Annual Wellness Exams
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An annual wellness exam is strongly recommended, even if you feel fine. This is how we achieve great health. It is much easier to correct or avoid health issues early on before they become problems. A wellness exam is an opportunity to craft a preventative health care plan for yourself.
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An annual wellness exam is a head-to-toe exam that is intended for health maintenance. The focus is on preventative medicine, but we may make initial plans for further evaluation of additional issues that arise during the exam. This is also a good time to refill your ongoing medications for the year, such as hormones, birth control, and antivirals.
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Yes and no. The annual wellness exam is for wellness, as it is named. However, it is not uncommon for patients to also have additional concerns or problems that need to be addressed. We will always do our best to provide most the complete care, but additional follow up appointments may be needed, depending on what issues are present. It’s always ok to schedule a problem visit and a separate annual exam to be sure we have enough time to properly evaluate and treat any health concerns.
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This depends on your age and previous pap history. Sometimes we can find records of your previous pap, depending on when and where it was last completed. We are always happy to review your previous pap records if done with an outside provider. Knowing your HPV vaccine status is also very helpful when we are planning your care.
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Maybe. It depends on your age and health concerns. Some labs are considered preventative medicine and are well covered in this visit. It will always be recommended that you check your insurance benefits to know what is specifically covered for you by your plan.
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While a physical exam is traditionally considered part of an annual exam, there are times when some patients will decline the physical exam or parts of the exam. Please always review any concerns with your practitioner, as we are trauma-informed and are very prepared to support you. Our goal is to remove any potential barriers that might keep you from your best health, and we always aim to create the safest space to meet your needs.
Abnormal Pap Management
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A pap test is a screening lab to check for cancer or pre-cancerous changes of the cervix and/or vagina, starting at the age of 21. The frequency of the pap test depends on age and previous pap results. This test can also screen for HPV starting at the age of 30.
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A provider will review all abnormal pap results and make a specific follow up recommendation depending on the severity of the abnormal pap and the previous pap history. Some people will only need to wait and recheck the pap in a year at the next annual exam. Other people will need further evaluation with a minor procedure in clinic called a colposcopy.
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Colposcopy is a minor in-clinic procedure to sample tissue from the cervix and/or vagina to further evaluate the abnormal changes on a pap. Sometimes a provider may see a lesion on the cervix or vagina during an exam and colposcopy can be used to further evaluate, regardless of pap history.
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A provider will review the high-grade colposcopy findings and discuss next steps, specific to your history and results. High-grade findings on a colposcopy will often need another procedure to treat the affected area. Cold Knife Cone (CKC) or Loop Electrosurgical Excision Procedure (LEEP) are most often considered for treatment of moderate or severe changes on a colposcopy.
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The HPV vaccine (Gardasil) is recommended for routine vaccination to all children starting at ages 11 or 12 to reduce the risk of cervical & other forms of HPV-related cancer. People aged 26 and under who have not completed the HPV vaccine series are encouraged to complete it. Some adults ages 27 to 45 may also be candidates to complete the HPV vaccine series and this should be discussed with your provider.
Recurrent Vaginitis
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Recurrent vaginitis is four or more episodes of vaginal infection in one year. Common causes of recurrent vaginitis are bacterial vaginosis and/or candida (yeast). Contact dermatitis, co-infection, and hormonal changes can also contribute to recurrent vaginitis.
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People with recurrent vaginal infections should have a detailed health history and appropriate testing to determine the root cause of the recurrent vaginitis. Some testing may include STI screening, vaginitis panel, and/or vaginal culture.
Perimenopause/Menopause
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Menopause is defined as a loss of ovarian activity and 12 months in a row without a period. The average age of menopause is 52. Perimenopause is defined as the timeframe prior to menopause and includes fluctuation in hormones and menstrual irregularities. People often start to experience early symptoms of perimenopause in their mid-forties and the transition to menopause typically lasts 8 to 10 years. Most common symptoms associated with this transition may include hot flashes, night sweats, vaginal dryness, mood irritability, poor sleep, decreased libido, and changes in body composition.
