OBGYN Concierge Health

A breast self-exam is done to detect changes that could lead to breast cancer. To learn what is normal for your breasts and to find any problems, you should do a breast self-exam once a month. Why Do Breast Self-Exams? If breast cancer is found early, most women can be treated with success. That is why routine breast self-exams, mammography and checkups by your doctor are vital.

How to Do a Breast Self-Exam

The best time to do the breast self-exam is a few days after your period ends each month. It's easier at this time because your breasts are less tender or swollen. There are two parts to a breast self-exam —looking and feeling.

Looking

In the first part of the exam, you are looking in the mirror for any changes.

Feeling

In the second part of the exam, you are feeling for any changes. You can do this lying flat on your back, standing, or when you are taking a shower or bath. It often is easier to examine your breasts when they are smooth and wet with soap and water. It's a good idea to examine your breasts both ways — lying down and standing. Examine one breast at a time. Feel with the pads (not tips) of your three middle fingers. Remember how your breasts feel each month. Mark any lumps or other changes on the diagram shown here. Show it to your doctor.

Signs of a Problem

If you notice any of these symptoms during your breast self-exam, call your doctor:

• A lump
• Swelling
• Skin irritation
• Dimpling
• Pain
• Nipple retraction (nipple turns in)
• Redness of nipple or breast skin
• Scaly nipple or breast skin
• Nipple discharge

Finally

Do the breast self-exam once a month. If you detect any signs of a problem, talk to your doctor.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

The natural way for babies to be born is through the mother's vagina. Sometimes, however, it isn't possible. In such cases, cesarean birth may be performed.

Reasons for a Cesarean Birth

There are many reasons why a cesarean birth may be the best way to deliver your baby.

A Large Baby

Sometimes a baby is too big to pass safely through the mother's vagina and the surrounding bones (pelvis). This is known as cephalopelvic disproportion.

Multiple Pregnancy

Women having two or more babies may need cesarean birth.

Failure of Labor to Progress

About one-third of cesarean births are done because labor stops.

Concern for the Baby

The baby could be having trouble during labor and may need to be delivered by cesarean birth. One reason may be that the umbilical cord is pinched or compressed or not enough blood is flowing to the baby from the placenta.

Problems With the Placenta

Placenta previa is a condition in which the placenta is below the baby and covers part or all of the cervix. This will block the baby's exit from the uterus.

Medical Conditions

Women with certain medical conditions are more likely to have a cesarean birth. For example, if a woman has diabetes or high blood pressure.

Previous Cesarean Birth

Sometimes, having had a cesarean birth before can play a part in whether you will need to have one again. Many women, however, who have had a cesarean birth before can try to deliver vaginally.

The Procedure

In most hospitals, your birth partner may stay with you in the operating room for the cesarean birth.

Preparation

Before you have a cesarean delivery, the nurse prepares you for the operation.

Anesthesia

Anesthesia will be given so that you do not feel any pain during surgery. You will be given either general anesthesia, an epidural block or a spinal block. If general anesthesia is used, you will not be awake during the delivery.

Delivery

The doctor will make an incision through your skin and the wall of the abdomen. Another will be made in the wall of the uterus. The baby will be delivered through the incisions, the umbilical cord will be cut, and then the placenta will be removed. The uterus will be closed with stitches that will dissolve in the body.

Complications

Like any major surgery, cesarean birth involves risks. These problems occur in a small number of women and usually are easily treated: The uterus, nearby pelvic organs or skin incision can get infected. You can lose blood. You can get blood clots in the legs, pelvic organs or lungs. Your bowel or bladder can be injured.

After Delivery

If you are awake for the surgery, you can probably hold your baby right away. You will be taken to a recovery room or directly to your room. You may need to stay in bed for awhile. A hospital stay after cesarean birth is usually four days. The length of your stay depends on the reason for the cesarean birth.

After You Go Home

It will take a few weeks for your abdomen to heal. It's important to help yourself heal. For a few weeks after the cesarean birth, you should not place anything in your vagina or do any strenuous activity.

Finally

There are many reasons why a cesarean birth may be needed to deliver your baby. Many maternity centers have childbirth classes and support groups for couples who may need cesarean birth. If you have questions or concerns about cesarean birth, ask your doctor or nurse.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

Regular exercise builds bones and muscles, gives you energy, and keeps you healthy. It is just as important when you are pregnant.

Benefits of Exercise

Becoming active and exercising at least 30 minutes on most, if not all, days of the week can benefit your health in the following ways:

• Helps reduce backaches, constipation, bloating and swelling
• May help prevent or treat gestational diabetes
• Increases your energy
• Improves your mood
• Improves your posture
• Promotes muscle tone, strength and endurance
• Helps you sleep better

Changes in Your Body

Pregnancy causes many changes in your body. Some of these changes will affect your ability to exercise.

Joints

The hormones produced during pregnancy cause the ligaments that support your joints to become relaxed.

Balance

Remember that during pregnancy you are carrying extra pounds — as much as 25 to 40 pounds at the end of pregnancy. The extra weight in the front of your body shifts your center of gravity and places stress on joints and muscles, especially those in the pelvis and lower back.

Heart Rate

The extra weight you are carrying will make your body work harder than before you were pregnant. Exercise increases the flow of oxygen and blood to the muscles being worked and away from other parts of your body. So, it's important not to overdo it.

Getting Started

Before beginning your exercise program, talk with your doctor to make sure you do not have any obstetric or health condition that would limit your activity.

Choosing Safe Exercises

Most forms of exercise are safe during pregnancy. However, some types of exercise involve positions and movements that may be uncomfortable, tiring or harmful for pregnant women. For instance, after the first trimester of pregnancy, women should not do exercises that require them to lie flat on their backs. Certain sports are safe during pregnancy, even for beginners:

• Walking is a good exercise for anyone.
• Swimming is great for your body.
• Cycling provides a good aerobic workout.
• Aerobics is a good way to keep your heart and lungs strong.
• Other exercises, if done in moderation, are safe for women who have done them for a while before pregnancy:
• Running
• Racquet sports
• Strength training

The following activities should be avoided during pregnancy:

• Downhill snow skiing
• Contact sports
• Scuba diving

Your Routine

Exercise during pregnancy is most practical during the first 24 weeks. During the last three months, it can be difficult to do many exercises that once seemed easy. This is normal. If it has been some time since you've exercised, it is a good idea to start slowly. Begin with as little as five minutes of exercise a day and add five minutes each week until you can stay active for 30 minutes a day. Always begin each exercise session with a warm-up period for five to 10 minutes.

