What is the benefit of a well women exam and breast exam?

It is very important that women begin having regular well-women exams yearly beginning at the age of 13-15 years old. The benefit of this exam is that your doctor can find problems before they start, or they can diagnose problems early on so that you can receive treatment sooner. Beginning at the age of 13-15 years old, your well-women exam will include a pelvic exam and clinical breast exam. The pelvic exam serves a purpose to check if the internal organs of a female are normal by your doctor feeling the shape and size of the organs. The breast exam serves a purpose to check for breast cancer, which is done by your doctor feeling and looking at your breasts.

At the age of 21 years old, or if one becomes sexually active prior to 21, a procedure called a pap smear will be introduced to your annual well-women exam, along with the pelvic and breast exam. The benefit of a pap smear is to diagnose cervical cancer, or any abnormal changes in the cervix that could eventually lead to cancer. This procedure is performed with a speculum that is used to look at your vagina and cervix, which is the opening to a woman’s uterus. During the pap smear test, a small sample of cells will be obtained from the cervix with a small brush. These cells are examined under a microscope for abnormalities. If the results of your pap smear are normal, you should have one performed every 3 years. However, if your results of your pap smear are abnormal, your doctor may repeat them more often.

In conclusion, one can benefit from a well-women exam and clinical breast exam because you are being checked for cancer or pre-cancer signs that can be treated early on.


A Pap smear test is a preventative measure that looks for cancerous and precancerous cells in the cervix. The following guidelines are the most up-to-date recommendations from the American College of Obstetrics and Gynecology:

  • Pap smear once every 3 years for women under 30.
  • Pap smear and HPV (human papillomavirus) test every 5 years for women under 65.
  • Women over 65 do not need a Pap smear unless there is a history of two or three abnormal test results in the last 5 to 10 years, or if there is a history of dysplasia or cervical cancer.
  • Pap smear and HPV testing is not recommended for girls under 21 years of age.

Note: There are different guidelines that apply to women who have cervical cancer or are positive for history of HPV

Note: Although a pap smear is recommended every 3 years, women should still plan for an annual exam yearly

Cervical cancer is a type of cancer that occurs in the cells of the cervix, which is the lower part of the uterus connecting to the vagina. Cervical cancer begins when healthy cells in the cervix come to have a genetic mutation that results in abnormal cells (cancer cells). These abnormal cells grow and multiply out of control, and they do not die. If the cervical cancer is not diagnosed and treated in a timely matter, these abnormal cells will form a mass and can eventually spread to the rest of the body.

During a pap smear procedure, cells from the cervix are obtained for examination. The cells are obtained to see if there are any abnormal cellular changes in the cervix, and if there are any precancerous or cancerous cells present If the results of the pap smear are abnormal, your doctor will repeat the pap smear and further testing may be necessary.

HPV, a sexually transmitted disease, has been known to be associated with the cause of cervical cancer. HPV is a very common STD and will typically go away on its own in young healthy women, which is why HPV testing is not typically performed until the age of 30. Women, and men, can receive a vaccination called Gardasil to protect them from two strains of HPV that are major contributors to cervical cancer, and two other types of HPV that are major contributors to genital warts.



A pap smear is a quick in-office procedure in which you will lie on your back on the examination table, with you feet in stirrups position. The doctor will gently insert a speculum to open the walls of your vagina and look inside your cervix. The doctor will then scrape your cervix with a small instrument to obtain cells. The cell samples are preserved and sent to the laboratory for examination. The pap smear is very short, and it is normal to feel slight discomfort or pressure but no pain. It is also common to have a little bleeding after the procedure due to the scraping of the cervix. The results will take a few days to get back and your doctor will notify you if anything is abnormal.

Prior to having a pap smear, you should avoid douching, using tampons and sexual intercourse for 24 hours. It is best to try to schedule your pap smear when you will not be on your period due to blood of fluid interfering with your test results, however you may still have a pap smear done on your period.


