Dr. Sharda Jain
Chairperson
Women Wing, IMA.

Regular  general and pelvic examination, Haemoglobin test , Pap smear and pelvic ultrasound are vital components of women’s health. These annual check up can give you  early indications of anaemia, high blood pressure , any abnormalities in women’s reproductive organs and breast  . It is better to catch any disease in its early stages, when it may be easier to treat. Somehow the psyche of Indian house wife is to neglect her health and spend no money  on herself

Self-Exam and self analysis of abnormal symptoms
Tiredness, irritability, giddiness are very common symptoms Self examination  will help you better understand your own body and what is normal for you. Periodically examine your entire body specially  breast/abdomen and  genital area for any lump, sores, warts, red swollen areas, or unusual discharge.  Lump any where on body is always abnormal and needs removal. Genital sore signifies sexually transmitted  disease.  A normal vaginal discharge  may be  white to  yellowish white and smell slightly like vinegar. It can be either  thick  or thin and present in large  or small amounts; every woman’s perception of discharge  is different. During ovulation (the midpoint between periods), there is often a large amount of clear, slippery mucus . If your discharge seems unusual in amount, smell, or texture – kindly see your doctor. If  discharge  is blood stained, all the more reason, that  you should seek doctor’s  help early . There are few studies from rural India and slum based ladies showing that over 70% had abnormal symptoms relating to  vaginal discharge, itching, pelvic pain and genital sore , but women took them as part of being a women due to lack of health awareness.

There should be no pain or straining when you urinate. The urine should come out in a fairly steady  stream. The urine should  be pale yellow, and it should not have a strong ammonia smell. If you experience pain or burning when you urinate, again you should see your doctor, get urine routine and culture examination done prior to taking any medication.

The problem of lack of bladder control is noted by almost 50%  or more of menopausal women and nearly 25% of younger women. Due to shyness, again they suffer in silence and do not seek medical help. Women should know that simple operative procedures are available which require only 6- 8 hours stay in hospital and your problem of lack of bladder control is relieved (TVT procedure).

BP of every women should not exceed 120/80 (without medication or with medication). If it is more, the longevity is markedly affected. After checking at two occasions, medication and life style changes need to strongly recommended.

Pelvic Exam and Pap Test
A pelvic  exam given by a   doctor  will generally consist of an external genital exam, a Pap test, and a manual exam.  Ultrasound needed only if doctor feels the need of it after examination .

The Pap test  is the screening exam for cancer of the cervix (the lower part of the uterus). The Pap test detects 90 to 95 percent of cervical cancers, making, it is a reliable and important screening test. Cervical cancer is the most common cancer in women  in India and accounts for 30-40% of all cancer in women.   Your doctor  will gather several samples of cells from your cervix using special spatula and small brush . The cells are put on a slide and sent to a lab for  exclusion of cancer cells.

If your Pap test results are abnormal, you will be asked to return for more testing. You may have another Pap test, or your doctor may try to find the area in your cervix that contains abnormal cells using a special magnifying device (colposcopy). It is good to remember  that Pap test is only screening test and only Biopsy  confirms the diagnosis of cancer. Some gynaecologists say  that cancer cervix patient can be also swelled from long distance.

By manual exam, your doctor detects abnormalities in the shape or size  of your ovaries and uterus.

Ultrasound if done early can also  help the doctor and patient to pick up the disease early, specially the benign and malignant tumours. This is a  very popular investigation and now and more and more doctors are relying on it.

Heamoglobin  test should  be made mandatory part of the check up, as 50% women from of middle and upper class and  nearly 75- 85 %  women of poor class are anaemic,  which simply drains their energy, makes them prone to diseases and infection. It is also pertinent to remember that heamoglobin of women after the age of  2 years should not be less than 12 gm%. It is wrong to say that  haemoglobin  of 8-10gm% can be taken as normal for Indian women.  The average  h heamoglobin test  of our  western counterparts is  13-14 gm%.

Scheduling of  Annual Check up and Pap Test
It is strongly recommended that  mass awareness should  be  created for annual check up.  Lady must visit her doctor once in a year. Examination alone can detect 75% of cancer, anaemia, high blood pressure and warn you against  overweight/obesity and possible diabetes..

It is recommended  that women should have  first Pap test when they  become sexually active. This practice is strictly followed in Western world. That is why inspite of increased sexual activity, cervical cancer is less than 1% in those communities.  After initial check up, the Pap tests  are recommended every 1 to 3 years, depending on your risk factors. You may not need annual Pap tests if:

• You have  had several normal Pap smears in a row (done annually).
• You have only one sex partner.
• You don’t have other risk factors for cervical cancer (for example, a personal or family history of cervical or uterine cancer or a personal history of a sexually transmitted disease such as genital warts).
  • You have had a hysterectomy for a reason other than cancer.

  If you have risk factors for  precancerous cervical lesion  or a history of abnormal Pap  tests, it is recommended that you have a Pap test each year.  Arrange to have the test 1 or 2 weeks after your period ends. Do not   douche, have  sexual intercourse, or use feminine hygiene products for at least 24 hours before a Pap test, because doing any of these things can alter the test results.

  Good health demands great personal  care, effort and spending little money on doctor’s fees. It is also calls for an understanding the advantage and need of individual’s annual check up and actualize  her independent  worth in the family.

  Delhi gyanecologist Forum : Pioneer in community health started “annual checkup campaign and checkup” at more than 50-60 sites by gynaecologists on 8th December (Free) since 2001. Awareness for checkup in  middle and upper class women has definitely increased. Similarly Movement Against Anaemia (MAA) and osteoporosis has also  caught on. It is very satisfying that women are getting aware that their Heamoglobin  should be over 12 gm%, but lack of Government support  in distributing  Iron tablets is the bottleneck.