Jefferson University Hospitals

Frequently Asked Questions

Discovering cervical abnormalities early through regular pap smears has been shown to significantly decrease the chance of developing cervical cancer. The growing number of women who get yearly pap smears today accounts for a significant drop in cervical cancer in the United States over the last 25 years. With early detection, precancerous changes in the cervix can usually be treated before they develop into cancer.

Who needs a pap smear?

Getting an annual pap smear is the best prevention for women against cervical cancer. The American Cancer Society recommends that women get a pap smear three years after they become sexually active or when they reach the age of 21, whichever comes first. This simple diagnostic procedure involves the removal of a tiny sample of cells from the opening of the cervix for laboratory testing. Pap smears are typically done during an annual gynecological check-up or routine physical.

Pap tests may detect abnormal cell changes long before they turn into cancer. In rare cases, a cervical abnormality may be missed on a pap smear. For this reason, all women should be alert to the possible symptoms of cervical cancer, which include persistent bleeding and bleeding after intercourse. If you have these symptoms, call your doctor, even if your last pap smear was normal.

What does an abnormal pap smear mean?

An abnormal result indicates that the cells on the outer layer of the cervix have changed in an unusual way. This does NOT mean you have cancer. Precancerous cell changes are 10 to 20 times more frequent than true cervical cancer. Sometimes, though, these unusual cells develop into preinvasive or precancerous lesions called “dysplasias” (dis-play-shas). If the dysplasia is severe, your physician will recommend removing the cells. Untreated, dysplasia can develop into cervical cancer.

An abnormal pap smear may also indicate the presence of the human papilloma virus (HPV), a common sexually transmitted disease also known as genital warts. Once a woman has been diagnosed with HPV, she needs to get pap tests more regularly because HPV is associated with the development of dysplasia.

Other times, abnormal pap smears are caused by infections that can be treated with medication.

How do I find out if the abnormal pap smear is linked to cancer?

If your pap smear shows an abnormality, your physician may suggest you have another diagnostic test called a colposcopy (col-pas-co-pee). This test provides a more specific and reliable indication of precancer or HPV infection than the pap smear. In a colposcopy, the physician applies a mild, vinegar solution to the cervix making any abnormal cells more visible. Using a binocular magnification device called a colposcope, the physician looks for abnormalities on your cervix and takes biopsies (small samples of tissues) from the most abnormal area. These samples are then sent to the laboratory for examination.

How are serious cervical abnormalities treated?

If you are diagnosed with moderate or severe dysplasia, you might need to have an additional biopsy performed after a colposcopy to rule out cancer and to remove additional abnormal cells. Your physician may perform either a cone biopsy or LEEP (loop electrocautery excision) procedure, depending on which is more appropriate in your case.

The cone biopsy is performed in a surgical outpatient unit under general anesthesia. The physician removes a cone-shape piece of the cervix with a scalpel. The LEEP procedure is performed under local anesthesia and employs a wire loop supplied with an electrical current to remove the tissue. Both diagnostic techniques are also used to treat some precancers that are restricted to the lower portion of the cervix.

If your physician detects a lesion elsewhere on the cervix, laser surgery may be recommended. Here, a beam of light is directed on the abnormal area and the heat kills the cells.

What happens if I don’t seek treatment for an abnormal pap smear?

Precancer is a warning that you are at risk of developing cancer. Therefore, if your pap test suggests a precancerous change in the cervix, it is in your best interest to seek further evaluation as soon as possible. Close, careful monitoring through pap smears and colposcopy is essential in preventing precancerous lesions from progressing to invasive cancer.

Invasive cervical cancer is treatable through radiation and/or hysterectomy. However, these treatments are both more complicated and more prolonged than the treatments for precancers described above. Cure rates are also lower, depending on the extent of the cancer.

If you detect and eliminate precancerous lesions promptly, your chances for a cure are excellent. From 90-95 percent of women treated by cone biopsy, the LEEP procedure, and laser are cured. Five percent of patients need retreatment.

Can I prevent cervical abnormalities?

You can reduce your risk of cervical cancer and other precancerous abnormalities by getting routine pap smears and protecting yourself against the HPV virus. Limiting your sexual partners and using condoms will reduce, but not eliminate your risk of HPV. If you smoke, giving up cigarettes will also cut your chances of cervical cancer.

