Amanda Wilde (Host): You might cringe at the thought of an annual gynecological exam, but it's one of the most effective forms of self care available to us. And that's why we're talking about yearly exams with OBGYN Dr. Laurel Walton. This is Woodlawn Health DocTalk, a podcast from Woodlawn Health. I'm Amanda Wilde. Welcome, Dr. Walton.

Laurel Walton, DO,OB/GYN, FACOOG: Thank you for inviting me.

Host: It's great to have you. And I think you're going to demystify some of the mysteries around yearly exams. The yearly exams we're talking about have everything to do with the reproductive organs. Can you describe what to expect at a yearly exam?

Laurel Walton, DO,OB/GYN, FACOOG: Well, I'm going to clarify a little bit first for you. A yearly exam for a lady is a yearly exam from the head to the toe. And so when we examine a yearly exam by an obstetrician, gynecologist should be examining from the head down to and through the reproductive aid or through the reproductive area, which is the pelvis.

No different than when you have an exam yearly for a male, should go from the head to the toe and should include a prostate exam. So it's a exam of the whole body.

Host: So the exam we're talking about is an exam of the whole body at the gynecologist?

Laurel Walton, DO,OB/GYN, FACOOG: You have it.

Host: Okay, so this is not the same as your yearly physical.

Laurel Walton, DO,OB/GYN, FACOOG: Well, it depends on who is doing it and what you want to get out of it. A yearly exam, the problem that we have is a yearly exam is an exam that includes the whole body. I'm looking to try to make sure you don't have any problem with you. A gynecologist is their expertise, as mine is, is in the pelvis, and that's what I look at, but that doesn't mean I can't find somebody who has a heart problem or a lung problem as well.

So, at yearly exam, whether it's done by an obstetrician, gynecologist, or a family practice doctor or an internist should include the whole body. That's what a yearly exam is.

Host: Makes sense to me. Talk about the pelvic part of the exam, because I think that is what most women fear or feel anxiety about.

Laurel Walton, DO,OB/GYN, FACOOG: Oh, I think you're right. I think for many years, women have had this theory that if they go to their family doctor, and especially I'm not trying to hit it on the men, but if they have a male, they feel a little embarrassed to unstrip, if you will, take off their underwear and be put up in stirrups to be looked at.

So for a long time, women have been apprehensive of getting a yearly pelvic and Pap, which should go along with their yearly exam. They don't have to get a Pap every year. That's every three to five years, but a pelvic should be looked at yearly. So when you come in, you get undressed, you have your gown on and you sit on the table.

You examine down to the waist and then you're put up in the stirrups and from there you then look at the outside of the genitalia and then you proceed to do a pelvic exam where you look at the cervix itself. You don't get to see the uterus. That's, the cervix is a lower part of the uterus and so that's what we take our Pap of.

Then after the Pap is done, you proceed to feel to make sure the uterus and the tubes and ovaries are normal size and don't have any masses, and she doesn't complain of any tenderness. The mistake of doing just a Pap, leaves a lot to be desired because what if she's 50 and she's menopausal. But when I examine her, her uterus is, up to her belly button. There's something wrong, even though she's not having any menstrual flow, and she's not coming in with post menopausal bleeding. So unless you do a look and a feel, you can't tell her if there's something right or wrong.

Host: So sometimes something can be wrong, but there aren't any symptoms.

Laurel Walton, DO,OB/GYN, FACOOG: Correct.

Host: Yeah, because, that's what I was going to ask. Is it so important to have these exams yearly? Because we know about 50 percent of women don't do this that often. And if we're feeling fine, you know, what's the purpose?

Laurel Walton, DO,OB/GYN, FACOOG: Yeah. You know, I kind of chuckle a little bit because I get into discussions and, I was a PA before I was a physician. And so I can tell you when we examine patients, the thoughts are, when you come in for a yearly, I'm going to listen to your chest. And as I tell family practice doctors, I don't call it a yearly unless you do the full exam, because she doesn't know if there's anything wrong.

I said, but I bet if I came and asked for a yearly, I haven't had a heart attack yet either, but I bet you listened to my heart. So how can you tell a lady that she's fine if you don't look at her pelvis? You may not have to do a Pap because it's every three years after, three to five years after the age of 30, and every three years when you're less than 30 starting at the age of 24.

So if she's fine, but she has a uterus that's growing, it will grow before it starts to bleed and tell her that she has a uterine cancer. And unfortunately, if she's menopausal, and she starts to bleed after the age of 50, I have a higher risk that the cancer she's going to have is not a cancer that's very pleasing.

It's not one that I can always take care of. It's something that has grown to a state that may not be as easy to care for as somebody who came in and I said, hmm, little larger uterus. Now I have to look for why it's larger. Has she had any bleeding and she's not telling me about? Is there polyps inside the uterus or is there something growing that I need to get my ultrasound and I need to look inside with a hysteroscope. So that's the only way we can tell because unfortunately you can't tell about a heart either unless you listen to it and if you hear something that's wrong then you're going to ask for somebody to assist you by doing some imaging. It's no different, it's just that people forget that I'm looking at the organs that are in the lower part of the body as opposed to what's in the chest.

Host: So why do you think women put off having this done?

Laurel Walton, DO,OB/GYN, FACOOG: Oh, I think a lot of it's embarrassment. A lot of it has been, I think, for a long time that women didn't think they can get uterine cancer. A lot of times I think, you know, and I'm not saying this in any way to put down a physician or a patient, but I think sometimes the physicians are just as embarrassed as the patient and therefore they just ignore it.