Breast cancer is one of the top cancers affecting women. Breast cancer is a disease that is caused by cells in the breast to grow at an unconditional rate. While the exact cause of breast cancer is still unknown, a breast exam is used to help detect early signs. The ways to detect breast cancer involve self-examination clinical examination and mammogram. It is important that these exams are performed to ensure that further testing and treatment are done in a prompt way.



Breast Self-Examination

It is appropriate for women to begin introducing self-breast examination in their early teen years, and should continue this on a regular basis starting at the age of 20. These are simple exams that should only take a few minutes. The best time to perform an accurate breast self-exam is 7 days prior to beginning your period, and it’s easiest to remember by doing them in the shower.

The first part of a breast self-exam is to physically look at your breasts to see if there are any visible changes. These changes may include breast size, breast shape, swelling and skin texture. While checking, you should pay attention to any red, scaly or irritated skin, or any dimpled, puckered or retracted areas of the skin. The last thing you should look at are the nipples, specifically if the nipple appears to be inward or bigger than normal, and if there is any fluid discharge. You should look for all of these changes in front of a mirror.

The second part of a breast self-exam is physically feel your breasts for any changes. This part of the exam can be performed standing or laying down, again, most women find it easy to do when they are in the shower. Begin by raising your right arm and placing the right hand behind your head. Using the pads of your three middle fingers on your left hand, you should feel the different tissues throughout your right breast using light, medium and firm pressure. While feeling around, you should pay attention to anything that feels like a lump or mass. A mass that would raise suspicion would be painless and very firm or hard. You should also check your right nipple for any discharge, by squeezing the nipple lightly. When you finish completely checking the breast, you should check the armpit for any new lumps or bumps. After you complete the right breast and right armpit, you should repeat these steps with the left breast.

After you perform a breast exam multiple times, you will learn which lumps or bumps are normal to your own body and if there are any new ones. If you are uncertain about a lump in your breast or if you believe it is new, you should contact your doctor. Also contact your doctor if you do find any changes in appearances that are listed above. Please note that many women experience fibrocystic breast changes that are in sync with their periods.


Clinical Breast Examination

A clinical breast-examination is similar to your breast self-examination, except that it is performed by your gynecologist during your annual exam yearly. During your clinical breast-examination, you should inform your doctor of any changes in your breasts, and discuss family history of breast cancer. During your clinical breast-examination, you will undress from the waist up and put on a clinic gown with the opening in front like a robe. Your doctor will use a similar method to a breast self-examination, assessing your breasts, armpits, neck and chest area. Your doctor will note and discuss any changes in your breasts in terms of size, shape, appearance and if they feel any suspicious lumps or masses.



A mammogram is a short procedure that looks into further depth for breast cancer. This procedure uses a type of X-ray used to specifically identify breast masses or tumors. A radiation technician will assist in carefully placing both breasts between two plates that compress your breasts to flatten and spread the breast tissue. The x-ray machine will then take pictures of your breasts. This procedure can be uncomfortable for some women but it is usually very fast. A mammogram is used to see if a tumor is present in the breast, but it cannot tell if the tumor is benign or malignant. If your results are abnormal, your gynecologist may ordered additional testing.

The American Breast Cancer Foundation and American Cancer Society recommend that women should get a mammogram done every year, beginning at the age of 40. However, if there is a strong family history of breast cancer, your doctor may begin you getting mammograms at an earlier age. This is important because early detection of breast cancer ensures for a better outcome.


Sexually transmitted diseases (STDs) are bacterial, viral and parasitic infections that are spread through any form of sexual activity. The people who are at highest risk of sexually transmitted diseases are: females, youth, and people of minority groups. Although not every STD has symptoms, they can lead to severe consequences in women if they are not treated in a timely matter. Consequences can lead to difficulty with becoming pregnant, when pregnant and when breast feeding an infant. There are many different kinds of STDs in which some are curable and some are not, and some are more harmful than others. Some untreated STDs can lead to infertility and in some cases, death, which is why it is so important to receive prompt care and treatment if you think you may have been exposed to one.