What are clinical trials?

When laboratory research shows that a new treatment method has promise, patients with cancer have the opportunity to receive the treatment in clinical trials or protocols.

By participating in a clinical trial you may have the first chance to benefit from improved treatment methods and the opportunity to make an important contribution to medical science.

To find out more about current clinical trials that you may be able to participate in, ask your doctor or call 215-955-1661 or 1-800-JEFF-NOW.

What is vaginitis?

Vaginitis is an inflammation of the vagina, due most often to infection. If you have vaginitis, your vaginal tissues may become red, swollen and irritated. You may feel a burning or itching sensation, and may notice an abnormal discharge and odor.

While vaginitis may make you uncomfortable, it is usually not serious. Although treatable, vaginitis rarely disappears on its own. Because different things can result in vaginitis, your doctor will need to determine the cause before treating your condition.

What causes vaginitis?

Your vagina is a muscular tube connecting your uterus with the outside of your body. Normally, your vagina harbors microscopic organisms that keep the vagina naturally acidic and forms a barrier against infection. If something happens to change the acidity of the vagina, however, harmful microorganisms may grow out of control, causing the symptoms of vaginitis—itching, irritation, swelling, redness and abnormal discharge.

If your general resistance to disease has been lowered by stress, illness, lack of sleep or poor diet, for example, you may be particularly vulnerable to vaginal infections. In addition, some sorts of vaginal infections can be transmitted during sexual intercourse.

What causes the acidity of the vagina to change?

Many things can alter the level of acidity in your vagina. For example, if you take antibiotics for another disease, the microscopic organisms responsible for maintaining the acid level in your vagina may be destroyed. As a result, your vagina becomes less acidic. Diabetes and pregnancy also affect vaginal acidity to a lesser degree.

Physical things can change vaginal conditions. For example, tampons or douching can irritate the vaginal walls. Tight slacks and panties without a cotton crotch can result in vaginitis.

What is "abnormal" discharge?

Your vagina cleanses itself by means of secretions that form normal vaginal discharge. This discharge ranges from clear to cloudy, and has no odor. Normal vaginal secretions are usually limited in quantity, so production of a stain on underwear is sometimes abnormal. Abnormal discharge usually has a distinctive odor, and is often accompanied by itching, burning or irritation.

How is vaginitis treated?

Treatment depends on what specific organism is responsible for your case of vaginitis. In order to treat you effectively, your healthcare professional will need to determine the exact cause of your problem. Although self-treatment for vaginitis, especially yeast infections, is common, studies suggest that as many as 60 percent of women who treat themselves for a yeast infection are treating the wrong thing.

If you notice any of the symptoms of vaginitis, make an appointment to see your physician. Your doctor will examine your vagina and take a sample of the vaginal discharge for examination under a microscope. Because the discharge contains important clues to the cause of your condition, do not douche or use vaginal medication before seeing your doctor.

If the examination reveals that you have a vaginal infection, your doctor will prescribe appropriate medication. If your vaginal tissues have become irritated for a different reason, your doctor will tell you how to alleviate your problem.

What kinds of vaginal infections cause vaginitis?

The three most common types of vaginal infections are bacterial vaginosis, candidiasis and trichomoniasis. The symptoms for each of these infections differ as well as the treatments.

What is bacterial vaginosis?

Bacterial vaginosis is caused by the rapid growth of several different types of bacteria. The infection may cause an abnormal discharge with an unpleasant odor; however, up to 50 percent of patients may have no abnormal signs or symptoms. Bacterial vaginosis responds promptly to antibiotics, such as metronidazole and clindamycin. In the United States, bacterial vaginosis is the most common form of vaginitis.

What is candidiasis?

Candidiasis, also known as yeast or fungus infection, is another common cause of vaginitis. Pregnant, obese and diabetic women and women taking antibiotics or birth control pills are particularly vulnerable to candidiasis. Candidiasis causes an inflammation of the vaginal walls, with itching, redness and irritation, sometimes accompanied by a white, odorless discharge. If you have candidiasis, your doctor may prescribe oral medication or medication in the form of vaginal creams, gels or suppositories to destroy the yeast and restore the vagina to its normal state.