Things to Watch

The changes your body is going through can make certain positions and activities risky for you and your baby. While exercising, try to avoid activities that call for jumping, jarring motions, or quick changes in direction that may strain your joints and cause injury. While you exercise, pay attention to your body. Do not exercise to the point that you are exhausted.

After the Baby's Born

Having a baby and taking care of a newborn is hard work. It will take a while to regain your strength after the strain of pregnancy and childbirth. Taking care of yourself physically and allowing your body time to recover is important. If you had a cesarean delivery, difficult childbirth or complications, your recovery time may be longer. Check with your doctor before starting or resuming an exercise program.

Finally ...

Exercise during pregnancy can help prepare you for labor and childbirth. Exercising afterward can help get you back in shape. Before you begin an exercise program, talk to your doctor. Follow this guide to help maintain a safe and healthy exercise program during pregnancy.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

Pregnancy is a major event. If you plan for it, you can make wise choices that will benefit both your health and that of your baby.

A Preconceptional Visit

If you are planning to become pregnant, you should let your doctor know.

Special Concerns

Medical Conditions

Some women have medical problems, such as diabetes (high blood sugar), high blood pressure and cardiovascular (heart and blood vessel) problems, that may increase risks for them or their fetus. Your doctor will discuss your current treatment with you before you are pregnant. You should tell your doctor if you are taking medications, either prescribed or bought over the counter. Some can harm your fetus.

Infections and Vaccinations

Infections can harm both the mother and the fetus. Vaccination can prevent some infections. If you have not been vaccinated for diseases such as measles, mumps and rubella, tell your doctor. Infections passed through sexual contact — sexually transmitted diseases (STDs) — also are harmful during pregnancy.

Past Pregnancies

Some problems with past pregnancies can occur again. Therefore, your doctor will ask questions about any past pregnancies. If you have had more than one miscarriage or a previous baby with a birth defect.

Family Health History

Some conditions occur more often in families. If a close member of your family has a history of a disorder, you may be at greater risk of having it, too. Certain disorders can be inherited. These are called genetic disorders. Testing can be done to detect some genetic disorders.

Lifestyle

Your doctor may ask about your family life, work and lifestyle to learn of any behaviors and exposures that could be a risk.

Diet and Nutrition

Your doctor will review your diet. He or she may suggest changes in areas such as:

Your weight

Your use of vitamins and other food supplements Your eating habits, such as a vegetarian diet or fasting Any eating disorders you may have

Keeping Fit

Good health depends on both a proper diet and exercise. If you need to lose weight, you should do so before pregnancy and again after giving birth.

Domestic Violence

Victims of domestic violence before pregnancy often are victims during pregnancy. If you are being abused, tell your doctor.

Alcohol, Tobacco and Illegal Drugs

Alcohol, tobacco, and illegal drugs can harm both you and your fetus. No amount of these substances has been proven safe to use during pregnancy. Cigarette smoking can cause premature birth, low birth weight, premature rupture of membranes, and problems with the placenta. The risk of the baby dying from sudden infant death syndrome (SIDS) also is increased.

Environment

Some substances found at home or work may harm your fetus if you become pregnant. If you could be exposed to a harmful substance, take steps to avoid it.

Planning for Support During Pregnancy

Pregnancy may put a lot of demands on you and your family. As you plan your pregnancy, talk with your family about it. Also, having a baby can cost a lot. As part of your plans, find out whether your health insurance pays for the cost of prenatal care, birth and well-baby care. Find out how much time your employer allows for maternity leave for pregnancy.

Finally

Becoming a parent is a major commitment filled with challenges, rewards and choices. Make a few changes now: keep fit, eat wisely, avoid things that could be harmful, and visit your doctor.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

Women Hormone Therapy

At menopause, a woman's body makes less estrogen and she stops having menstrual periods. This is a natural stage in a woman's life. The lack of estrogen can bring on symptoms such as hot flushes and vaginal dryness. It also can increase the risk of osteoporosis (bone loss). Because of this, women may choose to take hormone therapy (HT) to restore estrogen after menopause. Benefits of Hormone Therapy Hormone therapy can relieve the symptoms of low estrogen levels (hot flushes and vaginal dryness) and decrease the risk of osteoporosis. The decision to begin HT depends on your:

Personal needs

Medical and family history Symptoms

• Risk of bone loss
• Hot Flushes
• About 75 percent of all women going through menopause have hot flushes (hot flashes). A hot flush is a sudden feeling of heat that spreads over the face and body. The skin may redden like a blush. Hot flushes may come on a few times a month or several times a day, depending on the woman.

Protection from Osteoporosis

Osteoporosis in women results from low estrogen levels. Estrogen helps protect against bone loss. After menopause, a woman's bones slowly lose strength and become more fragile. As a result, older women are more likely to break bones. The hip, wrist, and spine are affected most often. Hormone therapy can help slow bone loss after menopause. Exercise also can help prevent bone loss.

Vaginal Dryness

Loss of estrogen causes changes in the vagina. Its lining may become thin and dry. These changes can cause pain during sexual intercourse. They also can make the vagina more prone to infection, which can cause burning and itching.

Other Benefits

Some studies have shown that estrogen has a positive effect on mood and short-term memory in women.

Concerns and Risks

Like most treatments, hormone therapy is not free of risk. Using estrogen alone causes the lining of the uterus to grow and increases the risk of endometrial cancer. To reduce this risk, your doctor will recommend another hormone called progestin if you have a uterus. All women are at risk of breast cancer. This risk increases with age. An issue of great concern to women is whether hormone therapy in-creases the risk of breast cancer. Women who take combined (estrogen and progestin) HT have an increased risk. The risk appears to be small, but increases throughout the time that HT is taken. Women who take HT also are at increased risk of stroke, heart attack, and forming blood clots.

Treatment

When they choose to take HT, most women who have a uterus take estrogen and a progestin. Hormone therapy can be given in many ways.