STDs are caused by bacterial, viral or parasitic infections that are spread to one another during any type of sexual activity, including oral, anal or vaginal sex. There does not necessarily need to be penetration in order for an STD to spread, and they can be spread through female and male contact, male to male contact or female to female contact. There are currently as many as over 25 different types of infectious organisms that cause STDs.

According to the American Social Health Association, the United States has the highest rate of STDs in the world. People that are most likely to be infected with one of these diseases and experience a serious medical complication are: women, youth and people of minority groups. These diseases are more easily passed from men to women, which is why women are more likely to be infected. The easiest way to avoid risk of infection during sexual activity is to use protection such as condoms.


Different Types of STDs


This STD can affect the urethra, rectum, throat, vagina and cervix in women. The different symptoms of chlamydia include burning with urination, vaginal discharge or bleeding, abdominal pain and pain during sexual intercourse. However, it is common to show no symptoms when infected. This disease can lead to blindness, eye infection, lymph node infection and respiratory infection. If not treated, it can spread to the uterus and fallopian tubes which can cause pelvic inflammatory disease, infertility or ectopic pregnancy. This STD is diagnosed through a vaginal culture and is typically treated successfully with antibiotic medications. Both sexual partners should be treated to prevent further spreading.


Genital Herpes

Genital Herpes can affect the labia, vagina, cervix, anus, mouth and inner thighs in women. Herpes can cause repeated outbreaks of small blisters on genitals, rectum, or areas of nearby skin. Genital herpes cause symptoms of tingling, burning or itching with red blisters. Additional symptoms may include vaginal discharge, painful urination, severe headache, fever, muscle aches, fatigue and loss of appetite.

Diagnosis and treatment of genital herpes is very important because if left untreated, it can cause severe complications such as spreading to a newborn during birth which can lead to serious complications to the brain or spinal cord infection. It is important to inform your doctor when pregnant if you have had a herpes outbreak in the past.

This disease is diagnosed through a blood test. While there is no cure to genital herpes, there are medications that can be prescribed to lessen your symptoms. After a herpes outbreak occurs, you should make sure to use female or male latex condoms every time you are engaging in sexual intercourse.



Gonorrhea is a bacterial infection that can be spread through any type of sexual activity. This bacteria are attracted best in dark, warm, moist areas such as underwear, and grow in the fallopian tubes, uterus, cervix, urethra, vagina and eyes. Symptoms of gonorrhea include a thick green-yellow colored vaginal discharge, vaginal itching or burning, increased urination and burning or pain while urinating. Spotting between menstrual periods and painful sexual intercourse are also common symptoms. This disease is diagnosed through a vaginal culture. If gonorrhea is not treated in a timely matter, it may further cause tubal scarring that can prevent pregnancy, sterility, vulvovaginitis, painful intercourse or pelvic inflammatory disease (PID).


Hepatitis B and Hepatitis C

Those with multiple sex partners, those with other STDs, those who participate in oral/anal sex and men who have sex with other men are at a high risk of contracting Hepatitis B or C. Hepatitis B is caused by infection from hepatitis B virus and hepatitis C is caused by infection from the hepatitis C virus. These diseases are under the category of blood-borne viruses because they are spread from an infected person to a non-infected person through blood or body fluid containing blood, commonly semen or saliva, or through sharing needles for IV drugs.

Hepatitis B and C is very serious because it can be transmitted from mother to child during birth. Chronic forms of these diseases can lead to life-threatening medical complications, such as transplants, or ultimately death. There are no cures, but there is a vaccine offered to protect against only hepatitis B. Using a male or female condom reduces the risk of contracting hepatitis. This disease is diagnosed through a blood culture.



The human immunodeficiency virus (HIV) infection is a viral infection that slowly destroys the whole immune system and progresses into acquired immune deficiency syndrome (AIDS). HIV is spread through blood, semen and vaginal secretions during sexual activity such as oral, vaginal or anal sex. The most common symptoms of HIV are flu-like symptoms, however it is very common to show no symptoms at all which is why HIV is very easily spread. HIV causes the immune system to be suppressed, which leads to possible development of pneumonia or cancers. While there is no cure for HIV and AIDS, there are medications that can assist infected people to live healthier and longer lives. Latex condoms are the number one way to reduce contracting and/or spreading HIV. This disease is diagnosed through a blood test.


