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Women's Health Matters

The Women's Health Matters series covers health topics pertinent to student life in order to promote a safe and healthy university experience.

Topics in this series include:

  • Contraception

    If there are topics of interest you would like to see in our Health Matters series, send us an health [dot] promotion [at] mcgill [dot] ca (e-mail) .



    Pap Smear

    The Pap smear (Pap test) was named for Dr. George Papanicolaou, who developed the test in 1943. It is an important part of any gynecological exam. A swab is used to remove a tissue sample from the cervix (the lower end of the uterus) for examination. The Pap smear is considered by many to be the best tool available for identifying pre-cancerous or cancerous cells. Since the development of the Pap smear, the number of deaths from cervical cancer has decreased 70%. However, the test does not check for STDs or infections.

    How is a Pap Smear performed?

    You will be asked to remove your clothing, and given a gown to wear. You will be left alone in a curtained area to change. Once you have changed, you will be asked to lie down on your back on the examining table, with your bum at the edge of the table and your knees or feet supported in foot supports, called stirrups.

    The doctor will place a metal or plastic instrument called a speculum into your vagina to gently expand its walls so the cervix can be seen. This can be slightly uncomfortable, and the speculum may feel cool. Feel free to tell the doctor if you are too uncomfortable.

    The doctor will look at your cervix for any abnormal discharge, irritation or growths. The doctor will then collect cells from around the opening of your cervix using a small wooden scraper (kind of like a tongue depressor) or special brush. This part shouldn’t hurt, so make sure you tell the doctor if it does.

    The cells are then smeared on a glass microscope slide (hence the name Pap “smear”) and preserved with a solution to prevent them from drying and changing appearance.

    After the Pap smear, your doctor will examine your uterus and ovaries. By placing one hand on your abdomen and gently pushing the uterus up with two fingers of the other hand in the vagina, the doctor will check for abnormalities.

    What does a Pap smear tell you?

    A technologist examines the slide under a microscope, looking for abnormalities (such as pre-cancerous or cancerous cells) among the 50,000 to 300,000 cells on the slide. In most women, Pap smears are normal. If they don't look normal, the Pap smear is repeated. Further exams may also be needed.

    How Often Should I have a Pap Smear?

    If you are over 18 years of age or sexually active (with males OR females), you should have a Pap smear once a year. Talk to your doctor to determine the most appropriate frequency for you.

    Who is at high risk for cancer of the cervix?

    Risk for cervical cancer is increased proportional to the number of foreign bodies that have come close to it. Thus, women who have had multiple sex partners (male OR female) are in a higher risk group.

    Doctors have identified the following risk factors for the disease:

    Women who have had more than one sexual partner.
    Women whose partner has had more than one sexual partner.
    Women who became sexually active before maturity, usually age 18.
    Women with a history of vaginal infections (including yeast) or genital warts.
    Women who had their first child before age 20
    Women who have had many pregnancies

    How can I improve the accuracy of my Pap Smear?

    Do not use talcum powder, cream or hygiene applications in or around the vagina, as they may mask clues to diagnosing some vaginal conditions.

    Make sure your appointment for your Pap smear does not fall during your period.

     


    Colposcopy

    A colposcopy is a procedure very similar to a Pap smear, but it is done by a specialist to whom you will usually be referred by your regular doctor.

    You will be asked to change into a patient gown, and then lie down on an examining table on your back, with your feet in the stirrups. A doctor will then use a speculum to open the walls of your vagina so that your cervix can be seen. Vinegar will then be squirted on your cervix, because it helps make abnormal cells visible; don’t be surprised if you smell it.

    A colposcope, a lighted magnifying instrument that looks like a small mounted pair of binoculars, will then be used to look at your vaginal walls and cervix for abnormal cells.

    A colposcopy is done in the hospital. You make an appointment with the specialist, and can leave as soon as the procedure is done. You should feel little or no discomfort; however, a colposcopy is often combined with a cervical biopsy, which may cause you some discomfort.

    Why a colposcopy?

    A Pap smear is an excellent tool to identify the presence of abnormal cells, but a colposcopy can more accurately identify the specific areas where the abnormal cells are. A colposcopy also allows for treatment of pre-cancerous conditions through less invasive methods than might otherwise be necessary.

    Studies indicate that cancer of the cervix starts with superficial cell changes, which can under certain conditions progress gradually towards invasive cancer. Abnormalities may show up on a Pap smear, but further investigation with a colposcopy can help identify pre-cancerous conditions earlier, for a greatly increased chance of early treatment and a complete cure.

    You should also be referred for a colposcopy if you are diagnosed with genital warts, or HPV, since the virus may attack the cervix and create pre-cancerous conditions, which must be treated as early as possible.

    What kind of treatment may be used?

    Dysplasia of the cervix (abnormal growth of tissues) must be treated as potential cancer.

    When you have a colposcopy, any lesions found may be treated by:
    Laser beam to destroy cells in a small area resulting in little or no damage to surrounding cells, or
    Cryotherapy, which involves the use of liquid nitrogen to destroy abnormal tissues by freezing.
    Genital warts, or HPV, can now also be treated with a cream.
    A cervical biopsy, or the removal of some of the abnormal tissue, may be done to determine the nature of the abnormality.

    Make sure you ask questions and discuss your options with your doctor before the colposcopy, so that you can understand what is going on.

    What happens after a colposcopy?

    Depending on the treatment chosen, you may experience some vaginal discharge for ten to fourteen days. You should not douche, use vaginal tampons, or have sexual intercourse during that period, because the cervix needs time to heal.

    You will have to follow up for one year with the specialist who performed the colposcopy, at 3 or 6 month intervals. You should then have two Pap smears with your regular doctor at six-month intervals before you can return to your regular Pap Smear schedule.