• Continuous cyclic therapy
• Continuous-combined therapy
• Cyclic therapy
• Follow-up

When taking hormone therapy or other medications, you should follow your doctor's advice carefully and get regular checkups.

Finally ...

Hormone therapy can help relieve some of the symptoms that affect women at menopause. Before making a decision about HT, talk to your doctor about what may work best for you, considering your personal needs and family and medical history.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

Today, more and more couples are starting families later in life. Most women over age 35 have healthy pregnancies and healthy babies. There is no set age that is unsafe for women to become pregnant.

Fertility

Medical advances have opened the door for women to have safer pregnancies in their 30s and 40s. Even so, some questions arise for these women. They may have concerns about whether their age will affect their ability to become pregnant, their health and the health of their baby. There is no precise age at which you become less fertile. One reason that women may become less fertile is that ovulation, the release of an egg from one of the ovaries, occurs less often as a woman ages. If you are in your mid-30s or older and are concerned about your fertility, or if you have not conceived after six months of having sex without any form of birth control, you may want to talk with your doctor.

Health Problems

Certain medical and obstetric problems occur more often as women age. Some women have conditions — such as high blood pressure or diabetes — that are present before pregnancy. About 10 percent of women over 35 have high blood pressure. Women aged 35 and over also are more likely to have diabetes or to develop gestational (during pregnancy) diabetes. Miscarriage — loss of a pregnancy before 20 weeks — occurs in about 15 percent to 20 percent of all pregnancies. It is more common in older women. Stillbirth — delivery of a baby that has died before birth — occurs more often in women over age 35 than in women aged 20 to 35. Older women also are more likely to have infants of low birthweight (weighing less than 5 1/2 pounds). Cesarean delivery also is slightly more common for women having their first child after age 35.

Being Prepared

Being prepared for pregnancy is the best way for couples of all ages to improve their chances of having a baby.

Preconception and Prenatal Care

Good health care before you become pregnant — sometimes called preconception care — will help you throughout your pregnancy. Early and regular prenatal care #151; care before the baby is born — may increase a woman's chances of having a healthy baby.

Genetic Counseling

Genetic counseling is advised for women who will be 35 or older when their baby is due, couples who have already had a child with a birth defect, and couples with a family history of genetic problems, birth defects, or mental retardation.

Testing

A number of tests can help detect disorders before, during and after pregnancy. Advances in medicine have made having a child safer. Testing for genetic problems is offered to women who will be 35 or older when their baby is due. You will want to discuss with your doctor the pros and cons of having these tests done:

Amniocentesis

Chorionic villus sampling (CVS)

Personal Issues

A woman having her first child in her mid-30s or older may be faced with issues besides her health and that of her child. She may be used to having control of her life. It may take longer to become pregnant than she thought. On the other hand, an older woman may feel sure that she is ready to have a child.

Finally

Most women have healthy pregnancies and normal babies. Many older women show no greater signs of problems than younger women.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

A balanced diet is a basic part of good health at all times in your life. During pregnancy, diet is even more important. The foods you eat are the main source of the nutrients for your baby. As your baby grows, you will need more of most nutrients.

Before You Become Pregnant

Before you are pregnant is the best time to begin eating a healthy diet. Eating right before you become pregnant can help make sure that you and your baby start out with the nutrients you both need. This also is the time to begin taking a folic acid supplement. Folic acid is a type of vitamin that is key to the growth of your baby, especially during the first months of pregnancy. Not getting enough folic acid in your diet before you are pregnant and early in pregnancy increases the risk of birth defects such as neural tube defects. Getting good health care before you are pregnant will help you throughout your pregnancy.

Weight Gain

Pregnant women are sometimes concerned about gaining too much weight. Keep in mind that your diet is the main source of energy for your baby. That means you have to eat more while pregnant. When you are pregnant, you need about 300 calories more a day than you usually eat. How much weight you gain during pregnancy depends on your weight before pregnancy. A healthy gain for most women is between 25 and 35 pounds. If you are overweight, you should gain less, but some weight gain is normal. If you are underweight, you should gain more.

A Healthy Diet

The first step toward healthy eating is to look at the foods in your daily diet.

Meal Planning

Try to plan your meals. Planning meals in advance can help ensure you and your family eat a balanced diet.

Basic Nutrients

Every diet should include proteins, carbohydrates, vitamins, fats and minerals. To be sure your diet gives you the right amount, you should know which foods are good sources of each. The labels on food often have the letters RDA. This stands for Recommended Daily Allowance. RDAs are levels of nutrients you need every day.

Extra Nutrients

You may need extra nutrients because you are pregnant. These may include iron, folic acid and calcium. They can be given as single pills or as a combined pill. Sometimes a prenatal vitamin contains all you need. Ask your doctor or nurse how your needs can be best met. Check with your doctor before taking any vitamins, herbs or other supplements that are not prescribed to you.

Folic Acid

To help prevent neural tube defects, a woman should take 0.4 milligrams of folic acid daily before and during pregnancy. It should be taken for one month before pregnancy and during the first three months of pregnancy. Women who have had a child with a spine or skull defect are more likely to have another child with this problem. These women need higher doses of folic acid — 4 milligrams daily.

Special Concerns

Vegetarian Diets

If you are a vegetarian, you can continue your diet during your pregnancy. You will need to plan your meals with care to ensure you get the nutrients you and your baby need.

Lactose Intolerance

Milk and other dairy products are the best sources of calcium in your diet. But, some women have symptoms such as bloating, diarrhea, gas and indigestion after drinking milk or eating dairy products. This is known as lactose intolerance. If you are pregnant and lactose intolerant, make sure you are getting enough calcium. Talk with your doctor or dietitian.

Mercury

Fish is an important part of a healthy diet. However, women who are pregnant, may become pregnant, or are nursing should not eat shark, swordfish, king mackerel or tilefish. These fish contain high amounts of a form of mercury that may harm an unborn child's or baby's brain or nervous system.

Listeriosis

Listeriosis is an illness caused by bacteria found in certain foods. The foods most likely to have the bacteria are unpasteurized milk, soft cheese, raw vegetables and shellfish. Because the symptoms of listeriosis are like the flu, it's not always found. If you have a fever or flulike illness, samples from your vagina, cervix and blood may be checked. To prevent listeriosis, wash all fresh fruits and vegetables before using them.