And that's not a good excuse with me. I think you have to want to make sure you make sure your patients stay well. And the only way you do that is to look at them and address a yearly exam is from the head to the toe. And it includes looking at anything I can see and anything I can feel.

Host: A body is a body is a body. Do you have tips to help women prepare for their exams ahead of time?

Laurel Walton, DO,OB/GYN, FACOOG: I think that you want to, you know, I always tell ladies, if you have a problem, you, and you know, some of us have a short memory. So write them down. Any question is not a bad question unless you don't ask it and it's a question that you've been concerned about. I've had ladies that I'll ask, are you having any vaginal bleeding?

They'll say no, and I'll say, so let's talk about any discharge. Let's talk about any pain. Let's talk about, do you have pain with intercourse? They're afraid to say it because, for a long time, especially my more mature patients, and I don't ever say we're old, it's more mature with me, that they didn't talk about sex, and nowadays I bet a 10 year old can tell me more than a 80 year old can.

So, they were kind of in the closet, and they weren't taken to the doctor, and when they were taken, they didn't do a pelvic or a Pap or any of that unless you were pregnant. And even then, some ladies delivered at home and never saw a doctor until they came out to deliver the baby. So, a lot has changed from the conception of how women were cared for, years in the past, to what we do in the present.

And the present is to keep women healthy so that they can live to that age of a hundred that ladies are supposed to be living to the high 90s now. And don't let their life be cut short because their uterus was growing. Had you done that pelvic, you would have caught that the uterus was larger, and then you could have sent them to an obstetrician gynecologist or see the obstetrician gynecologist who every year knows what that uterus should feel like based on how old you are.

You know, a 90 year old's little uterus is going to be about two inches long, but the size of a normal uterus without children should be about the size of an upside down pear.

Host: Should women continue having these exams throughout their lifetime when they are 90, 95?

Laurel Walton, DO,OB/GYN, FACOOG: It depends on the situation. Some ladies are in nursing homes and they don't get out. I have a 95 year old mother who does is in a nursing home and she does not get out but until she was in a nursing home at the age of 91 she saw a gynecologist probably every six months because she had a problem with a prolapse and that's where the organs start to come down towards the opening of the vaginal canal.

So, I won't say that you shouldn't, but it's kind of interesting, the, after the age of 50 for women, the risk of having a heart attack is higher, almost five times higher than it is for a male. Why is that? They are starting to have or don't have any hormones which were a protective effect for against heart disease and against osteoporosis.

Well, it doesn't change from the uterus either. After the age of 50, the highest rate for uterine cancer is in the, about the age of 54 to 57. So why do we stop getting pelvics and Paps at the age of 50 is beyond me. Now, at the age of 80, well, I have ladies that want to make sure they're staying healthy.

So they come in, they get their yearly. They don't need a Pap unless I see something on the cervix abnormal or I feel something abnormal. But it's a full exam,

Host: But it seems to me what we're saying is to keep your mind at ease, yeah, you should continue these exams in whatever way works for you as you age. And it's not only getting the exam, but you're describing it as an opportunity to talk with your doctor.

Laurel Walton, DO,OB/GYN, FACOOG: Correct.

Host: Is there anything else you'd like a patient to know or keep in mind when they come in for their yearly exam?

Laurel Walton, DO,OB/GYN, FACOOG: Well, I think you have to tell a patient that, young ladies, when they start having intercourse or when they become of age that they think they want to participate in sexual endeavors, you want them to know how they can prevent coming into diseases that they can't do anything about because maybe they started too soon and didn't protect themselves.

That doesn't necessarily mean that they have to have a pelvic and a Pap. When somebody is sexually active is when they start having a pelvic exam. When they're not sexually active, they should start pelvic exams at the age of 21. When does a Pap start? The age of 21. If they're sexually active, they get a pelvic when they're sexually active.

So if you're 12, yes, you would get a pelvic by me. You would not get a Pap, however, until your age of 21. Now that brings out another problem that people ask me about, and I'll just say it because then the question of human papillomavirus, which is the number one cause as we talk today for cervical cancer. Well, the younger age, less than 24, has the highest rate of having human papillomavirus.

However, statistically, the rate of it invading the cervix is so low prior to the age of 21 that we do not do Paps until the age of 21 because it would not change how we treated that patient. So, we don't do Paps until we're 21, but if they're pelvic should bae done as part of their exam because what if there's something on the cervix you see?

Or what if she has human papillomavirus and she has an abnormal cervix? Then that may be a time that you're going to have to do something. But again, I think it's just being open to the fact that patients should feel comfortable with whoever they're seeing and that may be part of our problem in that we're not open with the patients.

I don't know. I see a lot of ladies from the youngest ladies I see are five. Now I don't do pelvics on five year olds, but they're sent to me because they have fallen in the tub and they have a cut in the vulva area, which is the outside of the female genitalia. And mom's concern has that cut gone up into the vaginal canal.

That is a concern. So I have seen little girls as young as five, and I've seen ladies as old as 98. And I've done pelvics from the age of 10 who are sexually active to the age of 80 who still say, I just want to make sure everything's working.

Host: Well, this has been a very enlightening conversation about the process of yearly exams, why they're important, what to expect, and something that we as women will be looking after our whole lives with the help of good doctors like you. So thank you for explaining all of that.

Laurel Walton, DO,OB/GYN, FACOOG: Well, thank you very much for having me.

Host: That was Dr. Laurel Walton, Obstetrician and Gynecologist at Woodlawn Health. If you found this information helpful and need to schedule your yearly exam, call 574-223-2020 to make an appointment with Dr. Walton or one of our other providers. Thanks for listening to Woodlawn Health Doc Talk, a podcast from Woodlawn Health.