changing of pads/tampons

Question: When Should I Change Tampons or Pads during My Periods?

Answer: During your periods, pads or sanitary napkins should be changed as often as necessary to prevent the pad from becoming soaked with menstrual flow. You will learn to know how long you feel comfortable before you change pads during your periods.

If you use tampons during your periods make sure you change them at least every 4 to 8 hours to help prevent a rare, but potentially fatal disease called toxic shock syndrome or TSS. Always use the lowest absorbency tampon necessary for the amount of menstrual flow you are experiencing on each day of your period. Using super absorbency tampons on the lightest day of your period potentially puts you at risk for toxic shock syndrome. Those most at risk for TSS include women under thirty, particularly teenage girls.

Don’t believe it if someone tells you that only certain types of tampons put you at risk for TSS. That just isn’t true. It doesn’t matter if the tampon is made of the purest cotton or of rayon, or what absorbency it is – all tampons put you at risk for toxic shock syndrome.

Your risk for toxic shock syndrome may be lessened by alternating between tampons and pads. For example, many women use tampons during the day and pads at night during their periods. Other methods for reducing your risk for toxic shock syndrome and other problems resulting from tampon use that are recommended by the Food and Drug Administration or FDA include:

• Always read and follow the directions for tampon insertion on the brand that you purchase.

• Learn which absorbency is right for your menstrual flow and choose the appropriate tampon absorbency.

• Change your tampon at least every 4 to 8 hours.

• Think about alternating pads with tampons.

• Know the signs and symptoms of toxic shock syndrome.

• Don’t use tampons between periods.

  Reference: NWHIC

Do I need to See my Doctor for Menstrual Cramps

Answer: While it’s perfectly normal for girls and women to experience mild cramps during menstruation, there are times when women need to call the doctor about painful periods. Fortunately, the majority of women get effective relief from menstrual cramps using self-help remedies. However, if self-help remedies fail to provide effective relief from your menstrual cramps after 3 months, contact your doctor for diagnosis and treatment.

Of course, there are other times when you should call your doctor right away.

If you have menstrual cramps accompanied by a fever, an increased or foul-smelling vaginal discharge, if you experience severe pain, or if your period is more than one week late, and your have been sexually active you should seek immediate medical care.

While many women experience menstrual cramping the first few months after having an IUD inserted, you should have it removed if menstrual cramps continue after 6 months. You’ll also need to choose another type of contraceptive if you still want to avoid pregnancy.

Additionally, seek your doctor’s advice anytime you experience severe or sudden menstrual cramps. While menstrual blood clots and clumps of tissue are a normal part of your menstrual flow, when they occur together when severe, menstrual cramps or other symptoms contact your doctor for advice.

Finally, if you experience menstrual-like cramps at times other than during menstruation, more than five days before you expect your monthly period, or if your cramps last longer than your menstrual period, contact your doctor. You may have something as benign as Mittelschmerz. However, only your doctor can determine the cause of your menstrual cramps.

Anytime you have questions or concerns about your menstrual cycle or any other health issue, contact your doctor for advice.

how to relieve menstrual cramps at home

Answer: If you are one of the millions of women who experience menstrual cramps during your period, you’ll want to know what you can do to help relieve the pain. One of my favorite ways to reduce menstrual cramps is placing a heating pad placed on the lower abdomen, just below the belly button.

Other self-help measures include taking warm baths or showers, drinking warm beverages, and giving yourself a light massage by making circular motions with your fingertips around your lower abdomen. Make sure to schedule free time for yourself to relax and take care of yourself during the time of the month when you expect your periods.

Eating light, frequent meals and following a diet that is rich in complex carbohydrates (whole grains, fruits, and vegetables) and low in salt, sugar, alcohol, and caffeine also helps reduce painful menstruation for some women. It’s especially important for women who experience bloating or fluid retention during menstruation to lower their salt consumption, since excess salt intake can cause fluid retention.

Regular physical activity works wonders at reducing many of the symptoms of PMS, including menstrual cramps. If you’re under stress, like many of us are, you might also want to learn to distress and relax your body and mind through meditation or yoga.

Anti-inflammatory drugs, such as ibuprofen, which are available without a prescription, often provide effective relief from painful menstrual cramps.

