Women's Health

Vitamins
All menstruating (in other words, still having periods) Women should take a vitamin with iron, at least every few days. This can be 2 “Flintstone complete” vitamins or a chewable Centrum. The “Silver” vitamins don’t have much iron. The “A-Z” vitamins don’t all have iron, so please check your label.

Non-menstruating women should take a multivitamin withOUT iron. My favorite of these are the “Flintstones Gummy” vitamins. To get enough, however, an adult should take 2-3 of these. The “Silver” vitamins are OK. There is a Chewable Centrum Silver vitamin too.

Why Chewable Vitamins?
Many people don’t digest vitamins well. People with stomach problems, particularly ulcers, gastritis, esophagitis, just don’t have good absorption of vitamins. People on stomach medicines don’t absorb vitamins - like zantac, pepcid, and especially acid blockers like Prilosec, Prevacid, Nexium, Protonix, and Aciphex. 

People who have had Gastric surgery, especially Gastric Bypass or Stomach Stapling Bariatric surgery don’t absorb vitamins well. They must take chewables in higher doses. Dr. Stiles recommends a Centrum Chewable and Calcium plus D chewable, twice a day. They sometimes need B12 shots as well. We check multiple vitamin levels annually in folks who have had Bariatric surgery. 

People who have had Gallbladder removal or who have chronic diarrhea may not absorb fat-soluble vitamins well – especially Vitamin K, A, D, and E. They must take extra vitamin D sometimes, like in the chewable Calcium plus D tablets. 

Some medicines especially Metformin (Glucophage) inhibit B12 absorption. 

B12 is now available as a sub-lingual dissolving tablet. There are liquid vitamins. Calcium plus Vitamin D is available in a chewable tablet. 

 

The “Pap”

 

What is a Pap Smear?
The “Pap” or Pap smear is actually only one part of the Well Woman exam. “Pap” is short for Papanicolau, the guy who invented the test. The Pap refers to the sample that is taken of the woman’s cervix that screens for cervical cancer. This test is ESSENTIAL for sexually active women, to pick up early cancer of the cervix. This type of cancer is very easy to treat if caught early. (Please refer to our section on Cervical Cancer for more info on the Pap and the Exam.) 

What is the Cervix? 
The cervix is the bottom part of the uterus or womb that extends into the vagina. You can feel inside your vagina with a finger. If you are sitting, the cervix will be hanging down from above. All women should be familiar with their bodies and use the correct words for their body parts. 

The “Pelvic Exam”
This refers to the whole exam below the waist. First, a sheet is placed over the woman’s lap. Generally Dr. Stiles starts with what’s called the “bimanual exam.” After inspection of the external genitalia, one finger is placed inside the vagina. The other hand is used on the abdomen to feel for masses of the ovaries on each side, and the uterus in the middle. This helps locate the cervix for easier placement of the speculum, the plastic thing that goes in the vagina. The speculum is then placed gently inside the vagina. It is opened up to allow the cervix to be viewed. Sometimes the cervix will be very forward and high up, making it difficult to get into view. When in view, the Pap will be done. The Pap samples are taken using a brush on a stick, and a spatula on a stick. These are touched to the cervix to collect a few cells. Cells are tiny little bits of the surface of the cervix. They cannot be seen without a microscope. The brush and spatula collect a few cells that are put in the specimen jar of special liquid. The cells are looked at by a Microbiologist who can tell if they are normal or perhaps changing. 

Our paps are done using “Thin Prep” technology, the state of the art technology that gives better samples. Thin Prep makes menstrual blood less of a problem. It also picks up some infections like Trichomonas, Bacterial Vaginosis, and Yeast. We have found that Thin Prep is better at collecting the special cells we need, called “Endocervical Cells.” 

Abnormal Paps
There are several levels or classifications of abnormal Paps. The lowest level of abnormality and most common, is called “ASCUS” or “Abnormal Squamous Cells of Unknown Significance”. 

Abnormal Pap samples are automatically sent for HPV typing. This test looks for the High Risk type of HPV virus. These are subtypes of the virus that can cause cancer. There are many types of virus but only a few associated with cancer. If you have the High Risk type of virus, you will be referred to a Gynecologist for a special test called “Colposcopy”. 

HPV Virus
“Human Papilloma Virus” is very common. Some types cause genital warts, some types cause regular warts, and some types cause cervical cancer. Luckily there are new vaccines out for HPV, one of which is called, “Gardasil.” 

Role of the Immune System
As with all types of cancer, the immune system is key for preventing, controlling, and eliminating cancer cells. People with a weak immune system are prone to more cancer. People on immune suppressant medicines have more risk of all kinds of cancer. The immune system gets weaker with age, as well as with stress. People on special medicines for a transplant, for Rheumatoid Arthritis, Lupus, Sarcoidosis, or on Steroids.

When To Start “the Pap?”
It is recommended to start Pap Smears and Pelvic Exams when the woman is 18, sexually active, or if there are other female problems. These should be done annually. A good time to remember the Pap is on your birthday or at the beginning or end of the year.

Your First Pap
On your first Pap Smear or Pelvic exam, each step of the way will be explained in advance. It will be done very carefully and slowly so you can stop us if it hurts. It is nice to have a female relative in the room with you the first time. And a nurse is always present as well. It may be uncomfortable but shouldn’t be painful and it is very quick. 

How Often to Have a Pap?
It should be done annually. When a woman is monogamous with one partner who is also monogamous, and has had 3 normal Paps with that partner, she can reduce these to every 2-3 years. However, if her immune system is suppressed she may need them as often as every 6 months. Women who have had their uterus and cervix removed, as in the case of a Total Abdominal Hysterectomy, for something other than cancer, can stop Pap Smears.