Pica

During pregnancy, some women feel strong urges to eat nonfood items such as clay, ice, or laundry and corn starch. This is called pica. Pica can be harmful to your pregnancy.

Finally

Eating right during your pregnancy is one of the best things you can do for yourself and your baby. Take a look at the foods in your daily diet. Make sure they provide the nutrients you and your baby need. It's never too late to start eating a healthy diet.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

Routine Tests During Pregnancy

During pregnancy, certain lab tests are done on all women. These tests can help your doctor spot possible problems during your pregnancy. They also will give clues to how your baby is doing. Other tests you have depend on your medical history, family background, ethnic background or exam results.

Initial Lab Tests

Some tests are given to all pregnant women. Other tests may be offered to you to help detect any problems. A number of lab tests are recommended for all women early in prenatal care. Some of these tests are done to diagnose certain problems during your pregnancy. They are called diagnostic tests. Diagnostic tests may be offered based on your medical history, family background or previous test results. Sometimes your ethnic background may create a need for you to be tested for problems that occur more often in your ethnic group. Other tests do not diagnose problems - they are done to see if you or your baby is at risk of certain problems or birth defects. These are called screening tests. Lab tests done on all women include samples from your blood, urine and cervix. You also will be tested for certain infections, such as sexually transmitted diseases (STDs). The results of these tests are used to find out if there are any problems. If problems are found, many of them can be treated during pregnancy. Some of these tests will be done more than once. The results will be noted in your medical record. If you have concerns about any of these tests, talk to your doctor. No test is perfect. There may be a problem even if the test does not show it. Also, the problem may not exist even if the test does show it. Your fetus also may have a problem that the test was not designed to find.

Blood tests

Blood tests check for a number of things: Blood type and antibody screen - Your blood type could be A, B, AB or O. It can be Rh positive or Rh negative. If your blood lacks the Rh antigen, it is Rh negative. If it has the antigen, it is called Rh positive. Problems can arise when the fetus's blood has the Rh factor and the mother's does not. The mother's body may react as if it were allergic to the fetus. It will make antibodies that attack the fetus's blood. This can cause anemia (low iron levels). It will require special care during pregnancy. Hematocrit and hemoglobin - The hematocrit and hemoglobin levels in your blood are measured to check for anemia. Syphilis - Syphilis is an STD. Syphilis can be treated. If you have syphilis and are not treated, you could pass it to your baby. Rubella - Your blood will be checked for signs of past German measles (rubella). If you had this condition before, you are not likely to get it again. If you haven't had it, while you are pregnant you should avoid anyone who has the disease. Vaccines for the disease are available, but it is best not to give them during pregnancy. If your blood test shows you are not immune to rubella, you should get the vaccine after the baby is born. Hepatitis B virus - Hepatitis B infects the liver. If you have this infection, you can pass it to your baby. A drug called hepatitis B immune globulin may be given to help treat the illness. Your baby will be given the same medication and a vaccine against the disease after birth. Human immunodeficiency virus (HIV) - HIV is the virus that causes AIDS (acquired immunodeficiency syndrome). Pregnant women are tested even if they do not have special risk factors. Your doctor will tell you that you are being tested for HIV. The test results will be explained to you. If you have HIV, there is a chance you can pass it to your baby. You can be given medication during pregnancy to reduce this risk. For the Pap test, a speculum is inserted into the vagina. A small sample of cells is collected with a small brush or swab and scraper. The brush or swab is inserted into the cervical canal to reach the higher cells.

Urine test

Your urine will be tested at each prenatal visit. This test checks the levels of sugar and protein. Often, sugar in the urine is normal in pregnancy. High levels of sugar could be a sign of diabetes. Protein in the urine may be a sign of urinary tract infection, kidney disease or high blood pressure that occurs in late pregnancy. The urine test also is used to check for infections of the bladder and kidneys. If these problems occur, they can be treated.

Cervical test

A Pap test may be done to check for changes of the cervix that could lead to cancer. A sample may be taken from your cervix to check for certain STDs, such as gonorrhea and chlamydia. If any of these conditions are found, they can be treated.

Maternal Serum Screening Tests

Maternal serum screening tests are used to find out if you have a higher-than-normal risk of having a baby with certain birth defects. These tests measure the level of certain substances in your blood. The levels may be higher or lower than normal if your fetus has certain defects. The two most common screening tests are alpha-fetoprotein (AFP) and multiple marker screening. In most cases, they are done between 15 weeks and 18 weeks of pregnancy. Neither test poses a risk to the mother or fetus.

Alpha-fetoprotein test

Alpha-fetoprotein is a protein made by the fetus. It is present in fetal blood and in amniotic fluid (liquid that surrounds the fetus in the mother's uterus). A small amount of AFP crosses the placenta and enters your blood. A small amount of blood is taken from a vein in your arm and tested in a lab. Results come back in about a week. A high level of AFP can signal a risk of neural tube defects (such as spina bifida). A low level can signal a risk of Down syndrome. Positive results don't always mean there's a problem. For this reason, an abnormal screening test result is followed up with other tests.

Other Tests

Although they are not done on all women, you may be offered one or more of these tests during your pregnancy: Multiple marker screening measures the levels of the hormones estriol and human chorionic gonadotropin (hCG), as well as AFP, in your blood. This test can be done at the same time, using the same blood sample, as the AFP test. The results come back in 1 week to 2 weeks. If a fetus has Down syndrome, hCG levels often are higher than normal. Estriol levels and AFP often are lower than normal. Routine tests can be followed up with other tests if the results raise concerns. Your doctor also may suggest special tests if you have certain risk factors An ultrasound exam is a test that creates an image of your fetus from sound waves. This is done by moving a device (called a transducer) across your abdomen or placing a special device in your vagina. An ultrasound exam may be done on women whose doctors want to know the age of the fetus, confirm a diagnosis, or check what may be a problem. It can be done any time during pregnancy.