If you have PMS as well as menstrual cramps, you may want to try taking supplements such as vitamin B complex, essential fatty acids, calcium, and magnesium. The following supplemental amounts are in addition to the amount in a daily multi-vitamin and mineral supplement, which all women should take regularly:

• 1200 mg of calcium in two divided doses
• 250 mg of magnesium
  (If you experience constipation or diarrhea while taking magnesium, talk to your doctor. You may need to increase or decrease the amount of magnesium you take.)
• Supplemental vitamin B6 varies from 50 to 200 mg
• 50 mg of vitamin B1

Fish oil capsules may be helpful for women who have PMS, as well as menstrual cramps. Fish oil capsules contain the essential fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). The recommended schedule for fish oil capsules is 1000 mg of EPA and 700 mg of DHA, taken in two divided daily doses for two months. You should always take vitamin E supplement when supplementing with fish oil capsules.

Finally, some women find it helpful to keep their knees bent whenever they are lying down, which reduces the stretching of the pelvic muscles. If you sleep on your back, use a pillow under your knees to keep your legs bent. If you’re a side sleeper, try holding a pillow pressed to your lower abdomen with your knees bent.

_Source:

_{Painful Menstrual Periods; Medline Plus Medical Encyclopedia; http://www.nlm.nih.gov/medlineplus/ency/article/003150.htm; accessed 05/21/08. Cyclic Perimenstrual Pain and Discomfort: Nursing Management. Evidence Based Clinical psPractice Guideline; http://www.guidelines.gov/summary/summary.aspx?doc_id=7199&nbr=004302; accessed 06/23/08}

premenstrual syndrome

If you think you might have premenstrual syndrome or PMS, you are not alone. In fact, about three-quarters of all girls and women experience PMS during their reproductive lives. A syndrome is a group of symptoms that occur together and that are characteristic of a disease or condition. Premenstrual syndrome is present when certain physical and / or emotional signs or symptoms occur.

PMS Diagnostic Criteria

The University of California, San Diego has developed the most widely used and accepted diagnostic criteria for diagnosing PMS. Although over 150 symptoms have been associated with PMS, women must self-report at least one of the following physical symptoms of PMS and at least one of the following mental symptoms of PMS. Additionally, these symptoms must occur during the five days before menstruation begins to meet the diagnostic criteria for premenstrual syndrome.

The Physical Symptoms of PMS

• Sore, tender breasts
• Headache
• Abdominal bloating (the most common physical symptom)
• Swelling of the extremities

Mental Symptoms of PMS

• Fatigue (the most common mental symptom)
• Angry outbursts or mood swings
• Irritability
• Confusion
• Social withdrawal

All symptoms must disappear by Day 4 of the menstrual cycle and must not occur before Day 14 (of the average 28-day menstrual cycle) to meet the criteria for a diagnosis of PMS. The final requirement for a diagnosis of PMS is that symptoms must be present in the absence of any pharmacological treatments, hormone ingestion, or drug or alcohol use.

A true diagnosis of PMS causes identifiable dysfunction in social or economic performance and includes at least one of the following:

• Marriage or relationship problems which are confirmed by the partner of the woman seeking diagnosis of PMS
• Parenting difficulties
• Decreased performance and / or attendance problems, including being late, at school or work
• Less than normal amount of social activity during the premenstrual period of the menstrual cycle
• Legal issues
• Suicidal thoughts, words, or actions
• Seeking medical attention for physical symptoms of PMS

Some girls and women experience a more severe form of PMS called premenstrual dysphoric disorder, or PMDD. The diagnostic criteria for PMDD includes the above criteria as well as the presence of additional symptoms.

If you think, you have the symptoms of premenstrual syndrome see your physician for diagnosis and treatment. Getting a diagnosis of PMS requires keeping a menstrual cycle calendar for two or three menstrual cycles to reflect a pattern of symptoms.

_Sources:

_{The American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Washington, DC, American Psychiatric Association 1994.}

_{Robert F Casper, MD. Patient information: Premenstrual syndrome and premenstrual dysphoric disorder (PMDD), Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder, UpToDate [online]; accessed 10/24/2006.}

Getting Your Period

Probably the most talked about event of puberty for a girl is her period. Getting your period is another way of talking about menstruation.

Within about a year after beginning her growth spurt, most girls will have their first period. This marks the beginning of a girl's life as a young woman. In some cultures, this is celebrated publicly. Others choose to be more private about it. Some girls can't wait for their first period to come, while others may dread it or feel neutral about it. No matter how you feel, it's an important event in your life and part of the normal process of becoming an adult.

