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The Advanced Women's Sexual Health Check-Up is the set of scan and vaginal swabs to assess the woman health for cervical cancer, ovarian tumours and various STI infections. The study of thin prep also includes Human Papillomavirus detection.


The risk factors for gynaecological cancer include being post-menopausal, with a family history of ovarian cancer or cancers of the uterus, colon or breast, infertility problems or having had no children, in women who are overweight, smokers or those with comorbidity such as hypertension or diabetes, not engaging in cervical screening or persistent HPV, taking tamoxifen or unopposed oestrogen, first intercourse before sixteen, having multiple sexual partners or women who are HIV positive.

About

Ovary cancer can affect women at any age but is rare under the age of 30 and more common in women after 65. It can start in the ovary, fallopian tube or peritoneum. Approximately 7,000 women are diagnosed every year. Ovary cancer divides into subtypes of which some are more common than others. The most common subtype is epithelial ovarian cancer which comes from the cells on the surface of the ovary. Diagnosis is often delayed because women present with non-specific abdominal symptoms which can be confused for other conditions such as IBS. CT scans and abdominal ultrasound are used to confirm the diagnosis. Ovarian cancer is associated with an increased level of a tumour marker called ca125. Treatment is with chemotherapy and surgery including hysterectomy and removing the ovaries, appendix and omentum. Women who carry the BRCA1 and BRCA2 gene are at increased risk from developing the disease and may consider prophylactic ovary removal to decrease their cancer risk. There is no national screening programme.


Endometrial cancer is rare in women under 40 and becomes more common after 55. Approximately 9,200 women are diagnosed annually. At least 1 in 3 womb cancers may be caused by obesity and lack of exercise. Other causes include exposure to oestrogen and a rare genetic condition called Lynch Syndrome. The most common symptom is irregular vaginal bleeding and bleeding after the menopause. Diagnosis includes biopsy of the endometrium, abdominal ultrasound and CT scan. Treatment includes hysterectomy and ovary removal, external beam pelvic radiotherapy and internal brachytherapy. There is no national screening programme.

Each year more than 3,200 women are diagnosed with cervical cancer in the UK it can affect women at any age. There are two main types of cervical cancer, the most common is squamous cell cancer the other is adenocarcinoma. The main risk factor is infection from the Human Papilloma virus (HPV) other risk factors include a weak immune system caused by conditions such as HIV and smoking. Symptoms include abnormal vaginal bleeding, offensive discharge and lower back pain. Diagnosis is made by a biopsy from the cervix, MRI, CT and Positron emission tomography (PET) CT. Early-stage cancers are treated with a Large Loop Excision of the Transformation Zone (LLETZ), Needle Excision of the Transformation Zone (NETZ) and cone biopsy. More advanced cancers are treated with surgery, chemotherapy and radiotherapy. There is a national screening programme to detect pre-cancerous changes to the cervix which can treat abnormalities at an early stage.

Other types of Gynaecological cancers include: Vulval melanoma, basal cell carcinoma, sarcoma, adenocarcinoma and Bartholin gland cancer. In older women vulval cancer is linked with a skin condition called lichen sclerosis. Other skin conditions linked to vulval cancer are lichen planus and Paget’s disease. It is also linked to HPV and a pre-cancerous condition called vulval intraepithelial neoplasia (VIN). Smoking, a reduced immune system and cervical intraepithelial neoplasia (CIN) increase the risk of diagnosis. Symptoms include vulval burning, soreness, ulcerated areas, bleeding, moles, lumps in the groins, pain passing urine. Treatment is with surgery, chemotherapy and radiotherapy.


The visiting sonographer will also take a thin prep swab to look the evidence of the bacterium Chlamydia trachomatis (and 6 others), the most common bacterial sexually transmitted disease (STD) in the United Kingdom, the bacterium Neisseria gonorrhoeae, which causes the STD gonorrhoea, and the bacterium Trichomonas vaginalis, a sexually transmitted, microscopic parasite that causes vaginal infections in women and urethritis in some men.


These STDs are easily treated but can cause severe reproductive and health problems if left untreated. 1-4 weeks, up to 6 weeks. Many patients are asymptomatic carriers.