• Amniocentesis - a procedure in which a small amount of amniotic fluid and cells are taken from the sac surrounding the fetus and tested.
• Chorionic Villus Sampling (CVS) - a procedure in which a small sample of cells is taken from the placenta and tested.
• Genetic Tests - screening and diagnostic tests that often can show whether the fetus has certain birth defects. Some genetic tests are offered to all pregnant women. Others may be offered if your medical history, family history, age or physical exam raise questions about your baby's health.
• Glucose Screening - to test for diabetes, the patient drinks a special sugar mixture. An hour later, a blood sample is drawn from her arm and sent to a lab. There, a technician measures the level of glucose in the blood.
• Group B Streptococcus (GBS) - to test for GBS, samples are taken from the vagina, perineum and rectum and grown in a special substance. A urine sample also may be used.
• Tuberculosis - a simple skin test can check for tuberculosis even before symptoms occur.
• Ultrasound - a test in which sound waves are used to examine internal structures, including the fetus.
• Multiple marker screening
• Ultrasound

Finally...

Some tests are given to all pregnant women. Other tests may be offered to you to help detect any problems. Whether to have further testing is up to you. If results of your screening test show there could be a problem, don't be alarmed. Treatment is now available for many problems that may occur during pregnancy. Keep in mind that most babies are born healthy.

Glossary

Antigen: A substance, such as an organism causing infection or a protein found on the surface of blood cells, that can induce an immune response and cause the production of an antibody.

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina. Chlamydia: A sexually transmitted disease that can cause pelvic inflammatory disease, infertility, and problems during pregnancy.

Down Syndrome: A genetic disorder caused by the presence of an extra chromosome and characterized by mental retardation, abnormal features of the face, and medical problems such as heart defects.

Estriol: A hormone made by the placenta and the fetal liver.

Gonorrhea: A sexually transmitted disease that may lead to pelvic inflammatory disease, infertility, and arthritis.

Hepatitis B Virus: A virus that attacks and damages the liver, causing inflammation, cirrhosis, and chronic hepatitis that can lead to cancer.

Human Chorionic Gonadotropin (hCG): A hormone produced during pregnancy; its detection is the basis for most pregnancy tests.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body's immune system and causes acquired immunodeficiency syndrome (AIDS).

Maternal Serum Screening Tests: A group of blood tests that check for substances linked with certain birth defects.

Neural Tube Defects (NTDs): Birth defects that result from improper development of the brain, spinal cord, or their coverings.

Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope.

Sexually Transmitted Disease (STD): A disease that is spread by sexual contact, including chlamydial infection, gonorrhea, genital warts, herpes, syphilis, and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Syphilis: A sexually transmitted disease that is caused by an organism called Treponema pallidum; it may cause major health problems or death in its later stages.

Sexuality and Sexual Problems

Women — whether married or single, young or old — differ greatly in their sexual interest and response. A woman's sexual function is not limited to sexual intercourse. Her sexuality also includes the way she thinks and feels about herself as a woman. Some women have trouble with sex at some time in their lives. They often find it hard to talk about their sexual concerns — even with their partner, a trusted friend or their doctor.

Sexuality

Sexual identity is shaped and reshaped throughout life. A number of key factors affect your sexual development. These include early role models, religious teachings and early sexual experiences — both good and bad.

Sexual Problems

A woman's progress through the sexual response cycle varies greatly from one time to another (see box). No one pattern is more "normal" than another. If any of the stages of the cycle does not occur, though, it may cause a sexual problem. The Sexual Response Cycle A woman's body follows a regular pattern when she has sex. There are four stages:

• Desire
• Arousal
• Orgasm
• Resolution

Sexual response depends on a complex interplay — physical and emotional — between two people. Sexual problems can be linked to a physical condition, such as pregnancy or an illness. They also can relate to daily stress, poor communication between partners, unrealistic ideas about sexual performance, or problems with trust and commitment.

Lack of Desire

Lack of interest in sex — or lack of desire — is the most common sexual problem in women. With a low level of sexual desire, a woman may have a hard time getting aroused. Many women find that the stresses of daily living — such as concerns about work, family and money — can create a lack of desire.

Lack of Orgasm

Most women are able to have an orgasm during sexual activity. Some may reach orgasm by masturbation or by having their partner arouse them with their hands or with oral sex. Problems with reaching orgasm can stem from negative feelings about sex learned in childhood. Women who have suffered a trauma related to sex, such as sexual abuse, may not be able to reach orgasm. If a woman has no orgasm during sex, it does not mean it was a failure. Sharing love, closeness, warmth and tenderness are often enough.

Painful Sex

Dyspareunia is a term for pain during or after sex. This may include pain during entry into the vagina, pain during deep thrusting, or pain after sex. The pain can be on the surface or deep, along the middle of the pelvis, or on one or both sides. The most common cause is that the vagina is not well lubricated. Vaginismus also can cause pain during sex. This is a spasm of the pubic muscles and lower vagina. It makes entering the vagina painful.

Conditions That Can Affect Your Sexual Function

Some conditions can have a big impact on sexuality. They may be short-term, such as the flu or pregnancy, or may persist over time and require the couple to adjust.

• Pregnancy

In most cases, sexual activity doesn't have to change during pregnancy. Sex does not harm the fetus unless certain conditions are present.

• Menopause

As women approach menopause, they may lose desire slowly, have a hard time getting aroused, and feel pain during sex. The lack of estrogen that occurs after menopause makes the vagina dry.

• Cancer

Women with cancer often worry about how the disease will affect their sex life. Surgery, radiation and chemotherapy can be painful and sap the woman's energy. She may struggle with fears of death, disfigurement or the partner's rejection.

• Chronic Illness

Diseases that persist for a lifetime, such as diabetes, arthritis or heart disease, can have a major impact on a woman's self-image and her ability to feel sexual. Some medications can affect her desire or make it hard to reach orgasm.

• Male Factor

If a male partner is having sexual problems, pleasure for both partners may be affected. Many men have trouble with impotence — not being able to achieve or keep an erection — at some time in their lives.

• Impotence is usually caused by physical or medical factors.

If You Think You Have a Problem

Nearly every couple has a problem with sex at some time in their lives. Some problems go away on their own or can be worked out with patience and a caring and informed partner. Others may take more effort and a change of approach.

If you think you may have a health condition that is stopping you from enjoying sex, see your doctor. Any pain in the pelvic, genital or vaginal area is a sign that there may be a problem. Your doctor may be able to help you. Your doctor also can refer you to other experts. Sex counseling for individuals or couples is often short term and works well.