Most American girls start their periods between the ages of 9 and 15. There really isn't any way you can tell the day or week you'll get your first period. There also isn't really any way you can make it come sooner or delay it from happening. But you can understand what is happening inside your body to know what is normal for you.

During each period, the inner lining of your uterus is shed through the vagina, the passage that connects your inner reproductive organs to your outer sex organs or genitals. This lining is mostly blood and other tissues that have been building up since your last period. The purpose of this blood is to provide nutrients for a fertilized egg if you were to become pregnant. Girls start having their periods early in heir lives, but most don't decide to start a family till they've already been having their periods for many years. Most women stop having periods when they are between 45 and 55 years old. This is called menopause.

You may have heard some women talking about their monthly cycle. This cycle begins on the first day of one period and ends on first day of the next period. While women's periods do tend to come about once per month, there is a wide range in the length of menstrual cycle from woman to woman. Some women's periods come as often as every 21 days, some as far apart as every 35 days. The most common range is 25-30 days. Some women have regular cycles and their periods start exactly the same number of days apart each time. For other women, the length of their cycle varies from month to month.

There is also a great range in how much blood flow each woman loses during her period. You may have a heavy flow and need to change your pad or tampon frequently. Or you may have a light flow with barely any blood loss. Usually your flow will be heaviest at the beginning of your period. It may start out light, get heavier, and then get lighter again until it's over. It's also common to see some small clots or pieces of tissue in your menstrual blood. Most women's periods last from 3 to 7 days.

Another thing that can vary is the color of the blood on your tampon or pad. Sometimes the blood from your period can be a dark, rust-like color. Other times it can be a bright red color. The color may vary according to where you are in your period or the heaviness of your flow. Pay attention to the rhythm of your body, so you'll know what is normal for you in terms of flow, cycle and period length, and color of your blood.

~Adapted from the Women's Health Information Center

menstruation 101

Menstruation is the cyclic occurrence of uterine bleeding that occurs near the end of puberty in girls. Typically, first periods occur around age 12 or 13. However, some girls begin having periods as young as 8 or 9 years old, while others may be as old as 15 or 16. If menarche does not occur by the time a girl reaches the age of 16, she should see her doctor for evaluation. Menstruation usually begins about 2 1/2 years after girls begin developing breasts, and growing pubic and underarm hair.

Once menstruation begins, it continues until menopause occurs around the age of 50 when monthly menstrual cycles end. Surgical menopause occurs following removal of the ovaries during hysterectomy. Menstruation also temporarily stops during pregnancy. Hormonal contraceptives also stop normal menstruation and can safely be used to stop periods indefinitely or until pregnancy is desired. If menstruation fails to occur for any other reason, amenorrhea occurs. Amenorrhea is a menstrual cycle disorder.

For the most part, the menstrual cycle occurs predictably and without problems. However, when things don’t go right -– when you experience heavy or excessive bleeding, when your period doesn’t occur when expected, when you have physical or emotional symptoms during the weeks before you menstruation, or when you experience painful periods or other symptoms –- you may have a menstrual cycle disorder.

Abnormal uterine bleeding is a common menstrual cycle disorder that includes several types of abnormal bleeding patterns, including amenorrhea. Other menstrual cycle disorders include dysmenorrhea, premenstrual syndrome or PMS, premenstrual dysphoric disorder or PMDD, and uterine fibroid tumors. Other factors that may affect normal menstruation include stress, illness, exercise, diet and nutrition, and work, family, and relationship issues.

What Causes the Menstrual Cycle and Menstruation?

Your endocrine system produces hormones that work together with your reproductive organs to cause the menstrual cycle and menstruation when conception does not occur. The glands of the endocrine system produce hormones that regulate various bodily functions such as blood sugar levels, metabolism, and reproduction. The menstrual cycle occurs in distinct phases during which hormones cause the changes that prepare the uterus to sustain a pregnancy, and to cause menstruation when pregnancy does not occur.

How Often Does Normal Menstruation Occur?

The average menstrual cycle is 28 days and women menstruate, on average, about five to seven days during each cycle. The first day, or Day 1, of the menstrual cycle is the first day any bleeding occurs, even if it’s just spotting. It’s a good idea to use a calendar to keep track of your menstrual cycle. Tracking your periods and any symptoms that occur during the menstrual cycle can help your physician diagnose any problems that may occur.