Candidiasis can be persistent and may recur. If you have recurrent infections, talk to your doctor and take the medication that your doctor prescribes. Recurrent infection may require more intensive evaluation and therapy to get them under control.

What is trichomoniasis?

Trichomoniasis is an infection that can affect both the vagina and the urinary tract. Trichomoniasis is most often transmitted sexually. If you have this kind of infection, you may have an abnormal, yellow-green, foul-smelling discharge and a burning sensation, especially when you urinate. The symptoms may grow more severe around the time of your menstrual period.

Most often, trichomoniasis is cured effectively and rapidly with a medicine called metronidazole. Your doctor may prescribe one large dosage, or smaller doses taken over seven days. If you take metronidazole, you should not drink any alcoholic beverages. Some people experience side effects to the drug that may include nausea and darkening of the urine. To avoid re-infection, your doctor will recommend that your sexual partner be treated at the same time.

It is important to understand that sexually-transmitted infections sometimes "cluster" together. This means that if you have trichomoniasis (or "trich"), you may also have other more serious sexually-transmitted infections, such as gonorrhea, chlamydia or even HIV (AIDS). Your doctor can perform tests for these infections and provide treatment if necessary.

What else might be causing my vaginitis?

In addition to these infections, vaginitis may stem from other causes. Certain chemicals, such as those found in bubble bath and feminine hygiene sprays, can irritate vaginal tissue. So can improper use of tampons, tight clothing and non-cotton underwear. With the lack of estrogen stimulation after menopause, vaginal tissue grows thin and dry. This makes the vagina more vulnerable to injury and irritation, causing an inflammation called atrophic vaginitis.

How can I prevent vaginitis?

If you have repeated bouts with vaginitis, make a special effort to keep your vaginal area clean.

To prevent bacteria from spreading from the bowel and rectum to the vagina, wipe from front to back after a bowel movement. Clean the area around the vagina and vulva by washing daily, keeping the area as dry as possible. "Breathable" cotton underwear, or underwear with a cotton crotch, allows moisture to evaporate; other fabrics trap moisture that harbors harmful bacteria. Avoid tight clothing, which also traps moisture.

Take a break from tampons when you have your period. Use a sanitary pad for at least part of every 24-hour period.

Avoid unnecessary substances which might irritate delicate vaginal tissue. Irritants include feminine hygiene sprays, harsh soaps, perfumed toilet paper and tampons with deodorants. Avoid douching.

Take good care of yourself. Good general health will make you more resistant to vaginitis.

What if I think I have vaginitis?

While vaginitis will not go away by itself, it does respond to proper medical treatment. Don't try to treat yourself with home remedies, and don't use old prescriptions. Make an appointment to see your healthcare professional as soon as you notice any of the symptoms of vaginitis. The earlier you begin treatment, the quicker you will be rid of your infection. Be sure to finish all your medication, and to follow instructions carefully.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.

American College of Obstetricians and Gynecologists:

Why should I exercise?

Exercise offers many health benefits to women. Aerobic exercises, such as brisk walking, swimming, jogging, and cycling, are beneficial because they give you energy and increase your cardiovascular (heart and lung) endurance. Weight-bearing exercises, such as walking or jogging, and resistive exercises, such as weight training, can help prevent the loss of bone mass (osteoporosis) common to older women. In general, exercise lessens many of the symptoms of premenstrual syndrome and menopause. Some medical studies have shown a link between regular exercise and reduced risk for certain women's cancers. And of course, any regular exercise routine will help you to lose weight or maintain your ideal weight, which makes you look better and feel better.

Can anyone begin an exercise program?

Anyone in good health can start an exercise program. Of course, if you are pregnant or under a doctor's care for any other reason, get your doctor's approval before starting any new physical activities. Likewise, see a doctor first if you have high blood pressure, smoke, are overweight or are over 40 years old and have never exercised before.

Why is exercise good for my heart? Why is that important?

Your heart is a muscle that pumps blood throughout your body. Regular aerobic activities strengthen your heart by making it work harder. At the same time, they increase your body's ability to use energy-giving oxygen. Since heart disease is the number one killer of women in this country, building cardiovascular endurance — that is, strengthening the heart, lungs, and circulatory system — should be a priority in every woman's fitness program. Aerobic exercises are the most efficient way to do this. Remember, though, that for effective conditioning, you must choose activities that elevate your heart rate and keep it elevated for a period of at least 20 minutes straight, three times a week. Stopping and starting in the middle of your exercise is not as effective. However, it's okay to start slowly and, as the days and weeks go by, progress up to at least 20 minutes. Also, every exercise session should include a proper warm-up and cool-down with stretching.