Finally

Being able to express yourself sexually lasts a lifetime. It should be nurtured — it's a key part of feeling fulfilled. For all women, talking about sexual needs and concerns is a process that should never end. Sexual problems are common. If you are having a problem with sex, know there are many people with the skills and understanding to help. This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

The Menopause Years

Menopause is the time in a woman's life when she stops having menstrual periods. The years leading up to this point are called perimenopause, or "around menopause." Menopause marks the end of the reproductive years that began in puberty. The average age that women go through menopause is 51 years. Most women enjoy a healthy lifestyle for years afterward.

What Is Menopause?

Estrogen and Menstrual Changes

As menopause nears, the ovaries make less estrogen. One of the earliest and most common signs that menopause may be approaching is a change in your menstrual periods. You may skip one or more periods. The amount of flow may become lighter or heavier. At some point, the ovaries stop making enough estrogen to thicken the lining of the uterus. This is when the menstrual periods stop.

What to Expect

Menopause is a natural part of aging. The lower amounts of estrogen that come with menopause will cause changes in your body.

Hot Flushes

The most common symptom of menopause is hot flushes (hot flashes). As many as 75 percent of menopausal women in the United States will have them. A hot flush is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush. You also may break out in a sweat.

Sleep Problems

Hot flushes can cause a lack of sleep, often waking a woman from a deep sleep. A lack of sleep may be one of the biggest problems you face as you approach menopause.

Vaginal and Urinary Tract Changes

Loss of estrogen causes changes in the vagina. Its lining may become thin and dry. These changes can cause pain during sexual intercourse. They also can make the vagina more prone to infection, which can cause burning and itching.

Bone and Other Body Changes

Bone loss is a normal part of aging. At menopause, the rate of bone loss increases. Osteoporosis, a result of this bone loss, increases the risk of breaking bones in older women. The bones of the hip, wrist and spine are affected most often.

Emotional Changes

Menopause does not cause sudden mood swings or depression. However, the change in hormone levels may make you feel nervous, irritable, or very tired. These feelings may be linked to other symptoms of menopause, such as lack of sleep.

Sexuality

Menopause does not have to affect your ability to enjoy sex. Although the lack of estrogen may make the vagina dry, vaginal lubricants can help moisten the vagina and make sex more comfortable. Regular sex may help the vagina keep its natural elasticity. Some women find that they have less interest in sex around and after menopause. Lower hormone levels may decrease the sex drive. You are not completely free of the risk of pregnancy until one year after your last period.

The Gynecologic Visit

Routine visits to your doctor for breast, pelvic, and rectal exams are recommended for all women. Your doctor will do a Pap test to check for cancer of the cervix. Between visits you should perform a breast self-exam once a month. Depending on your age, your doctor may recommend that you have a mammogram. (Women older than 40 years should have a mammogram every one to two years, and then every year beginning at age 50 years.)

Hormone Therapy

Hormone therapy (HT) can help relieve the symptoms of menopause. It replaces female hormones no longer made by the ovaries. Depending on your situation, you may begin HT before menopause. If you are taking birth control pills, they will be stopped when you begin treatment.

Benefits

Many of the symptoms of menopause can be eased by taking estrogen.

Risks

Like any treatment, hormone therapy is not free of risk. In women with a uterus, using estrogen alone can increase the risk of endometrial cancer because estrogen causes the lining of the uterus to grow. Taking a progestin will help reduce the risk of uterine problems. The drawback of using a progestin is that menopausal women may start bleeding again. There is an increased risk of breast cancer in women who use combined hormone therapy.

Other Therapies

Women also can take selective estrogen receptor modulators (SERMs) to help prevent some of the bone problems that can occur during menopause. SERMs are a type of medication that strengthen tissues of the bones. If a woman does not take hormone therapy or SERMs, there are some other options for preventing bone loss. A medication called calcitonin slows the breaking down of bone. Other medications used to slow bone breakdown are bisphosphonates.

Staying Healthy

Good Nutrition

Eating a balanced diet will help you stay healthy before, during, and after menopause. It's important to eat a variety of foods to make sure you get all the essential nutrients. Choose a low-fat, low-cholesterol diet. Also, be sure to include enough calcium in your diet to help maintain strong bones.

Exercise

Exercise is very important, especially as you get older. Regular exercise slows down bone loss and improves your overall health. Follow a program of regular weight-bearing exercise, such as walking and aerobics.

Finally ...

Menopause is a natural event. Today, women can expect to live one third of their lives after menopause. The physical changes that occur around menopause should not prevent you from enjoying this time of your life. This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

The Pap Test

Since it came into use more than 50 years ago, the Pap test has greatly reduced the number of deaths caused by cervical cancer in the United States. The Pap test is used to find changes in the cells of the cervix that could lead to cancer. Once these changes are treated, cancer can be prevented.

The Cervix

The cervix is the lower, narrow end of a woman's uterus. It opens into the vagina (the birth canal). The cervix is covered by a thin layer of tissue. This tissue is like the skin inside your mouth.

What Is a Pap Test?

The Pap test, sometimes called a Pap smear or cervical cytology screening, is a simple test to look at cells taken from the cervix.

Who Should Have a Pap Test?

Pap tests are an important part of all women's health care. When and how often you have the test depends on your age and health history. You should have routine Pap tests if:

You are 21 years of age or older or You became sexually active at least three years ago, even if you are younger than 21 years of age or are not having sex now How Often Do You Need a Pap Test? All women should have a pelvic exam yearly. When a woman has a pelvic exam with a speculum, a Pap test may or may not be done. Be sure you know if a Pap test has been included in your exam.

Talk with your doctor about whether and how often you should have a Pap test. Women younger than 30 years should have a Pap test every year. If you are older than 30 years and have had three normal Pap tests in a row, you may not need a Pap test every year.

The Test Results

Most labs in the United States use the "Bethesda System" to describe Pap test results. Under this system, your results will be placed in one of several groups:

• Normal (negative)
• Atypical squamous cells (ASC)
• SIL (squamous intraepithelial lesion)
• Low-grade SIL (LSIL)
• High-grade SIL (HSIL)
• Atypical glandular cells
• Cancer
• Follow-Up

Cells taken from the surface of the cervix sometimes look abnormal. Usually abnormal cells are not cancer. Abnormal cells may go through many stages of change before cervical cancer appears. This often happens over a number of years. If the lab finds abnormal cells, your doctor may suggest more tests. This may be as simple as a repeat Pap test. Your doctor also may want to test for human papillomavirus (HPV). HPV is a group of related viruses, a few of which are linked to cervical changes. Sometimes an exam called a colposcopy may be advised. This exam uses a device like a microscope to look at the cervix. If an area of abnormal cells is seen, your doctor may decide that a cervical biopsy is needed. Treatment depends on the test results.