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No, but they may be helpful in clarifying best treatment plan since other health issues can have overlap in symptoms with perimenopause and menopause
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A thorough health history and sometimes labs can help determine when hormones might be helpful to manage symptoms of perimenopause and menopause.
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The Menopause Society does not put an age limit to when to stop hormones but advises the least amount of hormone for the least amount of time to support symptoms is good practice. This will vary person to person and should include a risk assessment and discussion between a patient and a provider to determine when to stop hormone therapy.
Hormonal Issues
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Premenstrual Dysphoria Disorder (PMDD)
Premenstrual Syndrome (PMS)
Polycystic Ovarian Syndrome (PCOS)
Hypothalamic Amenorrhea
Endometriosis
Infertility
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A detailed health history, including menstrual cycle, is critical in determining hormonal health. It is not uncommon to utilize labs to help verify hormonal dysfunction and to guide a proper treatment plan. Many health issues can affect hormone function, and a thorough evaluation is key to optimal health.
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Managing hormonal dysfunction may include a wide variety of interventions including lifestyle changes, supplements, medications, and hormones. Treatment plans should follow a collaborative approach with patient and provider to determine which options will serve optimal health outcomes.
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Difficulty getting pregnant can be very frustrating and is a valid reason to seek assistance. Typically, a medical evaluation for infertility is initiated when a person under 35 years old has been actively trying for pregnancy for 12 months or over 35 and actively trying for 6 months without success.
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Abnormal bleeding is considered any bleeding outside the expected menstrual cycle and may be abnormally frequent, lasting excessively long, heavier than normal or irregular. While slightly different, postmenopausal bleeding is also considered abnormal and should always be promptly evaluated.
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Pelvic ultrasound (abdominal and transvaginal) is frequently used to determine the cause of abnormal bleeding. Other testing may include vaginal swabs to rule out infection and endometrial biopsy. A pelvic exam is also included in evaluation of abnormal bleeding.
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There are some instances of abnormal bleeding when a procedure or surgery may be recommended, such as endometrial polyps, uterine fibroids, and ovarian cysts/masses. Sometimes hormones may be recommended, including a progesterone IUD insertion. All final treatment plans include a personalized discussion of potential management options and their associated risks/benefits.
Family Planning & Contraception
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Finding the right form of contraception to prevent or time pregnancy is based on personal preferences, health history, ease of use, duration of use, privacy and effectiveness. A thorough medical history, family history, and some targeted discussion can effectively narrow down best options for each patient’s needs.
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Patient perception of pain in response to IUD insertion can vary widely and it is not uncommon to feel anxious or nervous about this process. There are many options to support pain and anxiety during IUD insertion and/or removal. This may include local anesthesia and oral medications. On rare occasions, some people may need nitrous oxide or IV sedation. A preprocedural appointment can be made to discuss pain and anxiety management options in more detail, along with what to expect during the procedure.
Sexual Health
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Sexual health encompasses both physical and mental health. It is not limited to just the reproductive years. It incorporates not only disease and dysfunction, but also safety and satisfaction. Sexual healthcare should be free from bias and discrimination and support personal choices and autonomy to reproduce if they choose.
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Absolutely! There are many causes of sexual pain. A careful health history and physical exam to further evaluate is often needed. Some lab tests and imaging may be helpful depending on the presenting symptoms. Other types of practitioners may also be utilized to address the causes of pain with sex, such as a pelvic floor therapist, sex therapist and/or a sex coach. Treatment of any infections, hormonal issues and musculoskeletal dysfunction is essential to improve sexual function.
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Again, absolutely! Decreased libido can have many causes and layers of complexity. A careful health history is critical to making improvements. There are many things that can impact libido such as certain medications, hormonal issues, stress, strained relationships, fatigue, chronic illness and physical impairments. Open communication between patient and provider is essential to develop an effective plan of action and a safe environment to make progress.