St. Augustine Woman's Journal - Educational Resource to the Women of St. Johns County Since 2009

By Dr. Laila Needham
OB-GYN Associates of St. Augustine 

Frequently Asked Questions During Routine "Well Woman" Exam


April 1, 2017 | View PDF

The physicians of OB/GYN Associates of St. Augustine

The annual examination is a fundamental part of medical care and is valuable in promoting prevention practices, recognizing risk factors for disease, identifying medical problems, and establishing the clinician-patient relationship.

As a practicing OB/GYN for 6 years, I have shared a lot of advice with my patients. Here are some of the most common questions:

When should I start getting Pap tests and how often should I be tested?

An annual pelvic exam and Pap smear provides a standard of care that has proven to be one of the best preventative combos to protect women's health. The Pap smear has proven effective at detecting precancerous lesions, which represent early indicators of cervical cancer risk. Pap screening should begin at age 21. Then I recommend routine screening every 1-2 years for women between 21 and 29. For healthy women 30 and older who have had three consecutive normal screening results or negative HPV tests, Pap smears may be done every three years.

I had a hysterectomy; do I still need a Pap test?

Rarely is less cancer screening considered good medicine. However, in women who have had hysterectomies, less is more. Some women have had a supra-cervical hysterectomy, which leaves the cervix intact. In these women a Pap smear is still valid. Also, if the women had the surgery because she had cervical cancer or premalignant lesions, periodic Pap smears are required. If you do not know if your cervix was removed, your physician can perform a pelvic examination for confirmation.

How can I get screened for ovarian cancer?

Routine screening for ovarian cancer is not recommended by any medical organization. Women with a strong family history of this disease may be screened. Instead of routine screening, women should remain vigilant for the early signs and symptoms of ovarian cancer, such as abdominal or pelvic pain, unexplained weight loss, constipation, bloating, loss of appetite or feeling full more quickly after a meal and changes in urinary frequency. These symptoms must be evaluated by pelvic examination, CA-125, or ultrasound.

Can I still get my periods after menopause?

Menopause means the cessation, or stopping, of a woman's monthly cycle. On average, women begin menopause at age 51. If you have completed menopause, meaning you haven't had a period for more than a year, you shouldn't have any menstrual bleeding. Even a little spotting is not normal after menopause. This is called postmenopausal bleeding. There can be many causes of postmenopausal bleeding; make an appointment to see your doctor as soon as possible if you experience this.

I had breast augmentation, can I still get mammograms and how often?

Women who have implants are a special challenge for mammogram screening. The x-ray used for imaging the breast cannot go through silicone or saline implants well enough to show the breast tissue that is over or under it. Women with implants will usually have extra pictures called implant displacement views. Although these women do have more pictures taken at each mammogram, the guidelines for how often women with implants should have screening mammograms are the same as for women without them. Very rarely, mammogram can cause an implant to rupture. This can sometimes be diagnosed on a mammogram, but a ruptured implant is better seen on MRI.

When should I start getting screened for osteoporosis?

You're never too young to start preventing osteoporosis. Osteoporosis is the gradual thinning of bone tissue and loss of bone density over time. Total bone mass usually peaks around age 35, then it lessens. Women are more likely to develop osteoporosis than men due to several factors: women have less bone mass, tend to live longer, and take in less calcium. Bone loss speeds up after menopause when estrogen levels fall. Since the ovaries make estrogen, faster bone loss may occur if both ovaries are removed. Your doctor may order a DEXA scan to check your bone density and calculate risk of fracture. Medication and vitamin supplements can help, as does healthy lifestyle choices, such as regular exercise, eating right and maintaining a normal weight.

At what age should I stop having sexual intercourse?

Although many couples enjoy sex in their older years, there is absolutely no "normal" frequency for having sex at any age. If there's no conflict around sex in your relationship, and the relationship is loving and intimate in other ways, there is nothing to be concerned about. Since blood flow to the vagina lessens after menopause, consider having sex to keep it at its best. The vagina is a 'use it or lose it' place. The act of having intercourse stimulates blood to the vagina and keeps it healthy.

Regular checkup visits to our office while you are healthy makes it much easier to diagnose a problem when things aren't normal. This helps to find a problem in its initial stages rather than a crisis requiring an urgent visit to our office or the emergency room. It is all part of the concept of longitudinal long-term care relationship that we build with our patients.

Laila Needham, MD

Dr. Needham, knew at an early age she wanted to become an OBGyn. Graduated from University Medical School of King Hassan II in Casablanca, residency at Franklin Square Hospital in Baltimore Maryland. She started her private practice in Palatka and St. Augustine in 2009 and joined OBGyn Associates in 2014. In her spare time she enjoys boating, fishing and watching basketball games.


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