How Much Blood Loss is Normal during Menstruation?

You might be surprised to learn that, while it might often seem like much more, the total amount of blood lost during menstruation is only a few tablespoons. You may be experiencing excessive bleeding if you have to change pads or tampons every hour or so for several hours in a row. Contact your health-care provider if you experience excessive bleeding during your period.

What to Tell Your Doctor about Your Period

When your first period occurs, make sure to inform your doctor. From that point on throughout your reproductive years, your doctor appointments should include notation of the first day of your last period. Having a menstrual cycle calendar helps you to remember this information when asked. Other things you should tell your doctor about your period include:

• Having irregular, excessive, or other types abnormal bleeding
• Experiencing severe cramps during menstruation that is not relieved by OTC pain-killers, or experiencing pelvic pain that is unrelated to menstruation
• Not having periods
• Having menstrual cycles that are less than 21 days, or more than 35 days apart
• Anything about your period, or menstrual cycle, that seems abnormal for you

Tip: Girls often have irregular periods during the first few years after menstruation begins. It’s completely normal to have irregular periods while your body adjusts to all the physical and emotional changes that occur during adolescence.

_Sources:

_{Getting Your Period; GirlsHealth.gov; http://www.girlshealth.gov/body/period.htm; accessed 07/10/07.}

All About Menstruation; Teens Health, KidsHealth.org; accessed 07/10/07.

PELVIC EXAM

During a pelvic exam, your doctor visually and manually assesses your reproductive organs. A pelvic exam usually is done as part of a woman's regular checkup, or your doctor may recommend a pelvic exam if you're having symptoms such as unusual vaginal discharge or pelvic pain.

A pelvic exam is a relatively short procedure. In the course of a pelvic exam, your doctor checks your vulva, vagina, uterus, rectum and pelvis, including your ovaries, for masses, growths or other abnormalities. A Pap test, which screens for cervical cancer, may be performed during a pelvic exam.

Why it's done

To assess your gynecologic health. A pelvic exam often is part of a routine physical exam for women to find possible signs of a variety of disorders, such as ovarian cysts, sexually transmitted infections, uterine fibroids or early-stage cancer. Your doctor can recommend how frequently you need to be examined, but many women have a pelvic exam once a year.

To diagnose a medical condition. Your doctor may suggest a pelvic exam if you're experiencing gynecologic symptoms, such as pelvic pain, unusual vaginal bleeding, skin changes, abnormal vaginal discharge or urinary problems. A pelvic exam can help your doctor diagnose possible causes of these symptoms and determine if other diagnostic testing or treatment is needed.

No special preparation is required for a pelvic exam, although your doctor may recommend that you schedule your pelvic exam on a day when you don't have your period.

If you have questions about the exam or its possible results, write them down and bring them with you to the appointment, so you don't forget to ask about them during the visit with your doctor.

What you can expect

A pelvic exam is performed in your doctor's office and takes only a few minutes.

You'll be asked to change out of your clothes and into a gown. You also may be given a sheet to wrap around your waist for added comfort and privacy. Before performing the pelvic exam, your doctor may listen to your heart and lungs and perform a breast exam.

During the pelvic exam
During the pelvic exam, you lie on your back on an examining table, with your knees bent and your feet placed on the corners of the table or in supports called stirrups. You'll be asked to slide your body toward the end of the table and let your knees fall to the sides.

• External visual exam. First, your doctor visually inspects your vulva, looking for irritation, redness, sores, swelling or any other abnormalities.
• Internal visual exam. Next, your doctor uses a speculum — a plastic or metal-hinged instrument shaped like a duck's bill — to spread open your vaginal walls and view your vagina and cervix. Often, the speculum is warmed before it's inserted. Inserting and opening the speculum can cause pressure or discomfort for some women. Relax as much as possible to ease discomfort, but tell your doctor if you're in pain.
• Pap test. If your pelvic exam includes a Pap test (Pap smear), your doctor collects a sample of your cervical cells before removing the speculum. After the speculum is removed, your doctor examines your other pelvic organs for signs of abnormalities. Most experts agree that you should have your first Pap test within three years of becoming sexually active or by age 21, whichever comes first. How often you need a Pap test depends on your age and medical history. Talk to your doctor about when you should have a Pap test.
• Manual exam. Because your pelvic organs, including your uterus and ovaries, can't be seen from outside your body, your doctor needs to feel (palpate) your abdomen for this part of the exam. To do this, your doctor inserts two lubricated, gloved fingers into your vagina with one hand, while the other hand presses gently on the outside of your lower abdomen. This is to check the size and shape of your uterus and ovaries and identify tenderness and unusual growths. After the vaginal examination your doctor also inserts a gloved finger into your rectum to check for tenderness, growths or other irregularities.