PID (pelvic inflammatory disease)

The bacteria that cause other STDs also cause PID. PID infects the lining of the uterus, fallopian tubes or ovaries. Symptoms of this disease include but are not limited to abnormal colored or smelling vaginal discharge, abdominal pain, fever, spotting between periods, abdominal pain , or increased pain with intercourse.

PID is treated with an antibiotic medication and preventing sexual intercourse while infected.



Bacteria cause a syphilis infection, which has several stages. Syphilis can cause headache, rashes, fever, joint pain, hair loss and flu-like symptoms. Syphilis is very contagious, and can cause severe damage to the brain, nervous system, heart, skin and bone. There are antibiotics that can cure this disease. The use of female and male condoms may prevent the spread.

This disease is diagnosed through a blood test.



Trichomoniasis is a parasite that is transmitted by penis to vagina or vulva to vulva contact through an infected person. Some of the symptoms of this disease include heavy, frothy, foamy, foul smelling, green-white or yellow colored vaginal discharge. Additional symptoms include itching in the vaginal area or inner thighs with a swollen labia. This disease can be cured through antibiotic medication, and both you and your partner should be treated to prevent further spreading. This disease is diagnosed through a vaginal culture.


You should contact your doctor immediately if you are having any symptoms of the above STDs. Treatment and medication are very important to avoid further spreading and complications. It is recommended to be tested regularly, especially if you have a new sexual partner. The best way to prevent STDs is to use protection, such as a male or female latex condom.

What is pelvic pain versus pelvic pain with period and how is this treated?

Pelvic pain is pain that is directly below the belly button and above your legs. This pain may be due to a variety of causes that may or may not be related to gynecology. Unrelated causes include: appendicitis (inflammation of the appendix), bowel issues or kidney stones. On the other hand, there are many different causes of pelvic pain that could be relating to gynecology. First, pelvic pain could be due to menstrual cramps when you are on your period. This can be treated with over-the-counter pain relievers, or your doctor may prescribe birth control pills to control the pelvic pain. Second, the pelvic pain could be from an ectopic pregnancy, which is a pregnancy that is outside of the uterus. This pregnancy is painful and can be life threatening and is usually treated with immediate surgery to remove the embryo. A third cause of pelvic pain could be occurring from a sexually transmitted disease (STD), which typically can be treated with medication after being diagnosed through tests ordered by your doctor. A fourth common cause of pelvic pain is due to ovarian cysts, which can be diagnosed through ultrasound imaging of the ovaries. Treatment of ovarian cysts may include birth control medication or possible surgery. Other common causes of pelvic pain include: pelvic inflammatory disease (PID), uterine fibroids, endometriosis, urinary tract infection (UTI), pelvic organ prolapse, or painful sexual intercourse. There are many different treatment options for these causes of pelvic pain, including medicine, surgery or physical therapy care.

What is abnormal bleeding and what can you do about it?

Abnormal vaginal bleeding is defined as blood that comes from the vagina when you are not due for your period, or when the blood flow is in inappropriate or in irregular amounts. When one experiences abnormal bleeding, there are three questions to be asked: Are you pregnant? What is the pattern of the bleeding? And are you ovulating? It is common to experience abnormal vaginal bleeding during early onsets of pregnancy, which is why women often get early pregnancy versus abnormal bleeding from another cause confused.

The pattern of the abnormal bleeding is very important to note because it can help the doctor solve the problem of why the bleeding is occurring. Different patterns of bleeding to pay attention to include bleeding for too long versus too short, bleeding more frequently versus less frequently or heavy bleeding versus light bleeding. The last factor to pay attention to is ovulation. Ovulation typically occurs once a month, although it may occur less than that for some particular women. During ovulation, the ovary will release an egg and this will lead to a menstrual cycle and bleeding. Other signs that you are ovulating include breast tenderness, fluid retention, menstrual cramps, back pain and mood changes. On the other hand, signs that you are not ovulating every month include prolonged bleeding that occurs at random intervals, low blood progesterone levels and irregular body temperature fluctuations (i.e.- “hot flashes” or “cold flashes”) during the time that you should be ovulation.

