My Doctor Online The Permanente Medical Group

When to Schedule

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We used to think that women should get a Pap test every year. However, the latest research indicates that the frequency of Pap tests depends on your age and health status. All women should get Pap smears every 3 years starting at age 21, and most women can stop having Pap tests at age 65.

Women under 25

Annual Pap tests are not necessary because cervical cancer is extremely rare in women under age 25, and cervical cells become cancerous very slowly. If your Pap smear is normal, you can safely wait 3 years for your next Pap test. If the Pap test is not normal, we sometimes recommend additional testing for more serious changes. However, because mild changes in the Pap smear are so common and often go away without treatment, we usually just recommend repeating a Pap test in 1 year. 

Women 25 and over

After you turn 25, you should continue to have Pap tests every 3 years and also begin to be tested for human papillomavirus (HPV). If your HPV test is positive, it does not mean that you have, or ever will have, cervical cancer, but we will want to follow up with you more frequently. We can discuss how often you should come in for a checkup after we get the results of your test. 

You can stop having a Pap test if any of the following are true:

• You are over 65 and have had at least 3 normal Pap tests in the past 10 years.
• You are over 65 and have had a negative HPV test and a normal Pap test.
• You have had a total hysterectomy (your cervix was removed), and you have no history of cancer of the cervix, vulva, or vagina. 
• You have no history of being treated for high-grade dysplasia (including cervical intraepithelial neoplasia 2 or 3) or adenocarcinoma in situ.

Before Your Pap Test

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To get the best results, do not schedule this test during the time your next period is due. But if you get your period unexpectedly, come in anyway.

During the 48 hours before you come in:

• Do not have intercourse.
• Do not use vaginal medications or spermicide creams.
• Do not douche or place anything in your vagina. 

How It Is Performed

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The procedure is quick, and most patients do not experience any discomfort at all. A few women notice some mild cramping, like what they feel when they get their periods.

• When you come in for your routine exam, we will use a small instrument called a speculum to gently spread the walls of the vagina. This allows us to see the cervix.
• We will collect some of the cells from the cervix and send them to the lab to be checked for cancerous and precancerous changes. 

After the exam, you might notice a small amount of bloody discharge. This is normal.

Results

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You can expect to hear from us in about 2 weeks with your Pap test results.

If the test results are normal:

• You will receive a card in the mail or an online message.
• You can safely wait 3 years until your next Pap test.

If the test shows abnormal cells:

• We will contact you to arrange for follow-up exams.
• This could mean repeating your Pap test sooner than every 3 years.
• You may be asked to come back for a special procedure called a colposcopy. During this procedure, we use a magnifying instrument called a colposcope to look at your cervix in order to see if any areas look abnormal.

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Risk Factors

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We now know that most cases of cervical cancer are caused by a virus called the human papillomavirus (HPV). HPV is a common virus that can be passed from one partner to another during sex.

Most people carry the virus at some time in their lives, sometimes for a few months or a year or 2. There are many types of HPV, and most of them are harmless and will go away on their own. A few types of HPV can turn into cervical cancer, and a few types can cause genital warts.

The presence of HPV in anyone who has ever had sex is normal. Most women who have HPV will never get cervical cancer.

Risk Factors for HPV

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Your health and lifestyle can determine whether you are at a higher or lower risk for contracting HPV.

Sexual history. You have a greater chance of getting HPV if you have had lots of sexual partners (or if your partner has had lots of sexual partners).

Cigarette smoking. If you use tobacco, one of the best things you can do for your health is to quit now. Smoking doubles the risk of cervical cancer in women who have HPV. Exposure to secondhand smoke may also be a contributing factor.

A weakened immune system. If you are HIV-positive, undergoing chemotherapy, or have an otherwise weakened immune system, you should take extra care to avoid HPV. You are more likely to catch HPV, and it is also more likely that your HPV will develop into cervical cancer.

Prevention

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Cervical cancer is one of the most preventable cancers. To protect yourself, we recommend that you:

• Undergo regular Pap tests.
• If you smoke, stop. Contact us if you need help.
• Practice safer sex.
• Get the HPV vaccine if you are age 26 or younger.

The HPV Vaccine

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In 2006, the Food and Drug Administration approved an HPV vaccine for girls and women from ages 9 to 26. The vaccine protects against the strains of HPV that may cause precancerous changes in the cervix and genital warts. 

• The vaccine is given in 3 doses.
• It works best when it is given to girls before they become sexually active (usually ages 9 to 12).
• Girls and young women between ages 13 and 26 may also consider the vaccine.
• The vaccine likely will not benefit women who have had more than 4 sexual partners in their lifetime.

We can talk about whether the vaccine is right for you at your next checkup.

If you have already had the HPV vaccine, you will still need to have a Pap test at least every 3 years. While the vaccine is effective against certain types of HPV, it does not prevent all the types that could possibly cause cervical cancer. It is also important to know that the HPV vaccine does not protect you against other sexually transmitted bacteria and viruses like chlamydia, herpes, or HIV.

Your Care with Me

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Screening for cervical cancer is important, and we strongly recommend making regular Pap tests part of your health routine.

You should start having regular Pap tests at age 21. You should continue to have a Pap test every 3 years if your test results are normal. After you turn 25, this procedure will also including testing for human papillomavirus (HPV).

You can expect to receive your Pap test results in about 2 weeks. Once I’ve reviewed your results, my office staff or I will contact you with results by phone, e-mail, or regular mail.

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Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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