Usually, at each step along the way, your doctor tells you exactly what he or she is doing, so nothing comes as a surprise to you.

After the pelvic exam
After the pelvic exam is over, you can get dressed and then discuss with your doctor the results of your exam.

Pap smear: Still necessary after hysterectomy?

Are Pap smears still necessary if I'm 62 years old and have had a hysterectomy?

Answer

from Sandhya Pruthi, M.D.

A Pap smear is an important, reliable screening test for early diagnosis of cervical cancer. Whether you need routine Pap smear screening after a hysterectomy depends on the type of hysterectomy.

If you had your uterus and cervix removed (total hysterectomy) for a noncancerous condition, you may be able to stop having Pap smears. However, if your hysterectomy was for a cancerous condition or you had your uterus removed but your cervix remains intact (partial hysterectomy), you still need regular Pap smears. In either case, regular pelvic exams and mammograms are recommended.

Your age matters, too. According to American Cancer Society guidelines, you may be able to stop routine Pap smear screening at age 70 if you've had three or more normal Pap smears in a row and no abnormal Pap smears for the past 10 years. U.S. Preventive Services Task Force guidelines recommend stopping routine Pap smear screening at age 65 if you've had adequate recent testing and you're not at high risk of cervical cancer. Ask your doctor what's best for you.

And even if you've stopped routine Pap smear screening, it's important to resume screening if you have a new sexual partner — whether you've had a hysterectomy or not.

Pap smear: Do I need one if I'm a virgin?

Do virgins need Pap smears? Does a Pap smear cause you to lose your virginity?

Answer

from Sandhya Pruthi, M.D.

If you're a virgin — meaning you haven't had sexual (vaginal) intercourse — you probably don't need a Pap smear. And even if you do have a Pap smear, it will not cause you to lose your virginity. Although the instruments used to collect the cervical cells may stretch or even tear your hymen — the thin tissue covering the vaginal opening, which is present in some women who've never had sex — you will only lose your virginity when you've had sexual intercourse.

The purpose of a Pap smear is to collect cells from your cervix, which is the lower end of your uterus. The cells collected in a Pap smear can detect if you have cervical cancer or suspicious cells that indicate you may develop cervical cancer.

In most cases, cervical cancer is caused by a sexually transmitted disease called human papillomavirus (HPV). If you've never had any type of sexual intercourse, you're unlikely to have HPV. However, there are other risk factors for developing cervical cancer, such as family history and smoking, so talk to your doctor if you have concerns.

For effective cervical cancer screening, the American Cancer Society recommends that all women have an initial Pap smear by the age of 21 or after they've been sexually active for three years, whichever comes first.

pap smear...

What is a Pap smear?

A Pap smear is a test that checks for changes in the cells of your cervix. The cervix is the lower part of the uterus that opens into the vagina. Developed over forty years ago by Dr. George Papanicolaou, this test can help to detect cervical cancer at an early stage.

What are the benefits of this procedure?

Pap smears have made it possible to detect precancerous and cancerous conditions before they can progress to cancer that could spread to other parts of the body, and have save thousands of women's lives by catching cancers before they spread.

Are Pap smears 100% accurate?

No. Occasionally, the results indicate normal cell growth but abnormal cells are actually present. This is called a false-negative test.

What causes false-negative tests?

False-negative tests can occur for several reasons. The abnormal cells may not have been contained in the sample. There may have been too many or too few cells to allow an accurate reading. An infection could also cover up abnormal cells. If a Pap smear is performed on a regular basis, the chances of a problem going undetected are lower.

How do I prepare for a Pap smear?

Do not douche or use vaginal creams for two days prior to the test. Do not have intercourse within twenty-four hours of the test because it could cause inaccurate test results.

What happens during the procedure?

