The vagina is a dynamic ecosystem that is heavily influenced by hormones, sexual activity, and birthing. During the reproductive years, estrogen causes the vaginal lining to increase in thickness. Bacteria, mainly lactobacilli, maintain the vaginal pH to less than 4.5. Women with high vaginal concentrations of lactobacilli:
- are less likely to be infected with pathogenic microbes
- have less incidence of bacterial vaginosis (BV)
- are less likely to acquire HIV and other sexually transmitted infections (STIs)
- are more likely to have healthy pregnancy outcomes.
There are methods for increasing the lactobacilli in the vaginal canal. Talk to Dr. Hamilton if you are having or have had a history of infections.
Discharge from the vagina varies. Check out the following website for photographs of normal discharge throughout the cycle: http://www.beautifulcervix.com. Abnormal discharge can be caused by vaginal or cervical infections (i.e. BV, candidiasis or trichomoniasis) or noninfectious processes (i.e. lack of estrogen or allergic vaginitis). If you are experiencing burning, itching, or discharge that has changed color, is thick, curdy, or foul smelling, it is important to see a doctor.
In menopause, the vaginal epithelium thins, and the vaginal pH rises above 6.0. This can allow pathogenic microbes to proliferate and it can also make sexual intercourse uncomfortable. There are treatments to keep the vaginal tissue healthy, so make sure you talk to Dr. Hamilton before menopause so you can avoid any discomfort.
Pap smears test for cervical cancer, which is thought to be caused by the human papillomavirus (HPV), the common wart virus. There are over 100 HPV types, of which only a few have been associated with cervical, vulvar, anal, penile, and throat cancers. People with a healthy immune system generally clear HPV just like any other viral infection. If the immune system is compromised, it is believed that the virus persists and may cause cancer. As you can see, it is important to maintain a healthy immune system. Dr. Hamilton can provide you with guidelines to keep your cervix and immune system healthy so you can reduce your risk of cervical cancer.
The American College of Obstetricians and Gynecologists (ACOG) guidelines for Pap smear screening are as follows:
- Cervical cancer screening should start at age 21 years.
- Women aged 21–29 years should have a Pap test every 3 years.
- Women aged 30–65 years should have a Pap test and an HPV test (co-testing) every 5 years (preferred). It is acceptable to have a Pap test alone every 3 years.
- Women should stop having cervical cancer screening after age 65 years if they do not have a history of moderate or severe dysplasia or cancer and they have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the past 5 years.
- Women who have a history of cervical cancer, are infected with human immunodeficiency virus (HIV), have a weakened immune system, or who were exposed to diethylstilbestrol (DES) before birth should not follow these routine guidelines.
If you have an abnormal cervical cancer screening test result, you may have additional testing or treatment. Your health care provider will recommend when you can resume routine screening.
Why did the guidelines change? Studies over the past decades have found that there is no overall advantage to having yearly Pap tests over Pap tests every 3 years. Yearly Pap tests do find a slightly higher number of cancer cases than tests performed every 3 years. However, women who have yearly screening undergo many more follow-up tests for what turns out not to be cancer than women who have 3-year testing. You still should see your health care provider every year for well-woman care and any reproductive health care or information.
For women aged 30–65 years, the combination of a Pap test plus an HPV test can help predict whether dysplasia will be diagnosed in the next few years, even if the Pap test results are normal. If the results of both the HPV test and the Pap test are normal, the chance that mild or moderate dysplasia will develop in the next 4–6 years is very low.
You may be wondering why HPV testing is not recommended for women younger than 30 years. HPV infection is very common in younger women, but it usually goes away on its own. A positive HPV test result in a young woman (showing that she does have one of the cancer-causing HPV types) will most likely become negative without any treatment.
If you have had a hysterectomy, you still may need to have cervical cancer screening. Whether you need to continue to have screening tests depends on why your hysterectomy was needed, whether your cervix was removed, and whether you have a history of moderate or severe dysplasia.
After HPV vaccination
- Whether or not a woman has received the HPV vaccine (Gardasil), she needs to continue having her cervical cancer screening according to regular guidelines.
The above guidelines are consistent with those recommended by the American Cancer Society, the American Society of Colposcopy and Cervical Pathology.
*Women with any type of immune compromise; HIV; organ transplants; exposer to diethylstilbesterol (DES) while their mother was pregnant; and women previously treated for moderate or severe dysplasia (pre-cancer), or cancer of the cervix must have more frequent testing.
Sex is a normal, healthy, wonderful part of being human. Everyone wants to feel sexy!
There is nothing sexier than health and confidence! Antibiotics and other pharmaceutical drugs, diets of processed foods, lack of exercise, and stressful lifestyles make one unhealthy. Trying to live up the unrealistic media’s portrayal of women erodes confidence.
All of us are familiar with media photoshopping, which has created an idealism of beauty that is unattainable. If you are not, check out http://www.beautyredefined.net/ or search “media manipulation of images”. The only way to change the media’s portrayal of women is to fight back with your pocketbook – avoid buying the products that are marketed with fake “beauty”. Take the time to write to companies and let them know you’d rather see real women in their advertising.
We need to recognize that no matter what our shape or size, all women are beautiful. As Joseph Campbell put it, “women are it” and we are! Our intellectual, creative, seductive and alluring, communicative, supportive, nurturing, compassionate, and life bearing abilities literally maintain human existence. When we are cognizant of this magnificent role, it’s easy to recognize the importance of having a healthy attitude and a healthy body.