For HIV+ women, there are many aspects to staying healthy. You’re off to a good start if you take your medications on schedule, eat well, and get some exercise. But to take care of your whole body, you need to go to the gynecologist (GYN) regularly.

The gynecologist is the doctor who cares for a woman’s reproductive tract, which is made up of the:

• Vagina
• Cervix
• Uterus
• Fallopian tubes
• Ovaries

Certain GYN conditions are more common, more serious and/or more difficult to treat in HIV+ women than HIV- women. If left untreated, some minor infections can develop into more serious conditions. For this reason it is especially important for HIV+ women to see a gynecologist at least once a year.

Gynecologists are specialists in women’s health. One of the most important things they do is perform pelvic exams and Pap smears to check for cervical cancer. A Pap smear is a screening test that checks for changes in the cervix. An abnormal Pap smear can indicate inflammation, infection, abnormal cell growth (dysplasia), or cancer. When dysplasia is detected and treated early, cervical cancer can be prevented.

Gynecologists also test for sexually transmitted diseases (STDs) like gonorrhea, Chlamydia, and syphilis. They can evaluate and treat other infections like yeast infections and bacterial vaginosis.

Your gynecologist is also a great source of information about birth control and STD prevention.

It is very important for HIV+ women to have regular GYN visits and Pap smears. The Centers for Disease Control (CDC) recommend that:

• HIV+ women have a complete gynecological examination, including a Pap smear, when they are first diagnosed or when they first seek prenatal care
• HIV+ women have another Pap six months later
• If both tests are negative, yearly screening is recommended
• Women who have symptomatic HIV infection or who have had dysplasia in the past should receive a Pap smear every six months

You should be tested for gonorrhea and Chlamydia at the initial visit. Repeat the tests if you have a new partner or if you have unprotected sex.

In between visits, there are things you can do to keep yourself healthy:

• Use condoms to prevent the spread of STDs
• Keep track of abnormal vaginal discharge or lower abdomen pain: Call the doctor if it doesn’t go away
• Don’t douche or use a lot of scented soaps – they may cause irritation or yeast infections
• If you have questions about birth control or STDs, write them down and take them to your next visit

Now that you know why it’s so important to go to the gynecologist, here’s what to expect.

Usually, the doctor starts by interviewing you about your sexual history. You will be asked about:

• Your current sex life
• The number of sexual partners in your past
• Whether you have ever been pregnant or had an abortion
• What kind of birth control you use

These questions can be difficult or awkward for both the doctor and the patient. Even if it’s hard for you, do the best you can to answer honestly. The doctor needs complete information to take good care of you.

After the interview, the doctor may perform a breast exam. The doctor checks each breast for any lumps or masses.

Next, the doctor will perform the pelvic exam. He or she will ask you to lie down and scoot your butt to the end of the exam table. Then you will be asked to open your legs. The doctor will insert an instrument called a speculum into your vagina. This instrument separates the walls of the vagina so that your cervix (the opening to the uterus) is visible.

Then the doctor will use a small brush to collect some cells from your cervix for the Pap smear. The cells are examined under a microscope to see if there are any abnormal cells (dysplasia). Abnormal cells may signal the beginning of cervical cancer, or they may not mean anything at all. Repeat testing will performed if abnormal cells are found.

While the speculum is still inserted, the doctor will also collect samples to check for gonorrhea and Chlamydia.

After the speculum is removed, the doctor will perform a bimanual exam. In this exam, he or she places two fingers inside your vagina and places the other hand on your abdomen. He or she feels your internal reproductive organs (the ovaries and uterus) using both hands and checks for any pain.

Many women find the pelvic and bimanual exam slightly uncomfortable and embarrassing. One reassuring thought is that the speculum is used for only two or three minutes, and the whole thing is usually over in less than five. And the more often you go, the easier it gets.

It is possible for HIV+ women to have anal dysplasia also, which can lead to anal cancer. An anal Pap smear and physical examination are the best ways to detect anal dysplasia. It is important to ask your doctor to perform these tests on a regular basis.

Your gynecologic health is an important part of your total health! Regular GYN exams and Pap smears are crucial since many GYN conditions do not have obvious symptoms and can get worse without your realizing it. Detection and treatment in the early stages can prevent a GYN condition from progressing.

Find a gynecologist who has experience treating HIV+ women and/or knows how to screen and diagnose the common GYN conditions seen in HIV+ women. Make sure that your gynecologist is aware of what medications you are taking for other conditions and report any GYN problems or changes in your menstrual cycle.

1		Anderson, J. (1998). Gynecologic manifestations of HIV infection. Presentation at the Johns Hopkins University Conference on HIV/AIDS. Retrieved February 2005 from http://www.hopkins-aids.edu/brazil/speakers/framesets/anderson2_fr.html.
2		Levine, A. (2002). Evaluation and management of HIV-infected women. Annals of Internal Medicine. 136(3). 228-242.
3		Massad, L. et. al. (1999). Prevalence and predictors of squamous cell abnormalities in papanicolaou smears from women infected with HIV-1. JAIDS. 21(1). 33-41.