How can I tell if I'm working my heart hard enough?

In order to improve cardiovascular fitness, you must exercise hard enough to make your heart beat faster than it does at rest. How much harder will depend on your age and physical condition. To calculate this you can use this simple formula: 220 – age x 75% = your target heart rate. A general rule of thumb is, you should be able to talk, but not sing while performing your activity. If you can't talk, you're working too hard; if you can sing, you're not working hard enough.

How often should I exercise?

You should exercise at least three times a week. Aerobic exercises can be performed every day with no adverse effects. Resistive exercises, such as weight training or toning exercises, should be done every other day, to allow your muscles to recover. If you break your fitness pattern — especially if you stop exercising for more than six weeks — you will lose your conditioning benefits. You will need to begin building up your endurance all over again.

Do housework or childcare count as exercise?

Any activity is better than no activity. Certainly, heavy housework and chasing after children can increase your heart rate temporarily and give you some muscle tone. But these are no substitute for a regular fitness routine.

I've been exercising, but I'm still not losing weight.

A balanced, low-fat diet with the appropriate number of calories, combined with a sustained exercise program, is the best way to lose weight. If you exercise regularly without cutting calories or fat grams, you will lose weight more slowly. However, you should still notice a change in your body as your muscles become firmer.

As you progress in your exercise program, your body replaces fat cells with muscle, which weighs more. Thus, you may begin to look more slender even before a change shows up on the scale. As you continue to exercise, you will lose weight.

Will exercise affect my menstrual cycle?

A vigorous exercise routine can affect a woman's menstrual cycle. With excessive, intense exercise, you may find that you have less frequent menstrual periods, or you may not menstruate at all. Of course, these changes can be due to factors other than exercise. If you stop menstruating, consult your doctor to find the cause.

Other menstrual irregularities, such as bleeding or spotting between periods, and bleeding and pain after sexual intercourse, are not related to exercise. If you experience changes in your menstrual cycle, see your doctor.

I'm pregnant. Can I still exercise?

Exercising during pregnancy can help keep you both fit and comfortable as your pregnancy progresses. It will also help you get back into shape more quickly after your baby is born. Consult with your doctor about specific exercises you wish to do — your fitness level before you got pregnant and your condition during pregnancy will determine what exercise routine is acceptable for you.

You will find that the extra weight you are carrying will make you work harder as you exercise. Other changes that occur during pregnancy, such as a shift in the body's center of gravity, and the increased laxity of joint ligaments, will affect what one can do. Let your body guide you, and don't push yourself. Some healthcare institutions and fitness facilities offer special exercise classes for pregnant women.

Walking is an excellent exercise during pregnancy, particularly for women who did not exercise regularly before becoming pregnant.

OK, I'm sold. How do I begin?

Getting started is the hardest part of getting fit. Here are some tips to help get you on your way:

  • Plan time for exercise as you would a business meeting or other important engagement. Write it down in your calendar or appointment book.
  • Find a buddy to exercise with, someone who will keep tabs on you. The peer pressure might be just what you need to stay motivated.
  • Tell yourself you're only going to exercise for five minutes. Chances are, once you get started, you'll do more.
  • The number-one reason for quitting is lack of time. Choose a spot to exercise that's convenient to home or work.
  • Pick an activity that's fun for you.
  • Vary your routine.

Have a backup routine for emergencies. For instance, if you normally walk outside and it's raining, walk in a mall instead. Or exercise to videotapes.

Remember that part of being fit includes weight control, proper nutrition, stress reduction and healthy lifestyle choices. Becoming fit means saying "no" to unhealthy habits such as smoking, alcohol and drug misuse. A fit lifestyle can increase the number and quality of the years ahead of you.

For an appointment with a Jefferson physician, more information or health information and education programs, please call 1-800-JEFF-NOW (1-800-533-3669).

Speech- or hearing-impaired callers can access JEFF NOW® by calling 1-800-654-5984.