Is the Pap Test Always Accurate?

As with any lab test, Pap test results are not always accurate. Sometimes, the results show abnormal cells when the cells are normal. This is called a "false-positive" result. A Pap test also may fail to detect abnormal cells when they are present. This is called a "false-negative" result.

Finally ...

The Pap test is the best way to find cell changes that may lead to cancer of the cervix. Routine Pap tests can help find problems early. If a Pap test finds abnormal cells, your doctor will suggest further tests or treatment.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

Your health is a concern shared by you and your doctor. Your doctor takes care of your basic health needs and treats problems. This includes telling you about leading a healthy lifestyle and doing tests and exams to look for disease. It is up to you to follow a healthy lifestyle and be aware of any changes in your body that may signal a problem. Even if you are not having any problems, you should see your obstetrician–gynecologist, or ob-gyn, for routine checkups.

What Is an Obstetrician–Gynecologist?

An ob-gyn is a doctor who specializes in the care of women. He or she is trained in obstetrics — the care of pregnant women. This includes:

• Preconceptional period (before pregnancy)
• Pregnancy
• Labor and childbirth
• Postpartum period (after a baby is born)

Ob-gyns also are trained in gynecology. Gynecology covers a woman's general health care. This includes care of her:

• Reproductive organs
• Breasts
• Sexual function

It also includes treating hormone disorders and infections. Your ob-gyn also is trained in surgery to correct or treat pelvic organ or urinary tract problems.

Your ob-gyn offers preventive health care, too. This can help you to make choices that will prevent health problems. Preventive health care includes exams and routine tests that look for problems before you are sick. It also includes immunizations to prevent disease.

Your doctor can evaluate your health and provide care for a range of medical problems, not just those of the reproductive system. For many women, the ob-gyn is their primary care physician — the doctor they turn to first for health care.

Your Ob-Gyn's Qualifications

All ob-gyns receive complete medical training. Their training equips them to give general care to women, as well as care that relates to pregnancy and the reproductive organs. Ob-gyns have earned degrees from college and medical school. They also have completed a four-year course of special training — a residency — in obstetrics and gynecology. After residency, a doctor may be board certified by the American Board of Obstetrics and Gynecology. To become board certified, the doctor must pass two tests. The first is a written test. This test shows that he or she has the knowledge and skills required to treat women. It covers both medical and surgical care. He or she also must show experience in treating women's health conditions for two years in practice after residency. At this point, he or she takes a second test — an oral exam given by a panel of experts. This exam reviews the skills, knowledge and ability to treat many conditions. It includes a review of cases treated during the past year. Doctors certified after 1986 must be recertified in 10 years.

There are three subspecialty areas in obstetrics and gynecology:

• Gynecologic oncology
(care of women with cancers of the reproductive system)
• Maternal–fetal medicine
(care of women whose pregnancies are complicated by medical or obstetric problems)
• Reproductive endocrinology
(care of women who have hormonal or infertility problems)

All certified ob-gyns can treat patients with these disorders. Some doctors have special training that qualifies them to take a test to be certified in these areas. Such doctors often teach other doctors.

If the letters FACOG are written after your ob-gyn's name, it means that he or she is a Fellow (full member) of the American College of Obstetricians and Gynecologists (ACOG). All ACOG Fellows are board certified. ACOG is a national group of more than 36,000 ob-gyns. It supports women's health care issues and offers a range of teaching programs to help doctors keep up with the latest advances in women's health care.

Your doctor may be a Junior Fellow in ACOG. Junior Fellows are in a training program or have just finished training. They are in practice preparing to pass the final oral exam.

Your ob-gyn may work as part of a health care team of other professionals. This is known as a collaborative practice. This health care team is led by the ob-gyn and may consist of:

Residents — Provide care to patients at teaching hospitals after graduation from medical school.

Certified nurse–midwives — Care for women during pregnancy and childbirth. They have an extra 12 to 18 months of schooling after graduating from an accredited nursing program and must pass a national certification exam.

Nurses — Assist doctors in providing patient care and education. They have completed accredited nursing programs and passed tests.

Nurse practitioners — Provide a wide range of services, which includes obtaining medical histories, doing physical exams, and diagnosing and treating common illnesses and diseases. They are licensed registered nurses who have advanced education. In some states, they must pass a national certification exam.

Physician assistants — Handle various medical duties. They have completed at least a two-year educational program after college.

Dieticians — Give advice and guidance on diet and nutrition.

Social workers — Provide counseling and information on community services. They have studied in a special program and must be licensed.

Childbirth educators — Teach parents-to-be about conception, pregnancy, birth and parenting.

Collaborative practice brings together health care professionals with different knowledge and skills. They work as a team, and each member has a role. In this type of practice, patients receive care from many types of professionals. Each person does what he or she does best. Services are provided in a cost-effective manner that may save you waiting time, too. The contributions of each member are key to the care of the patient.

What Kind of Care Does Your Ob-Gyn Provide?

The care provided by your ob-gyn can range from a basic gynecologic exam to complete health care of reproductive or other disorders. The type of care depends on your needs and options available.

Well-Woman Visit

The well-woman visit is a key part of preventive care. This consists of an evaluation of your general health and an exam of your breasts and pelvic (reproductive) organs. With this exam, your ob-gyn:

Looks for health problems in their early stages Detects risks to your health Tells you how you can change your lifestyle to lower these risks You also may have certain tests and immunizations. It depends on your age. You should have a well-woman exam on a routine basis if you are sexually active or age 18 or older. Most women should see their ob-gyn once a year. More frequent exams may be needed based on your health risk factors. If you have a health problem or notice any changes in your body, such as an unusual vaginal discharge or genital itching, you should contact your doctor right away.