A Pap smear only takes a few moments and is a part of a routine pelvic examination. Yo u will be asked to lie on your back, with your knees bent and feet apart. Your clinician will insert a speculum into the vagina so that the cervix can be seen. Your clinician will use a special swab, brush, or stick to wipe off cells f rom inside the opening of the cervix and from the outer part of the cervix. These cells are smeared onto a microscope slide and taken for analysis.

What happens after the procedure?

If the cells appear normal, no treatment is necessary. If an infection is present, treatment is prescribed. If the cells appear abnormal, more tests may be necessary. A Pap smear is not 100% accurate, so it is always important to talk to your clinician about your results.

Are some women at higher risk for cervical cancer?

Women at an increased risk for cervical cancer include those who:

• have had more than one sexual partner or whose partner has had more than one partner
  
  
• were sexually active beginning at a young age (before age eighteen)
  
  
• have a history of genital warts
  
  

You can find out more about Pap smears by contacting the following organizations:

National Cancer Institute's Cancer Information Service
(800) 422-6237

American College of Obstetricians and Gynecologists (ACOG) Resource Center
(202) 863-2518

College of American Pathologists

Contributing to this FAQ on Pap Smears: University of Michigan's Women's Health Program, a National Center of Excellence in Women's Health, sponsored by the Office on Women's Health in the Department of Health and Human Services.

Reprint provided by the Office on Women's Health in the Department of Health and Human Services

When to See Your Gynecologist About Reproductive Health Problems

Is My Yearly Pelvic Exam the Only Time I Need to See the Gynecologist?

No, several circumstances may occur during the rest of the year. Consult your Ob/ Gyn whenever you experience abnormal signs and symptoms. These signs and symptoms include:

• Pelvic pain or menstrual cramps severe enough to disrupt your daily routine for even a few days a month.
• Abnormal bleeding occurs you must change sanitary napkins, tampons, or other menstrual products more often than once every two to three hours.
• Bleeding between periods.
• Any unusual discharge, pain, swelling, or itching of you vagina or lower abdomen.

Any of these symptoms can indicate a vaginal infection or sexually transmitted disease or STD which could affect your future fertility. They may also indicate other diseases such as:

• endometriosis,
• pelvic inflammatory disease,
• or a number of other reproductive disorders.

Of course, if you think you are pregnant, see your healthcare provider as soon as possible to help ensure a healthy pregnancy and healthy baby.

Also see your gynecologist more often if:

• you plan of getting pregnant,
  
• you think you may have a sexually transmitted infection or have a partner who has STI,
• have a history of sexually related illness,
  
• or have a mother or sister who developed breast cancer before .

Consult your healthcare provider, if you notice any changes in your breasts such as puckering, dimpling, or other changes to the skin of your breasts; have newly retracted nipples, or discharge from your nipples, not associated with breast feeding; if there is any change in your breast size or shape; or if you experience an increase in breast pain, discomfort or emotional issues before your period.

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

going to GYNECOLOGIST 101

When to See Your Ob / Gyn
Have you ever been to an Obstetrician / Gynecologist or Ob / Gyn for a pelvic exam and Pap test? If your answer is "No." and you are 21 or older, pick up your phone today and make an appointment with a local Ob/Gyn or a family planning clinic in your area. On the other hand, if your answer is "Yes," then how long has it been since your last Pap smear and pelvic exam? If you haven't seen your gynecologist for a year or longer it's time to make an appointment.

When Do Women Need Pelvic Exams?

Teenage girls should see an OB/GYN between the ages of 13 to 15. While pelvic exams are rarely required during this first visit, this visit helps to establish a relationship with the doctor of your choice and to go over your medical and sexual history (even if you have not had sexual intercourse.) This is a good time to ask questions about sexually transmitted diseases and contraceptives.

The American College of Obstetricians and Gynecologists or ACOG recommends that Pap smear testing begin within three years of sexual intercourse, or by age 21.Even young women who have not become sexually active need to visit a gynecologist by age 21. The ACOG further recommends yearly Pap smears until age 30 when healthy women who have had at least three consecutive normal Pap smears may begin to have the test every two or three years, or as often as their gynecologists suggest.

You should always see your gynecologist if you experience: You should always see your gynecologist if you experience:
- any unusualy and/ or persistent vaginal discharge,
- bleeding between periods,
- or bleeding after sexual intercourse.

While a yearly Pap smear is not always neccesary after age 30, all women still require an annual pelvic exam to check for any other changes or infections. If you've had an HPV test that was negative that doesn't mean you don't need to have a yearly pelvic exam. The ACOG established these guidelines with full knowledge that HPV causes cervical cancer.

