Caring for a Woman's Body: What Every HIV-Positive Woman Should Know About the Care and Prevention of GYN Problems
July 21, 2014
Table of Contents
- How Often Should You Go?
- What to Expect in the Office
- Common GYN Problems
- How to Prepare for Your GYN Care Appointment: A Checklist and Questions for Your Provider
For women living with HIV (HIV+), there are many aspects to staying healthy. You are off to a good start if you take your medications on schedule, eat well, and get regular physical activity. But to take care of your whole body, you need to get regular gynecologic (GYN) care from a health care provider. Gynecologic care refers to the diagnosis and treatment of issues affecting the female reproductive organs (also called the female genital tract).
It is very important for HIV+ women to have regular GYN visits and tests for cervical cancer. The US Centers for Disease Control and Prevention (CDC) recommends that:
- HIV+ women have a complete gynecological examination, including a Pap smear, when they are first diagnosed and when they first seek prenatal care
- HIV+ women have another Pap smear six months after diagnosis
- If both tests are normal, a repeat Pap smear should be done every year
- HIV+ women with symptoms or who have had dysplasia (abnormal cells in the cervix, or entrance to the womb) in the past should receive a Pap smear every six months until they have two normal tests in a row; then they can go back to having tests every year
You should be tested for gonorrhea and chlamydia at the first visit. It is important to repeat these tests if you have a new partner or if you have unprotected sex.
Usually, your provider will begin by asking you about your sexual history. You will be asked about:
- Your current sex life
- The number and sex (male/female) of sexual partners in your past
- Whether you have ever been pregnant or had an abortion
- What kind of birth control you use, if any
- How you protect yourself and your partner(s) from sexually transmitted diseases
- How you protect yourself (and possibly your partner(s)) from a different strain of HIV
These questions can feel uncomfortable for both the provider and the patient. Even if it is hard for you, do the best you can to answer honestly. Your provider needs complete information to take good care of you.
After the interview, the provider will examine different parts of your body. Not all providers perform all the exams listed below in the same order. It is common for the provider to ask a member of the health care staff (usually a medical assistant or nurse) to join her/him in your room for the physical exams. This is for everyone's protection and to make sure the exams are performed in a professional manner.
For the breast exam, the provider will ask you to lie back and raise one arm over your head as she or he feels with her/his hands for any lumps or masses in the breast on the side with your raised arm. The provider will then repeat this on the other side of your body, asking that you raise your other arm and feeling your other breast.
For the pelvic exam, the provider will ask you to lie down and scoot your butt to the end of the exam table. Then you will be asked to open your legs, bend your knees, and place your feet in the stirrups. Often, at this point, the provider will use her or his gloved fingers to examine the outside of your genitalia for any bumps, sores, or other problems. Next, your provider will insert an instrument called a speculum into your vagina. This instrument opens the walls of the vagina so that your cervix (the opening to the uterus) can be seen by the provider.
Then the provider will use a small brush to collect some cells from your cervix for the Pap smear. The cells will be sent to a laboratory to be examined under a microscope to see if there are any abnormal cells (dysplasia). Additional tests will be done if abnormal cells are found. While the speculum is still inserted, the provider may also collect fluid to check for infections.
Because Pap tests require laboratories and people skilled in reading them, resource-limited countries offer different tests to screen for dysplasia and cervical cancer. One method is called visual inspection with acetic acid, or VIA. When using VIA, health care providers swab acetic acid (also known as vinegar) on the cervix and look directly at it to see if any areas need treatment. Other countries use human papilloma virus (HPV) tests, which test samples taken from your cervix for the presence of HPV's DNA (its genetic material).
The bimanual exam is performed without a speculum. In this exam, the provider places two gloved fingers inside your vagina and places the other hand on your belly. He or she feels your ovaries and uterus between the hands and checks for any pain. The provider may also perform a rectal exam. During the rectal exam, the provider gently puts a lubricated, gloved finger into your rectum to feel for any unusual bumps or sores. She or he may collect a small amount of stool to check for blood.
Many women find the pelvic and bimanual exam slightly uncomfortable and embarrassing. One reassuring thought is that the speculum is used for only two or three minutes, and the whole thing is usually over in less than five. And the more often you go, the easier it gets.
Anal Pap Smear
It is possible for HIV+ women to have anal dysplasia, which can lead to anal cancer. A rectal examination with an anal Pap smear is the best way to detect anal dysplasia. There are currently no official recommendations for anal pap smear screening among HIV+ women; however, some providers perform this exam due to the higher risk for anal cancer among HIV+ people. Similar to a cervical Pap smear, an anal Pap smear includes the insertion of a small swab into the anus to collect cells that are then sent to a lab to be examined under a microscope to see if there are any abnormal cells.
It is important to remember that at any point during the breast, pelvic, bimanual, or anal exams, you can ask your provider to tell you what she or he is doing as it is happening. Some women find this helps them relax more throughout the exam.
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