Every woman should be conscientious about having a routine gynecological exam once a year.

This annual exam serves to detect current health problems and evaluate risk factors for new problems that can develop.

Early detection and learning ways to reduce your risks is every woman’s best defense. The annual gynecological exam helps provide guidance and testing that will promote wellness and good health habits for all women.


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Annual Exam

An Annual Exam Can Be Very Beneficial In Catching And Treating Issues

There’s a good chance you’re dreading it. . . the annual exam. While many women believe the purpose of an annual exam is to collect a pap smear, there is actually a lot more to the annual exam. The American College of Obstetrics and Gynecology recommends a yearly visit with a provider even if you are not due for a pap smear. It is a great time to address various concerns surrounding your health, evaluate regular screening tests, and discuss any changes you have been experiencing.

What to Expect During Your Exam

A comprehensive medical history is taken, including a family history to assess possible familial cancer risks. A physical exam is performed, including an assessment of blood pressure, height and weight, and a pelvic and breast exam. We will also likely address:

  • Nutrition and physical activity
  • Sexual practices
  • Contraception
  • Tobacco, alcohol, and drug use.
  • Urinary symptoms
  • Recommended screening exams: cholesterol, diabetes, thyroid, colonoscopy, mammogram
  • Recommended vaccinations

Annual testing for chlamydia and gonorrhea is recommended for all sexually active adolescents and young women up to age 25. Routine HIV testing is recommended for all sexually active adolescents and women beginning at age 19 until age 64.

For women who are experiencing menopause and pre-menopausal symptoms, the annual exam is an important opportunity to talk about managing symptoms and hormone treatment options in addition to supplements and prevention of osteoporosis.

When or Why Should You Go

  • The American College of Obstetricians and Gynecologists recommends that the first reproductive health visit happens between ages 13 and 15. While pelvic exams are rarely required during these first visits, the annual exam helps to establish a doctor-patient relationship. Young women can ask any questions they have about their development and/or menstrual cycle, methods of birth control and how to protect against sexually transmitted diseases.
  • Annual breast and abdominal exams should begin at age 19, and routine annual pelvic exams and Pap Tests begin at age 21.
  • Yearly, your gynecologist can address your menstrual cycle, any questions you may have about pregnancy, contraception, hormones, irregular or heavy menses, menopausal symptoms, and other health issues.

Pap Smear

A “pap smear” is a test that a doctor performs by brushing cells off the cervix and sending them to a pathologist for evaluation. The cells are evaluated for abnormalities that could lead to cervical cancer. Pap smears only check for cervical cancer and don’t evaluate for vaginal, ovarian or uterine problems. Since the advent of pap smears, cervical cancer has decreased by more than 50%. Most of the women in America who have cervical cancer never had a pap smear or skipped pap smears.

Doctors used to recommend pap smears yearly. Recently, we have learned more about Human papilloma virus (HPV) – the virus that leads to precancerous changes of the cervix and cervical cancer. Pap smears are now performed less frequently. This is done for 2 reasons – low risk abnormal pap smears in younger adults often resolve without treatment. Secondly, performing a pap smear and HPV in older adults is more accurate so the test does not need to be performed as frequently.

Below are basic recommendations regarding when to perform a pap smear or a pap smear and HPV test. These recommendations can vary depending on your personal history.

  • Pap smears should start at age 21 – even if the woman has started to have sex at a much earlier age
  • From the ages of 21-29 pap smears are recommended every three years unless there are certain conditions or abnormalities that change the recommendation to more frequently
  • From the ages of 30-65 pap smears plus testing for HPV (only the high risk HPV) are recommended approximately every three to five years
  • If you have a history of cervical cancer or precancer, have HIV/AIDS or have had exposure to DES or have other health issues – recommendations for pap smears may vary.

If you have an abnormal pap smear or history of an abnormal pap smear it is essential you follow the recommendations of your physician. By following abnormal pap smears and treating them appropriately we have significantly decreased cervical cancer in the US.

Human Papillomavirus

Abnormal pap smears are caused by HPV (Human Papillomavirus). HPV is a virus that has over 100 strains. Some are more dangerous than others – they are broken down into low-risk and high-risk infections.

  • Approximately 12 types of HPV cause genital warts. These growths may appear on the outside or inside of the vagina or on the penis and can spread to nearby skin. Genital warts also can grow around the anus, on the vulva or on the cervix. These are considered low-risk because they can lead to warts but do not lead to cervical cancer.
  • Approximately 15 types of HPV are linked to cancer of the anus, cervix, vulva, vagina and penis. They also can cause cancer of the head and neck. These types are known as “high-risk types.”

How Does HPV Cause Cancer?

The cervix is covered by a thin layer of tissue made up of cells. If HPV is present, it may enter these cells. Infected cells may become abnormal or damaged and begin to grow differently. The changes in these cells may progress to what is known as precancer. Changes in the thin tissue covering the cervix are called dysplasia or cervical intraepithelial neoplasia (CIN). In most women, the immune system destroys the virus before it causes cancer. But in some women, HPV is not destroyed by the immune system and does not go away. In these cases, HPV can lead to cancer or, more commonly, precancer.

Are there Screening Tests for Cervical Cancer?

It usually takes years for cervical cancer to develop. During this time, HPV infection can cause cells on or around the cervix to become abnormal. A Pap test, sometimes called cervical cytology screening, can detect early signs of abnormal cell changes of the cervix and allows early treatment so they do not become cancer.