There are many treatments for abnormal bleeding that vary depending on what the cause of the bleeding is. If the bleeding is occurring because you are not ovulating, your doctor can prescribe oral medication that typically includes a form of hormone to balance ovulation. If the cause of abnormal bleeding is leading to precancerous changes in the cervix, oral medication containing a hormone can also be prescribed. Last, if the abnormal bleeding is due to growths in the vagina, or the bleeding is not well controlled on medication, there are surgical options available.

Robotic surgery with the da Vinci Surgical System allows for your surgery to be performed laparoscopically, with smaller incisions in comparison to the traditional surgery where your body is open. The da Vinci System allows for only a few small incisions, putting the patient at the benefit for less pain, less scarring, less bleeding and less down time. The da Vinci System also puts the patient at an advantage because the surgeon can achieve greater dexterity and control during the procedure, allowing for little marginals for mistakes or complications.


The following gynecological conditions can be treated with the da Vinci Surgical System:

  • Abnormal or heavy uterine bleeding, uterine fibroids, endometriosis, pelvic pain, pelvic prolapse and gynecologic cancers and tumors


The following gynecological procedures can be performed with the da Vinci Surgical System:

  • Hysterectomy (the removal of uterus due to heavy abnormal bleeding or cancer), endometriosis, myomectomy (the removal of a fibroid), or a sacrocolpopexy (surgery to correct a pelvic prolapse)


A laparoscopy is a minimally invasive surgical procedure that uses a device called a laparoscope to view the internal female reproductive organs. The device is made up of a thin tube with a light and a viewing instrument. Images from the laparoscopy can be viewed by the doctor on a video monitor. This procedure is done to identify abnormalities and diagnose disease. It is often-times also used during complex operations.



This procedure is typically done in the operating room at a surgical center or hospital. It varies from patient to patient on whether it will be an outpatient procedure or involve inpatient stay. However, general anesthesia is always used and you will need someone to drive you home after the procedure.

During the procedure, your doctor will make a minimally invasive incision near your belly button where they will insert the laparoscope to look inside the body. Following the examination, incisions are closed with a few stitches which may cause slight pain or an uncomfortable feeling for a few days.

What is an OB ultrasound and why can it be used to diagnose abnormalities before birth?

An OB ultrasound is a technique that is used to produce pictures of a fetus inside of a pregnant woman. During an ultrasound, a type of jelly (ultrasound gel) is placed on the abdomen of the pregnant female, and a probe is placed over the gel and moves around the abdomen. This probe collects high frequency sound waves of the fetus, which, in turn, produces an image of the fetus on the viewing screen. This procedure is safe and painless for the mother and fetus.

OB ultrasounds are important because they can be used to diagnose abnormalities in the fetus before birth. These abnormalities are diagnosed based off of the imaging that is produced and by analyzing the heart rate determined during the ultrasound. Some of the abnormalities that may be diagnosed before birth includes: congenital heart defects (abnormality in structure and function of the heart), limb reduction defects (short or missing bones in arm or leg), cleft lip palate (abnormal closure of the tissue that is in the lip area), or neural tube defects (abnormalities that appear in the brain, skull, spine or spinal cord).


Advanced Women’s Health and Surgery is a gynecology clinic that offers a comprehensive range of women’s health and cosmetic services and surgery. Our clinic, led by Dr. Habibeh Gitiforooz with 20 years of experience at the Cleveland Clinic,  serves to give women the gynecological care that they need through all of the stages of their life. Our services are offered using the latest medical technology to make our patient’s visits as comfortable and smooth as possible.

We are accepting NEW patients (440) 772-4000

Advanced Women’s Health and Surgery is a gynecology clinic that offers a range of extensive women’s health services. Our practice serves to give women the gynecological care that they need through all of the stages of their life.