    This is, of course, an average schedule; your doctors will determine what is appropriate for you, based on the results of your colposcopy.

     

    Yeast Infection

    Yeast (a.k.a Candida, Monilia or fungus) is a fungal organism which normally grows in harmless quantities in both the vagina of women and the digestive tracts of both sexes, as candida grows best in a warm, moist, mildly acidic environment. Anything that upsets the normal bacterial or chemical environment of the vagina can contribute to a yeast infection.

    Yeast infections are relatively harmless but they can be uncomfortable and hard to get rid of. The main symptoms of a genital yeast infection include:

    • Itching, burning and vaginal pain or soreness.
    • Thick, white vaginal discharge.
    • Men may experience irritation and redness on the head of the penis or under uncircumcised foreskin.

    Factors which can lead to a yeast infection

    High sugar consumers and diabetics have increased sugar in their vaginal secretions that render them more susceptible to infection because yeast feeds on sugar.

    Antibiotics taken to kill harmful bacteria may also reduce other bacteria which help keep yeast in check.

    Pregnancy, birth control pills, oral corticosteroids and other hormones may alter normal hormone levels in the body and contribute to the overgrowth of yeast in the vagina.

    Fatigue and stress may weaken the immune system and favour infections including yeast.

    Sexual intercourse or oral sex is another means of transmitting yeast.

    Irritation from nylons, soaps, tight clothing, tampons, deodorants, douching, spermicide or intercourse itself, may also change the vaginal environment resulting is yeast infections.

    Helpful hints on avoiding yeast infections

    Take good care of yourself; eat a proper diet and try to alleviate stress through exercise, meditation or anything else that works for you.

    Avoid clothing that encourages irritation, particularly synthetic materials and tight fitting clothes such as jeans and panty hose. Try wearing cotton underwear.

    Wash underwear in mild soap and rinse thoroughly and avoid detergents. Reduce the use of feminine hygiene sprays, perfumed soaps, bubble bath, scented tampons and perfumed or coloured toilet paper. Douching is unnecessary.

    Clean the rectal and vaginal areas from front to back to prevent organisms from your bowel and rectum from contaminating your vagina.

    Use a water-soluble lubricant during intercourse in order to avoid irritation. Use condoms to avoid the transmission of microorganisms.

    Home Treatments

    • Some women obtain relief of mild symptoms by modifying their diet or using yogurt suppositories.
    • Over-the-counter medications such as Monistat and Canesten are effective.
    • A baking soda bath (1/2 cup per bath) may also provide some relief.
    • A health professional should be consulted if discomfort persists.

    Medical Treatments

    Yeast infections are usually treated with an antifungal agent which comes in the form of cream, tablets or suppositories that are inserted into the vagina with a special applicator. Always continue the medication for the specified time, even if your symptoms disappear, otherwise the infection may recur. It is important to remember that treatments, whether prescription or home remedy, may not address the actual cause of the overgrowth of the yeast.

     

    UTI

    This may be the first time you have been bothered by a urinary tract infection (UTI). Fortunately, if you follow a proper course of treatment and take adequate precautions, it may also be the last.

    The Urinary Tract
    The urinary tract consists of the kidneys, ureters, bladder and urethra. The kidneys filter fluid and wash products from the blood stream; these products and fluid pass from the kidneys through to the ureter and to the bladder. When the bladder becomes full of urine, it empties through the urethra.

    Urinary tract infections are caused by bacteria. Bacteria can infect any part of the tract, but they usually cause infections of the bladder (cystitis), urethra (urethritis), or kidneys (pyelonephritis).

    Normally, the urine in the bladder is sterile - that is, bacteria free. It is kept sterile because the bladder empties itself as soon as it becomes full, thereby preventing bacteria from sitting in the bladder long enough to begin multiplying. You can help the “wash out” mechanism to function optimally by urinating as soon as you feel the urge.

    Women and UTIs

    Unfortunately, despite the “wash out” mechanism, bladder infections are common in women of all ages. About 25% of women are estimated to have had an infection at least once in their lifetime, and half of the women infected will have at least one recurrence of the problem.

    Although women can flush out their bladders as efficiently as men, they have a shorter urethra, which makes it easier for bacteria from the anal or vaginal region to enter the bladder. Notably, bacteria which are harmless in these regions can cause a painful infection in the urinary tract. An infection caused by bacteria from the anal or vaginal region entering the urethra is called an ascending infection, and is common in girls under 10 and in young women as they become sexually active.

    Men and UTIs

    Except for a few cases in newborns and older men, urinary tract infections are rare in males. In men ~60 years of age, the prostate may enlarge and constrict the urethra, obstructing the flow of urine and interfering with the emptying of the bladder. Recall that when the bladder does not empty the bacteria have the opportunity to begin multiplying, causing an infection.

    Susceptibility

    It is unclear why some women are more susceptible to UTIs than others. It is known that some birth control methods may aggravate a urinary tract infection. For example, some diaphragm users find that the pressure of the diaphragm against the urethra can contribute to infection. (A different size of diaphragm or one with a different type of rim may solve the problem.) Contraceptive foams or vaginal suppositories could also irritate the urethra. Finally, dry condoms may put pressure on the urethra or the dyes and lubricants used may cause irritation.

    Stress and poor eating and sleeping habits often contribute to various types of infection by attacking the immune system. In addition, it is known that people with certain diseases (e.g. diabetes) may have an increased frequency of infections.

    Transmissibility

    UTIs are usually not contagious. As long as your sexual partner’s infection is not actually a sexually transmitted disease (for example, trichomonas, gonorrhea, etc.) you will not get infected.