An HPV test also is available. It is used along with the Pap test in women 30 years and older and as a follow-up test for women whose Pap tests show abnormal or uncertain results. The HPV test can identify 13–14 of the high-risk types of HPV.

How can I Prevent HPV?

Two vaccines are available that protect against certain types of HPV. We offer the Gardasil vaccine in our office. This vaccine is a three-shot series for women age 9 to 26 years old. The vaccine protects against two strains that cause genital warts and two high-risk strains associated with cervical cancer. It helps protect against 90% of genital wart cases. It protects against 70% of cervical cancer cases, 70% of vaginal cancer cases and up to 50% of vulvar cancer cases.

The following methods also help decrease the chance of infection:

  • Limit your number of sexual partners.
  • Use condoms to reduce your risk of infection when you have vaginal, anal, or oral sex.

Birth Control

Looking for safe, effective contraceptive and family planning methods? You’re in the right place. Metro OBGYN provides a full range of birth control options and can help you choose the method that is right for you.

Barrier Methods – Include condoms, cervical caps and diaphragms.

Combined Hormonal Birth Control – A very common and effective birth control you take daily.

  • Oral contraceptives – Birth control pills that contain hormones that inhibit pregnancy
  • Birth control patch (Ortho Evra) – Removable patch that sticks to your skin
  • Vaginal ring (NuvaRing) – A small, flexible ring inserted into the vagina once a month

Progesterone-only hormonal birth control – Daily birth control that does not contain estrogen. Good for women who are nursing or cannot take estrogen.

  • Birth control pills that only contain progesterone that inhibit pregnancy
  • Birth control shot (Depo-Provera) – Hormonal contraceptive that is injected just below the skin

Long-acting reversible contraception – Very effective birth control you do not need to think about daily. This is a good option if you do not want to get pregnant for a few years. The device lasts for 3 years up to 10 years and they can be removed sooner if you desire pregnancy.

  • IUD (Mirena, Skyla and ParaGuard) – T-shaped intrauterine device inserted into the uterus
  • Birth control implants (Nexplanon) – Hormone-releasing implant that is inserted into the arm and prevents pregnancy for up to three years

Emergency contraception – Birth control you can use to prevent pregnancy up to five days after unprotected sex (also known as the morning-after pill)

Permanent birth control – A great option when your family is complete.

  • Tubal ligation – surgical sterilization procedure that involves severing and tying the fallopian tubes; also known as having your tubes tied
  • Hysteroscopic sterilization (Essure®) – transcervical procedure for permanent sterilization

Call 651-227-9141 today for an appointment to discuss the risks, benefits, effectiveness and possible side effects associated with each method of birth control.


STDs include chlamydia, gonorrhea, genital herpes, human papillomavirus (HPV), syphilis, HIV as well as others. Almost half of new infections occur in young people ages 15 to 24. Even if you don’t have symptoms, you could have an infection and pass it along to someone else. Sexually transmitted diseases are spread through oral, vaginal or anal sex, or even through genital touching. It can be possible to contract without having had intercourse.

How STD Testing is Done

STD testing typically requires a genital exam. Gonorrhea and chlamydia can be tested from a vaginal swab or a urine sample. Other STDs like HIV, hepatitis C, hepatitis B and syphilis are tested for tested for with a blood draw.

Prevention and Education for Safer Sex

If you are sexually active, talk to your doctor about screening for STDs as well as vaccines available to help protect against sexually transmitted diseases like HPV and Hepatitis B. The center for disease control and the American College of Obstetricians and Gynecologists recommend that everyone aged 13-64 years be tested for HIV at least once in their lifetime.

Talk to your doctor to learn more about:

  • Health problems caused by STIs
  • Symptoms of different STIs
  • STI testing and treatment
  • Protecting yourself from STI


Menopause is defined officially by 12 months without a period and is when a woman’s period stops permanently. This timing of menopause varies from woman to women (just like the onset of periods). The average age women enter into menopause is 51.4 years. The time of transition into menopause is called “perimenopause.” These years bring a variety of physical and emotional changes.

At Metro OBGYN, we can help you manage menopause symptoms such as:

  • Hot flashes
  • Weight gain
  • Decreased libido
  • Painful intercourse
  • Mood changes and depression
  • Difficulty sleeping
  • Bleeding changes
  • Osteoporosis

What is Happening?

As menopause approaches the ovaries begin to make less and less estrogen. The lower levels of estrogen will cause thinning of the uterine lining. These changes can cause pain during intercourse, increased risk for vaginal and bladder infections, and general discomfort. The decrease in estrogen levels will also cause an increase in bone loss. Additionally, estrogen produced by the ovaries protects women from heart attacks and strokes. Subsequently, your risk for heart attacks and strokes increases with menopause.

What about Hormone Replacement?

Hormone replacement comes with risks and benefits. The recommendation is to use HRT (hormone replacement therapy) at the lowest dose for the shortest period of time. Estrogen is used to treat the main symptoms of menopause – hot flashes. Estrogen also protects against bone loss and can reduce vaginal and urinary discomfort. Estrogen therapy is not for everyone. The use of HRT can increase the risk of heart attacks or strokes as well as breast cancer. We approach each woman individually to determine the best treatment for her.

Women today are looking for ways to stay strong, healthy and connected throughout their lives. We can help you manage menopause treatment and successfully navigate this important time of change in your life.