When you go to the doctor for an annual exam, you should be getting much more than just a Pap smear. Too often, these visits are rushed and impersonal, leaving you with unanswered questions and an uncomfortable memory of the experience. A woman even told me that her doctor received a cell phone call right in the middle of a pelvic exam, and actually answered it!

At San Francisco Natural Medicine we provide comprehensive and personalized annual visits in a relaxed, comfortable environment. We believe that you deserve a caring doctor who will provide the following at your annual GYN visit.

Thorough Discussion of Health
Many women go in for annual Paps and this is their only interaction with a doctor all year. Even women who are actively working on a health concern may not realize that their annual GYN visit should be a comprehensive assessment of their health. This is an important opportunity to review your female health history, family history, diet and lifestyle, as well as your risk factors for common diseases. At San Francisco Natural Medicine, our annual visits provide time to answer your questions, with an emphasis on educating you about your body and how to optimize overall health and well being. During this visit we can also order any appropriate screening tests including blood work, breast imaging, ultrasounds, bone scans, etc.

Screening Physical
Though some doctors limit the annual check up to breast and pelvic exams, we believe that your annual exam is an important screening tool for your health from head to toe. We will measure your height, weight and blood pressure, check your pulses, examine your thyroid, heart, lungs, abdomen and skin, as well as any concerns that you have in other areas.

Comprehensive Breast Evaluation
Naturopathic doctors are trained to give very careful and thorough breast exams. You will also receive education about doing your own self exams. We emphasize the approach of getting to know your body and getting comfortable with how your normal tissue feels. This helps to tune you in to your body in a healthy way, and will lead to early detection of any concerning growths. If you are in need of imaging we will discuss the pros and cons of mammography as well as breast thermography, and can order the appropriate tests for you.

Comfortable Pelvic Exam
The pelvic exam is something that many women dread. To ease this anxiety we provide a relaxed environment, take the time to explain what we are doing and use techniques to make it as comfortable as possible. We use a clear plastic speculum, rather than a cold metal one, to allow for more comfort and a more thorough exam of your tissues. Because we strive to make your exam an educational experience, you will also have the opportunity to see your own cervix if you want to. Some women have never seen this part of their body before and are fascinated to see it for the first time.

The Pap (with HPV Test if Indicated)
A Pap is a screening test for cervical cancer and involves a collection of cells from the surface of your cervix. This sample is sent to a laboratory which analyzes it for abnormal cells, called dysplasia, which may indicate early signs of developing cancer. There is also a test that checks the sample for the presence of high-risk strains of HPV, which can cause cervical cancer. Current guidelines suggest that this additional testing be done for all women over 30 years old and for an abnormal Pap in women of any age.

Though HPV is highly prevalent, it is considered to be benign unless there are high-risk strains present in the cervical cells. If either the Pap or the HPV test are positive, further testing or closer monitoring will be recommended. Naturopathic treatments, aimed at supporting the immune system, successfully fill the gap between the “wait and see” approach and the more aggressive treatments typically offered in conventional medicine. If your Pap or HPV are abnormal we will have a follow up visit to help you understand the results and to discuss your treatment options.

If you are looking for a comfortable, comprehensive and informative annual GYN visit, please give us a call. As you can see, an annual exam with one of our naturopathic doctors is more than just a Pap smear.

A Word About the HPV Vaccine
by Amy Day, ND

Many of my patients are asking me about this vaccine, either for themselves or for their daughters. Since Gardasil was approved by the FDA in 2006, many organizations are recommending it for females aged 9 to 26 years old.  Due to pressure from the manufacturer, Merck & Co., many states even attempted to pass legislation to require it for all girls as they enter the sixth grade. It is a very controversial topic and I feel that the decision should be made on an individual basis. The vaccine only protects against 2 out of 13 of the strains known to be a high risk for causing cancer, but it does so effectively and may be worthwhile in certain populations. It does also protect against 2 of the strains that commonly cause genital warts, a contagious sexually transmitted infection. Though the vaccine is an impressive breakthrough in medicine and will certainly save lives, I question the necessity and safety of mandating it for all girls.

Women who get regular Paps, do not smoke, have strong immune systems, use condoms, have only a few sexual partners and have a healthy diet are generally at low risk for cervical cancer. As long as a woman is getting regular Paps and doing appropriate follow up and treatments, she can identify and manage any problems before cancer develops. Even for women who are diagnosed with cervical cancer, if it is detected in early stages, it is rarely fatal. Since the introduction of Pap smears in the 1950s, early detection and prompt treatments have caused cervical cancer rates to decrease by 75%. The rates of cervical cancer continue to decline, even though HPV infection rates are high. According to the CDC, approximately 20 million Americans are currently infected with HPV, yet the American Cancer Society estimates that only 11,070 women will be diagnosed with cervical cancer in 2008. These women likely wish the vaccine had been available for them, but not all of these cases would have been prevented.

One of my concerns is that vaccinated women could have a false sense of security and may not get their regular Paps. Because the vaccine only protects against strains 16 and 18 (which cause 70% of cervical cancer), these women are putting themselves at risk of late detection of advanced cancer (caused by the other high-risk strains). Another concern is that the vaccine contains aluminum as an additive, and some women have adverse reactions to the vaccine itself. Also, Gardasil is new enough that there are no long-term studies to show its safety and efficacy, especially for young adolescents. I admit that I am also skeptical of the financial motivations of the manufacturer, since this is one of the most expensive vaccines, and it is very heavily marketed to the public. If you are trying to decide whether the vaccine is appropriate for you, please discuss this with your doctor.