Your Pereodic Health Evaluation

Routine Tests by Age	Frequency
Ages 13-18
Pap test	Yearly when sexually active or by 18 years
Tetanus booster	Once between ages 11-16
Hepatitis B vaccine	One series for those not previously immunized
Ages 19-39
Pap test	Anually
Tetanus-diptheria	Every 10 years
Ages 40-64
All of the above in each category, plus:
Mammography	Every 1-2 years until age 50, then yearly
Cholesterol test	Every 5 years starting at age 45
fecal occult blood testing	Every 3-5 years after age 50
Sigmoidoscopy	Every year starting at age 50
Fasting glucose testing	Every 3 years after 45
Ages 65+
All of the above in each category, plus:
Urinalysis	Yearly
Influenza vaccine	Yearly
Pneumococcal vaccine	Once

Health History

During your exam, one of the first things your doctor does is obtain a history of your health. This will include information about:

• Your past illnesses
• Family health history
• Your menstrual periods
• Use of medications and birth control
• Whether you are or ever have been pregnant

The Pap Test

During the Pap test, cells are taken from the cervix to look for changes that could be a sign of cervical cancer or changes that could lead to cervical cancer. The test detects possible signs of disease in women who do not have symptoms such as bleeding, pelvic pain or discharge.

You should have your first Pap test by age 18 or when you become sexually active. Women are advised to have a Pap test once a year. Based on test results and the presence of any risk factors for cervical cancer, this test may need to be done more or less often. It's best to check with your doctor.

The doctor performs the Pap test during your pelvic exam. To ensure accurate results, you should arrange to have the test when you're not having your period. Do not douche or use vaginal medication for two to three days beforehand.

First, a speculum is inserted into the vagina so the cervix can be seen. Then a small brush or swab and applicator are used to remove cells from the cervix. You may have some spotting for a day or two after the test, especially if you're pregnant. Cells will be taken from inside the opening of the cervix and from the outer part of the cervix. They are sent to a lab to be tested. A trained technician or doctor looks for cells that do not appear normal. Results are based on how the cells look.

The Pap test is the best way to detect conditions that may lead to cervical cancer. By treating these conditions, cancer often can be avoided or treated early. The doctor also may ask about your job, level of stress, health habits, sexual activity and any risks to your health (such as an abusive relationship). Your answers should be honest and open. This will help your doctor look after your health. Anything you tell your doctor will be kept secret — no one else will know.

If you have any poor health habits, such as smoking, a high-fat diet, or drug or alcohol abuse, you should discuss these with your doctor. These habits can increase the risk of disease and have a bad effect on your overall health. Also, smoking and substance use can harm the health of your baby if you are pregnant. Your doctor can help you break poor habits and replace them with healthier ones.

If you are sexually active or planning to be, your doctor also can talk to you about contraception and prevention of sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV).

Physical Exam

The general physical exam often begins with a check of your weight and blood pressure. Your doctor also may listen to your heartbeat and feel your abdomen and neck. The exam is based on your age and any risk factors you may have. The gynecologic exam is done to assess the health of your reproductive organs. Your ob-gyn will first check your breasts for signs of lumps. You should do a breast self-exam regularly. If you are not sure how to do this exam, your doctor or nurse can teach you. After examining your breasts, the doctor does an exam of your pelvic organs. You will be asked to lie on a table with your legs raised and your knees bent and spread apart. The doctor first examines the outside genitals (vulva). He or she then will insert a slender device called a speculum into the vagina to view the vagina and cervix and take a sample of cells for testing. After the speculum is removed, the doctor inserts one or two gloved fingers into the vagina and reaches up to the cervix. The uterus and ovaries can be felt from the inside with this hand while the other hand presses on the abdomen from the outside. This allows the size, position and shape of these organs to be checked. During the exam, your doctor also may examine your rectum using a gloved finger. The exam can help your doctor detect any tumors or lumps or other problems that may be present.

Tests

The type of tests you receive and how often they are done depend on your age and whether you are at risk for any disease. One test that all women should have on a regular basis is the Pap test. This is done during the pelvic exam. The doctor uses a cotton swab or brush to take a sample of cells from the cervix. These are studied in a lab for signs that could signal cancer of the cervix (see box ).

Other tests also may be part of your well-woman exam:

Cholesterol test is a blood test done to check levels of cholesterol, a substance that helps carry fat through the blood. Patients with a high cholesterol count are advised about diet and other preventive health measures.

Mammography is an X-ray of the breasts to detect breast cancer.

Fecal occult blood test is a test of a stool sample for hidden blood that may detect colon or rectal cancer.

Sigmoidoscopy is the use of a slender device placed into the rectum and lower colon to look for cancer.

Urinalysis is a test done on urine to look for changes that might be a sign of illness.

Blood count is a test to detect anemia and infection.

If you are concerned about being exposed to STDs, including HIV, tell your doctor. He or she may suggest you have certain tests done.

Care of Reproductive and Other Conditions

Your ob-gyn can detect and treat a number of medical conditions that affect the reproductive system. An ob-gyn also may treat certain medical conditions that do not involve the breasts or reproductive organs. This is key for women who don't regularly see a doctor other than their ob-gyn. In some cases, the ob-gyn will diagnose a medical problem and refer the patient to another doctor for treatment. In others, the ob-gyn can treat the problem and provide routine health care. The decision on how to treat a disorder depends on how severe it is, whether it is getting worse or is under control, and the comfort level of a woman and her doctor.

Finally

You and your ob-gyn can work as a team to ensure your good health. If you take proper care of yourself, visit your doctor regularly, and report any symptoms that may signal a problem, you will increase your chances of staying healthy. It is always better to prevent illness — through a healthy lifestyle and preventive care — than to treat it.

Glossary

Collaborative Practice: A type of practice where care is given by a team of professionals.

Gynecology: The branch of medicine that involves care of women's health, including the reproductive system and breasts.

Obstetrician–Gynecologist: A doctor with special skills, training and education in women's health care.

Obstetrics: The branch of medicine that involves care of a woman during pregnancy, labor, childbirth and after the baby is born.

Pap Test: A test in which cells are taken from the cervix and examined in a lab for abnormalities that could signal cancer.

Sexually Transmitted Disease (STD): A disease that is spread by sexual contact, including chlamydia infection, gonorrhea, genital warts, herpes, syphilis and infection with human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Vulva: The lips of the external female genital area.