Women’s health issues are still taboo, and the nature of certain ‘embarrassing’ symptoms means that some women we are less willing to seek help. As a community healthcare service, we want to ensure our patients know it is ok to voice their worries and concerns about women’s health. By investigating suspected gynaecological cancer promptly can mean an earlier diagnosis and a better outcome.

Preparation

For the ultrasound scan, included in the package you need to fast for at least 4 hours and have a full bladder and it is therefore required that you drink one litre (2 pints of water) 1 hour before the scan. To check for abnormalities such as polyps, cysts and fibroids and assess your ovaries or uterus we may perform a transvaginal scan. The procedure is painless and involves insertion of a small probe (similar in size and shape to a tampon) into your vagina.


There are steps you can take to ensure you get the best possible results from your Pap or HPV test:

  • Try to schedule the test on a day when you do not expect to be on your menstrual period. If your period begins unexpectedly and will be continuing on the day of your test, try to reschedule the appointment.
  • Avoid sexual intercourse 48 hours before the test.
  • Do not douche 48 hours before the test.
  • Do not use tampons, or vaginal creams, foams, films, or jellies (such as spermicides or medications inserted into the vagina) for 48 hours before the test

Procedure

Ultrasound scan is performed using a transvaginal ultrasound probe. The specially designed probe will be inserted into your vagina so that the ultrasound waves can be focused on your ovaries.


The procedure for high vaginal swab will be performed by the same attending practitioner. It will involve the insertion of a small plastic device called a speculum into the vagina and then taking several swabs from the vagina and neck of the womb. It shouldn’t be painful, but it will feel a little uncomfortable. You can ask to stop at any point. You may experience some light vaginal bleeding after the procedure.

Indications

A Pap test can save your life. It can find cervical cancer cells early. The chance of successful treatment of cervical cancer is very high if the disease is caught early. Pap tests can also find abnormal cervical cells before they become cancer (precancers). Removing these precancers prevents cervical cancer over 95% of the time.


An HPV test can give your doctor more information about the cells from your cervix. For example, if the Pap test shows abnormal cervical cells, the HPV test can show whether you have a type of HPV that causes cervical cancer. Most women 21 to 65 years old should get Pap tests as part of routine health care. Even if you are not currently sexually active, got the HPV vaccine, or have gone through menopause, you still need regular Pap tests.


Experts recommend women 25–64 get Pap and HPV test together (called co-testing) every 5 years. Women older than 64 need a Pap test if they have never been tested, or if they have not been tested after age 60. HPV tests are recommended for women 30 and older. Although HPV is common in women younger than 30, it usually goes away on its own in these women. Pap tests combined with HPV tests, or HPV tests alone, are most useful for women 30 and older.

Some indications for Well Woman scan and infections test are:

  • General well-being Screening
  • Irregular Bleeding
  • History of infection
  • Discomfort
  • Inflammation
  • Abdominal pain
  • Abdominal bloating
  • Follow up on previous findings such as cysts
  • Abnormal Blood Tests
  • Tumours & Cancers
  • Vomiting
  • Polyps
  • Cysts
  • Iliac
  • Vessels

Interpretation

The sonographer will be able to tell you the results of the scan at the time of visit. You will also get a detailed ultrasound report to file with your health records.

The Pap test looks for any abnormal or precancerous changes in the cells on the cervix. If the Pap test results show these cell changes, this is usually called cervical dysplasia. Other common terms the healthcare provider may use include:
  • Abnormal cell changes
  • Precancerous cells changes
  • CIN (cervical intraepithelial neoplasia)
  • SIL (squamous intraepithelial lesions)
  • “Warts” on the cervix
All of these terms mean similar things—it simply means that abnormalities were found. Most of the time, these cell changes are due to HPV. There are many types of HPV that can cause cervical dysplasia. Most of these types are considered “high-risk” types, which means that they have been linked with cervical cancer. Just because a woman has cervical dysplasia, it does not mean she will get cervical cancer. It means that her healthcare provider will want to closely monitor her cervix every so often – and possibly do treatment – to prevent further cell changes that could become cancerous over time if left unchecked.


A positive test of any of seven infections indicates an active infection that requires treatment with a course of antibiotics.


Disclaimer

The test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario. Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider of the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

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