The physician examines the external genitals (vulva and perineum), the vagina and the cervix with a speculum, and the uterus and the ovaries to determine overall health.  A pelvic exam is recommended annually.

A pap smear is a simple screening procedure for cervical cancer and pre-cancer. Cervical cancer is caused by the Human Papilloma Virus (HPV). HPV is a common, sexually transmitted virus and usually has no symptoms or warnings. The new vaccine to protect against HPV is now available in our office for patients between the ages of 9 and 26. HPV testing may also be done with the pap smear.

We recommend women in their twenties have a pap smear bi-annually, or more often if you are classified as high risk. Your first pap smear should occur at age 21. Between age 30 and 70, your doctor will advise you on the recommended frequency of pap smears based on your individual risk factors, though generally the pap smear will be done less than annually.

As part of your routine pelvic exam, your doctor will gently manipulate your breasts to feel for any lumps or irregularities. She will also examine your breasts for unusual discoloration, dimples or puckering of the nipple.

The purpose of breast self-exams is to learn what your breasts feel like so you can notify your doctor of significant changes. We encourage our patients to perform breast self-exams at least once a month. Most women find this easiest to do in the shower or lying flat on their backs. Use a gentle rotating motion to feel your breasts and call your doctor if you feel any lumps or notice an external change such as discharge from the nipple, dimpling or puckering of the nipple, redness or scaliness. The American Cancer Society offers an excellent description of how to conduct a breast self-exam:

http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-detection

There are a number of options available to women seeking to prevent pregnancy, although no method is 100 percent guaranteed. They include:

• Diaphragms
• Oral contraceptive pills, patches or rings
• Progesterone injections
• Intrauterine devices
• Sterilization
• "Natural" methods such as timing intercourse to avoid ovulation