self-exams should be done every month (we will provide you information on how to do this) and regular clinical breast exams should be done by a health professional at least every three years.

At age 40 or older, breast self-exams should be done every month, yearly clinical breast exams should be done by a health professional and yearly mammograms are recommended (we can refer you for this service).

Although most breast lumps and changes are not cancerous, you need to have any changes checked by a health provider to establish benign (non-cancerous) from possibly cancerous changes. Most women who get breast cancer have no family history or other risk factors. Women at slightly higher risk for breast cancer include women whose mothers or sisters had breast cancer before the age of menopause, women who have never had children, and women who had their first child after the age of 30 years.

Pap Smear Screening:
You should start getting Pap smears within 3 years after your first vaginal intercourse (penis-vagina sex) or by the age of 21, which ever comes first. A Pap tests checks the cells of the cervix to see if they are normal. Risk for cervical cancer is higher in women who have had multiple sexual partners or in women whose partners have had multiple partners. Women with genital warts, women who smoke and those infected with the human immunodeficiency virus (HIV) are also at increased risk. Although most abnormal Pap test results don’t mean you have cancer, sometimes changes could lead to cervical cancer if left untreated.

Things you need to know when booking an appointment for your Pap smear:

Blood or other substances in the vagina can interfere with obtaining a pap smear, therefore we ask that you:
-  Book your appointment 1-2 weeks after your period will end.
-  Do not have sexual intercourse (penis in vagina) for 2 days before your appointment.
-  Do not put anything in the vagina for 2 days before your appointment. This includes tampons,
	douching and/or medications.
-  If you have a vaginal infection, this will need to be treated before your Pap smear screening
	can be done.
-  We will contact you ONLY if your Pap smear is NOT normal.

The guidelines we use for Pap smear screening is outlined below:

• Initial Screening: Begin screening at approximately 3 years after first sexual intercourse or by age 21, whichever comes first. Pap smear screening may be done sooner if indicated by medical history. Pelvic exams should be performed annually even if a Pap smear is not required.
   
• Until age 30: Yearly Pap smear screening is recommended.
   
• At age 30 or older: Screening options outlined below.
  
  1.  Less frequent Pap smear screening. After three consecutive yearly Pap smears are normal, screening may be reduced to every 2 years provided you don’t have any of the risks outlined in #2 below. Pelvic exams should be performed yearly even if a Pap smear is not required.
  
  2.  Yearly Pap smear for women who are at -risk for sexually transmitted infections, infected with HIV, immuno-suppressed, exposed to DES in utero, or had a previous abnormal Pap smear.
  
  3.  Women with cervix removed in hysterectomy. Women who have had a hysterectomy with removal of the cervix for benign (non-cancerous) reasons and with no history of abnormal or cancerous growth may discontinue routine Pap smear screening. Women with a history of an abnormal Pap smear should be screened yearly until they have three consecutive normal vaginal Pap smear tests; then they can discontinue routine screening.