Did you know that with each new sexual partner your risk of getting HPV increases by 15 percent? This means that having multiple sex partners raises your risk of HPV substantially. According to the ACOG guidelines for Pap testing women diagnosed with HIV or other diseases or conditions that lower immunity should continue having annual Pap smears after age 30.

Fact: The greatest single reason for the occurrence of cervical cancer is not having Pap smears according to recommended guidelines. The majority of women diagnosed with cervical cancer have not had a Pap smear in five or more years. Sadly, these women are usually at an advanced stage of cancer when they receive diagnosis.

What is Mittelschmerz?

If you're a woman who sometimes experiences pain on one side of your lower abdomen and you don't know what it is, keep track of its timing by observing and recording several menstrual cycles. If it occurs midway through your menstrual cycle — about 14 days before your next menstrual period — you're most likely experiencing a condition called mittelschmerz. A German word that means "middle pain," mittelschmerz is pain with ovulation.

In most cases, mittelschmerz doesn't require medical attention. For minor mittelschmerz discomfort, over-the-counter pain relievers and home remedies are often effective. If your mittelschmerz pain is troublesome, your doctor may prescribe an oral contraceptive.

The main symptom of mittelschmerz is a distinctive, one-sided lower abdominal pain or discomfort. The pain may switch sides every other month or every other time you feel it. It's also possible to feel it on the same side for several months in a row. The pain occurs on the side in which you're ovulating.

The pain usually lasts a few minutes to a few hours, but it may continue for as long as a day or two. Pain from mittelschmerz may be:

• A dull ache that feels like a cramp
• Sharp, sudden pain
• Accompanied by mild vaginal bleeding or discharge
• Rarely, severe

The location and the timing of your pain can help you identify mittelschmerz, especially if you have a history of it. Keep track of your menstrual cycle for several months and note when you experience this pain. If it occurs midcycle and goes away without treatment, it's most likely mittelschmerz.

When to see a doctor
In the vast majority of cases, mittelschmerz requires no medical intervention. However, contact your doctor if a new pelvic pain becomes severe, if it's accompanied by nausea or fever, or if it persists — any of which could indicate you have a condition more serious than mittelschmerz, such as appendicitis, pelvic inflammatory disease or even an ectopic pregnancy.

During your menstrual cycle, the female sex hormone estrogen causes your uterine lining (endometrium) to thicken every month to create a nourishing environment for a fertilized egg. Soon afterward, a follicle — a tiny sac in your ovary that contains a single egg (ovum) — ruptures and releases its egg (ovulation).

If the egg becomes fertilized by contact with a sperm on its way to your uterus, the egg implants in the lining of the uterus. However, most often the unfertilized egg passes through your uterus and out of your body. Shortly thereafter, your uterus releases this lining and your menstrual flow begins.

Mittelschmerz occurs during ovulation, when the follicle ruptures and releases its egg. It's estimated that 1 in 5 women experience ovulation discomfort. Some have mittelschmerz every month, while others have it only occasionally.

While the exact cause of mittelschmerz is unknown, here are possible reasons you may feel pain:

• Just before an egg is released with ovulation, follicle growth stretches the surface of your ovary, causing pain.
• Blood or fluid released from the ruptured follicle irritates the lining of your abdomen (peritoneum), leading to pain.

Pain at any other point in your menstrual cycle isn't mittelschmerz. It may be normal menstrual cramping (dysmenorrhea) if it occurs during your period, or it may be from other abdominal or pelvic problems. If your pain is severe during the time of ovulation or at any other time during your cycle, see your doctor.

If you need relief from the discomfort of mittelschmerz, try an over-the-counter pain reliever, such as acetaminophen (Tylenol, others), aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve).

If you experience mittelschmerz nearly every month and it causes you quite a bit of discomfort, talk to your doctor about the option of taking a birth control pill (oral contraceptive). Birth control pills prevent ovulation, which prevents mittelschmerz because the condition can only occur if an ovary releases an egg.

If the discomfort from mittelschmerz lasts more than a few minutes, try some home remedies to gain relief. Because heat increases blood flow, relaxes tense muscles and eases cramping, you might want to try:

• Soaking in a hot bath
• Using a heating pad on the side of your abdomen where the pain occurs