Well woman check

Question 1

Current pap smear guidelines

Answer 1

Women who have ever had sex and have an intact cervix between ages 18-20, or 1-2 years after first having sex, whichever is later.
Can cease at 70 if normal smears in las 5 years.
>70 no negative smear/request->pap smear

Question 2

LSIL result management

Answer 2

1. Repeat Pap test in 12 months (Practice Point).
   If the repeat test at 12 months shows LSIL (definite or possible) the woman should be referred for colposcopy.
2. A woman aged 30 years or more with a Pap test report of LSIL, without a history of negative smears in the preceding 2–3 years, should be offered either colposcopy or a repeat Pap smear at 6 months

Question 3

HSIL result management

Answer 3

Colposcopy and biopsy if necessary

Question 4

Commencing the consultation

Answer 4

General wellbeing
Contraception, sexual history (PPPPP), screening
Gynaecological
Obstetric
Medical
Family 
Social
Risk assessment->early coitus, multiple partners, not protective sex, smoking, immunosuppressed

Question 5

Advice about the pill risks

Answer 5

Major changes in formulation
Smaller doses of progesterone and estrogen
Most of information comes from earlier formulations
Three main concerns: thromboembolic, cardiovascular and breast cancer.
TE risk->3 X the risk, 15/100 000 in second gen, 30/100 000 in third gen. Risk in pregnancy is 300/100 000
Breast cancer->+risk in >40. Of localised disease, may be due to progression of pre-existing disease. Good prognosis.
Slight increase in cervical cancer.
If young, second generation, non-smoker->absolute risk very low
Risks and benefits and ultimately her decision

Question 6

When are estrogen + anti-androgen particularly useful

Answer 6

For women with acne
Mild hirsutism
Evidence of PCOS

Question 7

Pearl index of COCP

Answer 7

PI of 0.1

PI= method failure rate/100 woman-years= total accidental pregnancies X 1200/total months of exposure

Question 8

Contraindications to the COCP

Answer 8

History of TE disease
Existing CV/CerebroV disease or history
Breast Cancer
Known liver disease/markedly abnormal liver function tests, jaundice
Uncontrolled/severe HTN
Poorly controlled/vascular disease diabetes
Hx of frequent migraine with aura
Women >35 smoking >15 cigarettes
Active gall bladder disease

Question 9

Advice about pap smear and HPV

Answer 9

HPV is common and generally transient
At time of becoming sexually active
More than 100 subtypes, some may cause visible warts, some are high risk for causing pre-malignant lesions on cervix, vagina, vulva.
Other risk factors necessary- smoking ++ associations
Most of the time, temporarily infected, immune system deals with the virus.
3% may progress to HSIL and eventually cancer. Time for this is minimum for 6 years.
Chance of detecting premalignant change is very high with pap smear.
Also do chlamydia screen as standard.

Question 10

Are pap smears 100% effective at preventing cancer

Answer 10

No, but very effective
Occasionally can develop cancer/endometrium not detected on pap smear.
They are screening tests.
Cervical cancer went from ++killer of women, to rare.

Question 11

Should the bf be tested

Answer 11

Penis cancer is rare
Unless warts present, don’t need to be examined.
But usually warts caused by low risk